BackgroundPulmonary artery embolization due to projectile embolus is a rare complication in combat patients. Such embolization is rare for combat patients in the ongoing armed conflict, in East Ukraine since 2014.Case presentationWe report a clinical case of a 34-year-old Caucasian combat patient who was injured after an explosion of a booby trap hand grenade. This soldier was diagnosed with severe abdominal and skeletal trauma: damage of the duodenum and transverse colon, internal bleeding due to inferior vena cava damage and fractures of both lower extremities. The patient was treated at a highly specialized surgical center within the “golden hour” time. Whole-body computed tomography scan was performed as a routine screening method for hemodynamically stable patients, at which we identified a projectile embolus due to the explosion of a booby trap hand grenade in the right midlobar pulmonary artery. Our patient had no clinical manifestation of pulmonary artery embolism. At follow-up, our patient was diagnosed with the following complications: multiple necrosis and perforations of the transverse colon leading to a fecal peritonitis; duodenum suture line leakage caused the formation of a duodenal fistula; postoperative wound infection. These complications required multiple secondary operations, and in accordance to the principles of damage-control tactics, the extraction of projectile-embolus was postponed. Open surgery retrieval of the metal fragment was successfully performed on the 80th day after injury. Our patient was discharged from the hospital on day 168th after injury.ConclusionsLiterature analysis shows a significant difference of clinical management for patient with projectile embolism in hybrid war settings as compared to previously described cases of combat and civil gunshot injuries. Damage control tactics and the concept of the “golden hour” are highly effective for those injured in a hybrid war.A whole-body computed tomography scan is an effective screening method for asymptomatic patients with projectile-embolism of the great vessels.The investigation of a greater cohort of combat patients with severe injuries and projectile-embolism should be performed in order to develop a better guideline for these patients and to save more lives.

The aim — to improve results of surgical treatment for victims with infected gunshot wounds in soft tissues due to implementation of the complex multifactor surgical treatment.Materials and methods. The comparative analysis of the treatment results in 80 victims during the war at the east of Ukraine from 2014 — 2017 years has been carried out. All injured had either bullet or projectile soft tissue wounds of different localization, light or moderately severity of the injury, with infectious complications and without reciprocal aggravated syndrome. All wounded were males. Patents’ age was from 19 to 58 years old (34.3 ± 1.1 years). Based on the surgical approach the studied patients were divided into two groups. The main group was composed of 49 injured which were treated by traditional surgical methods with additional use of the complex multifactor therapy: impulse negative pressure, hybaroxia, low­frequent supersonic cavitation of wound surface, local administration of buffer antiseptic solutions. The control group was consisted of 31 wounded which were treated only by traditional surgical methods: daily dressings with antiseptics and ointment compositions, stage­by­stage surgical interventions. The bacteriological study was carried out by direct wound culture to the dense nutrient media, the material was dyed according to Gram, the study had identified the germ and the dissemination level.Results and discussion. We have identified the infectious agent in all studied cases of infected gunshot wounds in soft tissue. All infectious agents had an opportunistic origin: Pseudomonas aeruginosa — 22.5 %, Proteus mirabilis — 21.3 %, Staphylococcus aureus — 23.8 %, Streptococcus pyogenes — 18.8 % and Escherichia coli — 13.8 %. The bacterial spectrum of infectious wound was similar in both the main and the control patient groups. The main group showed significantly greater results in bacterial inoculation (sterile collection) (13; 25.6 %) on 5 — 7th day after hospital admission compared to the control group patients (2; 6.5 %; p < 0.05). The use of the complex surgical treatment for septic complications of gunshot wounds in soft tissues allowed to accelerate microflora elimination in the nidus of infection and led to a decrease in general bacteria number within wounds on 8th day by 15 times (р < 0.01), on 10th day by 22 times (р < 0.001) as well as achieved a complete elimination of pathogenic microflora (р < 0.001) on 15th day.Conclusions. The complex multifactor surgical approach for infected gunshot wounds treatment (impulse negative pressure, low­frequent supersonic wound cavitation, hybaroxia, local antiseptic solutions) allows to substantially improve wound sanation (46.9 % of sterile culture on the 10th day vs 16.1 % for traditional surgical treatment) and certainly decrease the concentration of pathogenic microflora in the wound (by 22 times on 10th day of treatment).