Resume. The purpose of the study was to reveal the main features of the development of purulent mediastinitis in a wounded person with penetrating gunshot wounds of the chest and neck in order to further improve the diagnosis and treatment of this difficult complication. The work reports on the injured K., 29 years old, with acute purulent-necrotic mediastinitis and late bilateral empyema of the pleura caused by a gunshot wound to the chest and neck. With early diagnosis of suppurative mediastinitis due to penetrating gunshot wounds of the chest and neck, active surgical tactics including wound dressing, drainage, massive antibiotic therapy, and adequate postoperative care with intensive care generally help to save the patient's life.
IntroductionThe healing of combat wounds can be complicated by the presence of foreign bodies. The present research aimed to study the regeneration of soft tissue injuries complicated by foreign bodies in the form of fragments of military uniforms.Methods60 rats were divided into four groups: intact (Int), control (Con) and two experimental (EG1, EG2). In Con, wounds were sutured without implantation of foreign bodies. A uniform consisting of 100% cotton was used as foreign bodies for EG1 and a uniform consisting of 65% cotton and 35% polyester for EG2. Histological studies were performed according to generally accepted methods. The growth factors wеre determined by ELISA.ResultsIn EG1, the inflammatory reaction proceeded protractedly, which complicated the development of granulation tissue. In EG2, considering the moderate inflammatory reactions, healing of the wounds became possible. The increase of the growth factors content in Con was maximal at the 15th day: basic fibroblast growth factor (bFGF)—2.2 times and vascular endothelial growth factor (VEGF)—1.6 times (p<0.001). In experimental groups, the bFGF content was maximal at the 60th day and exceeded the normal values by 1.7 times in EG1 and by 2.6 times in EG2 (p<0.001); the level of VEGF was slightly higher than that in healthy animals.ConclusionsThe study showed wound healing in all groups. The repair of injuries in rats of EG1 and EG2 was complicated by the textile implant and took longer. The dynamics of the content of growth factors reflected the impairment of wound healing processes. These violations were more pronounced in the EG1 group.
The article presents the results of experimental modeling of superficial fragment gunshot wounds of soft tissues, obtained in low-energy gunshot wounds. The pathomorphosis of gunshot wounds was studied, and the features and timing of their healing were compared depending on the temperature of the damaging fragments. The aim of the work was to study the effect of the temperature of the injuring shrapnel on the healing processes of the soft tissues of experimental animals with superficial low-energy fragment gunshot wounds. Using the random number method, laboratory animals (rabbits) were divided into 3 experimental groups (15 animals each). In each group, wounding was with fragments with different temperatures − 18°С, 50°С and 100°С. The control group consisted of 10 intact animals. On day 14th, 30th and 60th, 5 animals from each group were withdrawn from the experiment. Microscopic examination of soft tissues was performed using a PRIMO STAR light microscope (Carl Zeiss, Germany) at magnification by 56 and 400 times. When assessing the state of tissues in the area of wound damage, it was established that as the temperature of the injuring fragment increases, a slower filling of the defect formed by the necrotic detritus in the process of utilization of necrotic detritus is observed. The high temperature of the injuring fragment along with the mechanical rupture of tissues causes thermal coagulation necrosis. Dense coagulated necrotic masses covering the wound canal from the inside, not only increase the volume of necrotic masses, but also complicate the process of wound healing. At a temperature of wounding fragments 100°C, the formation of a necrotic crust on the surface of the wound occurred on average 3±1.2 days later than at temperatures of 18°C and 50°C, the least pronounced healing took place at the bottom of the wound and in the muscle tissue. Microscopically necrotic, not dystrophic changes were observed in myocytes. Thus, a comparative analysis of the pathomorphosis of soft tissues in a wound when injured from an air rifle MP-532 with different temperature of the fragments showed differences from both the alteration of the tissues and the regenerative potential.
The article analyzes and systematizes the changes in capsules of soft tissue foreign bodies of gunshot origin at the elemental, structural, cellular, tissue and clinical levels in dynamics. The terms "peak of maximum changes" and "biological adaptation of the organism" are defined. The identification of phases of carriage of foreign bodies is substantiated depending on the changes and time foreign body remained in soft tissues.
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