Retained bullet in the neck after gunshot wounds to the chest and arm in combat patient injured in the war in Ukraine: A case report

Gybalo, R. V.; Лурін, І. А.; Safonov, Vadym; Dudla, Dmytro I.; Oklei, D; Dinets, Andrii

doi:10.1016/j.ijscr.2022.107658

Cited by 15 publications

(4 citation statements)

References 14 publications

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“…The active phase of russia's war against Ukraine is demonstrated new challenges to military surgeons because of the high incidence of severe gunshot wounds due to the frequent application of high-energy weapons as well as modified bullets [2,3]. Our experience from the patient's management during russia's invasion showed some specific features of such gunshot wounds such as severe functional 23/ Том XXVIII / 1 disorders, an increased frequency of complications, and a high mortality rate [3,4,5,6,7,8,9].…”

Section: Dedicated To the Heroic Deeds Of Ukrainian Doctors In The Na...mentioning

confidence: 92%

Modeling of wound ballistics in biological tissues simulators

et al. 2023

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Modern weapons cause severe damage, accompanied by high rates of complications and mortality. The investigation of such kinds of weapons is in high demand considering the ongoing active phase of russia's war against Ukraine since February 2022. In order to understand the pathological processes that occur in and outside the gunshot wound, we conducted an experimental study using mathematical simulation. The results presented in the article will help to choose the appropriate surgical management and improve the results of treatment. The aim of this study was to investigate and evaluate the damaging effect of a 5.45 mm 7N6M bullet and a 5.45 mm V-max expansive bullet using numerical modeling of wound canals in ballistic plasticine. The Ansys Explicit Dynamics engineering complex was used to simulate the dynamics of the bullet’s motion. The basic equations, solved by the explicit dynamic analysis, express the conservation of mass, momentum, and energy in Lagrange coordinates. Together with the material model and the set of initial and boundary conditions, they determine the complete solution to the problem. Taking into account that the initial velocity of the bullet is 1185 m/s at a mass of 3.9 g, we obtain energy 2740 J. All this energy acts at the area of the wound canal with a depth of 150 mm. Injury with a conventional 7N6M bullet is characterized by the fact that it passes through the block and loses only part of the kinetic energy. The simulation results showed that the velocity of the bullet at the outlet is 220 m/s. Taking into account the initial velocity of the bullet 918 m/s with a mass of 3.4 g, we obtain the kinetic energy acting on the walls of the wound canal with a depth of 200 mm of about 830 J. Mathematic analyses showed that the expansive bullet has a soft core that deforms and transfers all the kinetic energy to the tissues immediately after penetration into the tissues. The loss of kinetic energy of the bullet (ΔE, J) is defined as the difference between the kinetic energy at the time of injury (Ec, J) and the residual energy of the bullet when leaving the material (Er, J). Numerical modeling of wound ballistics in biological tissue simulators allows us to determine with high accuracy the features of wound canal formation and tissue response to damage of bullets having different kinetic energy, which contributes to the choice of adequate surgical management during surgery for gunshot wounds.

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Section: Dedicated To the Heroic Deeds Of Ukrainian Doctors In The Na...mentioning

confidence: 92%

Modeling of wound ballistics in biological tissues simulators

et al. 2023

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“…There were identified 374 male patients who were surgically treated at a military field hospital (Level II of medical care) situated in a 20 km zone from the frontline. The term “Level” is used in the National Military Doctrine of Ukraine, aiming to show the stratification of the five tiers in which medical aid is provided [ 3 , 6 , 7 ]. Each Level is a kind of medical tier to be organized on a progressive basis from 1 to 5 to apply treatment, evacuation, specific approaches to patient support as well as rehabilitation.…”

Section: Materials and Patientsmentioning

confidence: 99%

“…Such gunshot injuries may cause massive damage to soft tissue and internal organs, resulting in lethal outcomes or more prolonged treatment and rehabilitation time [ 3 , 4 ]. The Russian-Ukrainian war was started in 2014, and for the first eight years, this war was ongoing as hybrid warfare, followed by the initiation of direct fights between the two armies in 2022 [ 5 , 6 ]. During the hybrid period of 2014–2020, and nowadays, we have noticed Russian army frequently uses various types of weapons with high damage properties ( e.g.…”

Section: Introductionmentioning

confidence: 99%

Gunshot injury to the colon by expanding bullets in combat patients wounded in hybrid period of the Russian-Ukrainian war during 2014–2020

et al. 2023

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Background A gunshot wound to the colon is a frequent injury in armed conflicts. An example of a high-energy modern weapon is hollow-point bullets, which is associated with increased tissue damage and lethal outcome. The aim of this study was to evaluate gunshot injuries to the colon in combat patients and to assess the difference in clinical features of patients with colon injuries by hollow-point versus shape-stable bullets. Patients and methods Analyses of clinical data were performed on 374 male soldiers from the Armed Forces of Ukraine with gunshot abdominal wounds with injury to the colon in East Ukraine between 2014 and 2020. Out of 374 injured, 112 (29.9%) patients were diagnosed with penetrating gunshot bullet wounds: 69/112 (61.6%) were injured by shape-stable bullets, and the hollow-point bullets injured 43/112 (38.4%) patients. Results More severe hemorrhagic shock stages were in patients injured by hollow-point bullets: shock stages III-IV was in 25 (58.1%) patients injured by the hollow-point bullets vs. 17 (24.6%) patients injured by shape-stable bullets (p = 0.0004). Left colon parts were more frequently injured as compared to the right colon side or transverse colon: 21 (48.8%) patients were injured by the hollow-point bullets (p < 0.0001), and 41 (59.4%) patients were injured by the shape-stable bullets (p = 0.032). A significant difference was identified for the frequent injury to the middle colon within the entire cohort (p = 0.023). Patients injured by the hollow-point bullets demonstrated a higher frequency of 3–5 areas of colon gunshot defects, which was detected in 18 (41.8%) patients injured by hollow-point bullets and none with shape-stable bullets injury (p = 0.0001). Colon Injury Scale (CIS) IV was detected in 7 (16.3%) patients injured by the hollow-point bullets as compared to 2 (2.9%) patients injured by shape-stable bullets (p = 0.011). Colostomy was performed in 14 (69%) patients injured by shape-stable bullets and in 12 (27.9%) patients injured by hollow-point bullets (p > 0.05). 15 (35%) patients died after injury by the hollow-point bullet, whereas 9 (13%) patients after damage by the shape-stable bullets (p = 0.0089). Conclusions All patients should be suspected to have an injury by bullet with expanding properties in case of penetrating abdominal injury (absent of outlet wound) and careful revision of the abdomen must be performed to identify possible multiorgan injury as well as multiple gunshot defects of the intestine.

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“…Vascular gunshot wounds are common in armed conflicts [1] , [2] , [3] . Such kind of injury is associated with a high risk of critical ischemia, limb amputation, and high morbidity [4] .…”

Section: Introductionmentioning

confidence: 99%

Retained bullet in the neck after gunshot wounds to the chest and arm in combat patient injured in the war in Ukraine: A case report

Cited by 15 publications

References 14 publications

Modeling of wound ballistics in biological tissues simulators

Modeling of wound ballistics in biological tissues simulators

Gunshot injury to the colon by expanding bullets in combat patients wounded in hybrid period of the Russian-Ukrainian war during 2014–2020

Temporary arterial shunts in combat patient with vascular injuries to extremities wounded in Russian-Ukrainian war: A case report

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