Статті в журналах: "Wounds and injuries"

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Vasil’ev, A. Yu, and I. S. Obelchak. "Multidetector computed tomography in the diagnosis of lesions of the main vessels for gunshot injury of the chest." Regional blood circulation and microcirculation 18, no. 1 (May 3, 2019): 31–38. http://dx.doi.org/10.24884/1682-6655-2019-18-1-31-38.

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Purpose – examine the possibilities of multislice computed tomangiography (MSCTA) in case of suspected damage to the great vessels in a chest gunshot fghting injury.Material and methods. A radiation survey of 130 wounded with gunshot injuries of the chest to assess the nature, diagnosis of gunshot injuries of the vascular bed.Results. Of the 130 wounded with gunshot wounds to the chest, 41 (31.5 %) of the injured had gunshot wounds to the chest were nonpenetrating, and 89 (68.5 %) had penetrating injuries. In 76 (58.4 %) patients with gunshot chest injuries, the nature of the wound was fragmentation, in 54 (41.6 %), wounds were bullet wounds. In the algorithm of radiation examination of patients with gunshot wounds of the chest to identify the nature of damage to the organs of the mediastinum and vascular structures, the main method of visualization was MSCT with contrast enhancement. Damage to the bone skeleton of the chest (ribs, collarbone, sternum, scapula) by MSCT was observed in 23 (17.6 %) patients. Almost half – 66 (50.1 %) of the wounded with gunshot injuries during MSCT examination, traumatic injury (pulmonitis) of the lung was observed. In 2 (1.5 %) cases, damage to the heart was detected that was not recognized at the stage of skilled surgical care. False posttraumatic aneurysm of the thoracic aorta was diagnosed in two wounded. Accuracy, sensitivity, specifcity of MSCT angiography in imaging of the vascular bed and diagnosis of damage to the great vessels of the chest cavity was 98, 97 and 97 %, respectively.Conclusions. MSCT made it possible to reliably assess the nature of the gunshot injuries of the chest, identify timely damage to the great vessels of the mediastinum, determine the localization of the foreign injuring bodies near the vascular structures, and determine the surgical tactics.

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Khoroshun, Eduard M., Volodymyr V. Nehoduiko, Vitaly V. Makarov, Serhiy I. Panasenko, Tamara P. Yakymova, and Serhii V. Tertyshnyi. "MACROSCOPIC AND MICROSCOPIC FEATURES OF FIREARM PENETRATING ABDOMINAL INJURIES WITH DAMAGE TO THE APPENDIX." Clinical and Preventive Medicine, no. 6 (December 19, 2023): 68–73. http://dx.doi.org/10.31612/2616-4868.6.2023.08.

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Introduction. In the structure of combat abdominal trauma during all periods of hostilities (according to ATO/JFO data), gunshot wounds dominated, accounting for 87.1%. An analysis of the distribution of those injured with gunshot wounds by the type of projectile causing the injury showed a prevalence of shrapnel injuries over bullet wounds – more than 80%. The aim of the research was to analyze the macroscopic and microscopic changes in firearm penetrating abdominal injuries with damage to the appendix. Materials and Methods. Eight appendectomies were performed due to firearm penetrating abdominal injuries with damage to the appendix. Complaints, medical history, examination data, ultrasound examination according to the FAST protocol, and radiological examinations were studied in all injured patients. To refine the diagnosis and determine the scope of surgical intervention, the WOLF videoendoscopic system was used. Histological examination of the removed appendices was performed, which were stained with hematoxylin and eosin and with the Van Gieson stain. A complex of pathomorphological studies was conducted using the Primo Star microscope (Carl Zeiss) at a magnification of ×140. Results. All injuries occurred while wearing a bulletproof vest and were characterized as blind, with 1 (12.5%) being gunshot wounds and 7 (87.5%) being shrapnel wounds. The entrance wound in firearm blind penetrating abdominal injuries with appendix damage was located in the right hypochondriac region – 4 (50%), right flank – 1 (12.5%), right inguinal region – 2 (25%), and mesogastric region – 1 (12.5%) cases. The average size of the entrance wound on the skin was 23.3±0.4×12.4±0.3 cm. All skin wounds were outside the bulletproof vest protection area. The injuries to the appendix had an average size of 15.4±1.2×9.3±0.1 cm. All removed foreign bodies were larger than 1 cm in their largest dimension. Conclusions. In most cases of firearm penetrating abdominal injuries, damage to the appendix is noted with an entrance wound predominantly on the right side. Macroscopically, in firearm blind penetrating abdominal injuries with appendix involvement, the wound on the skin is larger than on the appendix. All foreign metal bodies removed from the abdominal cavity after firearm shrapnel blind abdominal injuries with appendix involvement were of large size. Contusional injuries to the appendix tend to undergo destructive transformation, requiring surgical treatment - appendectomy. The increased frequency of appendix injuries can be explained by the widespread use of shrapnel ammunition in abdominal injuries when personal protective equipment does not provide protection for this area.

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Kvasnevskyi, Yevhen, Michailo Kashtalian, Oleh Gerasimenko, and Oleksandr Kvasnevskyi. "Experimental Study of Action Different Kinetic Energy on the Colon." Lietuvos chirurgija 21, no. 2 (May 2, 2022): 105–8. http://dx.doi.org/10.15388/lietchirur.2022.21.61.

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The purpose of the study. To increase the effectiveness of surgical care for the wounded with combat trauma of the colon by studying of ballistic, morphological and functional features of the gunshot wounds. Patients and methods. A study of surgical treatment of 83 wounded with combat injuries of the colon, received in the area of anti-terrorist operation in the period from 2014–2018. For comparative analysis of treatment results, two clinical groups were formed: comparison and main. The comparison group included 42 wounded who were treated from April 2014 to February 2015 (the first and second periods of ATO), who used traditional surgical tactics. The main group included 41 wounded who were treated from March 2015 to 2018. Results. Analysis of the distribution of wounded with combat trauma by type of wound / injury revealed that the vast majority of them in both groups had shrapnel wounds – 49 (59.1%). There were 30 (36.1%) victims with bullet wounds, and 4 (4.8%) with closed injuries. The wounded patients with the battle trauma of the thick bowel by type of injury had missile wounds as a rule – 49 (59.1%). There were 30 (36.1%) patients with bullet wounds, and 4 (4.8%) with closed injuries. Most of the injuries were combined – 58 (69.9%), and with only abdominal injuries – 25 (30.1%), mostly multiple – 21 (25.3%). The great majority of the thick bowel injuries belonged to sigmoid – 32 (38.6%) and transverse colon – 21 (25.3%), which is explained by relatively large size of these parts of the intestine. Conclusions. The choice of surgical tactics and scope of surgical interventions on damaged organs and structures took into account the results of experimental study of mechanogenesis and pathomorphology of gunshot wounds of the colon, obtained in bench studies by modeling gunshot wounds on “thoracoabdominal ballistic material”.

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Danchyn, A. O., O. M. Goncharuk, S. A. Usatov, M. S. Altabury, and G. O. Danchyn. "Biophysical mechanisms of the formation of wound channels in non-penetrating gunshot craniocerebral wounds." Ukrainian Interventional Neuroradiology and Surgery 35, no. 1 (June 30, 2021): 33–42. http://dx.doi.org/10.26683/2786-4855-2021-1(35)-33-42.

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Objective ‒ to develop recommendations for optimization of primary surgical treatment of gunshot penetrating craniocerebral wounds on the basis of theoretical and applied study of one of the sections of wound ballistics ‒ biophysical mechanisms of wound canal formation, concomitant impenetrable wounds and intracranial injuries.Materials and methods. The medical histories of 155 wounded who received a non-pe-netrating craniocerebral injury during the hostilities in the East of Ukraine in 2014‒2020 were studied. All of the wounded were males between 18 and 60 years old (mean age ‒ 35.1 years). To study the biophysical features of the formation of different types of wound canals at a given non-lethal kinetic energy transferred to the head tissues, the type of the wounding projectile, the flight trajectory, the nature of gunshot injuries to the soft tissues of the cranial vault and skull fractures and intracranial injuries were determined according to the data of clinical stu-dies and computed tomography and compared with the results of theoretical studies using the laws of wound ballistics.Results. There were 11 (7.1 %) bullet (only tangential) wounds, and 144 (92.9 %) shrapnel. The formation of wound channels depends on the type of the wounding projectile and its kinetic energy. Non-penetrating firearms bullet and shrapnel tangential craniocerebral wounds are caused by the destructive effect of injuring shells on the tissues, which at the moment of collision with the head have both destructive kinetic energy (>80 J) and less than destructive kinetic energy. Blind craniocerebral injuries are caused only by the traumatic effects of fragments with a small (<80 J) kinetic energy.Conclusions. With gunshot non-penetrating single shrapnel blind wounds, the wounds do not have a zone of secondary necrosis, and the zone of primary necrosis is small or insignificant, which makes it possible not to carve soft tissues around the wound during primary surgical treatment, but only to remove necrotic tissues. With gunshot non-penetrating shrapnel tangential and blind craniocerebral wounds, when the soft tissue wounds of the cranial vault do not gap, small size (damage to the skin, subcutaneous tissue to aponeurosis), primary surgical treatment is not performed. Such wounds are treated with a toilet and aseptic dressings. Wound canals ending in gunshot fractures are subject to primary surgical treatment in the same way as gunshot fractures.

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Khankhasykov, S. P., D. N. Zhilin, and V. V. Tokar. "Gunshot wounds to animals." BIO Web of Conferences 108 (2024): 03011. http://dx.doi.org/10.1051/bioconf/202410803011.

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Gunshot injuries are quite common in various animal species. In 40.0% of cases, this type of damage was detected on the corpses of roe deer, in 26.67% of cases, damage was noted on the corpses of Manchurian elk, 13.33% of cases were registered in horses and cattle. In 6.67% of cases, injuries were found on the dog’s corpse. In 40.0% of the cases, the injuries corresponded to blind gunshot wounds and were represented by an entrance gunshot wound and a wound channel. There was no exit wound. In 33.33% of the injuries corresponded to perforating gunshot and were represented by an entrance and exit wound opening and wound canal. 20% of the identified injuries are represented by tangential gunshot wounds, characterized by the presence of an open wound canal. In 6.67% of cases, injuries were attributed to bruised gunshot.

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Bradic, Nikola, Drazen Cuculic, and Ervin Jancic. "Terrorism in Croatia." Prehospital and Disaster Medicine 18, no. 2 (June 2003): 88–91. http://dx.doi.org/10.1017/s1049023x00000819.

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AbstractIntroduction:This report illustrates Croatia's experience with the terrorist attack in the city of Rijeka in October 1995. Also, the intention of this report is to outline how emergency services were functioning in this sudden-onset situation.Methods:The medical documentation of 27 wounded citizens in the attack was analyzed and the appearance of bodily wounds, severity of wounds, and the mechanisms of injury are described. From the forensic medical report, the wounds and damages sustained by the terrorist also were analyzed. All findings were compared with similar cases from around the world.Results:In the 27 wounded citizens, three (11%) had head injuries, and injuries of the abdomen in only two cases (7%) were found. The most common injuries sustained involved one or more extremities: 16 (59%) persons had wounds of an upper or lower extremity or a combination of multiple wounds. The main cause of death of the terrorist was explosive wounds to the chest and abdomen with destruction of multiple inner organs (primarily kidneys, liver, abdomen, and lung). Furthermore, the terrorist had a fracture of the skull base and multiple injuries to the brain.Conclusion:Comparing the findings with other data from the literature, the distribution in the percentages of wounded is almost the same as reported in many bomb attacks. In this case, the walls of the building protected many citizens, which is why so few were seriously injured. Forensic examination of the terrorist's body showed all of the characteristics of blast injuries.

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Loskutov, Aleksandr, Andriy Domanskyi, Ivan Zherdev, and Svyatoslav Lushnya. "Features of medical care in patientswith elbow joint gunshot wounds." ORTHOPAEDICS, TRAUMATOLOGY and PROSTHETICS, no. 1 (October 5, 2021): 5–8. http://dx.doi.org/10.15674/0030-5987202115-8.

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Gunshot wounds of the elbow joint are the third most common after knee and shoulder injuries. Features of the anatomical and functional structure of the elbow joint, the close location of the vascular and nervous formations, favorable conditions for the development of infection determine the severity of gunshot wounds and cause the complexity of its treatment. Objective. To evaluate the frequency and nature of the elbow joint gunshot wounds in the structure of the general combat injuries, as well as to determine the volume of medical care and direction of treatment of such injuries in the conditions of the regional hospital as a stage of care. Methods. A retrospective study included 1 809 patients (96.0 % of men, mean age (33.7 ± 0.2) years). Firearms limb injuries were detected in 1 013 (56.0 %) of all victims, of which the elbow joint — 25 (2.47 %). Mines and explosives injuries were in 22 (88 %) of the patients, bullet — in 3 (12 %). Results. Tactics of treatment of elbow joint gunshot wounds depended on the severity of the condition of the victims and the nature of concomitant traumatic injuries. In the structure of combat injury of the elbow joint the majority was combined (52 %) and multiple (40 %) injuries and was accompanied by gunshot fractures in 60 %. In patients who were in severe state, applied the tactics of Damage control in two stages. At the first stage the fractures were fixed with plaster splints or external fixation devices (EF), the wounds were not subjected to full surgical debridment (SD), but only washed with antiseptics and the visible foreign bodies were removed. In patients with soft tissue injuries wounds the primary SD was performed according to general principles, injured nerves were not restored. In the second stage, after patient is stabilized, the repeated SD of the wound was performed. After their uncomplicated healing the EF was removed and the method of fixation was changed to internal osteosyntesis. Conclusions. It is recommended to perform stabilization of intra-articular gunshot fractures of the elbow joint with EF and after uncomplicated wound healing go to the internal osteosynthesis. Key words. Elbow joint, gunshot wounds, treatment.

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Altabrouri, M. S., and S. A. Usatov. "Morphological Features of Wound Canals and Intracranial Pathology in Non-Penetrating Gunshot Craniocerebral Injuries." TERRA ORTHOPAEDICA, no. 3(118) (December 20, 2023): 40–46. http://dx.doi.org/10.37647/2786-7595-2023-118-3-40-46.

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Background. Non-penetrating craniocerebral trauma in modern warfare, according to our data, accounts for up to a fifth of all gunshot wounds of the skull and brain in armed conflicts at the end of the last century and the beginning of the current century. It is a complex problem of military field surgery, first of all from the point of view of solving an important task of the medical services of the warring parties – restoring the maximum number of wounded. The study of pathomorphological wound channels in various types of gunshot non-penetrating craniocerebral injuries gives opportunities for the development of adequate options for access during surgical treatment. Object: to reveal the morphological features of wound canals and internal cranial injuries in gunshot non-penetrating craniocerebral injuries for optimal planning the primary surgical treatment of the wound. Material and Methods. Study and analysis of morphological features of wound canals and intracranial pathology in 155 non-penetrating gunshot craniocerebral injuries of the military who underwent surgical treatment in the 2nd and 3rd level healthcare institutions during the war in 2014-2020. The morphology of wound canals and intracranial injuries were studied based on the laws of wound ballistics, clinical data, and computed tomography data. Results. The largest proportion of non-penetrating gunshot wounds is perforated and depressed fractures (39.9%); perforated fractures with penetration of a fragment to the inner plate of the bone account for 20% and incomplete (to the bone) make up 5.8%. Among blind non-penetrating wounds, single ones prevail (65.2%). More often, they have a cylindrical blind canal. Subarachnoid hemorrhage, brain congestion, and very rarely epidural hematoma (one case) are found in almost all perforated bone fractures. A more complex pathomorphological structure is present in multiple non-penetrating gunshot wounds. At the same time, only one fragment causes a depressed skull fracture. Large and small wound canals can be distinguished by width. The latter do not damage the bones and do not require surgical treatment. This type of injury is accompanied by a subarachnoid hemorrhage in 78% of cases and by brain congestion near the fracture in 43% of cases. Tangential injuries occur in 21.9% of injuries; they have a grooved elongated shape. The bottom of these wounds are linear and compressed fractures. Rarely, subdural and intracerebral hematomas are formed in the projection of the fracture. All non-penetrating injuries are accompanied by small brain congestion of the I-II degrees and subarachnoid hemorrhage. Epidural and intracerebral hematomas can rarely occur with blind non-penetrating cranial injuries. Conclusions. Non-penetrating multiple fragmental injuries are accompanied by the greatest soft tissue damage. In case of blind wound canals, there are incomplete perforated and perforated-depressed skull fractures; linear and depressed fractures occur in tangential canals. Regardless of the type of wound canals in the brain, there are small congestions (hemorrhages) and subarachnoid hemorrhage. In rare cases, epidural and intracerebral hematomas are formed. Subdural hematomas, sometimes combined with intracerebral hematomas, are found in tangential non-penetrating wounds. Projectiles in tangential wounds do not cause molecular shock and do not lead to secondary necrosis, therefore, it is not necessary to cut the edges of the wound during the primary surgical treatment.

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Khomenko, I. P., K. P. Gerzhyk, and B. M. Kucher. "The place and role of videothoracoscopic surgical interventions in war wounds and injuries of the chest organs." Reports of Vinnytsia National Medical University 22, no. 3 (September 28, 2018): 522–24. http://dx.doi.org/10.31393/reports-vnmedical-2018-22(3)-26.

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Thoracic injuries are considered to be one of the most severe injuries of human systems and organs, which are characterized by a large number of complications and high mortality. According to the ATO data in eastern Ukraine, the frequency of chest injuries in the general structure of combat surgical injuries is 11.7%, the overwhelming majority of which were non-penetrating injuries (83.6%). The overall mortality rate for penetrating wounds of the breast is 5–10%. Surgical tactics for injuries and injuries of the chest is diverse and depends on the type of traumatic injury, the time of first medical and specialized care, the severity of the condition of the victims, the presence of complications, the technical capabilities of the hospital. Objective: optimization of surgical tactics for wounds and injuries of the chest through the use of video-assisted thoracoscopic techniques. A retrospective analysis of the surgical treatment of 103 thoracic wounded and injured, which were located in the Military Medical Clinical Center of the Southern Region in Odessa and the area of responsibility (level II–IV medical care) from June 2014 to July 2017, was carried out. At the stages of medical evacuation of all 103 thoracic wounded and injured in most cases (41 people (39.8%)), drainage of the pleural cavity was sufficient to eliminate hemo- and pneumothorax — 25 (24.3%) underwent various surgical interventions from thoracotomic approaches, 16 (15.5%) had various video-assisted thoracoscopic surgeries, 16 (15.5%) had only surgical treatments for gunshot wounds, and 5 (4.9%) wounded and injured had only conservative therapy. Conclusions: Promising, in our opinion, can be the widespread introduction of video-assisted thoracoscopic interventions into the practice of surgeons who are involved in the ATO, followed by a multicenter assessment of the results.

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Kiran, J. V. K., H. Fereed, and S. K. Jadhav. "Medicolegal Evaluation of Fatal Firearm injury Cases in Ethiopia: An Autopsy Study." Journal of Indian Academy of Forensic Medicine 45, no. 1 (2023): 24–27. http://dx.doi.org/10.48165/jiafm.2023.45.1.6.

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Gunshot wounds are commonly encountered in forensic practice. The courts quite often specifically need to know which firearm injury is entry and which is exit. Although the examination of a recent gunshot wound is often straightforward, the appearance of the firearm wound may be affected by factors like multiple firearm injuries, putrefaction, charring. The forensic practitioner sometimes faces difficulty when the entry or exit wounds present atypically like the absence of secondary effects of discharge, as in decomposed bodies, which are supposed to determine or be specific to entry wound. Sometimes feature like abrasion collar is seen at the exit wound or is present in both entry and exit wounds as in cases of shored exit wound. This study focuses not only on the typical features which determine the entry wound but also on the few cases in which the presentation of entry and exit wounds are atypical. This study can be used in those cases of firearm injuries like multiple firearm injuries and decomposed cases.

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Kutasevych, Ya F., S. K. Dzhoraieva, M. O. Lyapunov, E. M. Khoroshun, M. S. Birukov, V. V. Kupriyanchuk, S. A. Shipilov, I. O. Mashtakova, V. V. Goncharenko, and O. K. Ivantsova. "COMPARATIVE ASSESSMENT OF THE SENSITIVITY OF CAUSES OF WOUND INFECTIONS TO TOPICAL ANTIBACTERIAL DRUGS." Dermatology and Venerology, no. 2 (2023): 7–10. http://dx.doi.org/10.33743/2308-1066-2023-2-7-10.

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The problems of treating victims with gunshot wounds are determined by the issue of prevention and treatment of purulent complications, because wounds received during hostilities are a priori infected, and the most dangerous complication of wounds is the development of purulent infection. The purpose of the research is to study the peculiarities of the microbial landscape of combat wounds and the antimicrobial activity of certain drugs in relation to extensively resistant and polyresistant microbial agents in order to develop algorithms in external therapy within the framework of complex treatment of these injuries Materials and methods. The data of microbiological studies of 32 victims with gunshot wounds were used in the work. Research results: Based on the results of monitoring the causative agents of purulent-inflammatory complications of wound injuries, a range of leading types of microorganisms was established: K. pneumoniae E. faecalis, S. haemolyticus, P. aeruginosa, E. coli. The isolation of flora resistant to most antibiotics from wounds dictates the need to change the strategy of infection control with strengthening measures to prevent nosocomial transmission and should be taken into account in the process of prescribing antibiotic therapy. Conclusion. The obtained results of the pilot study demonstrate the microbiological effectiveness of dioxidin, partially mupirocin and fusidin, which can be used in the complex treatment of microbial complications of wound injuries and the development of optimal tactics for providing medical care and treatment of the wounded, and can also serve as a basis for the development of a method of complex treatment for certain phases wound process, which allow simultaneous influence on several factors of pathogenesis.

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Zavhorodnii, S. M., O. I. Kotenko, M. B. Danyliuk, and M. A. Kubrak. "Surgical treatment of isolated soft tissue gunshot shrapnel injuries by combining primary delayed sutures with platelet-rich autoplasma injections into mine-explosive wounds." Zaporozhye Medical Journal 25, no. 4 (July 20, 2023): 339–45. http://dx.doi.org/10.14739/2310-1210.2023.4.269875.

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Aim: to assess the treatment effectiveness in patients with soft tissue gunshot shrapnel injuries by applying primary delayed sutures in combination with platelet-rich autoplasma injections into wounds. Materials and methods. The study included 60 (100.0 %) patients with soft tissue gunshot shrapnel wounds. All wounded were divided into two groups. The comparison group consisted of 30 (50.0 %) patients admitted to a hospital with primary delayed sutures (6–7 days). The main group included 30 (50.0 %) patients whose local treatment modification consisted in a combination of primary delayed suturing with platelet-rich autoplasma injection into a wound. A wound channel was observed on the 8th, 11th –14th days from the moment of injury using visual inspection, linear measurements and diagnostic ultrasound system (Mindray M6, 220A). Results. 60 (100.0 %) patients were urgently hospitalized to the third stage of medical evacuation and treated according to standard treatment protocols for this pathology at the third stage of evacuation. According to a wound defect localization, the wounded of the comparison groups, 30 (50.00 %), were distributed as follows: a lower limb wound – 22 (73.33 %) patients, an upper limb wound – 6 (20.00 %), and a trunk wound – 2 (6.67 %). The main group also included 30 (50.00 %) wounded, whose treatment at the third stage of medical evacuation was modified by using a combination of primary delayed sutures and platelet-rich autoplasma injection. On the 8th day after an injury, a visual inspection of the wounds detected no hyperemia or suppuration in both groups. The visual inspection of wounds in the comparison group at 11.0 ± 3.9 days post-injury revealed 24 (80.00 %) patients with complications such as seromas in 17 (56.67 %) cases, hematomas with wound suppuration – in 7 (23.33 %). In the main group, 2 (6.67 %) cases of wound suppuration were detected (U = 120.00, p = 0.000001). The basic parameters of wound linear measurements according to the diagnostic ultrasound system data at the 11th–14th day post-injury after primary and delayed suturing in the studied groups: in the comparison group, upper limb wounds – S (mm2) 43.3 ± 12.6, V (mm3) 53.3 ± 13.9; lower limb wounds – S (mm2) 194.7 ± 50.7, V (mm3) 706.3 ± 190.4; trunk wounds – S (mm2) 20.5 ± 7.2, V (mm3) 22.5 ± 5.4. In the main group, upper limb wounds – S (mm2) 28.2 ± 8.5, V (mm3) 23.2 ± 7.1; lower limb wounds – S (mm2) 56.4 ± 19.6, V (mm3) 102.4 ± 21.1; trunk wounds – S (mm2) 12.3 ± 3.2, V (mm3) 10.4 ± 2.9. The total duration of inpatient treatment at the 3rd stage of medical evacuation in the comparison group wounded was 30.0 ± 2.3 days, and in the main group it was 12.0 ± 3.1 days (U = 290.00, p = 0.0354). Conclusions. In the structure of gunshot shrapnel wounds in both groups, there were 43 (71.67 %) lower limb traumatic injuries, 11 (18.33 %) upper limb, and 6 (10.00 %) trunk injuries. The use of platelet-rich autoplasma in combination with primary delayed suturing stimulated wound healing and accelerated wound-healing process as evidenced by a significant decrease in the wound defect area and volume on the 11th–14th day post-injury in the main group compared to the comparison group. The method for treatment of gunshot shrapnel wounds developed by us reduced the frequency of postoperative complications since 24 (80.00 %) patients were diagnosed with complications in the comparison group, while only 2 (6.67 %) patients in the main group (U = 120.00, p = 0.00001). The use of platelet-rich autoplasma made it possible to reduce the length of hospital stay for patients at the third stage of medical evacuation: in the comparison group, this period was 30.0 ± 2.3 days, and in the main group, 12.0 ± 3.1 days (U = 290.00, p = 0.0354).

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Oosthuizen, GV, VY Kong, T. Estherhuizen, JL Bruce, GL Laing, JJ Odendaal, and DL Clarke. "The impact of mechanism on the management and outcome of penetrating colonic trauma." Annals of The Royal College of Surgeons of England 100, no. 2 (February 2018): 152–56. http://dx.doi.org/10.1308/rcsann.2017.0147.

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Introduction In light of continuing controversy surrounding the management of penetrating colonic injuries, we set out to compare the outcome of penetrating colonic trauma according to whether the mechanism of injury was a stab wound or a gunshot wound. Methods Our trauma registry was interrogated for the 5-year period from January 2012 to December 2016. All patients over the age of 18 years with penetrating trauma (stab or gunshot) and with intraoperatively proven colonic injury were reviewed. Details of the colonic and concurrent abdominal injuries were recorded, together with the operative management strategy. In-hospital morbidities were divided into colon-related and non-colon related morbidities. The length of hospital stay and mortality were recorded. Direct comparison was made between patients with stab wounds and gunshot wounds to the colon. Results During the 5-year study period, 257 patients sustained a colonic injury secondary to penetrating trauma; 95% (244/257) were male and the mean age was 30 years. A total of 113 (44%) sustained a gunshot wound and the remaining 56% (144/257) sustained a stab wound. Some 88% (226/257) of all patients sustained a single colonic injury, while 12% (31/257) sustained more than one colonic injury. A total of 294 colonic injuries were found at laparotomy. Multiple colonic injuries were less commonly encountered in stab wounds (6%, 9/144 vs. 19%, 22/113, P < 0.001). Primary repair was more commonly performed for stab wounds compared with gunshot wounds (118/144 vs. 59/113, P < 0.001). Patients with gunshot wounds were more likely to need admission to intensive care, more likely to experience anastomotic failure, and had higher mortality. Conclusions It would appear that colonic stab wounds and colonic gunshot wounds are different in terms of severity of the injury and in terms of outcome. While primary repair is almost always applicable to the management of colonic stab wounds, the same cannot be said for colonic gunshot wounds. The management of colonic gunshot wounds should be examined separately from that of stab wounds.

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Sriwiyati, Lilik, and Budi Kristanto. "Karakteristik Luka Dan Penggunaan Balutan Luka Modern." Adi Husada Nursing Journal 6, no. 1 (August 3, 2020): 8. http://dx.doi.org/10.37036/ahnj.v6i1.161.

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Abstract The most frequent injuries are chronic wounds, where the number is increasing every year. The most common type of wound is diabetic ulcer and the next is cancerous wound. Each wound has different characteristics, so the treatment of each wound is also different. There are various dressings in modern wound care, where each bandage has different indications according to the characteristics of the wound, it is necessary to do research on the characteristics of the wound and the use of modern wound dressing. The purpose of the study To describe the characteristics of wounds and the use of modern wound dressing in the Salud Wound Care Clinic, Kartasura. Research subjects: patients undergoing wound care at the Salud Wound Care Clinic, a total of 9 respondents. Method: Descriptive analytic. Research Results: The types of wounds treated were diabetic ulcer wounds, postoperative wounds, cancer wounds, and decubitus wounds, wound duration varied from 2 weeks to 1 year. Types of wound dressing used were foam, alginate, and hybrid technology dressing, there was a decrease the size of the wound area with a mean of 14,69 to 11,61, the majority of wounds in stage 2, the basic color of the wound is red, and the type of exudate is serous. Conclusion: There is a reduction in wound size, stage, and the wound exudate, as well as repairing the wound’s basic color with wound care using modern wound dressing. Keywords: modern wound dressing, wound characteristics.

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., Ani Anjarwati, Amalia Hikmatul Jannah ., Galu Kusuma Dewi Ramadani ., Masruro ., Khoirunnisa Rahmatillah ., and Siti Romla . "Pengenalan Luka Dan Macam-Macam Luka Dalam Kegiatan Tri Bakti PMR Di SDN Sukabumi I." Jurnal Pendidikan, Sains Dan Teknologi 1, no. 3 (December 23, 2022): 270–75. http://dx.doi.org/10.47233/jpst.v1i2.362.

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If the continuity of the cell structure is cut off due to imperfect or missing cell elements, it can cause damage to the protective function of the skin and can be accompanied by damage to other cell elements, which can be called a wound. Wounds can also be accompanied by other tissue damage. Accidents involving moving vehicles, falls, sudden or sharp shocks, and surgical procedures are all potential causes of injury. There may be abrasions, lacerations, bruises, cuts, knife wounds, and gunshot wounds among the several types of injuries that may occur. The purpose of the Tri Bakti activities that researchers carried out at SDN SUKABUMI 1 was to introduce injuries and their various types in PPMR Tri Bakti activities. In various wound problems, wound care generally uses procedures. To ensure the wound healing process goes as it should, wound care must adapt to the circumstances and challenges of the injuries that arise.

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Satti, Memuna Kausar, Sadaf Humayun, Muhammad Sajid, Kunza Naveed Asdaq, Tehreem Ashraf, and Mahjabeen Aftab. "Hydrogels for Wound Dressing Applications - A Systematic Review." Pakistan Journal of Medical and Health Sciences 17, no. 3 (March 24, 2023): 2–6. http://dx.doi.org/10.53350/pjmhs20231732.

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Aim: To discuss the currently available hydrogel wound dressings and their clinical effectiveness. Method: PubMed/Medline, HEC Digital Library, Wiley Online Library, Wolter Kluwer, Elsevier, and Google Scholar from the year 2013 to 2021 were searched to identify relevant clinical trials and studies. Results: Forty-three studies that assessed hydrogel vs. non-hydrogel dressings were identified. Compared to the latter, hydrogel dressings associated with a significantly shortened healing time of degree II burn (superficial and deep) wounds, diabetic foot ulcers, traumatic skin injuries, radioactive skin injuries, dog bites, and body surface ulcers. In addition, hydrogel dressing obviously increased the cure rate of diabetic foot ulcers, surgical wounds, dog bites, and body surface ulcers. Moreover, hydrogel dressing significantly relieved pain in degree II burn (superficial and deep) wounds, traumatic skin injuries and laser treatment-induced wounds. However, no significant differences obtained between hydrogel and non-hydrogel dressings in the healing time of surgical wounds, the cure rate of inpatients' pressure ulcers, and phlebitis ulcers. Conclusion: This comprehensive systematic review of the available evidence reveals that the application of hydrogel dressings advances the healing of various wound types and effectively alleviates the pain with no severe adverse reactions. These results strongly indicate that hydrogel products are effective and safe in wound management. Keywords: Hydrogels, wound dressing, surgical wounds, diabetic ulcer, burns.

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Stekolnikov, A. A., and M. A. Ladanova. "TECHNOLOGICAL INJURIES IN INDUSTRIAL PIG FARMING." International bulletin of Veterinary Medicine 1 (2020): 135–39. http://dx.doi.org/10.17238/issn2072-2419.2020.1.135.

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Industrial injuries in pig farms of closed type are a very common pathology. Howev-er, nowadays, injury prevention and treat-ment of sick animals in the conditions of industrial pig breeding complex do not bring good results and require improvements. Ac-cording to the literature, there is no infor-mation about the results of the use of oint-ments and immuno- stimulators in the treat-ment of pigs with bitten wounds of the ears, tails and other parts of the body. In this re-gard, we have set a goal to develop therapeu-tic measures for injuries of piglets in a pig breeding complex of a closed type. We ana-lyzed the prevalence of industrial injuries in pigs. During the clinical examination, we studied the specific structures of injuries. The main cause of pigs injuries in industrial farming is cannibalism. In 28 days, 60% of pigs in the second experimental group, showed complete cicatrization of the wound, and 40% of animals showed this process regenerated on 85-95%, meanwhile 2 days they also had complete scarring of the wound. In 28 days, 50% of pigs of the third experimental group had a complete cicatriza-tion of the wound, and for 50% were ob-served scarring of the wound by 75-85%, and only after 4 days they demonstrated the complete scaring of the defect. For the treatment of bitten wounds as a result of developing cannibalism, it is recommended, to use local treatment of wounds with chlor-hexidine solution and argosulfan ointment daily 2 times a day and also to use the im-munostimulator “Ferrovir” in a dose of 1.0 ml/m2 per week. Such scheme of treatment of bitten wounds gives the best therapeutic effect.

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Zhang, Jianying, Feng Li, Tyler Augi, Kelly M. Williamson, Kentaro Onishi, MaCalus V. Hogan, Matthew D. Neal, and James H. C. Wang. "Platelet HMGB1 in Platelet-Rich Plasma (PRP) promotes tendon wound healing." PLOS ONE 16, no. 9 (September 16, 2021): e0251166. http://dx.doi.org/10.1371/journal.pone.0251166.

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Platelet-rich plasma (PRP) is a widely used autologous treatment for tendon injuries in clinics. Platelets (PLTs) are a major source of high mobility group box1 (HMGB1) that is gaining attention as a chemoattractant that can recruit stem cells to the wound area to enhance healing of injured tissues; however, the contribution of PLT HMGB1 in wounded tendon healing remains unexplored. This study investigated the effect of PLT HMGB1 within PRP on tendon healing using PLT HMGB1 knockout (KO) and GFP mice. A window defect was created in the patellar tendons of both groups of mice, and wounds were treated with either saline, PRP isolated from PLT HMGB1-KO mice, or PRP isolated from GFP mice. Seven days post-treatment, animals were sacrificed and analyzed by gross inspection, histology, and immunostaining for characteristic signs of tendon healing and repair. Our results showed that in comparison to mice treated with PRP from PLT HMGB1-KO mice, wounds treated with PRP from GFP mice healed faster and exhibited a better organization in tendon structure. Mice treated with PRP from PLT HMGB1-KO mice produced tendon tissue with large premature wound areas and low cell densities. However, wounds of PLT HMGB1-KO mice showed better healing with PRP from HMGB1-KO mice compared to saline treatment. Moreover, wounds treated with PRP from GFP mice had increased extracellular HMGB1, decreased CD68, increased stem cell markers CD146 and CD73, and increased collagen III protein expression levels compared to those treated with PRP from PLT HMGB1-KO mice. Thus, PLT HMGB1 within PRP plays an important role in tendon wound healing by decreasing inflammation, increasing local HMGB1 levels, and recruiting stem cells to the wound area in the tendon. Our findings also suggest that the efficacy of PRP treatment for tendon injuries in clinics may depend on PLT HMGB1 within PRP preparations.

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Adaiyi, Obene Tonye, Abhulimen Victor , and Echem Richard . "Evaluation of Gunshot Wounds to the Extremities: Correlation of Red Cross Wound Score and Initial Response to Management." American Journal of Health, Medicine and Nursing Practice 7, no. 11 (September 14, 2022): 9–21. http://dx.doi.org/10.47672/ajhmn.1191.

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Purpose: Gunshot wounds to the extremities are a major cause of death and disability. The Red Cross Wound Score (RCWS) is a simple classification system that is thought to fairly assess severity of injury, influence surgical management and a good predictor of outcome in gunshot wounds. This study aims to evaluate the correlation between the Red Cross Wound Score RCWS and initial response to management. Methodology: This was a prospective study recruiting all consenting patients who suffered gunshot wounds to any extremity and presented at the University of Port Harcourt Teaching Hospital (UPTH). The study was conducted over a 12-month period between October 2018 and September 2019. Data on demographics, anatomical region of the body involved, type of gun time between injury and hospital presentation were obtained using a proforma. Analysis of extracted data was done by the aid of SPSS for Windows version 20. Findings: A total of 106 wounds from 82 patients were analyzed; seventy males (85.4%) and 12 females. AK 47 rifles and locally fabricated pistols were the wounding weapons in 32.9% and the left leg (28.3%) was the most injured extremity. Fifty-two wounds (49%) were grade 3, 44 (41.5%) wounds grade 2 and 10 wounds (9.4%) grade 1. There was a positive association between RCWS grade 3 wounds and limb length discrepancy and joint stiffness. Vascular injuries were seen in 6 patients (0.07%). Wound infection (46.2%), joint stiffness (41.5%) and shortening (34%) were the common complications in the study. The study showed that young adult males suffered more gunshot wounds than females. Most of the wounds were RCWS grade 3 and there was a positive association between RCWS grade 3 wounds and limb length discrepancy and joint stiffness. Patients with longer mean presentation time had a higher infection rate. Recommendations: The Red Cross wound classification should be adopted as a useful scoring system. Also, patients with gunshot injuries should present earlier to the hospital to reduce complications.

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Mittal, Vijay, Paul Mcaleese, Shun Young, and Max Cohen. "Penetrating Cardiac Injuries." American Surgeon 65, no. 5 (May 1999): 444–48. http://dx.doi.org/10.1177/000313489906500513.

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Our objective was to determine the influence of several clinical factors on the survival of patients with penetrating wounds to the heart. A retrospective review of 80 consecutive penetrating cardiac injuries treated in a Level II urban trauma center from 1980 through 1994 were examined. Thirty-six patients (45%) had gunshot wounds (including 1 shotgun wound), and 44 (55%) had stab wounds. Intervention consisted of emergency room (ER) or operating room thoracotomy. We measured the effect of several clinical factors on morbidity and patient survival. Survival rate was 17 of 36 (47%) in gunshot injuries and 35 of 44 (80%) in stab injuries, with an overall survival rate of 52 of 80 patients (65%). The average age was 24 years (range, 9–53), and there were 3 female patients. Twelve patients (15%) had multiple cardiac injuries, and 63 (79%) had other associated injuries. Fourteen patients (17%) presented with no blood pressure, and 55 (69%) were hypotensive on admission. ER thoracotomy was performed on 7 of 52 survivors (13%) and 24 of 28 nonsurvivors (86%). Survival after ER thoracotomy was 7 of 31 patients (22%). A selective approach is recommended, because ER thoracotomy has a limited role in penetrating cardiac injury. A high index of suspicion, prompt resuscitation, and immediate definitive surgical management resulted in a high survival rate for these frequently lethal injuries.

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Shaprynskyi, V. O., A. V. Verba, Y. V. Shaprynskyi, O. O. Fomin, and N. S. Fomina. "SPECIFIC ASPECTS IN TREATMENT OF SUPPURATIVE-INFLAMMATORY COMPLICATIONS IN GUNSHOT WOUNDS OF EXTREMITIES." Kharkiv Surgical School, no. 2 (June 20, 2021): 121–27. http://dx.doi.org/10.37699/2308-7005.2.2021.22.

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Summary. The aim of the study was to present an argument for treatment algorithm of patients with extremity gunshot injuries complicated by suppurative inflammation. Materials and research methods. Examination and treatment of 163 patients with gunshot wounds of the extremities were performed. All the wounded were divided into 3 study groups. The patients of group 1 underwent conventional treatment of gunshot wounds. In group 2, negative pressure wound therapy was used. Wounded patients of group 3 received vacuum-assisted therapy supplemented by the proposed scheme of counter-drainage and flow-through flushing irrigation of wounds with antiseptic solutions of 0.02 % decamethoxine and 3 % hydrogen peroxide. Bacteriological study of wound exudate was carried out, and sensitivity of microorganisms to antibiotics was determined. Results and its discussion. Wound microbiology analysis in victims of blast and mine-blast injuries demonstrated predominance of gram-negative bacteria in wound microbiocenosis — Acinetobacter spp. (53 % of cases) and Pseudomonas spp. (15 % of cases). Gram-positive cocci were isolated in 22.2 % of cases. Sensitivity study of nonfermentative gram-negative rods demonstrated them to have high level of resistance to most antibacterial agents. All strains of Acinetobacter and Pseudomonas spp. were sensitive to polymyxin B and colistin but resistant to inhibitor-protected and -unprotected amino penicillin. Beneficial effect of vacuum therapy in patients of groups 2 and 3 was evidenced by significantly reduced time of wound healing and hospital stay. The use of suggested mixture of antiseptics resulted in decrease of inflammation in 94.45 % and 88.89 % of patients in groups 3 and 2, respectively. Besides, in group 3, duration of hydration phase in wound healing process decreased to 5.7 days. The period of complete wound healing was shorter by 2.5 days, and hospital stay decreased from 14.97 to 10.8 days. Conclusions. Thus, predominance of gram-negative microorganisms in gunshot wounds as well as their high resistance to antibiotics should be considered when undertaking empirical antibiotic therapy in wounded patients. The proposed treatment algorithm involving negative pressure wound therapy supplemented with counter-drainage and flow-through flushing irrigation with a mixture of suggested antiseptics proved to be highly efficient in patients with extremity gunshot injuries complicated by suppurative inflammation.

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Zaporozhan, S. Y., D. B. Fira, and O. V. Pokryshko. "ANTIBACTERIAL THERAPY FOR PATIENTS WITH BURN INJURIES." International Journal of Medicine and Medical Research 8, no. 1 (September 5, 2022): 18–24. http://dx.doi.org/10.11603/ijmmr.2413-6077.2022.1.13098.

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Background. Treatment of burn wound infection is an urgent issue of contemporary medicine, including surgery, combustiology and microbiology. It is established that infectious complications are a challenge for burn patients. In the course of wound reparation, infectious complications may worsen. Along with surgical treatment, mechanical removal of pathogens from burn wounds is also important as well as antimicrobials for patients with severe burns. Objective. The aim of the study was to define the most common pathogens of purulent-inflammatory complications of burn wounds and their susceptibility to antibiotics. Methods. The study involved patients treated at the Center of Thermal Trauma and Plastic Surgery of Lviv I-Territorial Medical Association, the unit of St. Luke Hospital of Lviv. Collection of material from wound secretions of burn wounds was performed with sterile swab. The study was performed before prescription of antibiotics, at the end of the first and second weeks of the disease. The pathogens were isolated and identified. Antibiotic susceptibility was studied using standard research methods. The obtained results were analyzed by means of the software package of the microbiological monitoring system WHONET 5.2 (WHO Collaborating Centre for Surveillance of Antimicrobial Resistance) and the program Microsoft Office Excel 2007. Results. The study of smears from burn wounds proved that 240 strains of gram-positive and gram-negative microorganisms that caused purulent-inflammatory processes were isolated. Among the selected causative agents of a burn wound complicated by a purulent-inflammatory process, gram-negative bacteria predominated (60.8% of all detected microorganisms). Gram-positive flora of S. epidermidis and S. aureus were more common in the wound surface during the first week of the disease. In most patients with severe burns, bacterial associations were isolated from the wound surface (66.3%) in two and three weeks, and in three weeks Candida spp. were isolated. Non-fermenting rods A. baumannii and P. aeruginosa dominated among the gram-negative flora isolated from the wound surface of burns. The analysis of susceptibility of microorganisms isolated from patients with burns to antibiotics showed that almost all of the cultures were polyresistant. Conclusions. Gram-negative microorganisms, strains of non-fermenting bacteria predominated among the pathogens isolated from burn wounds complicated by purulent inflammation; Staphylococcus aureus prevailed among the gram-positive ones. The most significant clinical strains were highly polyresistant to antibiotics.

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Jalili, Reza, Myriam Maude Verly, Breshell Russ, Ruhangiz T. Kilani, and Aziz Ghahary. "645 Topical Application of a Novel Powdered Scaffold for Rapid Treatment of Skin Injuries." Journal of Burn Care & Research 41, Supplement_1 (March 2020): S168—S169. http://dx.doi.org/10.1093/jbcr/iraa024.265.

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Abstract Introduction In large skin injuries, lack of matrix deposition impedes timely healing process. The longer a wound remains open, the greater is the risk of infection, non-healing, and other complications. It is therefore crucial to find effective means to promote rapid closure of skin defects. Our group has previously developed a liquid in situ-forming nutritional scaffold, known as MeshFill (MF). MF has been previously proven to be very effective in accelerating the wound repair process, notably that of complex wounds. However, MF is limited in its application to deep and tunnelling wounds, and requires reconstitution with a solvent as well as maintenance at cold temperature until application. To address these limitations, our group has developed a powdered form of MF for rapid topical application on superficial skin injuries such as dehisced surgical wounds and burn injuries. Methods Our goal was to investigate whether a powdered form of MF could be directly applied onto the wounds to accelerate healing. Ideally, powdered MF would absorb the moisture within the wound environment and reconstitute into the gel form in situ. We examined the efficacy of powder MF (PMF) compared to reconstituted gel MF (GMF) and to a standard dressing protocol. To do so, splinted full thickness wounds were generated on the back of mice and treated with either PMF or GMF or were bandaged with no treatment (NT). The healing process was monitored until wounds were fully closed. Clinical wound measurements and histological assessments were performed to compare different treatment regimens. Results Application of both PMF and GMF accelerated wound epithelialization at days 7 and 14, compared to NT, and had faster wound closure times. On average, the PMF treatments healed 17% faster than the NT control, and the GMF treatments healed 21% faster than the NT control. No significant difference between PMF and GMF was found for any outcomes. Additionally, our results suggest that epidermis formation was more effective in P and MF conditions compared to NT. Conclusions These findings suggest that topical application of a powdered form of MeshFill is as effective as standard reconstituted MeshFill gel in accelerating the healing process of skin injuries. Applicability of Research to Practice Topical application of a powdered scaffold may be a very convenient and practical method for rapid treatment of large superficial wounds such as dehisced surgical wounds, burn injuries, and filling gaps in meshed skin grafts.

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Singh, Niten, Eric Bluman, Benjamin Starnes, and Charles Andersen. "Dynamic Wound Closure for Decompressive Leg Fasciotomy Wounds." American Surgeon 74, no. 3 (March 2008): 217–20. http://dx.doi.org/10.1177/000313480807400307.

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Decompressive fasciotomy for preservation of lower extremity function and salvage is an essential technique in trauma. The wounds that result from the standard two incision four-compartment leg fasciotomy are often accompanied by a wide soft tissue opening that in the face of true compartment syndrome are often impossible to close in a delayed primary fashion. We describe a technique using a device that allows for dissipation of the workload across the wound margin allowing for successful delayed primary closure. Consecutive patients who presented to the 28th Combat Support Hospital in Baghdad, Iraq with a diagnosis of compartment syndrome of the leg, impending compartment syndrome of the leg, or compartment syndrome of the leg recently treated with fasciotomies were followed. All patients underwent placement of the Canica dynamic wound closure device (Canica, Almonte, ON, Canada). Eleven consecutive patients treated at a combat support hospital in support of Operation Iraqi Freedom underwent four-compartment fasciotomies for penetrating injuries. There were five patients that underwent a vascular repair [three superficial femoral artery (SFA) injuries and two below knee popliteal artery injuries] and six patients that had orthopedic injuries (three comminuted tibial fractures, two fibula fractures, and one closed pilon fracture). Patients returned to the operating room within 24 hours for washout and wound inspection. Mean initial wound size was 8.1 cm; mean postplacement size was 2.7 cm; average time to closure was 2.6 days. All patients were able to undergo primary wound closure of the medial incision and placement of the Canica device over the lateral incision. Ten of the 11 patients (91%) could be closed in delayed primary fashion after application of the device. In our series of patients with penetrating wartime injuries and compartment syndrome of the leg we have found the use of this dynamic wound closure device to be extremely successful and expedient.

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Nuridah, Nuridah, Yuniarti Ekasaputri Burhanuddin, and Yodang Yodang. "Penanganan Awal pada Berbagai Jenis Luka Akut." Jurnal Abdimas Kesehatan (JAK) 5, no. 2 (June 16, 2023): 312. http://dx.doi.org/10.36565/jak.v5i2.515.

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Injuries that often cause injuries often happen to anyone and anywhere, and it is not uncommon for wounds to be difficult to heal and even become scars that cannot be removed due to ineffective wound care. The role of health educators is by providing education in community service activities through the practice of "early treatment of various types of wounds". The purpose of this service is to educate youth in increasing understanding regarding the proper handling of wounds. This activity was carried out in the Wihdatul Ummah Kolaka IT SMA school environment on Monday, December 12, 2022, which was attended by 27 student representatives and 5 teachers and staff in the form of practice groups using materials and consumables for wound care. With the education provided through wound care practices, students are able to properly practice how to care for various types of wounds and are able to understand properly the proper management of wound care.

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Yadav, Abhishek, Karthi Vignesh Raj K, Sukhdeep Singh, and Manish Kumath. "Atypical Firearm Wounds, One Projectile Leading to Multiple Injuries: Correct Interpretation and Correlation." Journal of Forensic Chemistry and Toxicology 7, no. 1 (June 15, 2021): 29–31. http://dx.doi.org/10.21088/jfct.2454.9363.7121.4.

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In the practice of Forensic medicine, firearm injuries cases pose a challenge, particularly those caused during the police/armed forces action also known as ‘Encounter’. Autopsy reports play a very important role in recreation/ reconstruction of the event and are an important evidence for review by other agencies. The track of the wounds, direction of firing, site of entry and exit wounds along with other internal injuries are used to authenticate and verify the version of police officers. Authors have observed that in certain cases of death consequent to firearm injury, sometimes atypical wounds are found which may be difficult to interpret at the time of performing autopsy. A meticulous postmortem examination coupled with cautious analysis and interpretation of injuries has to be done before furnishing a Medico legal opinion in such cases. The authors report such a case in which an atypical firearm wound was found in a police encounter case. The case is being reported only for academic purposes to highlight the importance of correct interpretation in such atypical wounds by a meticulous autopsy examination so as to prevent any further doubts in their correlation with sequence of events. Modern radiological techniques like Digital X-ray and PM MSCT should be used in firearm cases to enhance the objectivity and credibility of postmortem findings. Keywords: Firearm injuries; Encounter Deaths; Gunshot Wounds; Post Mortem Multi slice Computed Tomography.

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Farazin, Ashkan, Zahra Torkpour, Shakiba Dehghani, Ramin Mohammadi, Mina D. Fahmy, Saeed Saber-Samandari, Kirollos Adel Labib, and Amirsalar Khandan. "A Review on Polymeric Wound Dress for the Treatment of Burns and Diabetic Wounds." International Journal of Basic Science in Medicine 6, no. 2 (July 10, 2021): 44–50. http://dx.doi.org/10.34172/ijbsm.2021.08.

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Today, various commercial dressings have been developed and introduced to the market. The diversity makes it difficult for the nurse to choose the right type. Although the most important reason to use a wound dress is to protect the wound from infection and prevent infection, but in fact, the main purpose of using these materials is to speed up the wound healing process. Traumatic injuries result in an epithelial wound that disrupts the continuity of the skin surface. These differences reveal as abrasions, punctures, and injuries. Wounds are divided into two types; the skin is either cut or ruptured, including deep wounds and bruises, or surface wounds. Expedited wound healing has been considered since the archaic era of human civilization, with the earliest reported case from the Ancient Egyptians. Wound lesions in mummified humans were observed to be cover with animal skin, with signs of (primary/secondary) wound healing present. A "new wound dressing" is an advanced wound dress used in wound management as biocompatible and biodegradable biomaterials that heal wounds and burns. In the past, it was believed that dry wounds had expedited healing and wet wounds have been found to promote using re-epithelization and result in reduced scar formation. Wounds can be treated using various types of natural polymers and materials. Also, techniques like electrospinning and freeze-drying techniques can be used for the fabrication of standard wound dress. These wounds are associated with bandages, inflammation, bleeding, pain, and pus. In this work, we consider various types of wounds and techniques to treat the wound. Susceptibility to these areas, due to special symptoms for each of them. Products like hydrogels, hydrocolloids, films, sponges, and nano-fiber polymeric materials are used to promote healing. In this review, we examine the ideal products for the treatment of wounds in diabetic patients.

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Danchin, A. O., O. M. Goncharuk, M. S. Altabrowry, G. O. Danchin, S. A. Usatov, and O. P. Kovalenko. "Clinic and diagnostics of the non-penetrating gun-shoot craniocerebral injuries in the local war." Ukrainian Interventional Neuroradiology and Surgery 36, no. 2 (November 20, 2021): 34–43. http://dx.doi.org/10.26683/2786-4855-2021-2(36)-34-43.

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Objective ‒ to evaluate the features of the clinical manifestations and effectiveness of multi-slice computed tomography (MSCT) of the head for the diagnosis of non-penetrating gun-shoot head injuries in the local war.Materials and methods. The medical data of 155 patients who received a non-penetrating gun-shoot head injuries during the war in the Eastern Ukraine between 2014‒2020 were analyzed. All patients were males between 18 and 60 years (average age ‒ 35.1 years). The peculiarities of clinical manifestations and results of diagnostic evaluation of non-penetrating gun-shoot head injuries during specialized neurosurgical care in medical institutions on the third and fourth levels of medical aid have been studied.Results. Wide diagnostic capabilities of MSCT were revealed for determination of the wounds localization, type of the projectile, the nature of the wound channel, gunshot skull fractures, and associated intracranial injuries. It was found that with non-penetrating bullet and shrapnel tangential cranio-cerebral wounds, incomplete and depressed fractures usually occurred, and with single and multiple shrapnel blind wounds, incomplete ‒ perforated and depressed fractures with the presence of bone fragments. The pathomorphological features of the nature of the wound channels and intracranial injuries were determined. They are always associated by traumatic subarachnoid hemorrhages and brain contusions, in most cases – focal. Intracranial hematomas were observed in 3.1 % of the patients.Conclusions. Clinical manifestations of the non-penetrating craniocerebral gunshot wounds depend not only on the type of cranial soft tissue injury, but also on the nature of the skull fracture and are mainly occurred because of the severity of the traumatic brain injury. MSCT of the head makes it possible to determine the localization of the wound, the type of the wounding projectile, the nature of the cranial soft tissues damage, wound channel, gunshot skull fractures and associated intracranial injuries.

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Prawoto, Almas Nur, and Ishandono Dachlan. "use of amniotic membrane for wound healing in burn injuries." Jurnal Rekonstruksi dan Estetik 7, no. 2 (December 8, 2022): 64–71. http://dx.doi.org/10.20473/jre.v7i2.36050.

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Background: Burn injuries are associated with significant mortality and morbidity around the world. The care of burn wounds requires a great amount of medical resources therefore it is important to find a wound dressing that accelerates wound healing and is readily available. Objectives: This review article will provide an overview of the literature and background of the usage of amniotic membranes in burn patients. We will also discuss its properties of preventing infections, relieving pain, how it promotes and accelerates wound healing. Discussion: Human amniotic membrane is now used around the world as a relatively cheap temporary dressing for burn wounds. It has been shown to promote wound healing, create a moist environment, reduce pain intensity, reduce scar formation, prevent water and electrolyte disturbances and also reduce the risk of infections. Research has also shown that it contains antimicrobial properties that could be of great benefit in burn patients and is compatible to use in developing countries because it is readily available, easy to obtain and sterilize, able to cover wounds of large size, protects the wound from excessive water and electrolyte loss, reduces pain intensity, requires fewer dressing changes and is also more cost effective than conventional dressings. Conclusion: Amniotic membrane is a biological dressing that can be useful in the treatment of burn wounds. Further research should be conducted to investigate and understand the mechanisms of amniotic membrane for burn and wound care.

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Golovko, K. P., V. Yu Markevich, T. Yu Suprun, A. B. Vertiy, S. E. Komyagin, N. A. Zhirnova, and I. M. Samokhvalov. "Prospects for improving pre-hospital care for wounded with gunshot penetrating wounds to the chest." Bulletin of the Russian Military Medical Academy 22, no. 3 (December 15, 2020): 140–47. http://dx.doi.org/10.17816/brmma50550.

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Abstract. The analysis of injuries, life-threatening consequences and outcomes of treatment of wounded with penetrating chest wounds and the results of approbation of a prototype (medical) disposable set UD-02v for the elimination of strained and open pneumothorax, hemothorax, pleural drainage and collection of spilled blood with the possibility of subsequent reinfusion at the pre-hospital stage is presented. The prototype of the UD-02v set was created as part of the implementation of the state defense order in 2018. Its creation is due to the fact that despite the improvement of medical care at the stages of medical evacuation and the widespread use of individual armor protection, chest injuries currently remain a frequent type of combat surgical injury, accounting for 6 to 12% of all injuries. The main cause of death of injured and injured with chest injuries remains blood loss caused by continuing intrapleural bleeding and concomitant damage to other anatomical areas. Stressful pneumothorax, together with intrapleural bleeding, account for 93% of preventable causes of fatal chest injuries at the pre-hospital stage. Untimely elimination of the consequences of severe breast injuries should be considered as a negative factor affecting the outcome of treatment, and significant improvement in treatment results should be expected only in the case of early elimination of the most severe consequences of breast injuries. The developed set of UD-02v exceeds foreign medical devices in its medical and technical characteristics, and is the most promising for acceptance for the supply of the Armed forces of the Russian Federation as part of the samples of complete and service equipment.

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Eriksson, Elof, Gina L. Griffith, and Kristo Nuutila. "Topical Drug Delivery in the Treatment of Skin Wounds and Ocular Trauma Using the Platform Wound Device." Pharmaceutics 15, no. 4 (March 25, 2023): 1060. http://dx.doi.org/10.3390/pharmaceutics15041060.

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Topical treatment of injuries such as skin wounds and ocular trauma is the favored route of administration. Local drug delivery systems can be applied directly to the injured area, and their properties for releasing therapeutics can be tailored. Topical treatment also reduces the risk of adverse systemic effects while providing very high therapeutic concentrations at the target site. This review article highlights the Platform Wound Device (PWD) (Applied Tissue Technologies LLC, Hingham, MA, USA) for topical drug delivery in the treatment of skin wounds and eye injuries. The PWD is a unique, single-component, impermeable, polyurethane dressing that can be applied immediately after injury to provide a protective dressing and a tool for precise topical delivery of drugs such as analgesics and antibiotics. The use of the PWD as a topical drug delivery platform has been extensively validated in the treatment of skin and eye injuries. The purpose of this article is to summarize the findings from these preclinical and clinical studies.

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Bhandari, Prem Singh, Mrinal Kanti Mukherjee, and Sanjay Maurya. "Reconstructive challenges in war wounds." Indian Journal of Plastic Surgery 45, no. 02 (May 2012): 332–39. http://dx.doi.org/10.4103/0970-0358.101316.

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ABSTRACTWar wounds are devastating with extensive soft tissue and osseous destruction and heavy contamination. War casualties generally reach the reconstructive surgery centre after a delayed period due to additional injuries to the vital organs. This delay in their transfer to a tertiary care centre is responsible for progressive deterioration in wound conditions. In the prevailing circumstances, a majority of war wounds undergo delayed reconstruction, after a series of debridements. In the recent military conflicts, hydrosurgery jet debridement and negative pressure wound therapy have been successfully used in the preparation of war wounds. In war injuries, due to a heavy casualty load, a faster and reliable method of reconstruction is aimed at. Pedicle flaps in extremities provide rapid and reliable cover in extremity wounds. Large complex defects can be reconstructed using microvascular free flaps in a single stage. This article highlights the peculiarities and the challenges encountered in the reconstruction of these ghastly wounds.

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Low, Garren M. I., Kenji Inaba, Konstantinos Chouliaras, Bernardino Branco, Lydia Lam, Elizabeth Benjamin, Jay Menaker, and Demetrios Demetriades. "The Use of the Anatomic ‘Zones’ of the Neck in the Assessment of Penetrating Neck Injury." American Surgeon 80, no. 10 (October 2014): 970–74. http://dx.doi.org/10.1177/000313481408001013.

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The traditional classification of neck injuries uses an anatomic description of Zones I through III. The objective of this article was to characterize the association between external wounds and the corresponding internal injuries after penetrating neck trauma to identify the clinical use of the anatomic zones of the neck. Patients who sustained penetrating neck trauma from December 2008 to March 2011 were analyzed. All patients underwent structured clinical examination documenting the external zone where the wound(s) were located. All internal injuries were then correlated with the external wounds. An internal injury was defined as “unexpected” if it was located outside the borders of the neck zone corresponding to the external wound. In total, 146 patients sustaining a penetrating neck injury were analyzed; 126 (86%) male. The mechanism of injury was stab wounds in 74 (51%) and gunshot wounds in 69 (47%). Mean age was 31 years (range, nine to 62 years). Thirty-seven (25%) patients sustained had a total of 50 internal injuries. There was a high incidence of noncorrelation between the location of the external injury and the internal structures that were damaged in patients with hard signs of vascular or aerodigestive injury. The use of the anatomic zones and their role in the workup of penetrating neck injury are questionable.

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Yaremchuk, A., V. Chemerovsky, M. Rublenko, I. Chemerovska, and I. Rublenko. "Treatment of wound anaerobic infection in great horned animals: clinical example in a cow." Naukovij vìsnik veterinarnoï medicini, no. 2 (184) (November 23, 2023): 202–9. http://dx.doi.org/10.33245/2310-4902-2023-184-2-202-209.

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External mechanical problems contribute to a wider problem in the surgical field in dairy cattle. The frequency of early injuries is highest in the limbs, and the lowest in the posterior and tail area. Most often, cows have puncture wounds that are susceptible to infection. Infectious complications of injuries and improper care in the aggregate lead to a decrease in productivity, premature culling of animals, and even to their death. Therefore, the analysis of medical methods and their effectiveness in great horned cattle for the aggravation of a accidental wound with anaerobic infection is also relevant. We looked at the clinical episode of a cow of the 1st or 2nd lactation, which had a puncture wound in the sub-breast area, right next to the subscapular area. The cow tried to overcome the fence and was injured by the end of the rebar. The treatment protocol will first help to stop bleeding, wash the cavity of wound with an antiseptic, add antibacterial powder to it and close it with sutures, internally administer ceftioclene. After the development of infectious-flammable structure in the wound and bacteriological investigation, treatment included washing with H2O2, drainage with Levosin and Nitacid ointment, metronidozole, bicilin 3, and granulation with the granulation of wounds: hydrophobic ointments. This is the basis for the use of systemic antibacterial therapy, rational surgical tactics and drainage, local treatment of active pharmacological agents with antibacterial, analgesic and hyperosmodic agents. Key words: cow injuries, wounds, purulent inflammation, ointments on hydrophilic bases.

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Beardsley, Stephanie L., and Steven C. Schrader. "Treatment of dogs with wounds of the limbs caused by shearing forces: 98 cases (1975-1993)." Journal of the American Veterinary Medical Association 207, no. 8 (October 15, 1995): 1071–75. http://dx.doi.org/10.2460/javma.1995.207.08.1071.

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Summary Medical records of 98 dogs with wounds of the limbs caused by shearing forces (shearing wounds) were reviewed. Shearing wounds were reported most often in young dogs of many breeds, and most often resulted from trauma received during an encounter with an automobile. Wounds were located mainly on the distal portion of the limbs, with the most common site being the medial aspect of the tarsus and metatarsus. All injuries resulted in exposure of subcutaneous soft tissues, about three fourths of all injuries resulted in bone or joint exposure, and slightly more than half of the dogs had joint instability. All wounds were lavaged and debrided. Wounds were sutured, using primary closure techniques or methods that allowed the wound to remain partially or totally open to heal by second intention. Bandages were applied in all dogs. Most bandages were reinforced with a splint device. Grafting procedures or internal fixation devices were not used in initial treatment of the injuries. In the study reported here, healing time ranged from 2.0 to 8.7 weeks, depending on the size and depth of the wound and type of closure used. Mean number of anesthetic and surgical procedures was 1.7 per dog, and the mean number of rechecks after discharge from the hospital was 5.5 per dog. Outcome was considered excellent or good in 89 of 98 (91 %) dogs; these dogs were clinically normal or had only minor functional abnormalities after their injuries healed. Outcome was poor in 9 of 60 (15%) dogs.

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Jorgensen, Adam M., Naresh Mahajan, Anthony Atala, and Sean V. Murphy. "Advances in Skin Tissue Engineering and Regenerative Medicine." Journal of Burn Care & Research 44, Supplement_1 (December 26, 2022): S33—S41. http://dx.doi.org/10.1093/jbcr/irac126.

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Abstract There are an estimated 500,000 patients treated with full-thickness wounds in the United States every year. Fire-related burn injuries are among the most common and devastating types of wounds that require advanced clinical treatment. Autologous split-thickness skin grafting is the clinical gold standard for the treatment of large burn wounds. However, skin grafting has several limitations, particularly in large burn wounds, where there may be a limited area of non-wounded skin to use for grafting. Non-cellular dermal substitutes have been developed but have their own challenges; they are expensive to produce, may require immunosuppression depending on design and allogenic cell inclusion. There is a need for more advanced treatments for devastating burns and wounds. This manuscript provides a brief overview of some recent advances in wound care, including the use of advanced biomaterials, cell-based therapies for wound healing, biological skin substitutes, biological scaffolds, spray on skin and skin bioprinting. Finally, we provide insight into the future of wound care and technological areas that need to be addressed to support the development and incorporation of these technologies.

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Kutasevych, Ya F., S. K. Dzhoraieva, M. O. Lyapunov, E. M. Khoroshun, V. V. Honcharenko, V. V. Nehoduiko, and H. K. Kondakova. "Study of microbiological activity of topical antibacterial agents for treatment of combat injuries." Ukrainian Journal of Dermatology, Venerology, Cosmetology, no. 2 (June 30, 2024): 4–9. http://dx.doi.org/10.30978/ujdvk2024-2-4.

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The problems of combat injuries are determined by the issue of treatment of purulent complications, because wounds received during combat operations are usually infected, and the most serious complication of such wounds is the development of purulent infection. Objective — to study the features of the aerobic component of combat wounds, the sensitivity of causative agents of wound infection to antibacterial drugs, and the antimicrobial activity of individual drugs in relation to extensively resistant and polyresistant microbial agents in order to develop external therapy algorithms as part of the complex treatment of these injuries. Materials and methods. The data of microbiological studies of patients with combat wounds were used in the work. Results and discussion. Based on the results of monitoring causative agents of purulentinflammatory complications of wound injuries, a range of leading types of microorganisms was revealed. The isolation of flora resistant to most antibiotics from wounds dictates the need to change the strategy of infection control with strengthening measures to prevent nosocomial transmission, which should be considered when prescribing antibiotic therapy. Conclusions. Based on the results of monitoring the causative agents of purulent-inflammatory complications of wound injuries, a range of leading types of microorganisms was revealed: K. pneumoniae, E. faecalis, S. haemolyticus, P. aeruginosa, E. coli. The dominant microorganisms (by isolation frequency) in the wound contents were: staphylococci (3.0—5.69 lg CFU/ml), enterobacteria (4.69—7.0 lg CFU/ml), enterococci (3.0—4.69 lg CFU/ml). In addition, aerobic bacilli (3.0—3.69 lg CFU/g) and pseudomonads (5.69—7.0 lg CFU/g) were determined in the wound contents, which did not have a dominant character.The use of a topical agent containing dioxidin can contribute to the improvement of the effectiveness of the local treatment of purulent wounds infected with strains of gram-negative bacteria, in particular E. coli, K. pneumoniae and P. aeruginosa, with poly and extensive resistance to antibiotics both in monocultures and in microbial associations, in particular with strains of S. aureus, including MRSA.

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Golubovic, Zoran, Vojkan Stanic, Srbobran Trenkic, Predrag Stojiljkovic, Goran Stevanovic, Aleksandar Lesic, Ivan Golubovic, Dragan Milic, Aleksandar Visnjic, and Stevo Najman. "Penetrating injury of the lungs and multiple injuries of lower extremities caused by aircraft bombs splinters." Vojnosanitetski pregled 67, no. 8 (2010): 688–93. http://dx.doi.org/10.2298/vsp1008688g.

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Introduction. Injuries caused by aircraft bombs cause severe damages to the human body. They are characterized by massive destruction of injured tissues and organs, primary contamination by polymorph bacterial flora and modified reactivity of the body. Upon being wounded by aircraft bombs projectiles a victim simultaneously sustains severe damages of many organs and organ systems due to the fact that a large number of projectiles at the same time injure the chest, stomach, head and extremities. Case report. We presented a patient, 41 years of age, injured by aircraft bomb with hemo-pneumothorax and destruction of the bone and soft tissue structures of the foot, as well as the treatment result of such heavy injuries. After receiving thoracocentesis and short reanimation, the patient underwent surgical procedure. The team performed thoracotomy, primary treatment of the wound and atypical resection of the left lung. Thoracic drains were placed. The wounds on the lower leg and feet were treated primarily. Due to massive destruction of bone tissue of the right foot by cluster bomb splinters, and impossibility of reconstruction of the foot, guillotine amputation of the right lower leg was performed. Twelve days after the wounding caused by cluster bomb splinters, soft tissue of the left lower leg was covered by Tirsch free transplantant and the defect in the area of the left foot was covered by dorsalis pedis flap. The transplant and flap were accepted and the donor sites were epithelized. Twenty-six days following the wounding reamputation was performed and amputation stump of the right lower leg was closed. The patient was given a lower leg prosthesis with which he could move. Conclusion. Upon being wounded by aircraft bomb splinters, the injured person sustains severe wounds of multiple organs and organ systems due to simultaneous injuries caused by a large number of projectiles. It is necessary to take care of the vital organs first because they directly threaten the life of the wounded patient. Despite adequate surgical treatment of war wounds of the feet, because of massive defect of bone and soft tissue, amputation may be the only rational solution of the treatment. The resection of the lung may be successful method for the severe destruction of the lung.

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Chen, Amy Y., Michael G. Stewart, and Glenn Raup. "Penetrating Injuries of the Face." Otolaryngology–Head and Neck Surgery 115, no. 5 (November 1996): 464–70. http://dx.doi.org/10.1177/019459989611500519.

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We reviewed 78 consecutive cases of penetrating facial injuries treated at Ben Taub General Hospital in Houston, Texas, between 1992 and 1994, and we analyzed injury patterns on the basis of (1) the mechanism of injury, and (2) the entry zone of the wounds. We found that gunshot wounds were more likely to require emergent airway establishment than shotgun wounds or stab wounds ( p = 0.03). We noted a higher prevalence of globe injury among shotgun wounds than among gunshot wounds ( p = 0.02). Nine (12%) patients had intracranial penetration of a bullet or shotgun pellet. Patients with gunshot wounds required open reduction and internal fixation of facial bone fractures more frequently than patients with shotgun wounds ( p = 0.01). Thirty patients underwent arteriograms, and 10 demonstrated positive findings. Although there were only 3 deaths in our series, 29 (37%) patients overall had some complication caused by their penetrating facial trauma, including blindness in 12 patients. There was no significant difference in the prevalence of complications between gunshot, shotgun, and stab wounds ( p = 0.18). With these injury patterns in mind, we describe an algorithm for evaluation and management of penetrating injuries of the face.

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Dotsenko, E. H., S. O. Savvi, V. O. Lazyrskyi, and O. U. Skibo. "REMOVAL OF METAL FRAGMENTS FROM MINE-EXPLOSIVE INJURIES UNDER ANGIOGRAPHIC CONTROL." Kharkiv Surgical School, no. 2-3 (June 28, 2024): 252–55. http://dx.doi.org/10.37699/2308-7005.2-3.2024.49.

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Summary. Objective. Mine and explosive injuries are a serious problem of military conflicts and terrorist acts. Since the full-scale military invasion of the Russian Federation in Ukraine, the problem of treating mine-explosive wounds with the presence of metal fragments is an extremely important and urgent medical problem. Victims often receive multiple shrapnel injuries, which lead to serious consequences and complications. The duration of treatment for shrapnel wounds can vary significantly depending on the severity of the damage, infectious complications, and the timeliness of shrapnel removal. Materials and methods. The study is based on the analysis of the results of the treatment of 72 wounded with mine-explosive injuries with the presence of metal fragments, which got the hospital treatment at GI “V.T. Zaycev Institute of General and Urgent Surgery of NAMS of Ukraine” from 2022 to 2024, aged 18 to 72 years. Results and discussion. Active surgical tactics with removal of soft tissue fragments were used in all wounded: under angiographic control in 40 wounded (55,6%), video thoracoscopic or video laparoscopic in 17 wounded (23,6%), laparotomy access in 8 wounded (11,1%) and after thoraco-sternotomy with the use of magnets in 7 wounded (9,7%). Successful removal of debris was performed in 70 (97,2%) of the wounded. Specific postoperative complications were not noted in any case, 3 (4,2%) wounded patients developed seromas of postoperative wounds after thoracotomy. Conclusion. 1. 1. In 40 (55,6%) wounded, the removal of debris under angiographic control was effective. In addition to angiographic control, endoscopic visualization with debris extraction was used in 3 (4,2%) injured patients. 2. In 2 wounded (2,8%) after the puncture tracing of the fragment, a decision was made to leave them in view of the stability of the fragments in accordance with the developed classification, as well as in connection with the high traumatic nature of the necessary access. 3. The average duration of treatment until complete healing of wounds was 21,4 bed-days.

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Merkulov, D. S., E. Ya Fistal, and V. O. Demchuk. "Applicability of Ultrasonic Cavitation in Complex Treatment of Combat Surgical Trauma." Innovative Medicine of Kuban, no. 2 (April 29, 2024): 64–71. http://dx.doi.org/10.35401/2541-9897-2024-9-2-64-71.

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Background: The history of gunshot wound treatment dates back several centuries. However, every new war or protracted armed conflict makes surgeons return to this issue. In recent years the nature of wounds changed: injuries become more severe, with a larger amount of damaged tissue. Among the wounded persons, blast and fragment injuries prevail over gunshot injuries. Gunshot wounds, as a rule, differ from wounds inflicted by old-style weapons in the scale, depth, and severity of anatomical destruction of soft tissue and bones. Modern physical methods of wound management and preparation of wounds for plastic closure, such as low-frequency ultrasound, enable to debride the wound surface with minimal damage to viable tissues and perform plastic closure of soft tissue defects as radically and as early as could be.Objective: To improve methods of primary surgical debridement in patients with combat surgical trauma using low-frequency ultrasound.Materials and methods: We studied treatment results in 176 wounded and injured people hospitalized in the burn unit and the division of plastic surgery and cell transplantation at the V.K. Gusak Institute of Emergency and Reconstructive Surgery (Donetsk, Russian Federation) between 2015 and 2023. All the patients were divided into 2 groups. Group 1 (main) included 86 patients who underwent surgical wound debridement with ultrasonic cavitation. Group 2 consisted of 90 patients who were operated on without ultrasonic wound debridement. The groups of patients were comparable.Results: After surgical wound debridement, segmented neutrophils (78%-68%) were the main type of blood cells. After ultrasonic wound debridement, the amount of detritus decreased by 3.75 times. In the main group, the number of fibroblasts was 1.88 times higher than that in the comparison group. On day 4, the specific area of the granulation tissue was 1.7 times higher in the main group compared with that in the comparison group. Results of the morphometric control revealed that on day 4 the number of capillaries in the granulation tissue was 31.3 ± 2.5 units in the main group and 20.0 ± 1.12 units in the comparison group. Ultrasonic cavitation of wounds helps suppress wound infection by day 4-5 of treatment: in 82.2 ± 5.7% of the patients, the number of microorganisms per gram of tissue decreased below the “critical number”, whereas in the comparison group it was achieved in 28.9 ± 6.7% of the patients. According to laser Doppler flowmetry findings, we obtained a statistically significant increase in the mean blood flow value (M index) by 1.22 times 24-48 hours after surgical treatment. In the main group, 11.6 ± 3.4% of complications were reported, whereas in the comparison group it was 24.5 ± 4.4%, P < .05. The mean number of operations per person was 1.6 ± 0.4 in the main group and 2.8 ± 0.5 in the comparison group, P < .05. The mean duration of inpatient treatment was 13.5 ± 3.4 days in the main group and 24.3 ± 2.5 days in the comparison group, P < .01.Conclusions: We can conclude that ultrasonic cavitation is advantageous in routine surgical debridement of gunshot wounds followed by primary or delayed primary closure.

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Mitchell, Suzanne, Dhaval Bhavsar, Jessica Reynolds, Jessica Jones, and Julia M. Pena. "734 A Comparison of Burn Depth Assessment Between Clinical Diagnosis and Laser Doppler Imaging." Journal of Burn Care & Research 41, Supplement_1 (March 2020): S199. http://dx.doi.org/10.1093/jbcr/iraa024.317.

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Abstract Introduction Accurate burn assessment is crucial to prescribing appropriate treatment and is dependent upon the experience of the provider and the timing of diagnosis relative to the burn injury evaluation. Differentiating between a deep partial thickness and full thickness burn may not be easily discernible. To augment the clinical diagnosis of burn depth, a laser doppler image measures the microvascular blood flow of injured tissue to predict burn wound healing. The aim of this study is to evaluate the clinical assessment of burn wounds by experienced burn providers compared to the laser doppler image assessment in predicting which burn wounds should heal spontaneously in 3 weeks. Methods A retrospective chart review from 2012–2016, included 54 subjects. The clinical assessment included a description of burn variables relevant to the determination of spontaneous burn wound healing (burn depth, total body surface area, mechanism of injury, anatomical location, clinical burn depth diagnosis, and laser doppler image). A chi-square analysis compared the clinical diagnosis and the laser doppler assessment of burn wound depth, as well as the correlation between clinical diagnosis versus laser doppler image in predicting spontaneous burn wound healing. Results Comparing partial thickness burn injuries, there were 38 clinically diagnosed partial thickness injuries (by experienced burn providers) and 38 partial thickness burn injures diagnosed via LDI. Deep partial thickness burn injuries were diagnosed clinically in 9 subjects, compared to 10 via LDI. Full thickness burn injuries were diagnosed clinically in 7 subjects and 6 via LDI. A chi-square test was performed to examine the relationship between clinical diagnosis of burn depth and laser doppler image. The relation between these variables was significant,X2= 26.884, p< .000. Comparing clinically diagnosed burn depth to LDI, each approach (clinical or LDI) diagnosed 42 subjects with partial thickness or deep partial thickness burn injuries and all healed spontaneously. Two of the clinically diagnosed full thickness burn injuries required skin grafting. Six patients were lost to follow-up (X2= 17.745, p < .001). Conclusions This study confirms there is no difference between an experienced burn provider’s clinical diagnosis of burn wound depth and prognosis for spontaneous healing compared to a laser doppler image prognosis of burn wound healing. Applicability of Research to Practice In an era of advanced technologies, expert clinical bedside assessment is the standard of care.

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Jeong, Yeonjin, Sang-Yeul Lee, and Kun-Yong Sung. "Adjuvant Role of Botulinum Toxin A in the Management of Wounds Accompanied by Parotid Gland or Duct Injuries." Journal of Wound Management and Research 17, no. 1 (February 28, 2021): 24–29. http://dx.doi.org/10.22467/jwmr.2020.01438.

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Background: Parotid gland or duct injuries may occur after facial trauma or surgical procedures around the parotid gland. Such injuries often cause saliva to leak into the wound, and as a result, the autolytic enzymes in the saliva can delay wound healing. To promote wound healing in such cases, salivary leakage must be stopped until the wound has completely healed. Though there are several known measures for preventing salivary leakage, including compressive dressings, suction drainage, food restriction, and anticholinergic drugs, they often yield unsatisfactory results. This study aimed to evaluate the clinical efficacy of botulinum toxin A in stopping salivary secretions and inducing wound healing in wounds accompanied by parotid gland or duct injuries.<br/>Methods: A retrospective study was conducted to evaluate the efficacy of botulinum toxin A for treating salivary leakage due to parotid gland or duct injuries. Five patients were treated between 2011 and 2016, three of whom received postoperative injections with a total dose of 30–40 units of botulinum toxin A. One of the other two patients was injected with the same amount of botulinum toxin A preoperatively, and the other received an intraoperative injection.<br/>Results: All five patients showed an abrupt decrease of salivary leakage on the 3rd day after toxin injection and satisfactory wound healing without untoward side effects.<br/>Conclusion: This study demonstrates the critical role played by botulinum toxin A in management of wounds complicated by abnormal leakage of saliva, when the parotid gland or duct is injured.

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Maslyakov, VV, EV Krjukov, VG Barsukov, KG Kurkin, PA Dorzhiev, and VR Gorbelik. "Heart injuries: main clinical symptoms." Laboratory diagnostics, no. 1 (February 27, 2019): 53–56. http://dx.doi.org/10.24075/brsmu.2019.003.

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Injuries to the heart are uncommon in peacetime, yet they result in life-threatening conditions, which makes timely diagnostics a crucial factor in saving patients' lives. In this connection, it is important to define the main signs of heart injuries. This study aimed to analyze the basic clinical symptoms associated with various wounds to the heart. We have retrospectively analyzed such symptoms registered in 86 patients with varying chest injuries that affect the heart. All patients were treated in the emergency surgery unit of the Engels Town Hospital from 1991 to 2017. 41 (47.6%) patient had stab wounds, and there were 45 (52.3%) cases of gunshot wounds. 23 (26.7%) patients had chest injuries affecting heart exclusively, while for 63 (73.2%) the consequences were wounds to other organs. We found that the clinical picture depends on the kind of injury to the heart: stab and slash wounds translate into more pronounced symptoms, while gunshot wounds do not produce such an effect. Accepting patients, practitioners should take this fact into account. The misdiagnosis rate for stab and slash heart wounds is 9.7%, that for gunshot wounds — 17.7%, the latter being the result of vagueness of the clinical picture. The clinical signs are most pronounced in the cases of stab and slash wounds to the heart.

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Hatchimonji, Justin S., Nicole A. Meredyth, Sriharsha Gummadi, Elinore J. Kaufman, Jay A. Yelon, Jeremy W. Cannon, Niels D. Martin, and Mark J. Seamon. "The role of emergency department thoracotomy in patients with cranial gunshot wounds." Journal of Trauma and Acute Care Surgery 97, no. 2 (February 20, 2024): 220–24. http://dx.doi.org/10.1097/ta.0000000000004282.

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BACKGROUND Although several society guidelines exist regarding emergency department thoracotomy (EDT), there is a lack of data upon which to base guidance for multiple gunshot wound (GSW) patients whose injuries include a cranial GSW. We hypothesized that survival in these patients would be exceedingly low. METHODS We used Pennsylvania Trauma Outcomes Study data, 2002 to 2021, and included EDTs for GSWs. We defined EDT by International Classification of Diseases codes for thoracotomy or procedures requiring one, with a location flagged as emergency department. We defined head injuries as any head Abbreviated Injury Scale (AIS) score of ≥1 and severe head injuries as head AIS score of ≥4. Head injuries were “isolated” if all other body regions have an AIS score of <2. Descriptive statistics were performed. Discharge functional status was measured in five domains. RESULTS Over 20 years in Pennsylvania, 3,546 EDTs were performed; 2,771 (78.1%) were for penetrating injuries. Most penetrating EDTs (2,003 [72.3%]) had suffered GSWs. Survival among patients with isolated head wounds (n = 25) was 0%. Survival was 5.3% for the non–head injured (n = 94 of 1,787). In patients with combined head and other injuries, survival was driven by the severity of the head wound—0% (0 of 81) with a severe head injury (p = 0.035 vs. no severe head injury) and 4.5% (5 of 110) with a nonsevere head injury. Of the five head-injured survivors, two were fully dependent for transfer mobility, and three were partially or fully dependent for locomotion. Of 211 patients with a cranial injury who expired, 2 (0.9%) went on to organ donation. CONCLUSION Although there is clearly no role for EDT in patients with isolated head GSWs, EDT may be considered in patients with combined injuries, as most of these patients have minor head injuries and survival is not different from the non–head injured. However, if a severe head injury is clinically apparent, even in the presence of other body cavity injuries, EDT should not be pursued. LEVEL OF EVIDENCE Therapeutic/Care Management; Level IV.

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Galili, Uri. "Acceleration of Wound Healing byα-gal Nanoparticles Interacting with the Natural Anti-Gal Antibody". Journal of Immunology Research 2015 (2015): 1–13. http://dx.doi.org/10.1155/2015/589648.

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Application ofα-gal nanoparticles to wounds and burns induces accelerated healing by harnessing the natural anti-Gal antibody which constitutes ~1% of human immunoglobulins.α-gal nanoparticles present multipleα-gal epitopes (Galα1-3Galβ1-4GlcNAc-R), the carbohydrate ligand of anti-Gal. Studiedα-gal nanoparticles were comprised of glycolipids withα-gal epitopes, phospholipids, and cholesterol. Binding of anti-Gal toα-gal nanoparticles in wounds activates the complement cascade, resulting in formation of chemotactic complement cleavage peptides that induce rapid recruitment of many macrophages. The Fc/Fcγreceptors interaction between anti-Gal coatingα-gal nanoparticles and the recruited macrophages activates macrophages to produce cytokines/growth factors that promote wound healing and recruit stem cells. Studies of wound healing byα-gal nanoparticles were feasible inα1,3galactosyltransferase knockout mice and pigs. In contrast to other nonprimate mammals, these mice and pigs lack theα-gal epitope, and thus they are not immunotolerant to it and produce anti-Gal. Treatment of skin wounds and burns withα-gal nanoparticles resulted in 40–60% decrease in healing time in comparison with control wounds treated with saline. This accelerated healing is associated with increased recruitment of macrophages and extensive angiogenesis in wounds, faster regrowth of epidermis, and regeneration of the dermis. The accelerated healing further decreases and may completely eliminate fibrosis and scar formation in wounds. Since healing of internal injuries is mediated by mechanisms similar to those in external wound healing, it is suggested thatα-gal nanoparticles treatment may also improve regeneration and restoration of biological function following internal injuries such as surgical incisions, myocardial ischemia following infarction, and nerve injuries.

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Altabrouri, M. S., and S. A. Usatov. "Surgical intervention on the wound channels of gunshot non-penetrating craniocerebral injuries." Ukrainian Interventional Neuroradiology and Surgery 44, no. 2 (May 17, 2023): 24–33. http://dx.doi.org/10.26683/2786-4855-2023-2(44)-24-33.

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Objective – to optimize of surgical approaches to damaged tissues of the head and methods of primary surgical treatment for gunshot non-penetrating gunshot craniocerebral injuries in accordance with the principles of comprehensive and single-stage surgical treatment accepted in military field surgery. Materials and methods. An analysis of the surgical treatment of 155 wounded people with non-penetrating gunshot wounds of the skull vault and brain for the period from 2014 to 2020 was carried out. Anatomical and morphological features of wound canals were studied depending on the traumatic agent. Variants of surgical approaches for the primary surgical treatment of non-penetrable gunshot wounds of the skull and brainwere developed based on the clinical X-ray and computed tomography characteristics of the affected head tissues. Results. The choice of surgical approaches depends on the nature of the wound canals (single fragment blind, multiple fragment blind, ball and fragment tangent) and the presence of concomitant epidural and subdural hematomas. Primary plasty of the skull defect with a titanium plate during primary surgical treatment is indicated for gunshot impenetrable craniocerebral injuries with a single fragmental blind wound channel. Such plastic surgery was performed in 33.5% of cases with a favorable postoperative course. Peculiarities of surgical approaches to damaged tissues of the head in case of single fragmentary, blind wound canal; with multiple blind fragmental wound canals, the adjacent wound canal and the sequence of their surgical treatment were established. Conclusions. Planning of surgical approaches to damaged tissues of the head in case of gunshot impenetrable craniocerebral wounds in modern local wars should be carried out taking into account clinical and computed tomography data. The high proportion of comprehensive and one-time early primary surgical treatments (92.9%) performed on the first day after the injury testifies to the high efficiency of the system of providing specialized medical care during the local war.

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M. D., Zheliba, Verba A. V., Bohush H. L., Martsynkovskyy I. P., Kondratyuk V. M., Kovalchuk V. P., Fomin A. A., and Fomina N. S. "MICROBIOLOGICAL ASPECTS OF LIMBS WOUND INFECTION AND ITS COMPLEX TREATMENT WITH THE USE OF VACUUM-THERAPY IN PERSONS INJURED IN WAR ACTIONS." Modern medical technologies 42, no. 3 (October 2019): 50–55. http://dx.doi.org/10.34287/mmt.3(42).2019.4.

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Relevance. Topicality treatment problem of injured with gunshot wounds determined of the emergence of centers of armed conflict in eastern Ukraine with the use of modern methods of warfare. In the structure of sanitary losses during antiterrorist operation the overwhelming majority (62,5%) belongs to wounded limbs (lower – 37%, upper – 25,5%), in 35–40% of cases they are accompanied by fractures of the bones. The most dangerous complication of injuries is the development of purulent infection. Purpose of the study. Of research is the study of the specifics of the microbial picture of the fighting gunshot wounds of the limbs for rate its significance in the development of infectious complications and improvement of the results of complex treatment by the use of vacuum bandages. Materials and methods. In this work clinical, microbiological and cytological studies were used to control the course of the wound process in 162 victims with gunshot wounds of limbs followed by statistical processing of the results. Results. Microbiological examination of wounds showed that the main representatives of bacterial cultures are gram-negative non-fermenting sticks (68%), which in 53% of cases are Acinetobacter spp. and in 15% of cases Pseudomonas spp. Gram-positive Cocci were detected in 24% of the seedlings. Of the total number of isolates isolated from the wound, regardless of the timing of the receipt of materials after injury, the majority (79,5%) was characterized by resistance to antibiotics. Strains of gram-negative non-fermentative sticks possessed the highest level of resistance. The application of vacuum wound dressings has had a positive effect on the wound process and shortened the time of healing and wound preparation to a plastic closure. Conclusion. In the current military conflict, the dominant microflora of gunshot wounds is represented by acinetobacter and pseudomonas, which are resistant to most antibiotics. The use of vacuum therapy helps accelerate the processes of cleansing and regeneration of the wound shortens the timing of treatment. Keywords: microflora of gunshot wounds, vacuum therapy of gunshot wounds.

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Djuraev, Jamolbek A. "RADIOLOGICAL EXAMINATION OF FACE-JAW JOINT WOUNDS." Oriental Journal of Medicine and Pharmacology 02, no. 01 (March 1, 2022): 153–67. http://dx.doi.org/10.37547/supsci-ojmp-02-01-12.

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The reason for the interest in the problem of facial and maxillofacial injuries (CJS) is the increase in the number of injuries to the tissue structures of the face and brain, which is characterized by uncertainty of consequences and difficulty of treatment outcome. Occurrence of neurological deficits in the post-injury period disrupts patients’ social adjustment. The serious consequences of acute joint facial injuries make it one of the social problems of national and global importance.

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Sawatzky-Dickson, Doris, and Karen Bodnaryk. "Neonatal Intravenous Extravasation Injuries: Evaluation of a Wound Care Protocol." Neonatal Network 25, no. 1 (January 2006): 13–19. http://dx.doi.org/10.1891/0730-0832.25.1.13.

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Purpose:To evaluate an evidence-based wound protocol for intravenous extravasation injuries in neonates.Sample:Nine newborns with intravenous extravasation injuries. Birth weight: 582–4,404 gm, gestational age: 24–40 weeks.Results:Five wounds were colonized with coagulase-negative Staphylococcus species, two with diphtheroids, three with Enterococcus. There was no evidence of wound infection or systemic infection. Rates of wound healing ranged from one to six weeks.

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