Skull and brain gunshot wound during the armed conflict in eastern Ukraine. Report 2. Surgical treatment
Keywords:penetrating craniocerebral wounds, mine-explosive wounds, bullet wounds, surgical treatment, mortality, postoperative complications
Purpose. To improve the results of surgical treatment in patients with penetrating craniocerebral wounds (PCCW) by implementing optimal treatment strategy considering type of the injury, character of intra- and extracranial injuries.
Materials and methods. The results of examination and treatment of 41 injured persons with PCCW wounded in local fighting in the East of Ukraine. The injured persons were hospitalized to I. Mechnikov Dnipropetrovsk Regional Clinical Hospital in f period from May 25 to December 31 2014. In 37 (90.2%) patients PCCW were caused by mines and explosive devices, in 4 (9.8%) — by bullets. Rebound injuries were diagnosed in 15 (36.6%) patients, blind — in 20 (48.8%), perforating — in 6 (14.6%).
Results. Three main tasks of the surgical treatment of patients with PCCW were identified: hemostasis, infection prevention, prevention and correction of intracranial hypertension. To perform the tasks we justified the full implementation of 12 critical steps of the surgery. The introduction of more aggressive treatment principles reduced mortality to 7.3%. Postoperative complications occurred in 24.4% cases, most frequently liquorrhea (in 12.2%) and purulent-septic complications (in 12.2%) were diagnosed, rarely — vascular complications, and hydrocephalus.
Conclusions. The primary goal of PCCW surgical treatment — is surgery performing in full during one surgical intervention. At penetrating wounds debridement all nonviable tissue should be removed radically: detritus, blood clots, areas of brain crush, foreign bodies. At primary debridement primary skin reconstruction, dura mater of the brain, skull base and calvaria, and inflow-outflow wound drainage should be widely used.
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