DIAGNOSTICS AND SURGICAL TREATMENT OF GUNSHOT WOUNDS OF THE UPPER AND LOWER LIMBS WITH THE PRESENCE OF FOREIGN BODIES
Summary. The aim. Comparison of clinical, clinical instrumental and morphological data to establish the most informative signs of extremity foreign bodies, the possibility of choosing surgical tactics and improving treatment results.
Materials and methods. Removal of ferromagnetic metallic foreign bodies of various sizes was carried out under visual control using a magnetic search tool. Visual control of the removal of a foreign body allows you to assess the adequacy of its removal.
Results and its discussion. Removal of a foreign body was carried out using general surgical instrumentation under tactile control using the surgeon's finger and a Billroth curved hemostatic clamp or a mosquito curved hemostatic clamp.
Removal of foreign bodies of extremities under hardware control is possible both in continuous time (on line) and intermittent (step-by-step) mode - detection of foreign bodies, marking (leaving marks on the skin).
Removal of a foreign body was also carried out under X-ray control. Most often, a step-by-step technique was used, in which the characteristics of a foreign body were first determined, then it was removed and, finally, a control X-ray study was performed with uncertainty about the completeness of removal.
In cases where there were problems with the spatial perception of the location of foreign bodies, the removal of foreign bodies under visual, tactile and hardware control was difficult, we used a combination of these methods.
Conclusions. As a result of using the proposed modern diagnostic technologies, the completeness of removal of extremities foreign bodies significantly increased from 6.2±0.1 to 1.4±0.1 (p<0.005); the duration of their removal decreased from 30.4±1.8 to 11.2±1.3 minutes (p<0.005); the number of surgical interventions decreased from 2.8±0.2 to 1.7±0.1 (p<0.005); the expressiveness of the pain syndrome decreased from 7.3±0.2 to 5.2±0.4 points (p<0.005); the duration of inpatient treatment decreased from 18.6±1.1 to 16.5±1.3 days.
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