RESULTS OF TREATMENT OF WOUNDED WITH MIGRATION OF FOREIGN BODIES OF GUNSHOT ORIGIN
Authors: Khoroshun E. M. , Makarov V. V. , Negoduyko V. V. , Zamyatin P. M. , Verevkin I. V. 
Published: October 2024

Summary. The aim is to analyse the results of treatment of wounded with migration of foreign bodies of gunshot origin.
Materials and methods. We analysed 82 cases of gunshot fragmentation blind wounds of various localisations for a certain period, where there was a foreign body migration by various means. All the wounded were male, the average age was (43.2±4.1) years. The wounded were examined by radiological and, if indicated, video endoscopic methods. Depending on the methods used for diagnosis and removal of CT, the wounded were divided into two groups: the main group - 56 (68.3%) (from November 2018 to November 2023), where minimally invasive technologies were used, and the comparative group - 26 (31.7%) (from May 2014 to November 2018), where traditional open access was used. Statistical, system analysis, and questionnaire methods were used. The results of the study were analysed in the immediate, immediate and remote periods after the injury. The immediate period was assessed by the following indicators: the number of foreign bodies removed, duration of preoperative preparation, duration of surgical interventions, the presence of repeated surgical interventions, total bed days, and the presence and nature of complications. The immediate and long-term periods were assessed by the presence of complications, surgical interventions for complications, and impaired external respiratory function. Good long-term results were considered when the wounded did not make complaints related to the injury and surgical interventions, and the examination data indicated positive functional and structural dynamics, no complications from the injured area or the site of foreign body removal. Satisfactory results included the results of treatment with the presence of CT, which did not lead to long-term functional impairment and complications that did not require repeated conservative or surgical intervention. Unsatisfactory results were the results of treatment with the presence of ST, which led to long-term functional impairment and complications and required repeated conservative or surgical intervention.
Results. Primary surgical treatment of the wound in case of foreign body migration was performed in 57 (69.5%) cases, in 25 (30.5%) patients it was not performed. The approaches to surgical interventions for the migration of foreign bodies of gunshot origin, aimed at the site of migration onset, place of fixation (location), and removal of the foreign body, were as follows endoscopic - 7 (8.5%), thoracoscopic - 12 (14.6%), laparoscopic - 4 (4.9%), arthroscopic - 23 (28%), thoracotomy - 8 (9.8%), laparotomy - 15 (18.3%), open - 3 (3.6%) cases. Thus, open (traditional) approaches were used in 23 (28%) and minimally invasive approaches in 49 (59.8%) cases. Surgical treatment aimed at the site of migration onset, fixation (location), or removal of a foreign body was not used in 10 (12.2%) cases. The total number of detected CTs was 92 (100%), of which 87 (94.5%) were ferromagnetic metal fragments and 5 (5.4%) were bone fragments. Of the total number of detected foreign bodies, 1 (1.1%) CT remained unremoved, which indicates the peculiarities of this pathology - migration of CT of gunshot origin. CTs (metal fragments) were removed naturally in 16 (19.5%), in 1 (1.2%) CTs were not removed (localised in the liver) and 65 (79.3%) patients had CTs removed using a modern magnetic surgical instrument. The duration of surgical intervention in the comparison group was longer than in the main group, which is associated with the use of traditional open accesses. There were a total of 4 (4.9%) postoperative complications: 1 (1.8%) in the main group in the form of seroma and 3 (11.5%) in the comparison group (entrapment, postoperative wound suppuration and peritoneal adhesion). The total bed-day was significantly shorter in the intervention group than in the comparison group, which is associated with the use of minimally invasive technologies. In the immediate period, 70 cases were followed up: 46 (65.7%) in the main group and 24 (34.3%) in the comparison group. In the comparison group, 2 (8.3%) patients were operated on for postoperative ventral hernias. In the long-term period, 64 cases were followed up: 41 (64%) in the main group and 23 (35.9%) in the comparison group. Unsatisfactory results in the comparison group were due to 2 cases of adhesion and 1 case of postoperative ventral hernia. Satisfactory results in 6 (9.4%) cases were due to the presence of adhesions in the pleural cavity, minor impairment of external respiratory function, exacerbation of chronic pyelonephritis and oral prosthetics. Thus, the treatment results are better in the main group due to the absence of unsatisfactory results and a higher number of good results.
Conclusions. A feature of the treatment of gunshot wounds with foreign body migration is the mandatory removal of all migrating foreign bodies, regardless of the size of the foreign body. When diagnosing foreign body migration, the preoperative period increased by 4 times compared to cases without migration, which is associated with observation and the absence of indications for surgical intervention according to vital signs and the stages of medical care. The difference in the number of complications is associated with the use of traditional open access. When comparing the main group in the immediate period, the duration of surgery, the number of complications and the total bed-day are 2 times shorter. When comparing the results of treatment of foreign body migration, the results in the main group are better (95.1%) due to the absence of unsatisfactory results and a greater number of good results.