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Introduction. The analysis of experience in changing approaches to organizing medical care for combat eye injuries, changing treatment tactics for such patients during armed conflicts in the 20th and 21st centuries, domestic experience in providing medical care for eye and its adnexal injuries, highlights the search for informative methods of predicting long-term outcomes of the applied treatment methods. The aim of the study was to determine the informativeness of constructing a forecast of functional changes of the visual analyzer based on the results of treatment of patients with eye injuries during dynamic retrospective observation. Materials and Methods: The primary material for the study was medical documentation of combat eye injury patients (data from medical histories, outpatient cards, and discharge summaries) for the period of 2014-2015, who were treated at the National Military Medical Clinical Center "Main Military Clinical Hospital" (NMMCC "MMCH"). Indicators of the functional state of the visual analyzer were evaluated upon admission to the NMMCC "MMCH" and after 180 days following the injury. The study used the proposed F. Kuhn and colleagues' scale for evaluating long-term treatment outcomes (OTS-Ocular Trauma Score). Results. It was found that overall, the results of treatment for combat eye injuries and their adnexa at the NMMCC "MMCH" during the study period of 2014-2015 showed a high correlation with the calculated values of the probability of preserving visual functions according to the OTS scale. Almost all patients with a case of blindness remained blind in the injured eye six months later. In the group with light projection and movement of the hand near the face, an improvement in visual function in most cases (65%) was noted, while, according to the OTS scale, these patients in most cases remain in this group or move to the group with blindness. Cases with visual acuity of 0.005-0.1 after 6 months improve visual acuity with the transition in most cases to 0.1 and above. The same trend, but, as expected, with a higher probability in groups with visual acuity of 0.1-0.4 and above 0.5. The identified discrepancies justify the need for adaptation of the OTS scale for predicting functional changes in combat eye injuries, as it has been developed for use in eye injuries during peacetime. Conclusion: Considering the large number of wounded soldiers with severe eye injuries during the war with rf, scientific research on the implementation of a system for predicting long-term functional outcomes of the treatment of combat eye trauma based on clinical data at the time of initial examination remains relevant. The results obtained with the OTS (Ocular Trauma Score) assessment scale in most cases correspond to the results of the treatment of injured patients in the ophthalmology clinic of the NMMCC "MMCH" in 2014-2015. Further development of the existing OTS system and its adaptation to domestic conditions and the realities of providing ophthalmic care for combat eye trauma is promising for further study. [ABSTRACT FROM AUTHOR]

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

Background: A full-scale Russian invasion of the territory of Ukraine required the military medical authorities to introduce corrections in the operation of the support system for treatment and evacuation of casualties with combat ocular trauma (COT). While the combat activities were taking place in Kyiv's suburbs, the inpatient eye clinics of the city actively contributed to the provision of care to casualties. Purpose: To examine the results of the managing decisions made on the introduction of corrections in the operation of the support system for treatment and evacuation of casualties with COT on the basis of the comparative analysis of the efficacy of medical care provided to casualties at the eye clinic of the National Military Medical Clinical Center "Main Military Clinical Hospital" (NMMCC "MMCH"). Material and Methods: We presented the results of the analysis of (a) changes in the pattern and amount of treatment and diagnostic interventions provided to casualties in different time periods related to changes in the tactical combat situation and (b) transformation in the levels of provision of medical care to casualties with COT that took place due to the above changes. The structure of causes and locations of ocular and ocular adnexal injuries was calculated based on the aggregated data from medical papers related to treatment of combat casualties at the eye clinic of the NMMCC "MMCH" during 2014-2021 and February-April 2022. System, comparative and content analysis methods, descriptive modeling, statistical analysis and principal methods of treatment and diagnosis of eye disease were used as methods of the study. Results: It was demonstrated that the urgent corrections introduced in the conventional four-level system of medical and evacuation support during combat activities in the metropolitan suburbs of Kyiv were timely and adequate. We reviewed the changes in the pattern of COT in different periods of combat activities on the territory of Ukraine and indentified the issues requiring primary consideration in order to remove the shortcomings in the organizational support of the treatment and evacuation of casualties with COT. Conclusion: First, the results of our comparative analysis of the advanced support system for treatment and evacuation of casualties under combat actions in aggravated tactical situations (particularly, during the defense of the metropolitan area of Kyiv), demonstrated the efficacy of the algorithms and standards recommended by NATO. Second, the front line advancing to the outskirts of the metropolitan area required making urgent managing decisions on introducing corrections in the classical four-level support system for treatment and evacuation of casualties (particularly, those with COT), which caused the NMMCC "MMCH" to unite and coordinate their care efforts with those of the special medical facilities of the metropolitan area of Kyiv. There were changes in the amount of eye care provided, with a change to level 3 and subsequently in the opposite direction to level 4, within a very short period, which did not cause difficulties for the military medical personnel. Third, combat actions at the outskirts of the metropolitan area of Kyiv resulted in an increase in the percentage of the wounded with combat-related injuries of the eye and adnexa to 9.4% of the total number of wounded, with more than half (54%) of them represented by penetrating injuries, particularly those with an intraocular foreign body (43.3%). The percentage of binocular injuries and eye destruction increased to 29.8% and the percentage of multiple combat-related injuries to 81.4%, likely primarily due to wide use of high-kineticenergy weapons with high-velocity fragments from explosive munitions of these systems having wide-area effects. Fourth, we found that treatment outcomes were better when casualties with COT (a) had an early single-stage evacuation to the destination point and (b) were timely provided with special care, which is especially important in bilateral severe eye injuries with a threat of irreversible visual function loss. Finally, the identified problems and shortcomings were causeded primarily by impaired logistics of the support of treatment and evacuation of casualties, and shortage of medical staff (particularly, specialty doctors), medications and medical supplies, particularly at the territories which external communications were temporarily blocked. [ABSTRACT FROM AUTHOR]

Background: In connection with the war in Ukraine and the use of modern high-energy weapons by the enemy, the nature of injuries have changed. These changes require improvement of approaches to the treatment of patients with gunshot and mine-explosive bone defects., Case Presentation: We present the case of treatment of a 28-year-old Ukranian man with a gunshot multifragmentary fracture of the proximal humerus with a bone defect using three-dimensional printing of a polyetheretherketone frame (scaffold) for alloplastic material. The analysis of this case expands the possibilities of using three-dimensional printing technologies of polyetheretherketone scaffolds in the treatment of significant bone defects., Conclusion: Modern military trauma requires individualized treatment for each patient. The use of individual polyetheretherketone scaffolds in the treatment of a gunshot multifragmentary fracture with a bone defect has a positive clinical effect., (© 2024. The Author(s).)

INTRODUCTION AND IMPORTANCе: Russo-Ukrainian war is associated with severe injuries to the chest. Isolated chest injuries are associated with high mortality or advanced invalidization due to the severity of the trauma. The aim of the study was to demonstrate the experience and the challenges in diagnosis and management of the combat patient with gunshot injury to the lungs with subsequent migration of the shrapnel projectile to the segmental bronchus and its bronchoscopic removal by using forceps., Case Presentation: A male patient 44 years of age was injured at an artillery strike in East Ukraine. The patient was evacuated to the Forward Surgical Team (Role 1) facility within one hour after the injury. The bronchoscopy was performed and to our surprise, the metal fragment in the lumen of the right segmental S2 bronchi was visualized at bronchoscopy, indicating its migration from the first place. The decision was made to attempt to remove the metal fragment endoscopically. At bronchoscopy, the metal fragment was caught by the endoscopic forceps and therefore removed endoscopically. The time of endoscopic removal of the metal fragment was 8 min., Clinical Discussion: Removal of a foreign body (metal fragment) of gunshot origin from the lumen of a segmental bronchus by using bronchoscopy with endoscopic forceps is a rare phenomenon., Conclusions: The use of minimally invasive technologies in the treatment of gunshot blind penetrating wounds of the chest contributes to the reduction of operative trauma and shortens the time of operative treatment., Competing Interests: Declaration of competing interest The authors declare that they have no competing interests., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Russo-Ukrainian war is associated with severe traumas, including injuries to the major vessels. Penetrating aortic injury remains one of the most difficult injuries; the mortality rate is 90-100% in case of gunshot wounds, associated with frequent lethal outcomes due to uncontrolled bleeding. Of the three main abdominal veins, the inferior vena cava (IVC) is the most frequently damaged, which is required quick and appropriate surgical decisions to be made. Little is known about the management of gunshot injuries to such major vessels as the aorta and IVC. It is also worth mentioning about the importance to share our practical experience from the ongoing war for better understanding and future considerations by war surgeons of the vascular trauma management. The aim of the study was to demonstrate the specific features of the diagnosis and management of a gunshot shrapnel blind penetrating wound to the abdomen with injury to the aortic bifurcation level and the infrarenal section of the inferior vena cava., Case Presentation: A 44-year-old male soldier of the Armed Forces of Ukraine received a gunshot injury to the abdomen from a mortars' explosive shelling. The patient was evacuated to the Forward Surgical Team (Role 1) and received primary surgical treatment within one hour after the injury according to the "golden hour" principle. Then, evacuated was performed to the Role 3 hospital in Kharkiv. At the Role 3 hospital, the patient underwent second-look surgery as well as damage control surgery. At revision, no active bleeding was observed, and the surgical pads (packed previously by the Forward Surgical Team) were removed. Further revision showed a metal projectile within the aortic wall at the level of aortic bifurcation and wall defects were also detected for inferior vena cava. This metal projectile was removed by using the multifunctional surgical magnetic tool followed by suturing of the aortic wall defect as well as defects of the inferior vena cava., Conclusions: Application of Damage Control Surgery is a useful approach in the management of severe vascular injury as well as useful to stop abdominal contamination by intestinal contents. The application of a surgical magnetic tool for the searching and removal of ferromagnetic foreign bodies reduces operative trauma and reduces the time for identification of foreign bodies., (© 2024. The Author(s).)

The Russia-Ukraine war is associated with critical and severe thoracoabdominal injuries. A more specific approach to treating patients with thoracoabdominal injury should also include minimally invasive technologies. It remains unclear about the utility of using video-assisted thoracoscopic surgery (VATS) and laparoscopy in patients with thoracoabdominal injury. The aim of this study was to investigate and evaluate the utility of video-assisted thoracoscopic surgery, laparoscopy as well as magnetic tool applications for the management of severe thoracoabdominal injury in combat patients injured in the ongoing war in Ukraine and treated in the Role 2 deployed hospital. Patients and methods 36 male combat patients thoracoabdominal injury were identified for the study during the first 100 days from February, 24 2022. These individuals were diagnosed with thoracoabdominal GSW in the Role 2 hospital (i.e. deployed military hospital) of the Armed Forces of Ukraine. Video-assisted thoracoscopy surgery (VATS) and laparoscopy with application of surgical magnetic tools were applied with regards to the damage control resuscitation and damage control surgery. Results In 10 (28%) patients, VATS was applied to remove the metal foreign body fragments. Both thoracotomy and laparotomy were performed in 20 (56%) hemodynamically unstable patients. Of these 20 patients, the suturing of the liver was performed in 8 (22%) patients, whereas peri-hepatic gauze packing in 12 (33%) patients. Massive injury to the liver and PI 2.0-3.0 were diagnosed in 2 (6%) patients. Lethal outcome was in 1 (2.8%) patient. Conclusions Thoracoabdominal gunshot injuries might be managed at Role 2 hospitals by using video-assisted thoracoscopy (VATS) and laparoscopy accompanied by surgical magnetic tools. Damage control surgery and damage control resuscitation must be applied for patients in critical and severe conditions., (© 2024. The Author(s).)

Artificial intelligence (AI) encompasses the advancement of computers and robots, enabling them to surpass human capabilities in various aspects. By utilizing AI, programs have the ability to autonomously analyze and interpret data, offering information and executing actions without any human involvement. The ongoing war in Ukraine showed various aspects of severe gunshot injuries because of previously unknown course of wounds after application of ballistic missiles, drones, etc., which is frequently applied by russians. In such conditions, decision-making process by military medical doctors must be quick and rational, however in case of massive casualties, combined trauma (e.g. thoracoabdominal gunshot injury) MDs might have permanent challenges to apply appropriate care options and individualized approach. The aim of this study is to start the discussion about role and possible application of AI in management of gunshot injuries in combat patients or other individuals who received wounds relating to high-energy weapon. Conclusions. Gunshot wound is a clinical challenge in many cases among patients who were injured by high-energy weapons, requiring complex and quick decisions. AI might be applied as an additional tool for the decision-making process in case of severe trauma in deployed field hospitals, or in hospitals of higher Roles (3-4). This study is to start the research discussion about the utility of AI application for the management of the injured in the war associated with high-energy weapons.

Introduction: Russo-Ukrainian war is associated with application of high-energy weapon, causing severe multifragmental injuries to the bones an associating with severe bone defects. The aim of the study was to evaluate various methods to treat combat patients with severe defects of humerus and to demonstrate the experience of orthopedic war surgeons in managing gunshot injuries to the humerus defects in the ongoing war., Patients and Methods: A 24 patients were active-duty military personnel of Armed Forces of Ukraine. These patients were diagnosed with severe humerus defects due to gunshot injury in battlefield zone in various areas of Ukraine. Data was collected within period between February, 24th 2022 till January, 01st 2023. The following approaches were applied to replace bone defect: preoperative 3D printing with polyetheretherketone (PEEK) as orthobiological material; closed reduction, percutaneous lag screw and Ilizarov external fixation; vascularized fibula grafting., Results: Data analyses of the segmental defects of humerus showed 5 cm defect in 3 (13 %) patients, from 5 to 10 cm in 4 (17 %) patients, over 10 cm in 17 (71 %) patients. Analyses were performed in these 17 (71 %) patients, showing 5 patients treated with 3D-printed PEEK implants, 6 patients with vascular-pedicle graft of fibula, 6 patients with closed reduction, percutaneous lag screw, Ilizarov external fixation. Osteomyelitis was diagnosed in one case (20 %) after the use of PEEK implants, requiring to remove both PEEK implant and metal implants followed by application of the antibiotic joint spacers and Ex-Fix fragments of the humerus. In our opinion, the osteomyelitis happened due to inadequate debridement of the wound and non-compliance with the conversion criteria (replacement of the fixation method). The mean length of hospital stay was 5.5 months for patients treated with 3D-printed PEEK implants., Conclusions: Closed reduction, percutaneous lag screw and Ilizarov external fixation as well as vascularized fibula grafting are associated with good outcomes in management of the patients with severe humerus defect due to gunshot injury. 3D printing and PEEK implants could also be considered for the reconstructions of the humerus multifragmental fractures with a bone defect over 10 cm associated with gunshot injury due to high-energy weapon in the war settings., Competing Interests: Declaration of competing interest None., (Copyright © 2023 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Background: Gunshot injury to the hand is severe trauma, requiring complicated reconstruction surgery for the damaged anatomic site to restore all the hand functions. The aim of this study was to show the example of the distal phalanx reconstruction by using a flap with distal transverse digital artery (DTDA) blood supply as well as to demonstrate the utility of the audio Doppler application at the reconstruction stage in the combat patient injured in the Russo-Ukrainian war., Case Presentation: In this report, we present a case of a 26-year-old service member of the Ukrainian Armed Forces delivered to the Military Medical Clinical Centre on the fourth day after the gunshot gutter shrapnel wound of the distal flexor of the 2nd digit with a gunshot fracture of the ungula (distal) and middle phalanges of the 2nd digit of the right hand along with a bone deficiency of the osseous structure of the distal and middle phalanges, volar soft tissues. The dorsal metacarpal artery (DMCA) flap is a universal variant among the tools of the reconstructive plastic surgeon engaged in reconstructing defects of the digital dorsum and flexors with a limited range of flaps. We consider this to be a key that conforms with the majority of the reconstructive principles, such as 'analog replacement', and which is simple, adequate, and easy for operating with a minimal sequela of the donor site., Conclusions: The distal transverse digital artery (DTDA) could be considered for hand reconstructive surgery for repairing defects of the flexor surface of the digit injury and hands after severe gunshot injury., (© 2023. The Author(s).)

Background: Gunshot wounds injury to the thorax is common in armed conflicts or war, including the war of Russia against Ukraine. Injury to the chest is associated with a high mortality or physical disability due to damage to the lungs, heart, and major vessels. The aim of this report is to demonstrate a case of successful management of severe gunshot injury to the lungs using video-assisted thoracoscopic surgery and magnetic tool for a combat patient injured in the war in Ukraine., Case Presentation: A 51-year-old soldier of the Armed Forces of Ukraine received a gunshot injury due to shelling from artillery strikes in the Donbas battlefield area. After evacuation to Level II, a forward surgical team performed primary surgical debridement. Two hours after the injury, the patient was evacuated to the Level IV of medical care (Kharkiv). At Level IV, a CT scan showed penetrating gunshot wounds to the left part of the chest with injury to the upper lobe of the left lung with the presence of the 2 metal fragments of the artillery projectile with the size of 2.5 × 2.0 cm and 1.0 × 1.0 cm. These two fragments were removed by using video-assisted thoracoscopic surgery (VATS) using the inlet gunshot hole in the left lateral chest area, as well as the assistance of a magnetic tool., Conclusions: VATS and magnetic technologies should be considered for hemodynamically stable combat patients with a gunshot injury to the lungs in the ongoing war. Each combat patient could be treated by individualized approach such as using the wound canal as a scope port after primary surgical debridement of the wound and antibiotic prophylaxis., (© 2023. Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: The current war in Ukraine is associated with frequent applications of multiple-launch rocket systems and cruise missiles as well as other various high-energy weapons to cause severe injuries in military personnel including abdomen wounds, vascular injury, and limb amputations as well as genitourinary trauma. The aim of this report is to demonstrate a case of successful penile salvage by restoring its function in a combat patient with gunshot genitourinary trauma in conditions of an interrupted supply of medical equipment., Case Presentation: We describe a case of a 48-year-old male patient with a combined shrapnel gunshot wound to the penis with damage to the urethra and combined injury to the soft tissues of the left thigh. Several hours after the injury, the patient underwent primary surgical debridement of the left thigh, ligation of the great saphenous vein of the thigh, primary sutures on the penile urethra and navicular fossa, suturing of the rupture of the head and penis, drainage of the wound, catheterization of the bladder, and epicystostomy. An artificial erection was performed intraoperatively. The urethral catheter was removed 3 weeks after urethral suturing (May 4, 2022). The epicystostomy was removed 5 months after the injury (August 4, 2022) and 2 days after the restoration of spontaneous urination. At the follow-up of 7 months after the injury, the patient has normal urination with minor urinary dribbling, sufficient erection, and ejaculation., Conclusions: We have shown that in a case of gunshot wounds to the penis and hanging part of the urethra, even in the presence of combined severe purulent lesions of non-urological localizations, it is possible to perform a primary reconstruction of urogenital injuries using a primary urethral suture and applying a negative pressure device. Findings from this case report shed new light on the management of penile gunshot injury in ongoing warfare as well as provide evidence of the possibility to perform adequate management for penile injury in conditions of limited medical resources, violation of international humanitarian law, and under frequent strikes of high-energy weapons., (© 2023. The Author(s).)

Introduction: The full-scale war with Russia on the territory of Ukraine has revealed several problems related to care of the wounded. In this article, we summarize the mechanisms of injury and injuries sustained for the period February to April 2022, focusing on extremity injuries., Materials and Methods: We compared these to a period of lower-intensity warfare in 2014-2021. In both cases, we report patients treated by the National Military Medical Clinical Center (NMMCC) in Kyiv. We also sought to evaluate the care of the wounded from an organizational viewpoint, taking into account the four-level system of care also used by the North Atlantic Treaty Organization (NATO). Third, we sought to understand lessons learned that could improve the care of the wounded., Conclusion: During the 2022 conflict, the percentage of patients with extremity wounds who had long bone fractures increased and the percentage of people with long bone fractures who had bone defects increased, compared with 2014-2021. This may be due to the higher blast energy from the weapons used in the current conflict. Second, we adapted the four-level NATO system of care. Level 2 (first level hospital) care was provided by civilian hospitals close to the fighting, rather than mobile military hospitals. Level 3 (specialized) and 4 (highly specialized) care were combined into one hospital (NMMCC). This is the first description of flexible use of NATO's four levels. Finally, a major lesson learned was the need to improve use of damage control surgery., (© 2022. The Author(s) under exclusive licence to Société Internationale de Chirurgie.)