The aim: to improve the e—ectiveness of the surgical treatment of patients with foreign bodies in soft tissues using intraoperative ultrasound guidance. Materials and methods. A prospective single-center case-control study was conducted. A total of 247 patients with shrapnel and gunshot wounds were treated during the period 2021–2023. All patients were divided into group No. 1 - 189 patients operated under ultrasound guidance, group No. 2 - 23 patients treated in the surgical department using standard surgical techniques, and group No. 3 - 35 patients treated according to the recommendations of the International Committee of the Red Cross (foreign bodies were not removed). The results showed that the shortest duration of hospitalization was observed in group 1, amounting to 3.2±1.1 days. In groups 2 and 3, this indicator was signi†cantly higher: 8.4±3.1 and 18.7±5.1 days, respectively (p≤0.05). A similar trend was observed in the duration of outpatient treatment, which was minimal in group 1 (14.2±4.3 days) compared to groups 2 (23.4±2.1 days) and 3 (38.3±2.2 days) (p≤0.05). The complications were recorded in 8 patients in group 2 and 15 in group 3. The average duration of the procedure for removing foreign bodies under ultrasound guidance (group 1) was 12.2±2.2 minutes, which is much less than using a standard surgical methodology (61.6±4.5 minutes) (p≤0.05). The length of the surgical section in group 1 on average was 1.5±0.3 cm, while in groups with standard methods - 6.4±1.1 cm (p≤0.05). In the control group (group 3) 42.8% of patients (15 people) developed complications associated with retained foreign body in the wound. Conclusion. Comparison of the outcomes of treating the wounded using ultrasound-guided extraction of foreign bodies and traditional approaches demonstrated signi†cant advantages of ultrasound navigation. This approach helped to signi†cantly optimize and simplify the procedure for extracting fragments, as well as reduce the period of hospitalization of patients and outpatient treatment.
oskolochno-ognestrel'nye raneniya, inorodnoe telo, oskolok, udalenie, sonografiya, myagkie tkani
1. Lysenko M.V., Perekhodov S.N. Combat surgery. Moscow: MEDPROF; 2023. (In Russ.).
2. Combat surgery. National guideline. I. M. Samokhvalov eds. Moscow: GEOTAR-Media; 2024. (In Russ.).
3. Chantyr I. V., Zavgorodnev K. D., Belchenko V. A. Analysis of the quality of surgical care for patients with consequences of gunshot combat wounds of the maxillofacial area. Medical alphabet. 2024;(11):53-61. (In Russ.)
4. Saum G. R., Baum J. T., Hayward D., MacKay B. J. Gunshot Wounds: Ballistics, Pathology, and Treatment Recommendations, with a Focus on Retained Bullets. Orthop Res Rev. 2022;14:293-317.
5. Smith R.N., Tracy B.M., Smith S., Johnson S., Martin N.D., Seamon M.J. Retained Bullets After Firearm Injury: A Survey on Surgeon Practice Patterns. J Interpers Violence. 2022;37(1-2):NP306NP326.
6. Faguy K. Imaging foreign bodies. Radiol Technol. 2014;85(6):655-78.
7. Rich N. M. Shrapnel Wounds. JAMA. 1967;202(3):245. doi:10.1001/ jama.1967.03130160119038.
8. Eylon S., Mosheiff R., Liebergall M., Wolf E., Brocke L., Peyser A. Delayed reaction to shrapnel retained in soft tissue. Injury. 2005;36(2):275-281. doihttps://doi.org/10.1016/j.injury.2004.09.005.
9. Rooks V. J, Shiels W. E., Murakami J. W. Soft tissue foreign bodies: A training manual for sonographic diagnosis and guided removal. J Clin Ultrasound. 2020;48(6):330-336. doi: 10.1002/ jcu.22856.
10. Hanna T.N., Shuaib W., Han T., Mehta A., Khosa F. Firearms, bullets, and wound ballistics: an imaging primer. Injury. 2015;46(7):1186-96. doi:https://doi.org/10.1016/j.injury.2015.01.034.
11. Veselko M., Trobec R. Intraoperative localization of retained metallic fragments in missile wounds. J Trauma. 2000;49(6):1052-8. doi:https://doi.org/10.1097/00005373-200012000-00013.
12. Andrade E.G., Uberoi M., Hayes J.M., Thornton M., Kramer J., Punch L. J. The impact of retained bullet fragments on outcomes in patients with gunshot wounds. Am J Surg. 2022;223(4):787791.
13. Pinto A., Russo A., Reginelli A., Iacobellis F., Di Serafino M., Giovine S., Romano L. Gunshot Wounds: Ballistics and Imaging Findings. Semin Ultrasound CT MR. 2019;40(1):25-35. doihttps://doi.org/10.1053/j. sult.2018.10.018.
14. Snider E. J., Hernandez-Torres S. I., Avital G., Boice E. N. Evaluation of an Object Detection Algorithm for Shrapnel and Development of a Triage Tool to Determine Injury Severity. Journal of Imaging. 2022;8(9):252.
15. Savoia P., Jayanthi S.K., Chammas M.C. Focused Assessment with Sonography for Trauma (FAST). J Med Ultrasound. 2023;31(2):101-106. doihttps://doi.org/10.4103/jmu.jmu_12_23.
16. Zubov A. D., Senchenko O. V., Chernyaeva Yu. V. Ultrasound Imaging of Soft Tissue Foreign Bodies. Medical Visualization. 2016;(6):125-132. (In Russ.).
17. Dadayan A. R., Belik B. M., Tenchurin R. Sh., Bolotskov A. S. Ultrasound-Guided Removal of Deep-Lying Foreign Bodies of the Soft Neck Tissue In a Patient with a Shrapnel Wound. Journal of experimental and clinical
18. Yao Y., Pan Y., Liu S. Power ultrasound and its applications: A state-of-the-art review. Ultrason Sonochem. 2020;62:104722. doi:https://doi.org/10.1016/j. ultsonch.2019.104722.
19. Fagan P., Geiger C.D., Chenji G., Preston D.C. Neuromuscular ultrasound findings in gunshot wounds. Muscle & Nerve. 2024;69(4):416-421. doihttps://doi.org/10.1002/mus.28048.
20. Ditkofsky N., Nair J. R., Frank Y., Mathur Sh., Nanda B., Moreland R.,. Rotman J. A. Understanding Ballistic Injuries. Radiologic Clinics of North America. 2023;(61)1:119-128. doihttps://doi.org/10.1016/j.rcl.2022.08.005.
21. Snider E. J., Hernandez-Torres S. I., Boice, E.N. An image classification deep-learning algorithm for shrapnel detection from ultrasound images. Sci Rep. 2022;12:8427. doihttps://doi.org/10.1038/s41598-022-12367-2.
22. Hill R. Ultrasound for the detection of foreign bodies in human tissue. Annals of emergency medicine. 1997;29(3):353-6. doihttps://doi.org/10.1016/s01960644(97)70347-0.
23. Bloom B. A., Gibbons R. C. Focused Assessment With Sonography for Trauma. StatPearls. 2024. URL: https://www.ncbi.nlm.nih.gov/books/NBK470479/. (Accessed 29.08.2024).
24. Xu Y., Wang R., Zhu M., Li X., Pan X., Ni T., Zhou S. Diagnostic value of dynamic-extended focused assessment with sonography for trauma in patients with multiple trauma. Zhonghua Wei Zhong Bing Ji Jiu Yi Xue.
25. Sodagari F., Katz D. S., Menias Ch. O., Moshiri M., Pellerito J. S., Mustafa A., Revzin M. V. Imaging Evaluation of Abdominopelvic Gunshot Trauma. RadioGraphics. 2020;40:1766-1788. doihttps://doi.org/10.1148/rg.2020200018.
26. Anthony J. W. Gunshot Injuries: What Does a Radiologist Need to Know? RadioGraphics. 1999;19(5):1358. doi:10.1148/ radiographics.19.5.g99se171358.
27. Peramaki E. R. Pictorial Review of Radiographic Patterns of Injury in Modern Warfare: Imaging the Conflict in Afghanistan. Canadian Association of Radiologists Journal. 2011;62(2):90106. doihttps://doi.org/10.1016/j.carj.2010.03.005.
28. Rudenko M. X-ray diagnostics of gunshot wounds of main vessels of the limbs: theoretical analysis. ScienceRise: Medical Science. 2023;4(55):24–28. doihttps://doi.org/10.15587/25194798.2023.291217. 29. Shankar H., Cummings C. Ultrasound Imaging of Embedded Shrapnel Facilitates Diagnosis and Management of Myofascial Pain Syndrome. Pain Pract. 2013;13:405-408. doihttps://doi.org/10.1111/papr.12002.
