The Effectiveness of Intraoperative Ultrasound Navigation in the Removal of Soft Tissue Foreign Bodies Localized in Areas with Complex Surgical Anatomy After Gunshot Shrapnel Wounds

RELEVANCE The greatest technical difficulties in the surgical removal of foreign bodies after gunshot shrapnel wounds (GSW) of soft tissues arise when fragments are deeply located near large vessels, nerve trunks, and in the area of the tendon-ligamentous apparatus of the extremities. At the moment, there is practically no information about the possibilities of removing soft tissue fragments localized in areas with complex surgical anatomy using intraoperative ultrasound navigation (IUN).

AIM OF THE STUDY To evaluate the effectiveness of the use of IUN in the removal of soft tissue foreign bodies localized in areas with complex surgical anatomy after GSW.

MATERIAL AND METHODS A comparative analysis of the outcomes of surgical treatment of 74 patients with GSW of soft tissues, in whom foreign bodies were localized in hard-to-reach anatomical zones near large vessels, nerve trunks, as well as in the thickness of the tendon-ligamentous apparatus of the extremities, was carried out. In 26 patients (group 1), foreign bodies were removed by a conventional surgical method. In 5 patients, a C-Arm X-ray machine was additionally used during the conventional procedure. In 48 patients (group 2), foreign bodies were removed using IUN.

RESULTS In 19.2% of group 1 patients, during the conventional surgical intervention, it was not possible to visualize and remove the foreign body. When removing soft tissue foreign bodies under conditions of additional use of X–ray scanning, we noted damage to large nerve trunks in 3 cases, and the intersection of tendons in various limb segments in 1 case. In 38.5% of patients, the operation was performed under anesthesia. The average length of the incision to remove the fragment was 18 cm (14; 21). The average duration of surgery was 150 minutes (90; 210). In group 1, 5 (19.2%) patients developed postoperative wound infectious complications. The average length of hospital stay was 10 days (7; 18). In patients of group 2, the use of IUN made it possible to clearly visualize the foreign body in soft tissues and nearby anatomically important structures, which ensured the safe performance of closed surgical manipulations in the wound during fragment extraction. In those patients, the operation was performed under local anesthesia. A positive result of the intervention (removal of the foreign body) was achieved in all the cases. The average length of the surgical incision was 1.5 cm (0.9; 2.1). The average duration of the intervention is 18 minutes (11; 24). In the 2-nd group of patients, there were no wound infectious complications in the postoperative period. The average length of hospital stay was 4 days (3; 5).

CONCLUSION The use of IUN in the removal of soft tissue foreign bodies localized in hard-to-reach and “dangerous” anatomical areas can significantly increase the effectiveness of surgical treatment of patients with GSW due to clear visualization of all stages of fragment extraction, optimization of surgical access and surgical technique, which significantly reduces the degree of surgical trauma and shortens the duration of surgery.

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