Woundary ballistics of biological tissue’s plastic deformation on the model of ballistic plastiline using hollow point and shape-stable bullets

Introduction. Modern military conflicts make many challenges for military surgeons associated with the use of new types of weapons – hollow point bullets. The solution to this problem, firstly, depends on studying the characteristics of the terminal ballistics of such ammunition and comparing the data obtained with the characteristics of traditional weapon. The aim of the work is to conduct experimental modeling of the wound canal and residual wound cavity, which is formed due to plastic deformation from hollow point and non-hollow point bullets. Materials and methods. The studies were carried out on 40 blocks of ballistic plasticine, in each of which one shot was fired from an AKS-74 assault rifle and a ZBROYAR Z-10 carbine. Depending on the type of ammunition, the blocks of ballistic plasticine were divided into 4 groups: Group 1 – 10 blocks into which shots were made with 5.45 mm non-hollow point military cartridges with "PS" bullets with a steel core "7N6"; Group 2 (10 blocks) – 5.45x39 mm cartridges with "V-Max" hollow point bullets; Group 3 (10 blocks) – with cartridges 7.62x39 mm; Group 4 (10 blocks) – cartridges 7.62x39 mm with hollow point bullets of the "SP" type. Results and discussion. Only for a 5.45 mm military cartridge with "PS" bullets, both inlet and outlet bullet holes were detected in all 10 observations. When using non-hollow point bullets, the outer area of ​​the bullet inlet correlates with the caliber of the projectile (1.6 times larger when using 7.62 mm bullets). For hollow point bullets, the caliber of the projectile does not significantly affect the area of ​​the inlet (P < 0.05). The expansive properties of the bullet significantly increase the area of ​​the bullet hole by 14.87-31.2 times compared to non-hollow point ammunition. Increasing the caliber of the non-hollow point bullet leads to a significant increase in the area of ​​the sagittal section of the residual wound cavity in 1.59-2.03 times; whereas the expansive properties of the bullet do not significantly affect either the perimeter or the area of ​​the sagittal section of the residual wound cavity. For non-hollow point bullets, the volume of the residual wound cavity is more correlated with the caliber of the bullet (increases by 3.36 times); whereas for an hollow point bullet, its caliber has a smaller effect on the volume of the residual cavity (increases by 1.37 times). The expansive properties of the bullet affect the volume of the residual wound cavity in two ways: for 5.45 mm bullets the residual wound cavity increases 1.49 times, for 7.62 mm bullets it decreases 1.65 times. The use of hollow point bullets of 7.62 mm leads to greater collateral damage (zone of secondary necrosis, molecular shock) due to the scattering of the kinetic energy of the bullet to the elastic deformation of near-woundary tissues compared to non-hollow point analogues. The use of 5.45 mm expansive bullets leads to the formation of a larger volume of irreversible damage due to plastic deformation compared to non-hollow point analogues. Conclusions. The resulting model of plastic deformation of soft tissues, depending on the type of modern small arms, showed the dependence of the spatial configuration of the inlet bullet hole, residual wound cavity and deformation and fragmentation of the bullet on the caliber of the cartridge and its expansive properties

Penetrating gunshot wounds to the penis: a case report of combat patient injured in the war in Ukraine

Abstract 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

A new approach for reconstruction of the gunshot defect of the flexor surface of the ungual (distal) phalanx by the proper transverse branch of the digital artery: a case report of combat patient injured in the Russo-Ukrainian war

Abstract 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