A clinical case of using the concept of monitoring in the treatment of a gunshot defect of the soft tissues of the knee joint

Rapid rehabilitation and restoration of the function of damaged anatomical areas in the military is the main goal of military medicine. In the case of gunshot wounds of the knee joint with defects of soft tissues, one of the optional methods of reconstructive and plastic "closure" is the usage of a propeller flap. The clinical case represents a mine-explosive wound of the lower extremities with a defect of the soft tissues of the lateral aspect of the right knee joint in a serviceman of the Ukrainian Armed Forces as a result of artillery shelling in the east of Ukraine in November 2022. There was an isolated shrapnel tangential non-penetrating wound on the lateral aspect of the right knee joint with a soft tissue defect measuring 7.2x3.2-1.0 cm. The aim of the work was to study the thermographic and sonographic features of soft tissue perfusion after gunshot injuries of the lower extremities and on the basis of the temperature dynamics data from the wound surface in combination with the sonographic examination of the vessels to determine the rationality and relevance in the reconstruction of defects of the lower extremities by propeller tactics. Reconstruction with flap with a perforating vessel as the "key" of LSGA (lateral superior genicular artery) and a dynamic multimodal concept (DMT) with the use of audio doppler in the pre-, intra- and postoperative period) with closure of the defect due to a rotary perforating flap with supplying was carried out. During the entire period of treatment, of the injured the temperature background from the surface of the flap was followed up using FLIR C2, and sonographic changes in blood flow were monitored in the projection of the LSGA location. We came to the conclusion that applying the technique of flaps on perforating vessels, several goals are tactically achieved: restoration of the completeness and function of the damaged area, reduction of complications in the recipient and donor areas. Thus, the propeller flap can be classified as a primary option for "replacemen t" of tissues among the restorative tactics of the damaged area of the lower extremities caused by a gunshot origin

Endocrine dysfunction in the pathogenesis of combat surgical trauma and post-traumatic stress disorder (scientific review)

The modern hostilities have created the unique challenges for medical, surgical and rehabilitation assistance to people liable for military service who have sustained injuries in the battle conditions. The experience of providing medical care for participants of modern military operations has shown that endocrine dysfunction is a leading pathogenetic link that affects the human body in combat surgical trauma and post-traumatic stress disorders. The main pathogenetic mechanism of trauma and post-traumatic stress disorders is associated with dysfunction of the hypothalamic-pituitary-adrenal axis. Hormones such as cortisol, dehydroepiandrosterone, adrenaline and noradrenaline are involved in the neuroendocrine mechanisms of stress development. These hormones regulate and control the stress response, reflecting the stages of its course and the adaptive capacities of the organism. Dysfunction of the hypothalamic-pituitary-thyroid axis has a significant importance in the regulation of both acute and chronic stress accompanied by the clinical development of various thyroid disorders such as hyperthyroidism, Graves’ disease, autoimmune thyroidopathies and nodular transformation. Therefore, the practical significance lies in the clinical studying the key indicators of pituitary-adrenal and pituitary-thyroid function, monitoring the function of the adrenal glands and the thyroid. Correction of these disorders, the treatment and rehabilitation of patients with combat-related traumatic injuries should be carried out with specialized endocrinological assistance. This approach will be relevant for military medicine in Ukraine in the following years

DEFINITIONS OF SURGICAL CARE TO WOUNDED WITH SOFT TISSUES DEFECTS GUNSHOT WOUNDS ON THE III AND THE IV LEVELS OF MEDICAL CARE MAINTENANCE DURING THE ATO/JFO

Relevance. The large number of wounded in modern military conflicts “encourages” and in some cases requires revision and modernization of previous views, concepts and theories of medical care providing to wounded during military operations. The optimal concept for the surgical care provision transformation to wounded with soft tissues gunshot defects is to change the approach and tactics of viewpoint at soft tissues gunshot defects which should tactically and strategically rely on the principles of reconstructive and restorative surgery which corresponds to NATO countries medical protocols. Objective: to establish the characteristics of the main and additional diagnostic and treatment schemes the content and volume of surgical care for the injured with soft tissues gunshot defects in the conditions of the III and IV levels of medical care providing in the Military Medical Forces of the Ukrainian Armed Forces. Materials and methods. 342 wounded were included into the study who were treated in the health care system of the Ukrainian Armed Forces from December 2016 to December 2021. 128 of them consisted the main group and 214 - the comparison group. The third level of medical support was formed and implemented at the operational level at the expense of surgical departments (clinics) of the Military Medical Clinical Centers of the Northern and Eastern Regions, medical institutions of the Ministry of Health of Ukraine and provided for the provision of specialized medical assistance: diagnosis of injuries and necessary inpatient treatment of the wounded with the aim of their fastest return to military units or referral to the fourth level of medical care. The fourth level of medical care (highly specialized treatment and rehabilitation) was formed and implemented at the strategic level on the basis of Military Medical Clinical Centers (National, Southern, Central and Western regions Region), research institutes of the National Academy of Sciences of Ukraine and provided for provision of highly specialized medical care using high-tech equipment and highly specialized medical procedures of high complexity. Results. In general, the experience of the Ukrainian Armed Forces medical support during ATO/JFO showed the high efficiency of specialized surgical treatment of the injured with soft tissues gunshot defects in highly specialized departments of treatment and prevention institutions of the IV level using the most effective diagnostic and treatment technologies. We believe that a similar transformation of medical care provision to the wounded took place due to the fact that, in accordance with the proposed and implemented differentiated surgical tactics with a multimodal approach to wounded with soft tissues gunshot defects reconstruction, new staffs of medical companies of brigades and battalion medical posts were proposed and approved during the JFO, the positions of riflemen were introduced paramedics of departments, combat medics of platoons, senior combat medics of companies. Taking into account the results obtained it should be noted that the system of medical care providing for the transition to a higher level should include: - the possibility of qualified medical assistance providing from the II level aimed at recovery, stabilization, and in some cases saving the life of a wounded serviceman on the basis of "damage control resuscitation" which meets the NATO protocols requirements; - available in terms of time and operational situation, the use of air evacuation for the purpose of wounded with gunshot defects of soft tissues, which demonstrates an increase in the rate of preservation of 20-25% of the volume of the damaged anatomical structure; - use of modern additional technologies in the form of dynamic digital thermography and audio doppler. Conclusions. The listed positions obtained during the surgical care implementation at the III-IV levels of medical care have demonstrated that the use of additional alternative portable technologies meets the requirements and conditions of a rapidly changing theater of operations in a modern military conflict

Prospects of non-drug approaches to Alzheimer's disease

Despite the urgency of the problem of prevention and treatment of neurodegenerative processes underlying Alzheimer's disease (AD) and other severe disorders of the central nervous system, therapeutic and prophylactic potential of drugs is yet insufficient. Numerous adverse effects of the drugs, which might improve cognitive function in patients with AD substantiate serious consideration of measures enhancing adaptive potential and mobilizing self-defense of the body. It is clear now that endogenous defense systems of the brain can limit progression of AD long after the onset of the disease. The measures mobilizing the self-defense include administration of natural adaptogens and various types of adaptation, such as adaptation to dietary restrictions, promotion of physical and mental activity, and adaptation to hypoxia. This review presents data supporting a hypothesis that non-drug activation of self-defense of the body can prevent cognitive decline induced by neurodegenerative processes in the brain by targeting key points of AD pathogenesis

Possible use of adaptation to hypoxia in Alzheimer's disease: A hypothesis

Disorders in memory and other cognitive functions in Alzheimer's disease (AD) may result from an exhaustion of adaptive reserves in the brain. Therefore it is a challenge to find methods to increase the adaptive reserve of the organism to combat AD. Excitotoxicity, Ca2+ homeostasis disruptions, oxidative stress, disturbed synthesis of NO, and impaired cerebral circulation are suggested as key pathogenic factors of AD. At present it appears that stimulation of the self-defense systems in neural cells is a promising strategy in restricting the progression of AD. These systems include those of antioxidants, heat shock proteins (HSPs), NO, and other so-called stress-limiting systems. Non-drug activation of these systems can be achieved most efficiently by adaptation of the organism to environmental challenges, such as hypoxia. In this paper the potential of methods used in adaptive medicine is explored. The protective mechanisms of adaptation to hypoxia may be related to restriction of oxidative stress in the hippocampus, the limitation of a decrease in NO production induced by β-amyloid, and increased density of the vascular network in the brain. In this review we selectively present data that support the idea that adaptation to hypoxia is a possible non-drug means in the prevention of AD. In our opinion this strategy may provide a break-through in the clinical approach of this disease. © Med Sci Monit, 2005

Prospects of non-drug approaches to Alzheimer's disease

Despite the urgency of the problem of prevention and treatment of neurodegenerative processes underlying Alzheimer's disease (AD) and other severe disorders of the central nervous system, therapeutic and prophylactic potential of drugs is yet insufficient. Numerous adverse effects of the drugs, which might improve cognitive function in patients with AD substantiate serious consideration of measures enhancing adaptive potential and mobilizing self-defense of the body. It is clear now that endogenous defense systems of the brain can limit progression of AD long after the onset of the disease. The measures mobilizing the self-defense include administration of natural adaptogens and various types of adaptation, such as adaptation to dietary restrictions, promotion of physical and mental activity, and adaptation to hypoxia. This review presents data supporting a hypothesis that non-drug activation of self-defense of the body can prevent cognitive decline induced by neurodegenerative processes in the brain by targeting key points of AD pathogenesis

Possible use of adaptation to hypoxia in Alzheimer's disease: A hypothesis

Disorders in memory and other cognitive functions in Alzheimer's disease (AD) may result from an exhaustion of adaptive reserves in the brain. Therefore it is a challenge to find methods to increase the adaptive reserve of the organism to combat AD. Excitotoxicity, Ca2+ homeostasis disruptions, oxidative stress, disturbed synthesis of NO, and impaired cerebral circulation are suggested as key pathogenic factors of AD. At present it appears that stimulation of the self-defense systems in neural cells is a promising strategy in restricting the progression of AD. These systems include those of antioxidants, heat shock proteins (HSPs), NO, and other so-called stress-limiting systems. Non-drug activation of these systems can be achieved most efficiently by adaptation of the organism to environmental challenges, such as hypoxia. In this paper the potential of methods used in adaptive medicine is explored. The protective mechanisms of adaptation to hypoxia may be related to restriction of oxidative stress in the hippocampus, the limitation of a decrease in NO production induced by β-amyloid, and increased density of the vascular network in the brain. In this review we selectively present data that support the idea that adaptation to hypoxia is a possible non-drug means in the prevention of AD. In our opinion this strategy may provide a break-through in the clinical approach of this disease. © Med Sci Monit, 2005