PATHOMORPHOSIS OF DIAPHRAGMATIC GUNSHOT WOUNDS

Khomenko I. P., Yakimova T. P., Shypilov S. A., Mikhailusov R. М., Nehoduyko V. V.

PATHOMORPHOLOGY

Scentific article

Diaphragmatic damage is a potentially life-threatening condition for the victim, and delay in diagnosis and treatment significantly increases the mortality rate from this type of injury. Microscopic examination of soft tissue of the diaphragm removed during surgical treatment of the wound will reveal peculiarities of pathomorphosis of distant tissues and will help to clarify the pathogenesis of the changes occurring and further development of more effective methods of treatment of diaphragmatic gunshot wounds. Object and methods. Histological studies of biomaterial removed from wounds in 37 wounded patients after primary and repeated surgical treatment of wounds on 1, 2, 3 days after gunshot wounds were performed to study the pathomorphological changes of soft tissues arising after the gunshot wounds of the diaphragm. The study examined the wound surface, the edges of the wound, the wound canal. Evaluated the state of muscle, fibrotic and connective tissue at the cell and tissue level. They noted the presence of altered changes and the degree of their severity. Results and discussion. The peculiarity of the pathomorphism of the diaphragmatic gunshot wounds one day after the injury is the complete lack of signs of reparation and regeneration, signs of chronic inflammation in certain foci of damage and widespread hemorrhage due to damage to the microcirculatory bed. Histologically, the second day after wounding with a low kinetic energy of a firearm, signs of alteration of tissues with weak signs of utilization of destruction dominate, signs of chronic inflammatory processes appear. In the endosomal zone, with retained its functional qualities and capillary vessels, the hearths of future fibroticisation are already formed. The peculiarity of high-energy firearms is the unprecedented fragmentation of soft tissues, multifragmental damage to the diaphragm, the absence of even minimal signs of repair and regeneration the second day after injury. At day 3 after injury, degenerative, atrophic and necrotic processes in the muscle tissue and fibrous tissue of the diaphragm in the area of a gunshot wound have no signs of regeneration. At the same time, in vessels and damaged tissues, signs of chronic inflammation of young collagen fibers, endo- and perimiositis are found, which in the future may intensify and complicate exacerbation, the appearance of abscesses and phlegmonous inflammation. Conclusions. The determined microscopic features of the tissues of the diaphragmatic gunshot wounds obtained as a result of the use of modern high-kinetic weapons require the development of controlled methods of surgical treatment of a gunshot wound with a view to the complete removal of all necrotic and maximal preservation of healthy soft tissues to maintain the mobile function of the diaphragm and prevent the development of purulentinflammatory postoperative complications.

pathomorphosis, gunshot wounds, wounded diaphragm

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«Bulletin of problems biology and medicine» Issue 2 Part 2 (151), 2019 year, 214-219 pages, index UDK 612.014.2:616-001.45:611.26

10.29254/2077-4214-2019-2-2-151-214-219