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

Abstract

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.

Keywords

• perforator flap
• gunshot defects of the lower extremities
• reconstruction