Abstract
<jats:p>Background. The goal is to demonstrate the features of diagnosis and treatment for gunshot wounds to the neck with tracheal damage. Materials and methods. Patients with gunshot wounds to the neck were divided into two groups: the main one (n = 32), which was formed from February 2022 to February 2026 and used proposed methods of diagnosis and treatment, and the comparison group (n = 31), which was formed from May 2014 to January 2022 and used traditional methods of diagnosis and treatment. All patients were male, their average age was 34.2 ± 3.1 years. Clinical research methods included the study of complaints, anamnesis, and examination data. Instrumental research methods were beam imaging, laser imaging, electrocardiography, video laparoscopy, video thoracoscopy, and metal detection. Radiation studies included fluorography, radiography, radioscopy, computed tomography, and ultrasound. The refinement of foreign body (FB) dimensions was carried out preoperatively using computer vision techniques and algorithms. General clinical, biochemical, coagulation and immunological studies were conducted with the determination of blood group and Rh factor, hepatitis B and C, human immunodeficiency virus, microprecipitation reaction (if there is consent) according to generally accepted methods. Histological studies of the removed tracheal tissues were carried out according to the standard method, with hematoxylin and eosin staining. Treatment outcomes in the long term were evaluated as good, satisfactory and unsatisfactory according to the criteria. Statistical processing was carried out using the standard office package Microsoft Office 2013 with the Microsoft Excel application and statistical programs for medical and biological research Biostatistics (Statistical Graphics Corp., USA), version 4.03 for Windows, Statistica 10.0. Results. According to our data, combat injuries to the neck make up 2.1 % of the total structure of injuries. Isolated neck injuries account for 7.2 %, multiple — 13.3 %, associated — 69.8 %, combined — 9.7 % of cases. Shrapnel wounds to the neck make up 87.2 %, bullet wounds to the neck — 8.6 %, knife wounds — 3.8 %. By type of injuries: soft tissue injury — 83.3 %, oropharynx — 4.5 %, trachea — 1.7 %, esophagus — 1.2 %, neck main vessels — 1.8 %, thyroid gland — 7.5 % of cases. Leading research methods for gunshot wounds to the neck are examination, ultrasound of the neck, X-ray of the neck, multispiral computed tomography, both native and with contrast, video esophagoscopy and video bronchoscopy. Treatment for class I injury — primary surgical debridement (PSD) of the wound; in class II injury — PSD, tracheal suturing, wound cleaning and drainage; in class III — PSD, tracheal suturing, myoplasty, tracheostomy, wound cleaning and drainage; in class IV — PSD, tracheal suturing, primary plastic surgery, tracheostomy, wound cleaning and drainage; in class V — staged surgical treatment with reconstruction. By class, the distribution was as follows: I — 17 (27 %) patients, II — 23 (36.5 %), III — 18 (28.6 %), IV — 5 (7.9 %), V — 0 %. In terms of the detection of tracheal injuries, the classes were distributed in descending order as follows: II — 23 (36.5 %), III — 18 (28.6 %), I — 17 (27 %), IV — 5 (7.9 %), V — 0 % of cases. The scope of surgical intervention was dominated by suturing of the tracheal wound — 23 (36.5 %), followed by non-suturing of the tracheal wound with superficial wound — 17 (27 %), suturing of the tracheal wound with resection of 1 or 2 half-rings and myoplasty — 11 (17.5 %), PSD with tracheostoma — 7 (11.1 %) and primary reconstructive interventions on the trachea (circular and subcircular tracheal resections) — 5 (7.9 %) cases. In the main group, significantly better results are noted than in the comparison group: in the completeness of FB removal — from 1.4 ± 0.1 to 2.4 ± 0.1, duration of FB removal — from 26.3 ± 1.7 to 8.2 ± 1.1 minutes, successful attempts to remove ST — from 1.8 ± 0.1 to 2.6 ± 0.2, severity of pain syndrome — from 6.1 ± 0.2 to 4.2 ± 0.4 points and total bed-days — from 16.5 ± 1.1 to 14.4 ± 1.3. In the main group, the number of complications was 12 (19 %) that is significantly lower (p ≥ 0.001) than in the comparison group — 22 (34.9 %) cases, which is related to the effectiveness of the applied treatment methods. In the near future, tracheal stenosis in the main group developed in 2 (3.2 %) cases, in the comparison group — in 4 (6.3 %). Performing early plastic surgery on the trachea leads to a decrease in the number of stenoses in the distant period. In the main group, results were reliably good (p ≥ 0.05) in 18 (30 %) patients, satisfactory — in 8 (13.3 %), unsatisfactory — in 4 (6.7 %); in the comparison group: good results — 9 (15 %) cases, satisfactory — 11 (18.3 %), unsatisfactory — 6 (10 %), which indicate the effectiveness of the applied treatment methods. Lethality: main group — 2 (6.25 %), comparison group — 4 (12.9 %) cases. Conclusions. A full-fledged comprehensive approach to verifying gunshot wounds to the trachea in modern combat surgical neck trauma, with an emphasis on radiological diagnostic techniques, contributes to their correct stratification and the selection of the optimal method, volume, and time of surgery. The proposed clinical and tactical classification of injuries to the cervical trachea has a direct practical orientation, significantly simplifies and optimizes the process of making decisions when determining treatment. Improved surgical management for cervical tracheal injuries based on a standardized clinical and tactical approach significantly improved the treatment outcomes in this severe category of patients compared to traditional empirical surgical methods. The completeness of FB removal increased significantly (p < 0.05), from 1.4 ± 0.1 to 2.4 ± 0.1, the duration of FB removal decreased from 26.3 ± 1.7 to 8.2 ± 1.1 minutes, the number of successful FB removal attempts increased from 1.8 ± 0.1 to 2.6 ± 0.2, the severity of pain syndrome decreased from 6.1 ± 0.2 to 4.2 ± 0.4 points, and the total bed-days decreased from 16.5 ± 1.1 to 14.4 ± 1.3. The qualitative consequences of implementing improved surgical methods for the treatment of injuries of the cervical trachea based on a standardized clinical and tactical approach indicate that in the main group significantly (p ≥ 0.05) good results were obtained in 18 (30 %) cases, satisfactory — in 8 (13.3 %), unsatisfactory — in 4 (6.7 %) versus comparison group: good results — 9 (15 %), satisfactory — 11 (18.3 %), unsatisfactory — 6 (10 %) cases, which indicates the effectiveness of the applied treatment methods.</jats:p>