Ultrasound diagnostics of muscle viability in case of combat limb injury

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Abstract

The paper shows the possibilities of ultrasound diagnostics in case of combat injury of the extremities. The criteria for the viability of muscle tissue are analyzed, and a comparison with other instrumental methods, native and with contrast enhancement, is carried out. The possibilities of new modes of ultrasound diagnostics – micro-V and assessment of total muscle blood flow using digital technology are evaluated. The effectiveness of the technique in detecting the death of muscle tissue due to acute ischemia is shown. In patients with mine explosion injury accompanied by rhabdomyolysis with a high risk of sepsis and multiple organ failure, ultrasound is the safest and most informative method for diagnosing pathological changes in muscle tissue.

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About the authors

A. V. Esipov

National Medical Research Center for High Medical Technologies – the A.A.Vishnevsky Central Military Clinical Hospital of the Ministry of Defense of the Russian Federation

Email: yame77@mail.ru

заслуженный врач РФ, доктор медицинских наук, доцент, генерал-майор медицинской службы

Russian Federation, Krasnogorsk, Moscow region

V. V. Yamenskov

National Medical Research Center for High Medical Technologies – the A.A.Vishnevsky Central Military Clinical Hospital of the Ministry of Defense of the Russian Federation

Author for correspondence.
Email: yame77@mail.ru

заслуженный врач РФ, лауреат Государственной премии РФ, доктор медицинских наук, полковник медицинской службы 

Russian Federation, Krasnogorsk, Moscow region

O. V. Pinchuk

National Medical Research Center for High Medical Technologies – the A.A.Vishnevsky Central Military Clinical Hospital of the Ministry of Defense of the Russian Federation

Email: yame77@mail.ru

заслуженный врач РФ, профессор, полковник медицинской службы

Russian Federation, Krasnogorsk, Moscow region

A. A. Abrosimov

National Medical Research Center for High Medical Technologies – the A.A.Vishnevsky Central Military Clinical Hospital of the Ministry of Defense of the Russian Federation

Email: yame77@mail.ru
Russian Federation, Krasnogorsk, Moscow region

P. A. Zinovev

National Medical Research Center for High Medical Technologies – the A.A.Vishnevsky Central Military Clinical Hospital of the Ministry of Defense of the Russian Federation

Email: yame77@mail.ru
Russian Federation, Krasnogorsk, Moscow region

M. A. Voronova

National Medical Research Center for High Medical Technologies – the A.A.Vishnevsky Central Military Clinical Hospital of the Ministry of Defense of the Russian Federation

Email: yame77@mail.ru
Russian Federation, Krasnogorsk, Moscow region

M. S. Avdeev

National Medical Research Center for High Medical Technologies – the A.A.Vishnevsky Central Military Clinical Hospital of the Ministry of Defense of the Russian Federation

Email: yame77@mail.ru
Russian Federation, Krasnogorsk, Moscow region

References

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  2. Бояринцев В.В., Кутепов Д.Е., Пасечник И.Н., Федорова А.А. Рабдомиолиз. Междисциплинарный подход. – М.: ГЭОТАР-Медиа, 2023. – 144 с.
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  4. Есипов А.В., Пинчук О.В., Яменсков В.В. Лечение сочетанных костно-сосудистых повреждений конечностей в многопрофильном военном госпитале // Воен.-мед. журн. – 2020. – Т. 341, № 1. – С. 34–38.
  5. Есипов А.В., Фокин Ю.Н., Пешехонов Э.В., Апевалов С.И., Алехнович А.В., Есипов А.С. Дорожная политравма: опыт организации лечебно-диагностического процесса в многопрофильном стационаре // Воен.-мед. журн. – 2020. – Т. 341, № 6. – С. 9–15.
  6. Петровский Б.В. Краткий исторический обзор учения об огнестрельных ранениях кровеносных сосудов // В кн.: Опыт советской медицины в Великой Отечественной войне 1941–1945 гг. – М.: Медгиз, 1955. – Т. 19, Гл. I. – С. 15–25.
  7. Смирнов А.В., Добронравов В.А., Румянцев А.Ш., Каюков И.Г. Острое повреждение почек. – М.: ООО «Медицинское информационное агентство», 2015. – 488 с.
  8. Фундаментальные вопросы высокотехнологичной медицинской помощи при дорожно-транспортной политравме / Под ред. А.В.Есипова. – М.: Наука, 2021. – 453 с.

Supplementary files

Supplementary Files
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2. Fig. 1. Ultrasound scanogram. Wounded C. Absence of structural integrity of the muscles of the anterior group of the right tibia (A) and preserved structural integrity of the muscles of the left tibia (B)

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3. Fig. 2. Ultrasound scan of the injured right femur. The same injured person. Decreased total blood flow in the rectus muscle of the right thigh: 11% of pixels (arrow) on the right

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4. Fig. 3. Ultrasound scanogram. Same wounded man. Contralateral left lower extremity. Total blood flow in the rectus muscle of the left thigh is 27.9% pixels (arrow)

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5. Fig. 4. Ultrasound scanogram. The same wounded man. Collateral blood flow in the right posterior tibial artery

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6. Рис. 5. Ультразвуковая сканограмма. Тот же раненый. Магистральный характер кровотока по контрлатеральной левой задней большеберцовой артерии

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7. Fig. 6. Ultrasound scanogram in micro-V mode. Same wounded C. Deterioration of microcirculation in the injured muscle of the right tibia (A) and unchanged muscle of the contralateral left tibia (B)

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8. Fig. 7. Ultrasound scanogram. The same injured person. Reduced elasticity of the injured muscle of the right tibia, predominance of red color scheme

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9. Fig. 8. Ultrasound scanogram. The same injured person. Normal elasticity of the muscle of the contralateral left tibia, green color predominance

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10. Fig. 9. Zone of muscle fiber necrosis (cardiolysis, plasmocoagulation), formation of necrotic detritus: 1 - zones of demarcation inflammation; 2 - infiltration with polymorphonuclear leukocytes, many macrophages. Coloration: hematoxylin-eosin

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11. Fig. 10. Total necrosis: 1 - necrosis zone of muscle fibers (cardiolysis, plasma coagulation); 2 - inflammatory infiltration of polymorphonuclear leukocytes. Coloration: hematoxylin-eosin

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Copyright (c) 2024 Esipov A.V., Yamenskov V.V., Pinchuk O.V., Abrosimov A.A., Zinovev P.A., Voronova M.A., Avdeev M.S.


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