PLACE AND ROLE OF SOFT TISSUE ULTRASOUND EXAMINATION IN TOURNIQUET SYNDROME

Authors:

Abstract:

The purpose of the study was to demonstrate and analyze the possibilities of ultrasound diagnosis of tourniquet syndrome. All wounded were admitted at the Military Medical Clinical Center of the Northern Region of the Command of the Medical Forces of the Armed Forces of Ukraine from advanced surgical groups at different times from the wound with an existing tourniquet on the limb at different times after the tourniquet was placed (from 5 to 72 hours, on average 8.2±0.6). There were 32 male wounded. The average age of the wounded was 39.4±2.6 years. According to the location of the tourniquet, the wounded are distributed as follows: shoulder – 5 (15.6 %), thigh – 24 (75 %), leg – 3 (9.4 %) patients. All the wounded underwent an ultrasound and elastographic examinations. We used an average result after 12 measurements of each muscle group. When studying the data of muscle elastography against the background of the existing tourniquet, a significant difference in the elastography indicators of healthy superficial and deep muscles being under the tourniquet due to compression is noted. Elastography indicators in deep muscles are always higher than in superficial muscles. Changes in muscle elastography are localized by the location of the tourniquet. The use of ultrasound examination of soft tissues in tourniquet syndrome has an additional character. According to the data of elastography of soft tissues in the case of tourniquet syndrome, it is possible to determine the extent of soft tissue damage, which is important for determining the size of surgical intervention.

Keywords:

gunshot wounds of the limbs tourniquet syndrome soft tissue elastography ultrasound diagnostics

References:

1. Atlas boyovoyi khirurhichnoyi travmy (dosvid antyterorystychnoyi operatsiyi/operatsiyi ob’yednanykh syl). Pid. red. V.I. Tsimbalyuk. Kharkiv: Collegium, 2021. 385 p [in Ukrainian].
2. Dynnyk OB, Zhaivoronok MM, Kobylyak NM, Kharchenko MS. Ultrazvukova elastohrafiya: teoriya i praktyka stvorennya navchalnoho trenazhera. Promeneva diahnostyka, promeneva terapiya. 2014; 3: 42–53 [in Ukrainian].
3. Khoroshun EM, Makarov VV, Negoduyko VV, Shipilov SA, Klapchuk YuV, Tertyshnyi SV. Problemy diahnostyky ta likuvannya turniketnoho syndromu pry vohnepalnykh poranennyakh verkhnikh i nyzhnikh kintsivok. Khirurhiya dytyachoho viku. 2023; 3(80): 83–91 doi:10.15574/ PS.2023.80.83 [in Ukrainian]
4. Caubère A, de Landevoisin ES, Schlienger G, Demoures T, Romanat P. Tactical tourniquet: Surgical management must be within 3 hours. Trauma Case Rep. 2019; 22: 100217. doi: 10.1016/j.tcr.2019.100217
5. Cheremskyi A, Goloborodko N. Emergency tourniquets: from past to present. EMERGENCY MEDICINE. 2019; (1.96): 42–47. https://doi.org/10.22141/ 2224-0586.1.96.2019.158744.
6. Flattres A, Aarab A, Nougaret S, Garnier F, Larcher R, Amalric M. et al. Real-time shear wave ultrasound elastography: a new tool for the evaluation of diaphragm and limb muscle stiffness in critically ill patients. BMC. Crit Care. 2020; 24: 34. doi: 10.1186/s13054-020-2745-6
7. Glick CPTY, Furer MAJA, Glassberg COLE, Sharon R, Ankory MAJR. Comparison of two tourniquets on a mid-thigh model: the Israeli silicone stretch and wrap tourniquet vs the combat application tourniquet. Mil. Med. 2018; 183 (Suppl 1): 157–161. doi: 10.1093/milmed/usx169.
8. Karamyshev DV, Zhdan VM, Dvornyk VM, Hordiienko LP, Kundii ZhP. Universally applicable approaches to the tactical level of aid and medical support for the personnel of the armed forces of Ukraine. World of Medicine and Biology. 2022; 4(82): 74–79. doi: 10 26724/2079-8334-2022-4-82-74-79
9. Khomenko IP, Tertyshnyi SV, Vastyanov RS, Talalayev KO. Soft tissues gunshot defects ultrasound investigation use in reconstructive-restorative surgery. World of Medicine and Biology. 2021; 3(77): 169–174. doi: 10.26724/2079-8334-2021-3-77-169-174
10. Kragh JF Jr, Dubick MA, Aden JK, McKeague AL, Rasmussen TE, Baer DG, Blackbourne LH. U.S. Military use of tourniquets from 2001 to 2010. Prehosp Emerg Care. 2015; 19(2): 184–90. doi: 10.3109/10903127.2014.964892.
11. Sabate-Ferris A, Pfister G, Boddaert G, Daban JL, de Rudnicki S, Caubere A, Demoures T, Travers S, Rongieras F, Mathieu L. Prolonged tactical tourniquet application for extremity combat injuries during war against terrorism in the Sahelian strip. Eur J Trauma Emerg Surg. 2022; 48(5): 3847–3854. doi: 10.1007/s00068-021-01828-4
12. Spreadborough PJ, Strong AL, Mares J, Levi B, Davis TA. Tourniquet use following blast-associated complex lower limb injury and traumatic amputation promotes end organ dysfunction and amplified heterotopic ossification formation. Journal of Orthopaedic Surgery and Research. 2022; 17: 422. https://doi.org/10.1186/s13018-022-03321-z
13. Stiver ML, Mirjalili SA, Agur AMR. Adult Skeletal Muscle with Ultrasound 2-D Shear Wave Elastography: A Scoping Review. Ultrasound Med Biol. 2023; 49(6): 1353–1362. https://doi.org/10.1016/j.ultrasmedbio.2023.02.005.
14. Vijayan A, Asha ML, Naveen S, Mukhejee I. Elastography: A novel diagnostic method. IP Int J Maxillofac Imaging 2016; 2(4): 129–132. DOI: 10.18231/2455-6750.2016.0001
15. Xue EY, Chandler LK, Viviano SL, Keith JD. Use of FLIR ONE Smartphone Thermography in Burn Wound Assessment. Ann Plast Surg. 2018; 80 (4 Suppl 4): 236–238. doi: 10.1097/SAP. 0000000000001363

Publication:

«World of Medicine and Biology» Vol. 20 No. 87 (2024) , с. 108-113
УДК 616.721.2-002+613.67:617+617.57/.58-001.45-089.81-073.65s

DOI:

https://doi.org/10.26724/2079-8334-2024-1-87-108-113