[Combat gunshot skull and brain injuries]. 2021

Sh Kh Gizatullin, and A V Stanishevskiy, and D V Svistov
Burdenko Main Military Clinical Hospital, Moscow, Russia.

There have been over 15 ended and ongoing armed conflicts in the world between 2014 and 2020. The total number of irrecoverable losses in these conflicts exceeded 800 000 people. In modern conflicts, gunshot head wounds account for 37.4% of sanitary losses of surgical profile. These injuries are characterized by high mortality rate. Changes in fighting nature entail changes in structure of wounds and treatment approaches. OBJECTIVE To analyze treatment strategy and features of surgical interventions for combat gunshot head injuries considering literature data for the period from 2014 to 2020. METHODS We analyzed the PubMed and eLibrary databases using the following keywords: head gunshot wound, traumatic brain injury, head trauma, combat trauma, wartime injury. We selected the reviews, original articles and case reports devoted to head gunshot wound management for the period 2014-2020. Manuscripts in Russian, Ukrainian and English with available abstract and/or full-text article were reviewed. Data on the incidence and structure of craniocerebral injuries, mortality and treatment strategy were analyzed. RESULTS We found 24 publications matching searching criteria. The majority of manuscripts were devoted to craniocerebral wounds received by combatants and civilians during the hostilities in the south-east of Ukraine (7 manuscripts), in Iraq and Afghanistan (4 manuscripts), as well as in the Syrian Arab Republic (12 manuscripts). Craniocerebral wounds occupy a leading position in overall structure of gunshot wounds and result the highest mortality compared to other wounds. There is a tendency towards the prevalence of bullet wounds over splinter wounds. CONCLUSIONS Modern wars and armed conflicts are characterized by changes in the structure of gunshot wounds. Craniocerebral injuries are ones of the most severe and characterized by high mortality. Data on their incidence and structure of gunshot craniocerebral wounds are advisable to be used in planning and organizing care for the wounded, as well as for development of preventive measures.

UI MeSH Term Description Entries
D001930 Brain Injuries Acute and chronic (see also BRAIN INJURIES, CHRONIC) injuries to the brain, including the cerebral hemispheres, CEREBELLUM, and BRAIN STEM. Clinical manifestations depend on the nature of injury. Diffuse trauma to the brain is frequently associated with DIFFUSE AXONAL INJURY or COMA, POST-TRAUMATIC. Localized injuries may be associated with NEUROBEHAVIORAL MANIFESTATIONS; HEMIPARESIS, or other focal neurologic deficits. Brain Lacerations,Acute Brain Injuries,Brain Injuries, Acute,Brain Injuries, Focal,Focal Brain Injuries,Injuries, Acute Brain,Injuries, Brain,Acute Brain Injury,Brain Injury,Brain Injury, Acute,Brain Injury, Focal,Brain Laceration,Focal Brain Injury,Injuries, Focal Brain,Injury, Acute Brain,Injury, Brain,Injury, Focal Brain,Laceration, Brain,Lacerations, Brain
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D012426 Russia A country located in north Asia bordering the Arctic Ocean, extending from Europe (the portion west of the Urals) to the North Pacific Ocean. The capital is Moscow. Russian S.F.S.R.,Russian Federation (Europe),Russian SFSR
D012886 Skull The SKELETON of the HEAD including the FACIAL BONES and the bones enclosing the BRAIN. Calvaria,Cranium,Calvarium,Skulls
D014948 Wounds, Gunshot Disruption of structural continuity of the body as a result of the discharge of firearms. Gunshot Wound,Gunshot Wounds,Wound, Gunshot

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