Journal of Clinical Practice · Published 2026-07-01 · DOI 10.17816/clinpract713711
Alexander V. Smirnov, Aishe A. Keshvedinova, Ivan L. Anyushin, Vladimir Yu. Gritsun, Evgeny A. Epifantsev, Evgeny A. Velichko, Viktor N. Lesnyak, Iraida A. Demina, Tatiana V. Klypa, Nikolay A. Soloviev, Yury V. Ivanov, Aleksandr V. Troitskiy
BACKGROUND: Chest injuries account for a significant proportion of all combat trauma and are associated with mortality categorized as «preventable» or «potentially preventable». AIM: To characterize, through retrospective analysis, a cohort of casualties sustaining combat chest trauma from modern weaponry, and to compare the immediate outcomes of two surgical management strategies — comprehensive (Early Total Care) versus minimally sufficient surgical care (Early Appropriate Care) — delivered in a civilian hospital located in close proximity to the front line. Methods: A retrospective study of the immediate treatment outcomes of 304 wounded was conducted. Patient groups were stratified based on the nature of the wound (penetrating wound/blunt blast trauma) and the surgical strategy used (active in the initial period of treatment, followed by a transition to minimally adequate). Results: Penetrating mine-blast chest wounds were present in 187 patients, non-penetrating mine-blast chest trauma with pulmonary contusion — in 117. Multislice computed tomography (MSCT) was performed in all casualties. Patients with penetrating wounds were divided into two subgroups: subgroup I received comprehensive surgical care under the Early Total Care (ETC) principle (n=88; thoracotomy was performed in 36 (41%) patients, pleural drainage in 52 (59%)); subgroup II received minimally sufficient surgical care under the Early Appropriate Care (EAC) principle (n=99; initial pleural drainage was performed in all patients, and thoracotomy was required in only 3 (3%) cases during an observation period of 22.4±1.2 hours). Both subgroups were statistically comparable with respect to injury severity and hemothorax volume (p 0.05). The study demonstrated no difference in immediate outcomes between subgroups (including achievement of adequate oxygen saturation without respiratory support, hemodynamic stabilization with cessation of active hemorrhage, complete lung re-expansion, and absence of mediastinal shift on follow-up chest radiography). Mean time to evacuation to the next echelon of care was 28.1±2.5 hours in Subgroup I and 22.4±1.2 hours in Subgroup II (p=0.03). Among patients with blunt blast chest trauma, pleural drainage was required in 21 (17.9%) and thoracotomy in 1 (0.85%). No in-hospital deaths occurred in any group. CONCLUSION: Transitioning to a minimally sufficient surgical strategy for modern mine-blast chest trauma — specifically, initial pleural drainage with a large-bore silicone tube and thoracotomy reserved for strict indications — does not result in deterioration of immediate outcomes at the forward stage of care, enables a significant reduction in time spent at the front-line hospital, and facilitates earlier evacuation to rear medical facilities.
Abstract from DOAJ. Public domain (CC0 1.0).
Read the article at the publisher →
Smirnov, A., Keshvedinova, A., Anyushin, I., et al. (2026). DIAGNOSIS AND TREATMENT OF COMBAT-RELATED MINE-EXPLOSIVE CHEST TRAUMA AT THE FOREFRONT OF MEDICAL EVACUATION IN A CIVILIAN HOSPITAL. Journal of Clinical Practice. https://doi.org/10.17816/clinpract713711