I M Samokhvalov

Saint Petersburg Medical Academy, Sankt-Peterburg, St.-Petersburg, Russia

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Publications (39)2.49 Total impact

  • V A Reva · I M Samokhvalov
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    ABSTRACT: Rapid growth of medical technologies has led to implementation of endovascular methods of diagnosis and treatment into rapidly developing battlefield surgery. This work based on analysing all available current publications generalizes the data on using endovascular surgery in combat vascular injury. During the Korean war (1950-1953) American surgeons for the first time performed endovascular balloon occlusion of the aorta - the first intravascular intervention carried out in a zone of combat operations. Half a century thereafter, with the beginning of the war in Afghanistan (2001) and in Iraq (2003) surgeons of central hospitals of the USA Armed Forces began performing delayed endovascular operations to the wounded. The development of technologies, advent of mobile angiographs made it possible to later on implement high-tech endovascular interventions in a zone of combat operations. At first, more often they performed implantation of cava filters, somewhat afterward - angioembolization of damaged accessory vessels, stenting and endovascular repair of major arteries. The first in the theatre of war endovascular prosthetic repair of the thoracic aorta for severe closed injury was performed in 2008. Russian experience of using endovascular surgery in combat injuries is limited to diagnostic angiography and regional intraarterial perfusion. Despite the advent of stationary angiographs in large hospitals of the RF Ministry of Defence in the early 1990s, endovascular operations for combat vascular injury are casuistic. Foreign experience in active implementation of endovascular technologies to treatment of war-time injuries has substantiated feasibility of using intravascular interventions in tertiary care military hospitals. Carrying out basic training courses on endovascular surgery should become an organic part of preparing multimodality general battlefield surgeons rendering care on the theatre of combat operations.
    Angiologii͡a i sosudistai͡a khirurgii͡a = Angiology and vascular surgery 06/2015; 21(2):166-175.
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    ABSTRACT: The aim of the given study was development of surgical tactics in case of femoral artery injury, caused by medium-calibre bullet, on the basis acute experiment on large biological objects. Experimental animals were shot into mid third of the femora by a rifle cartridge in 7,62-mm calibre (AK-47 made in 1943). The analysis of microstructure, made in 5 cross-sections performed every 1-centimetre way from the wound canal, showed that there were no any damages of arterial wall. Authors came to conclusion that the surgical debridement of the gunshot wound, made by a rifle cartridge in 7,62-mm calibre of AK-47, should consist of exsection of devitalized section of artery.
    Voenno-medit͡sinskiĭ zhurnal 12/2014; 335(10):19-24.
  • I M Samokhvalov · V A Reva · V Iu Ul'chenko
    Vestnik khirurgii imeni I. I. Grekova 07/2014; 173(2):105-11.
  • I M Samokhvalov · A V Zhabin · A R Grebnev · V I Badalov · G E Trufanov · V V Suvorov
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    ABSTRACT: In severe abdominal trauma ultrasound provides fast and accurate diagnostics of damages and detect the source of internal bleeding. In the absence of trained professionals (in injury care centre of 2-3rd levels, In emergency situations) it is possible to use by the method of research in the reduced volume. The article presents a comparative analysis of the use of traditional methods and reduced ultrasound diagnostics of abdominal injuries on 56 victims. Concluded that reduced ultrasound is affordable, mobile, fast and accurate method of diagnosis, allowing to use it repeatedly.
    Voenno-medit͡sinskiĭ zhurnal 07/2014; 335(4):30-6.
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    ABSTRACT: Massive intracavitary hemorrhage in case if severe concomitant injury is the most frequent cause of death. Necessity of blood loss replacement requires effective and safe methods. One of them is blood reinfusion - technically less complicated method. The article shows advantages of using the hardware and filtration methods of blood sampling and reinfusion, developed scale rapid diagnosis of the level of hemolysis of autologous blood. Using of the method of filtration blood sampling provides 2X minimal amount of free hemoglobin than using an aspirator and reinfusion of blood with the contents therein to free hemoglobin 2.0g/ L prevents the risk of developing the syndrome and massive blood transfusion reduces the incidence of deaths at 11%. In patients with massive intracavitary hemorrhage it is advisable to use the method of semi-quantitative rapid analysis of free hemoglobin color scale.
    Voenno-medit͡sinskiĭ zhurnal 07/2014; 335(3):26-30.
  • I M Samokhvalov · V A Reva
    Voenno-medit͡sinskiĭ zhurnal 04/2014; 335(1):77-80.
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    ABSTRACT: The article describes the clinical case and analyzes the literature concerning endoprosthesis replacement in the case of traumatic thoracic aortic injury in polytrauma. Current strategy of diagnostics and treatment of patient in critical condition with rupture of isthmic aortic part is based on the principle of multistage surgical treatment (damage control orthopedic). The external fixation of multiple pelvis and extremities fractures and on-time implantation of stent-graft in thoracic aortic part were performed at first hours after the admission. A condition of the patient was stabilized. The delayed reconstructive operations on pelvis and extremities bones allowed obtaining the satisfactory functional result. The principles of staged surgical treatment and the use of on-time high-technology methods allowed saving life for the patient even in critical situation in I level traumatologic centre.
    Vestnik khirurgii imeni I. I. Grekova 03/2014; 172(5):101-7.
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    ABSTRACT: Ongoing intra-abdominal bleeding is the main life-threatening sequence of blunt abdominal trauma. The use of local hemostatic agents allows achieving fast and reliable hemorrhage control in case of parenchymatous organs injury. We investigated the efficacy of a dressing "Celox Gauze" in an experimental model of grade IV liver injury in large animals in the setting of coagulopathy. We used the following experimental model: 30-35% of blood volume was withdrawn followed by severe liver injury and hemostatic agent application. Laboratory tests were controlled in three endpoints. Hemostasis was evaluated in 2 days. "Celox Gauze" was effective for hemorrhage control in 100% of cases. All animals survived until the end of the experiment. Perihepatic packing with "Celox Gauze" applied is more effective to control hemorrhage than packing only. It has been noted lower volume of blood loss, lower decrease of red blood cells in animals of "Celox Gauze" group. We noted no adverse effects. Histological analysis showed the absence of any significant local hepatic damage. In whole the local hemostatic agent "Celox Gauze" has been shown highly effective in the model of parenchymatous bleeding. Additional studies with more number of animals are warranted to confirm our results.
    Voenno-medit͡sinskiĭ zhurnal 03/2014; 334(11):24-30.
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    ABSTRACT: A goal of this study is to review perspective technologies of surgical care to the wounded on the basis of an analysis of the experience in medical support in local armed conflicts and a study of the achievements of modern trauma surgery. The study is based on the analysis of personal experience, results of scientific researches being carried out in the Military Medical Academy and a comparison review of available papers and works in the field of our study. Perspective technologies of surgical care to the wounded are strongly dependent on the pre-hospital care: high technologies in personal medical equipment, special disposable devices used in case of life-threatening consequences of injuries and traumas during emergency medical care and advanced trauma management. The main innovation of the last ten years in war surgery is considered to be damage control surgery. Wide application of abbreviated surgical operations (the first phase of damage control surgery) makes the use of remote surgery (telesurgery) for treatment of the wounded more practicable. Increasing effectiveness of military surgeon education is based on the use of all possible achievements in education and information technologies. Feedback in surgical care to the wounded is supplied with analysis of its results in the medical Register of the wounded military.
    Voenno-medit͡sinskiĭ zhurnal 09/2013; 334(6):24-30.
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    ABSTRACT: Pathogenesis and early diagnosis characteristics of acute deep vein thrombosis (advt) have been studied in 323 polytrauma patients (iss: 29.4 +/- 2.0 score). Acute vein thrombosis, confirmed by us examination, was determined in 22.3% of patients (in the case of severe craniocerebral trauma--scct--12.6%, extremity trauma--60.5%, spinal trauma 75%, severe sepsis--25%). Despite the complex diagnosis and prophylaxis (thrombus removal, thrombosed veins ligation, external iliac vein and inferior vena cava clipping, permanent and removable cava-filters positioning) pulmonary artery thromboembolism (pate) developed in 3.1%. ADVT in patients with polytrauma developed as a pathogenic basis of systemic inflammatory response syndrome (sirs), which was observed to be associated with endothelium damage and thrombophilia. Hence, thrombophilia values (high levels of crp, f.viiia, D-dimer, low levels of antithrombin iii--at-iii), which are characteristic of sirs, lose their informativeness in the early diagnosis of advt and pate risks identification. In this regard, early advt diagnosis in polytrauma should be based on doppler study results, and the adequacy of anticoagulant and antiplatelet therapy should be determined by the levels of crp, f.viiia, D-dimer, activated partial thromboplastin time--aptt, anti- xa heparin activity, international normalized ratio--inr, platelet aggregation, thrombodynamic potential, at-iii.
    Voenno-medit͡sinskiĭ zhurnal 08/2013; 334(8):25-30.
  • I M Samokhvalov · V A Reva · A A Pronchenko · A N Petrov
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    ABSTRACT: The authors consider one of possible variants of surgical treatment of shoulder girdle trauma, which is accompanied by an injury of the main artery. It is based on the application of the principle of staged surgical treatment (damage control orthopedic). The well-timed sufficient diagnostics and treatment of bone-arterial trauma, coordinated work of several surgical teams, the appropriate postoperative management of patients with the using of postponed high-technology intervention allowed obtaining an optimal functional result for extremely severe multitrauma of the chest and limb.
    Vestnik khirurgii imeni I. I. Grekova 07/2013; 172(1):45-9.
  • I M Samokhvalov · P K Kotenko · V V Severin
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    ABSTRACT: There are two triage groups of the walking wounded in a medical company of a brigade/special-purpose medical team: those returning to fighting role and those who have to be evacuated to level 3 echelon of care. The main purposes of surgical care of the walking wounded in the 3rd echelon of care are the following: diagnosis of injury pattern ruling out severe damages and separation of the independent category of the walking wounded. There is medical evacuation of the walking wounded from the 3rd echelon to the 4th echelon deployed in a combat zone. The walking wounded who needs less than 30 days of staying in hospital are evacuated to the garrison military hospitals and medical treatment facilities subordinated to a district military hospital. The wounded with the prolonged period of hospitalization (more than 30 days) are evacuated toward the district military hospital. Treatment of the walking wounded should be accomplished in the military district where the armed conflict goes on.
    Voenno-medit͡sinskiĭ zhurnal 06/2013; 334(1):4-8.
  • Igor M Samokhvalov · Nikolay A Tyniankin · Viktor A Reva · Todd E Rasmussen
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    ABSTRACT: Vladimir A. Oppel (1872-1932) was a forefather of military trauma systems. As a surgeon in the Russian Army in World War I, Oppel experienced the challenges and inefficiencies associated with caring for large numbers of combat wounded, the inefficiencies he observed leading to unacceptable morbidity and mortality. As a consequence, Oppel envisioned a coordinated sequence of surgical care on the battlefield and developed the concept of "targeted evacuation." In his work, Oppel was among the first to propose the "right operation for the right patient at the right location at the right time." Central to Oppel's precepts were (1) the forward positioning of surgical care close to the point of injury, (2) the development of a reserve of proficient and deployable military surgeons, and (3) the provision of specialized surgery to optimize survival and reduce morbidity. Oppel's teachings were validated during World War II in the performance of the Soviet casualty evacuation system and in all modern wars modern since. Today, nearly 100 years after the work of Vladimir Oppel, the benefits of a coordinated or "targeted" trauma system, working to optimize survival after trauma, are well recognized around the world.
    04/2013; 74(4):1178-81. DOI:10.1097/TA.0b013e3182858407
  • I M Samokhvalov · A A Pronchenko · V A Reva
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    ABSTRACT: External hemorrhage of extremities wounds is the leading cause of soldiers' death on the battlefield. In these cases control of massive arterial bleeding require not only prompt and effective measures, but also safety procedure. We assessed on volunteers the effectiveness, application time and pain intensity during the use of construction powerful quick-grip one-handed bar clamp. In results we found that the use of improvised quick-grip clamp for hemorrhage control in axillary and popliteal areas stops arterial blood flow in an extremity in all cases proven by Doppler ultrasound examination. Application time in axillary zone was 15.3 +/- 5.2 sec, in popliteal area--27.3 +/- 8.0 sec. In the groin area, the use of this improvised device was not effective due to technical characteristics (small distance between the main frame and the pressure surfaces). There do appear to be sufficient reasons to design the universal clamp for hemorrhage control from the wounds of junctional zones as well as proximal segments of extremities on Advanced Trauma Management stage and also for civilian prehospital emergency care.
    Voenno-medit͡sinskiĭ zhurnal 01/2013; 333(11):39-44.
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    ABSTRACT: The organization of surgical care for the wounded in various local wars and armed conflict has its own characteristics, the study of which is necessary to optimize the planning of medical evacuation support of troops. It is based on the concept on an early specialized surgical care. The paper discusses the problematic issues of medical care to the wounded in past peacekeeping operations, and analyze features of specialized surgical care.
    Voenno-medit͡sinskiĭ zhurnal 10/2012; 333(7):4-10.
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    ABSTRACT: In terms of prognosis of the outcome of traumatic disease as a disease of adaptation particularly significant is a functional component. Updating of options of the course of traumatic disease allow to combine two principles of intensive care such as individual focus and standardization. Innovations of recent years, embedded into the battlefield surgery clinic of Military Medical Academy n. a. S.M.Kirov in tactics and content of intensive care, improved the current situation on the results of treatment of patients with polytrauma.
    Voenno-medit͡sinskiĭ zhurnal 02/2012; 333(2):19-24.
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    ABSTRACT: Damage control surgery (DCS) is an important option in the store of war surgery and surgery of trauma. The main purpose of our investigation was to specify the percentage of the injured who need DCS. We performed retrospective study of the patients in the combat operations in Chechnya (1994-2002) and in peacetime (2005-2010). Total lethality in group with the standard surgical approach was 62.3%. It was significantly higher than the lethality in group of patients who underwent DCS - 50.0% (p < 0.05). Thus, the experience of DCS in War Surgery Department confirms that DCS is perspective tendency in treatment of patients with severe and extremely severe trauma, and allows decreasing lethality in 12.3%.
    Voenno-medit͡sinskiĭ zhurnal 09/2011; 332(9):30-6.
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    ABSTRACT: The deaths happened as a result of wounds caused by non-lethal weapon (NLW) are mainly associated with severe and extremely severe damage of brain. However, vast number of specific problems occurs in cases of extracranial gunshot wounds caused by NLW. Taking into account little physicians' experience, and absence of standard approaches to treatment of these wounds till now. This paper embraces peculiarities of clinical signs, diagnosis and surgical treatment of cervical, truncal, and extremities wounds caused by NLW. Our investigation allowed to draw a conclusion that gunshot wounds caused by NLW have similar characteristics. These ones are the same with signs of wounds caused by small arms. Surgical treatment of wounds caused by NLW is based on the standard approaches to treatment of low-velocity missile wounds.
    Voenno-medit͡sinskiĭ zhurnal 09/2011; 332(9):36-41.
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    ABSTRACT: One of modern tendencies of carrying out long ALV of patients with polytrauma is application of "early" tracheostomy. Thus optimum terms of early tracheostomy are defined indistinctly and vary from 2 to 10 days from beginning of ALV. It is established that at predicted long ALV of patients with polytrauma optimum terms of tracheostomy performance is the second period of traumatic illness (12-48 hours from the moment of getting trauma). Tracheostomy, executed for patients with polytrauma for the purpose of maintenance long AL V in early terms, promotes improvement of gases diffusion, microcirculation in lungs, improvement of system of external breath as a whole and it is accompanied by decrease in frequency of development life danger infectious pulmonary complications and lethality reduction.
    Voenno-medit͡sinskiĭ zhurnal 05/2011; 332(5):20-4.
  • Source
    V.A. Reva · A.A. Pronchenko · I M Samokhvalov
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    ABSTRACT: To analyse management and outcomes of carotid artery (CA) injuries. Retrospective study of the patients in the combat operations in Chechnya (1999-2002) and in peacetime (2003-2009). A total of 46 patients with missile (27) and stab (19) wounds, who had common and internal CA injury, underwent an open surgery. Temporary shunts (TSs) were placed in eight patients with more severe injuries. Retrospective analysis of patients' data. CA ligation and CA repair were performed in 9 and 37 patients, respectively. Of the nine patients with CA ligation, five developed neurologic deficit; the remaining four patients died (100% of poor outcomes). Of the 37 patients with blood flow restoration, nine patients died and neurologic deficit persisted in two patients (30% of poor outcomes) (p < 0.05). Among patients with TS, three patients died and two had stable neurologic deficit (63% of poor results). Of the patients without TS, 10 patients died and five had neurologic disorders (56% of poor outcomes) (p = 0.53). CA repair is the method of choice in CA injury. TS use does not result in a decreased mortality rate or neurologic deficit reduction in patients with severe injuries.
    European journal of vascular and endovascular surgery: the official journal of the European Society for Vascular Surgery 03/2011; 42(1):16-20. DOI:10.1016/j.ejvs.2011.01.025 · 2.49 Impact Factor

Publication Stats

3 Citations
2.49 Total Impact Points


  • 2013
    • Saint Petersburg Medical Academy
      Sankt-Peterburg, St.-Petersburg, Russia
  • 2011
    • Sergei Kirov Military Medical Academy
      Sankt-Peterburg, St.-Petersburg, Russia