Circumstances of Injury:

During an assault on enemy positions, the unit successfully secured the occupied territory. However, while completing the mission, the soldier sustained severe injuries, suffering gunshot wounds to the shoulder, thigh, arm, and abdomen.

Diagnosis:

• Aftermath of a mine-explosive injury (21.08.2023).
• Defect of the proximal section of the right humerus.
• Soft tissue defect on the anterior and lateral surfaces of the right shoulder.

Aftermath of Mine-Explosive Trauma:

• A trauma caused by an explosive blast or shrapnel resulting in severe damage to bones and soft tissues.
• Complications include tissue defects, risk of infections, and impaired limb functionality.

Defect of the Proximal Section of the Right Humerus:

• Loss of bone tissue in the region connecting the humerus to the shoulder joint.
• Causes joint instability and limits arm functionality.

Soft Tissue Defect on the Anterior and Lateral Surfaces of the Shoulder:

• Significant damage to the skin, muscles, and fascia in the shoulder area.
• May expose the bone or joint, complicating the recovery process.

Clinical Plan:

Placement of an Articulating Spacer:

• A temporary device acting as a substitute for the shoulder joint.
• Maintains mobility and stability of the shoulder joint while preventing infections.
• Made of antibiotic cement, it provides localized infection prevention at the surgical site.

Replacement of Shoulder Soft Tissue with a Thoracodorsal Flap:

• Tissue transfer from the scapular region (latissimus dorsi muscle) to cover the defect.
• The thoracodorsal flap offers:
  • Adequate blood supply to the defect site.
  • Restoration of tissue volume and protection of bone or prosthetic structures.

Endoprosthesis Placement:

• After 3–5 months, once tissue stabilization is achieved, a permanent shoulder joint prosthesis will be installed.
• This will restore limb functionality and improve the patient’s quality of life.