Surgery in a 7-year-old child with blast injury to the left shoulder and left gluteal region with penetrating abdominal trauma

The management of pediatric patients with gunshot-related polytrauma remains a major challenge, both in the acute phase due to the combined nature of injuries, and during reconstructive surgery. Treatment outcomes depend on an appropriately selected management strategy from the moment of first aid through specialized surgical rehabilitation at a tertiary care center. This clinical case report presents the management of a 7-year-old girl with combined blast injuries to the left shoulder and left gluteal region. During the clinical course, a foreign body migrated from the gluteal region into the abdominal cavity. The injury resulted from an explosive device detonating in proximity to the child. The patient was initially admitted to a primary care hospital in Krasnyi Lyman due to a combined blast injury. Primary surgical debridement of the left shoulder wound was performed with primary wound closure and immobilization using a plaster splint. After stabilization, the child was transferred to the Central District Multidisciplinary Hospital in Svatove, where revision and gauze tamponade of the left gluteal wound were performed. Later that day, the patient was transferred to the Republican Children’s Clinical Hospital in Luhansk, where repeated surgical debridement of the left shoulder wound was carried out with removal of primary sutures and application of external fixation using a wire–rod external fixation device for an open fracture of the left humerus. An additional diagnostic evaluation revealed a foreign body in the soft tissues of the gluteal region. The child was transported by air medical service to the Research Institute of Emergency Pediatric Surgery and Traumatology (Dr. Roshal Clinic) in Moscow for further specialized treatment. The diagnosis of blast injury to the left shoulder and left gluteal region was confirmed in the Clinic, and the foreign body migration into the abdominal cavity was identified. An individualized, staged surgical treatment strategy was developed during the inpatient stay. The appropriately selected treatment strategy resulted in survival and function restoration of the injured organs and limb segments. Modern adjunctive physical wound treatment modalities ensured rapid wound preparation for closure without infectious complications.