Surgical treatment of the consequences of modern combat trauma

I.R. Trutyak, A.Yu. Fil, V.I. Medzyn, R.I. Trutyak


Background. The purpose of the study was to analyses the traumatic diseases in injured and wounded patients with combat surgical trauma, to characterize the causes of complications and to explain the ways of their treatment and prevention. Materials and methods. 1566 patients with combat surgical trauma were treated in the Military Medical Clinical Centre of the Western Region (MMCCWR) in 2014–2015. 709 (45 %) of them had missile injuries, 323 (21 %) — mine blast trauma, 127 (8 %) — gunshot injuries, 367 (23 %) — combat non-gunshot damages and 40 (3 %) — combined burning injuries. Multiple injuries were diagnosed in 161 (10 %) and associated — in 386 (25 %) wounded soldiers. Wounded and injured patients were admitted to the hospital by aeromedical and land transport evacuation of II and III levels of care after emergency surgical procedure and antishock intensive care. 153 (9.7 %) of wounded patients were admitted to the intensive care unit immediately after transportation. Results. 819 (52.3 %) of wounded and injured combatants hospitalized in MMCCWR required stage surgical procedures and surgical treatment of combat trauma early and late complications. Conservative therapy was effective in 102 (6 %) patients. Combat trauma complications were divided into two groups: predicted complications and those that could have been avoided. Predicted complications include posthemorrhagic anemia, hypoproteinemia, abdominal compartment syndrome, postoperative wound infection and postoperative hernia after program relaparotomy, pulmonary inflammatory complications, inflammatory urinary processes after bladder catheterization. Complications that could have been avoided depended on the time of evacuation and medical support, medical teams experience in combat surgical trauma treatment, medical material and technical resources and realization of the appropriate medical care. Conclusions. The main causes for the unsatisfactory combat surgical trauma treatment results are wounds caused by modern high-energy weapon, specific battlefront situation, continuous unstable patient’s condition, inadequate blood loss and hypoproteinemia compensation, inadequate capacity of the first surgical procedure, poor training of the medical personnel for the combat surgical trauma treatment and limited medical resources.


combat surgical trauma; complications


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