Clinical and organizational aspects of firearm injuries of the upper extremities

S.S. Strafun, N.O. Borzykh, I.M. Kurinny, O.V. Borzyh

Abstract


Background. The specificity of military operations with the use of modern military hardware determines the severity of damage, which in turn aggravates and complicates the provision of medical care in terms of restoration of anatomical structures and functional capabilities. The said substantiated the need for improvement, development of the latest technologies, principles of surgical treatment of the wounded, in particular, those with gunshot injuries of the upper extremities. The purpose of our work is to prove the effectiveness of surgical treatment of the victims with polystructural firearm injuries of the upper extremities in the context of reducing the evacuation routes to the institution providing quaternary medical care. Materials and methods. The subject of the study was 63 soldiers with polystructural firearm wounds of the upper extremities. Two monitoring groups were selected. The criterion for the distribution was the time between injury and admission to the hospital providing highly specialized, quaternary, care, namely: up to a week and a period from 1 to 6 months. The first group included 21 patients, who were hospitalized within the week, the second — 42 people, who for various reasons were hospitalized in 1–6 months after gunshot wound of the upper limbs. Results. The average time from the injury to the planned restorative-plastic surgery in the first group was 21.0 ± 3.2 days, in the second — 73.0 ±
± 6.5 days. A comparative analysis of long-term results shows that the patients in the first group, who were hospitalized at IV stage within one week after the injury, required highly specialized medical care and received it, which enabled 15 of the 21 wounded (71.4 %) to return to service, and the rest — to everyday duties. Whereas the number of patients in the second group, who were at this level of care in 1–6 months after the injury, was almost twice less, namely 16 out of 42 (38.1 %). The rest — 26 (61.9 %) patients — continued to receive medical and rehabilitation assistance. Conclusions. Thus, the timely and adequate provision of medical care at a highly specialized level serves as the guarantor for preser­ving the quality of life of the wounded and the condition that allows them to be returned not only to ordinary daily duties, but also to a majority of professional military activities.


Keywords


upper extremity; firearm wound; surgical treatment; polystructural damage

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DOI: https://doi.org/10.22141/1608-1706.6.18.2017.121180

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