Clinical and organizational peculiarities of providing trauma care to the patients with soft tissue defects in gunshot and mine blast injuries of the limbs
Background. The purpose of the study was to improve the results of trauma care for the patients with soft tissue defects based on the introduction of differentiated surgical approach to wound closure at the stages of medical evacuation (SME). Materials and methods. The total array of the study was presented by 2051 victims with comminuted, bullet and mine blast injuries of the limbs occurred from April 2014 to September 2016. Surgical approach to the closure of soft tissue defects was based on metric classification, taking into account the area, volume and anatomical zones of the wound. Results. The combination of the metric characteristics of wound defects by area, volume and localization of wounds in a single classification made it possible to offer a comprehensive approach to sorting the wounded people at the SME and to determine the further surgical management for closing soft tissue defects. In accordance with the sorting and evacuation purposes, patients with gunshot injuries of the foot and hand (the third zone of damage) were treated in specialized tertiary and quaternary centers. With medium and large wounds of the hip, lower leg, shoulder and forearm, medical care was provided in secondary and tertiary medical centers, with large and extensive wounds of the corresponding localization — in specialized quaternary hospital. Conclusions. The introduction of differentiated surgical approach in patients with soft tissue defects at the SME made it possible to improve the functional results: to increase the proportion of good ones from 46.9 to 53.7 %, to reduce the relative number of unsatisfactory outcomes from 18.8 to 11.6 %.
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