Extent of the Surgical Care to the Wounded with Gunshot Forearm Fractures at the Stages of Medical Evacuation During Anti-Terrorist Operation

S.O. Korol, B.V. Matviichuk, A.M. Domansky


Background. The aim of the study was to determine the structure of surgical procedures performed on the stages of medical evacuation (SME) in injured with gunshot fractures of the forearm bones and extremity avulsions during the anti-terrorist operation (ATO) from 2014 to 2015. Materials and methods. An array of clinical study consisted of 45 wounded with gunshot fractures of the forearm bones and mine-explosive injuries from 2014 to 2015 during the anti-terrorist operation. In the structure of the forearm wounds, the fractures and avulsions were 10.95 %. Gunshot fractures were observed in 88.89 % of the patients, extremity avulsions at the forearm level — in 11.11 %. All the wounded were men, 88.89 % — servicemen of the Armed Forces of Ukraine. Results. In patients with gunshot forearm fractures and extremity avulsions, at the SME of base and first levels of care we have performed temporary stop bleeding, the application of aseptic dressings, analgesia, immobilization means at hand, and emergency evacuation. On the second level of SME, an initial debridement (81.83 %) and fasciotomy (42.42 %) were performed. The important antishock measure of the second level was application of external fixation device (36.36 %), as well as intramuscular injection of antibiotics and tetanus toxoid. On the third and fourth levels of SME, the vast majority of surgical procedures were repeated surgical treatment of wounds and fasciotomy. Improving the quality of implementation of repeated surgical treatments promoted the use of vacuum therapy, ultrasound cavitation and rehabilitation. Conclusions. Providing assistance to the wounded with gunshot fractures and extremity avulsions during ATO resulted in 64.45 % good and 24.44 % satisfactory functional results 1–2 years after injury.


therapeutic measures; stages of medical evacuation; gunshot forearm wounds; gunshot forearm fractures; mine-explosive wounds; extremity avulsions


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