Modern approaches to the surgical treatment of combat injuries of the hand at the stages of medical evacuation
The objective of the study was to analyze the methods of surgical interventions on the stages of medical evacuation (SME) during the anti-terrorist operation (ATO) from 2014 to 2015. Materials and methods. The clinical group consisted of 25 wounded persons with gunshot fractures and mine-explosive wrist wounds from 2014 to 2015 during the ATO. Fractures and avulsions during ATO totaled 21.67 % of all wrist injuries. Of these, gunshot fractures were observed in 98.67 % of patients, hand avulsions — in 1.33 %. All the wounded were men. Results. Patients with gunshot bone fractures and hand avulsions at the basis and the first level of medical care require a temporary bleeding control, early imposition of aseptic dressings, analgesia, immobilization using improvised means and urgent evacuation. On the second SME, initial surgical debridement of the wounds (93.32 %) and fasciotomy (33.33 %) were mainly performed. An important antishock measure of the second level is stable position of external fixation device (26.67 %), as well as administration of antibiotic drugs and tetanus toxoid. During the third and fourth SME, the vast majority of surgical procedures were repeated surgical treatment of wounds and reconstructive surgeries. Conclusions. Providing medical care to the wounded persons with gunshot fractures and hand avulsions during ATO resulted in to 58 % of good, 38 % of satisfactory and 4 % of unsatisfactory functional results 1–2 years after the injury.
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