Rzaeva Aitadj Akif kizi Ahmaidi Malika Students of KHNMU Fadeev Oleg Doctor of Medicine, N., docent Topicality. Today, gunshot wounds are a problem of both military medicine and the entire health care system. The main topic of military field surgery is the healing of bullet wounds of the extremities. During the Great Patriotic War, the frequency of limb injuries exceeded 70%, and in current military conflicts it approaches 50-60%.
Due to the high number of bullet wounds to the limbs during military skirmishes, the complication of soft tissue and bone injuries, as a result of the improvement of firearms; due to slow consolidation, false joints and defects of bone tissue, this issue is considered relevant and needs to be resolved.
It is obvious that timely provision of adequate medical assistance at the stages of medical evacuation will save the lives of the maximum number of wounded.
Materials and methods. Scientific articles and medical literature were used as materials.
The positive result of the treatment of gunshot wounds of the lower limbs depends on the timing of wound healing, as well as, what is especially important, on the choice of the method of stabilization of limb fragments. The use of emergency internal osteosynthesis is prohibited or minimized. But in specialized structures, stable and functional internal fixation with delayed healing can be performed in half of the victims.
Goal. To study the peculiarities of the treatment of gunshot injuries of the limbs, to summarize the experience and effectiveness of the use of surgical techniques
We know that according to the nature of the violation of the integrity of the bones, gunshot fractures can be divided into: multipart fracture, fracture "at a distance", crescent fracture, and hole fractures.
A special difference between gunshot wounds and others is the complexity of the treatment and diagnostic process. Most of the wounds are multiple and combined, so it is difficult to establish the sequence of actions. It is for this reason that the algorithm for providing assistance to victims with gunshot wounds has been determined. The scheme included groups of wounded with through and blind: superficial wounds on the skin, subcutaneous fatty tissue, deep soft tissue damage and without damage to bone structures; deep bone fractures without vascular and nerve damage and deep bone fractures with vascular and nerve damage. According to the nature of the injuries, specific treatment measures are determined.
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The tactics of treating a gunshot wound depended on the severity of the victim's condition. Patients with stable fractures underwent surgical treatment of fractures and internal fixation with an external fixation device. Surgical treatment of a fracture consists in the removal of non-viable fragments deprived of blood supply and fixation with connective tissue. Bone fragments with vascular tissue and large articular surfaces are preserved. General principles of treatment of gunshot wounds were applied to soft tissue wounds: shrapnel, cut, primary suture failure. Sometimes, if necessary, a slight convergence of the edges of the wound is used to cover nerves, blood vessels and tendons. Small superficial wounds do not require surgical intervention. In severe and visible edema, decompression fasciotomy was performed to prevent compartment syndrome. Damage control tactics were used in unstable and severe patients with bone damage (9.2%). In extremely serious patients, open wounds and fractures are not operated upon until the traumatic shock is overcome, they are washed with antiseptic solutions, foreign objects are removed, the edges of the wounds are treated with antibiotics and covered with an aseptic bandage. In case of traumatic limb amputation, clamps are placed on the main vessels, wounds are treated with antiseptics, antibiotics and bandages are applied. Intensive therapy was then continued.
After stabilization of the patient's condition, the following stages of surgical interventions are performed within 24-36 hours: Surgical treatment of fractures and amputations for wounds of abdominal organs is carried out after the 2nd stage with an interval between operations of 2-3 hours. especially if there is a drop in blood pressure during the procedure.
In case of involvement of large vessels (2%), stabilization with external fixation devices and otoplasty of the vessels of the damaged zone were performed. At the initial stage of surgical treatment, the damaged nerves were not restored. In heavily contaminated wounds, the nerve is not removed, but if there is a nerve in the wound, marking and plastic are used in the later stages of the operation.
After the initial surgical treatment, the wounds were cleaned within 48-72 hours.
VAC bandages were used, visible necrotic tissue was opened and removed, hematoma was drained, voids were drained. After rehabilitation, the wounds were finally closed with various types of skin grafts.
Stabilization of gunshot fracture wounds with rod devices during the primary surgical treatment of the wound was mostly final. However, in 10% of cases with instability of fragments, a change of method to the Ilizarov apparatus was used, and in 5% of cases of intra-articular fractures and instability of the external fixation apparatus, a change in anatomical localization was used. during bone osteosynthesis, the method of fixing the articular surface is used. The criteria for switching to another method of fixation were: problem-free recovery, normal level of C-reactive protein, absence of inflammation in the general blood test and 2 weeks after removal of the device. Active surgical strategies that allow removal of external fixators after healing and repositioning of fixation, when performed as indicated, shorten healing time in individuals with long bone fractures and provide better functional and anatomical outcomes for intra-articular fractures.
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As a result, correction of deformity, stabilization of fractures and wound healing were achieved in most patients.
Conclusions:
1. Gunshot wounds of the extremities are extremely severe injuries, the main method of treatment of which is primary and secondary surgical treatment of wounds.
It is carried out with anti-shock therapy and prevents severe purulent complications and significant damage.
2. Surgical approach to isolated fractures - primary operation, fasciotomy, immobilization of the limb to protect the wound. At the next stage, it is recommended to impose (reinstall) external fixation devices, perform orthopedic operations for bone and soft tissue defects.
Reference:
1. Ankin N.L. Vіdstrocheniy vnutrishnіy osteosynthesis pіd chas vіkuvannya vognepalnyh fractures / L.M. Ankin, N.L. Ankin // Orthopedics, traumatology and prosthetics. - 2012. - No. 2. - 114-118.
2. Barinov V.S. Surgical treatment of fire wounds of blood-bearing mains for the minds of Afghanistan / V.S. Barinov // Bulletin of Surgery named after. I.I. Grekov. - 2011. - T. 170, No. 2. - S. 114.
3 Bilenky V.A. Analysis of pardons for the first hour of the first surgical treatment of fire wounds of soft tissues / V.A. Bilenky, V.V. Negoduiko, R.M. Mikhailusov //
Surgery of Ukraine. - 2015. - No. 1. - S. 7-13.
4. Viyskovo-Polyova surgery of local wars and of violent conflicts / Ed. E.K.
Gumanenko, I.M. Samokhvalova. - M.: Geotar-Media, 2011. - 704 p.
5. Koltovich A. Surgical treatment of wounded men with combined thermomechanical injuries (CTMI) using damage control surgery / A. Koltovich, A.
Voynovsky, D. Ivchenko // Eur. J. Trauma Emergency Surgery. — 2010. — Vol. 36, Suppl. 1. — P. 212-213.
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