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Vol 342, No 9 (2021)

Articles

Military field surgery in 2031

Samokhvalov I.M., Kryukov E.V., Markevich V.Y., Badalov V.I., Goncharov A.V.

Abstract

The modern problems of military field surgery and the ways of its further development are analyzed. The introduction of new medical technologies in the changed conditions of combat operations of asymmetric wars fundamentally changed the nature and results of medical care for the wounded. The forced reduction in the volume of operations aimed at saving the lives of the wounded in advanced medical units and hospitals, requiring repeated reconstructive interventions, which was previously regarded as a deficiency or even a defect in the activities of military field surgeons, is today considered as a way of bringing surgery closer to the wounded. A general pattern of military conflicts in remote theaters of military operations is the need for additional special training of medical personnel sent to the combat zone. The reason for this is not only the specificity of combat pathology, but also the need to master special surgical technologies for the staged treatment of the wounded, little used in peacetime surgery, and often simply insufficient training of military doctors in the treatment of wounds and injuries. In this regard, the role of specialized military medical and educational universities with experienced military field surgeons working there has increased.
Voenno-medicinskij žurnal. 2021;342(9):4-11
pages 4-11 views

The structure and nature of modern combat surgical trauma

Denisov A.V., Badalov V.I., Krainyukov P.E., Goncharov A.V., Markevich V.Y., Golovko K.P., Anisin A.V., Suprun T.Y.

Abstract

The analysis of the structure and nature of the sanitary losses of the surgical profile in the armed conflicts of recent decades is based on the study of the medical records of 5895 wounded, as well as data from the available literary sources. A significant tendency was revealed for an increase in the frequency of mine - explosive wounds - from 16.7% (war in Afghanistan, 1979-1989) to 30.3% in later armed conflicts. In the structure, the leading localizations are currently injuries to the limbs (up to 71.7%) and the head (up to 21.6%), which may be associated with both a change in the nature of the conduct of hostilities (widespread use of explosive weapons) and the use of modern body armor, effectively protecting the chest and abdomen from most bullets and shrapnel. The data obtained make it possible to predict a further increase in the frequency of mine and explosive wounds in the structure of the incoming stream of wounded in future armed conflicts, which will undoubtedly require the medical service to adjust the organization and content of the corresponding treatment and evacuation measures.
Voenno-medicinskij žurnal. 2021;342(9):12-20
pages 12-20 views

Practical training course SMART: the results of three years of training military and civilian surgeons

Goncharov A.V., Reva V.A., Petrov A.N., Suvorov V.V., Grebnev A.R., Nosov A.M., Markevich V.Y., Samokhvalov I.M.

Abstract

The existing system of training specialists in the field of military field surgery and injury surgery does not meet modern requirements. This circumstance necessitated the development and implementation of new forms of education, the most effective of which is considered to be the conduct of practical training on biological material and cadavers. Since 2018, on the basis of the Military Medical Academy, the first in Russia innovative educational and practical course SMART (modern methods and algorithms for treating wounds and injuries) has been held, combining training on living tissues, cadaver material, and robot simulators. Over three years, the course has been continuously developing, separate new courses have appeared on the admission of victims (SMART.PP), vascular trauma (SMART.Angio), endovascular surgery (SMART.REBOA). Today, the SMART course has become a modern educational platform for training not only surgeons but also doctors of any specialty involved in providing medical care to the wounded and injured. During the existence of the SMART training platform, 651 listeners underwent training on various issues of injury surgery during 18 courses.
Voenno-medicinskij žurnal. 2021;342(9):20-29
pages 20-29 views

Navigational technologies in injury surgery

Badalov V.I., Spitsyn M.I., Korostelev K.E., Yarmoshuk R.V., Shevelev P.Y.

Abstract

The introduction of new technologies will improve the results and outcomes of treatment of severe concomitant craniocerebral and spinal trauma, increase the accuracy of manipulations, and reduce the number of errors in the treatment of victims. One such technology may be surgical navigation, which has already established itself as a high - precision procedure, the use of which demonstrates convincing results in the treatment of isolated injuries and when used in elective surgery. The expediency of using surgical navigation for traumatic intracranial hematomas is shown, which allows access and install drainage or an endoscope into the hematoma cavity as accurately as possible in a safe area. This method has shown high efficiency when installing ventricular drainage to assess the dynamics of changes in intracranial pressure. The advantages of using the navigation in the surgical treatment of concomitant spinal injuries have been demonstrated. Surgical navigation due to excellent visualization and high positioning accuracy of instruments and screws of metal structures have a significant advantage over three - dimensional fluoroscopy. The use of navigation can significantly reduce the number of errors and complications, as well as maximize the accuracy of screw insertion during stabilizing operations on the spine while reducing the operation time by 20%.
Voenno-medicinskij žurnal. 2021;342(9):30-40
pages 30-40 views

Problems of intrapelvic bleeding arrest in unstable fractures of the pelvic bones

Kazhanov I.V., Borisov M.B., Mikityuk S.I., Gavrishchuk Y.V., Denisenko V.V., Grebnev A.R., Ganin E.V., Kolchanov E.A.

Abstract

The results of treatment of 349 patients with unstable injuries of the pelvic ring and signs of intrapelvic bleeding were analyzed. The assessment of the clinical effectiveness of the developed algorithm for the timely diagnosis of intrapelvic bleeding and its final stop using open and endovascular methods of surgical hemostasis was carried out. In the comparison group (170 people), mechanical stabilization of the pelvic ring was performed, and bleeding was expected to stop due to the effect of biological tamponade. In the main group (179 people), after mechanical stabilization of the pelvic ring, pelvic tamponade, or resuscitation endovascular balloon aortic occlusion, angioembolization was used. The choice of the method of surgical hemostasis depended on the hemodynamic parameters, the source of intrapelvic bleeding, the presence of life - threatening injuries to other areas of the body, the severity of the victim’s condition, the effectiveness of the previously used method for stopping intrapelvic bleeding. The implementation of this algorithm made it possible to reduce the overall mortality by 1.8, the daily mortality by 2.7 times, and also to reduce the duration and volume of blood transfusion replacement therapy by 1.8 times.
Voenno-medicinskij žurnal. 2021;342(9):41-50
pages 41-50 views

Differentiated surgical tactics for abdominal trauma, accompanied by damage to the liver and spleen

Suvorov V.V., Markevich V.Y., Goncharov A.V., Pichugin A.A., Myasnikov N.I., Petukhov K.V., Kuraev P.I., Nosov A.M., Kaznacheev M.V., Skakunova T.Y.

Abstract

The advantages of the implementation of a differentiated approach for the diagnosis and treatment of abdominal trauma accompanied by damage to the liver and spleen are presented. The following treatment strategies are used to diagnose and treat abdominal injuries: ETC, DCS, and NOM. The choice of the optimal treatment protocol is carried out in the course of applying a differentiated treatment and diagnostic algorithm, the main criteria of which are the results of clinical and instrumental examination with an assessment of the severity of the condition. It is important to use modern practical classifications of liver and spleen injuries identified during patient examination. Based on the analysis of treatment materials for 151 patients with abdominal trauma, accompanied by damage to the liver and spleen, it was found that the implementation of a differentiated approach is safe and justified.
Voenno-medicinskij žurnal. 2021;342(9):50-57
pages 50-57 views

Experience in the use of open, endovascular, and hybrid methods of treating combat injuries of blood vessels: observations of one surgeon

Reva V.A.

Abstract

Delivering medical care for the wounded with combat injuries of blood vessels is one of the most difficult problems of military field surgery due to the high frequency of deaths and amputations of the extremities. The author’s personal experience of providing assistance to 20 wounded with vascular injuries in modern military conflicts at different levels of surgical care is described. An increase in the number of vascular injuries in military conflicts has been shown up to 10%. Moreover, 80% of them are wounds of the main vessels of the extremities (2/3 - the lower extremities, 1/3 - the upper). Only 15% of the wounded had intracavitary bleeding, 2 were delivered to the stage of surgical care in a terminal state. For the stabilization of hemodynamics in the latter, for the first time in the combat zone, the method of resuscitation endovascular balloon occlusion of the aorta was used. The widespread use of ultrasound diagnostics, diagnostic angiography through the installation of an introducer, early operations depending on the condition of the wounded and the degree of limb ischemia (autovenous plasty, lateral suture, temporary vascular prosthetics, recanalization, and arterial endoprosthetics, wide fasciotomy) made it possible to exclude cases of death and secondary amputations of the extremities.
Voenno-medicinskij žurnal. 2021;342(9):57-68
pages 57-68 views

Hybrid technologies in the treatment of the severe concomitant injury (Literature review)

Samokhvalov I.M., Petrov A.N., Reva V.A., Myasnikov N.I.

Abstract

The experience of creation, development, and application of hybrid technologies in the work of hospitals providing assistance to victims with severe concomitant trauma is analyzed. The reasons for the formation and the need to use a hybrid anti - shock operating room are described. The stages of the gradual introduction of hybrid technologies into surgical practice are disclosed. The results of using a hybrid operating room and different views on trauma care, difficulties arising in the course of work in the operating room are summarized. The modern approaches to the treatment of patients with severe concomitant trauma in a hybrid operating room are presented. The use of hybrid technologies creates the prerequisites for the creation of a new strategy for the treatment of polytrauma, which makes it possible to improve outcomes by reducing the time required for accurate diagnosis of injuries, a quick start of emergency surgery/resuscitation using both traditional open interventions and minimally invasive endovascular methods of hemostasis.
Voenno-medicinskij žurnal. 2021;342(9):69-77
pages 69-77 views

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Voenno-medicinskij žurnal. 2021;342(9):77
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Prospects for the use of modern domestic medical devices to eliminate the life - threatening consequences of injuries and treat traumatic shock on the battlefield and advanced stages of medical evacuation

Samokhvalov I.M., Miroshnichenko Y.V., Golovko K.P., Boyarintsev V.V., Rodionov E.O.

Abstract

The study aimed to develop proposals for the inclusion of promising medical devices to eliminate the life - threatening consequences of injuries and treat traumatic shock in the standard equipment of the medical service of the Armed Forces. The article provides an overview of modern medical devices, which, in terms of their medical and technical characteristics, are considered the most promising for adoption for the Armed Forces’ supply as part of the standard equipment of the medical service. The results of the analysis of their effectiveness and comparison with foreign analogs are presented. The inclusion of such medical devices in the composition of first - aid kits, medical bags, medical kits, medical kits, and packs will reduce prehospital mortality and significantly affect severe complications after they are admitted to the hospital link of the medical service. In combination with the tactics of multistage surgical treatment of polytrauma, the early elimination of life - threatening consequences of injuries at the prehospital stage suggests the emergence of a new strategy in the treatment of severely wounded - «early pathogenetic treatment of severe injuries».
Voenno-medicinskij žurnal. 2021;342(9):78-88
pages 78-88 views

Department of the Military Field Surgery celebrates the 90th anniversary

Samokhvalov I.M., Badalov V.I., Tynyankin N.A., Lyashedko P.P., Bechik S.L.

Abstract

The 90-year history of the department and clinic of military field surgery of the Military Medical Academy, founded in 1931 by an outstanding surgeon, creator of the system of staged treatment of the wounded, V.A.Oppel, is presented as the first such department in the country and in the world. The staff of the Department of Military Field Surgery was outstanding military surgeons M.N.Akhutin, S.I.Banaitis, N.N.Elansky, V.I.Popov, A.N.Berkutov, I.I.Deryabin, I.A.Eryukhin. The purpose of the publication is to show the importance of the Department of Military Field Surgery of the Military Medical Academy in the training of surgical personnel, the formation of military medical doctrine, and the development of methods for providing surgical care to the wounded. The staff of the clinic still provides surgical care to the wounded in modern military conflicts. The Clinic of Military Field Surgery is a level 1 trauma center that provides multidisciplinary emergency care for the most severe and complex wounds and injuries, which allows its specialists to be recognized experts in all sections of injury surgery.
Voenno-medicinskij žurnal. 2021;342(9):89-94
pages 89-94 views

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Voenno-medicinskij žurnal. 2021;342(9):95-96
pages 95-96 views

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