Vol 342, No 9 (2021)

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.

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%.

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.

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.

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».