Peculiarities of surgical treatment of wounded with combined thermomechanical injuries of the lower extremities under conditions of counter-terrorist operation.

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Abstract

The authors analysed results of treatment of 67 wounded with injuries of the extremities, combined with burns. Two therapeutic approaches to surgical treatment were used. The first therapeutic approach (Early total Care - ETC) involved providing of a complete surgical care (the whole body is examined) during the first emergency operation and was used in 24 (35,8%) injured. The second therapeutic approach implied a differentiated approach to the treatment of wounded and treatment of injuries and was used in 43 (64,2%) patients. If arterial blood pressure was above 90 mm Hg, ETC approach was used in 19 (28,4%) wounded. If systolic blood pressure was less than 90 mm Hg programmable surgical approach Damage Control Surgery (DCS) was used in 24 (35,8%) patients. The use of differential surgical approach has led to increase in the number of complications from 45,8 to 55,8% (p=0,044) and decrease in mortality c 12,5 to 9,3% (p=0,039) compared with the group of wounded, where was used only traditional approach of single-stage treatment.

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References

  1. Абакумов М.М., Богопольский П.М. Damage control: что нового? // Хирургия. - 2007. - № 11. - С. 59-62.
  2. Гуманенко Е.К., Бояринцев В.В., Гаврилин С.В. и др. Тактика «Damage control» при боевых повреждениях живота // Новые технологии в хирургии: Сб. тр. Международного хирургического конгресса. - Ростов-на-Дону, 2005. - C. 16.
  3. Дубров В.Э., Блаженко А.Н., Ханин М.Ю и др. Реализация динамического контроля повреждений (damage control) в остром периоде политравмы // Политравма. - 2012. - Т. 1. - С. 68-74.
  4. Мусалатов Х.А., Петров Н.А., Силин Л.Л. и др. Лечение больных с множественной комбинированной термомеханической травмой конечностей идентичной локализации // Диагностика и лечение политравм: Материалы Всерос. конф. - Ленинск-Кузнецкий, 1999. - С. 204.
  5. Нечаев Э.А., Грицанов А.И., Минуллин И.П. и др. Взрывные поражения: Руководство для врачей и студентов / Под ред. чл.-кор. РАМН Э.А.Нечаева. - СПб: Фолиант, 2002. - 656 с.
  6. Поярков В.Д., Зыков Д.В., Вознюк Д.И. Повреждение сосудов конечностей при комбинированных термическо-травматических повреждениях // Возможности и перспективы диагностики и лечения в клинической практике: Тез. докл. Всерос. науч.-практ. конф. - М., 1992. - С. 377-379.
  7. Соколов В.А., Бялик Е.И., Иванов П.А., Гараев Д.А. Практическое применение концепции «Damage control» при лечении переломов длинных костей конечностей у пострадавших с политравмой // Вестн. травматол. и ортопед. - 2005. - № 1. - С. 3-7.
  8. Borgman M., Matos R.I., Blackbourne L.H., Spinella P.C. Ten years of military pediatric care in Afghanistan and Iraq // J. Trauma Acute Care Surg. - 2012. - Vol. 73. - P. 509-513.
  9. Bose D., Tejwani N.C. Evolving trends in the care of polytrauma patients // Injury. - 2007. - Vol. 37 (1). - P. 20-28.
  10. Burch J.M., Ortiz V.B., Richardson R.J. et al. Abbreviated laparotomy and planned reoperation for critically injured patients // Annals of Surgery. - 1992. - Vol. 215. - P. 476-483.
  11. Ecke H., Faupel L., Quoika P. Considerations on the time of surgery of femoral fractures // Unfallchirurgie. - 1985. - Vol. 11 (2). - P. 89-93.
  12. Edwards M.J., Lustik M., Eichelberger M.R. et al. Blast injury in children: an analysis from Afghanistan and Iraq, 2002-2010 // J. Trauma Acute Care Surg. - 2012. - Vol. 73 (5). - P. 1278-1283.
  13. Frye K., Lutterman A. Burns and fractures // Orthop. Nurs. - 1999. - Vol. 18. - P. 30-35.
  14. Grotz M.R., Gummerson N.W., Genslen A. Staged management and outcome of combined pelvic and liver trauma. An international experience of the deadly duo // Injury. - 2006. - Vol. 37 (1). - P. 11-19.
  15. Harwood P.J., Giannoudis P.V., van Griensven M. et al. Alterations in the systemic inflammatory response after early total care and damage control procedures for femoral shaft fracture in severely injured patients // J. Trauma. - 2005. - Vol. 58 (3). - P. 446-454.
  16. Hawkins A., Maclennan P.A., McGwin G. Jr. et al. The impact of combined trauma andburns on patient mortality // J. Trauma. - 2005. - Vol. 58 (2). - P. 284-288.
  17. Hildebrand F., Giannoudis P., Krettek C., Pape H. Damage control: extremities // Injury. - 2004. - Vol. 35 (7). - P. 678-689.
  18. McArthur B.J. Damage control surgery for the patient who has experienced multiple traumatic injuries // AORN J. - 2006. - Vol. 84 (6). - P. 992-1000.
  19. Pape H.C., Peitzman A.B., Schwab C.W., Giannoudis P.V. Damage control management in the polytrauma patient. - New York: Springer, 2008. - 464 p.
  20. Santaniello J.M., Luchette F.A., Esposito T.J. et al. Ten year experience of burn, trauma, and combined burn/trauma injuries comparing outcomes // J. Trauma. - 2004. - Vol. 57 (4). - P. 696-700.
  21. Stubig T., Mommsen P., Krettek C. et al. Comparison of early total care (ETC) and damage control orthopedics (DCO) in the treatment of multiple trauma with femoral shaft fractures: benefit and costs // Unfallchirurg. - 2010. - Vol. 113 (11). - P. 923-930.
  22. Taeger G., Ruchholtz S., Waydhas C. Damage control orthopedics in patients with multiple injuries is effective, time saving, and safe // J. Trauma. - 2005. - Vol. 59 (2). - P. 408-415.
  23. Teasdale G., Murray G., Parker L., Jennett B. Adding up the Glasgow coma score. // Acta Neurochir. - 1979. - Vol. 28 (suppl). - P. 13-16.
  24. Wilkinson E. The epidemiology of burns in secondary care, in a population of 2,6 million people // Burns. - 1998. - Vol. 24 (2). - P. 139-143.

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Copyright (c) 2015 Dubrov V.E., Koltovich A.P., Khanin M.Y., Paltyshev I.A., Ivchenko D.R., Tsvigun O.V., Kobritsov G.P., Gereikhanov F.G.



СМИ зарегистрировано Федеральной службой по надзору в сфере связи, информационных технологий и массовых коммуникаций (Роскомнадзор).
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