Organization of sorting and surgery of wounds with soft tissue defects during the joint force surgery

Khomenko І.P., Lurin I. A., Korol S. O., Shapovalov V. Yu., Hrebennikov K. O., Halushka A. M., Tertyshnyi S. V., Matviichuk B. V. Organization of sorting and surgery of wounds with soft tissue defects during the joint force surgery. Journal of Education, Health and Sport. 2020;10(1):259-269. eISSN 2391-8306. DOI http://dx.doi.org/10.12775/JEHS.2020.10.01.029

https://apcz.umk.pl/czasopisma/index.php/JEHS/article/view/JEHS.2020.10.01.029

http://dx.doi.org/10.5281/zenodo.3973586       

 

 

 

 

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© The Authors 2020;

This article is published with open access at Licensee Open Journal Systems of Nicolaus Copernicus University in Torun, Poland

Open Access. This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author (s) and source are credited. This is an open access article licensed under the terms of the Creative Commons Attribution Non commercial license Share alike.

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 Received: 20.12.2019. Revised: 25.12.2019. Accepted: 31.01.2020.

 

 

ORGANIZATION OF SORTING AND SURGERY OF WOUNDS WITH SOFT TISSUE DEFECTS DURING THE JOINT FORCE SURGERY

 

І. P. Khomenko1, I. A. Lurin2, S. O. Korol2, V. Yu. Shapovalov3,

K. O. Hrebennikov 4, A. M. Halushka1, S. V. Tertyshnyi3, B. V. Matviichuk5

 

1Command of the Medical Forces of the Armed Forces of Ukraine

2Department of Military Surgery, Ukrainian Military Medical Academy, Kyiv, Ukraine

3Military Medical Clinical Center of the Southern Region, Odessa, Ukraine

4Orthopedic and Traumatology Center of Kyiv City Clinical Hospital №12, Kyiv, Ukraine

5Traumatology Department of the Military Medical and Rehabilitation Center, Irpin’, Ukraine

 

Khomenko Igor Petrovich, Commander of the Medical Forces of the Armed Forces of Ukraine, Kyiv Commander, Corresponding Member of the National Academy of Medical Sciences of Ukraine, Professor, Doctor of Medical Sciences, Major General of the Medical Service Chief.

03168, Kyiv, Povitroflotsky Avenue 6; +380503580279; hip65@ukr.net

orcid.org/0000-0002-8199-5083

Lurin Igor Anatolievich, Ukrainian Military Medical Academy, Kyiv Corresponding Member of the National Academy of Medical Sciences of Ukraine, Professor Doctor of Medical Sciences, Major-General of the Medical Service, Professor of the Department of Military Surgery.

01015, Kiev, str. Moskovskaya 45/1, h. 33; +380501353039; lurin@i.ua

orcid.org/0000-0001-6280-1725

Korol Serhii Olexandrovich, Ukrainian Military Medical Academy Kyiv, Professor Doctor of Medical Sciences, Colonel of Medical Service, Professor of the Department of Military Surgery.

01015, Kiev, str. Moskovskaya 45/1, h. 33; +380976909858; sergej.korol72@gmail.com

orcid.org/0000-0002-1036-0355

Shapovalov Vitalii Yuriovich, Military Medical Clinical Center of the Southern Region, Odesa, Ph.D Colonel of Medical Service, a Leading Surgeon; 65044, Odesa, str. Pirogovska, 2; +380508155113; vushapo@gmail.com; orcid.org/0000-0002-4241-0775

Hrebennikov Kostyantin Olexandrovich, Resident of Kyiv City Orthopedic Center, Kyiv City Clinical Hospital №12, Ukraine, Kiev; 01103, Kyiv, str. Profesora Pidvysotskoho, 4a,

kgreben@bigmir.net; orcid.org/0000-0003-2595-8218

Halushka Andrii Mykolaevich, Command of the Medical Forces of the Armed Forces of Ukraine, Kyiv, Professor Doctor of Medical Sciences, Colonel of Medical Service.

03168, Kyiv, Povitroflotsky avenue, 6; +380445200764; galushka_a@i.ua

orcid.org/0000-0003-3530-0946

Tertyshnyi Serhii Volodimirovich, Military Medical Clinical Center of the Southern Region, Odesa, Ph.D., Lieutenant Colonel of the Medical Service, Head of the Department of Surgical Infection; 65044, Odesa, str. Pirogovska, 2; +380677522559; drug2008@ukr.net

orcid.org/0000-0002-4949-5409

Matviichuk Bohdan Vladislavovich, Military Vedical and Rehabilitation Center, Irpin, Senior Lieutenant of Medical Service, Resident of Traumatology Department.

08200, Irpin, str. 11th line, h. 1; +380632154423; matviichuk@i.ua; orcid.org/0000-0003-3770-3984

 

Personal contribution of the authors

Khomenko IP - Research concept;

Lurin IA - Research design;

Korol SO - Collection of material;

Shapovalov VYu - Writing the text;

Hrebennikov KO - Formulation of conclusions;

Halushka AM - Statistical data processing;

Matviichuk BV - Introduction of the methodology at the second level of medical care;

Tertyshnyi SV - Implementation of the methodology at the third and fourth levels.      

 

Abstract

Introduction. The experience of providing medical care during the Anti-terrorist operation in eastern Ukraine showed that in the structure of modern combat surgical trauma gunshot wounds with soft tissue defects are between 64.9-68.2%, of which 36.4-37.5% are small and medium, 28.5-30.7% are large and very large defects.

Aim: To improve the results of providing surgical care to the wounded with soft tissue defects by introducing a variety of surgical tactics of wound closure to the medical care levels.

Material and Methods. The total array of the study was 2537 wounded with shrapnel, bullet and mine injuries from April 2014 to September 2018. The determination of surgical tactics for closing soft tissue defects was performed at the basis of metric classification taking into account the area, volume and anatomical areas of the lesion.

Results. The combination of metric characteristics of wound defects by area, volume with localization of wounds in a single classification allowed the offer of a comprehensive approach to sorting the wounded at the level of medical care and to determine further surgical tactics to close soft tissue defects. In accordance with the sorting and evacuation purposes, the wounded with gunshot wounds to the foot and hand (third zone of injury) were treated in specialised centres to the fourth level of medical care. In the case of medium and large wounds of the thigh, leg, shoulder and forearm, medical care was provided at the second and third levels. And in the case of large and very large wounds of the specified localisation was provided in specialised clinics of the fourth level.

Conclusions. The introduction of differentiated surgical tactics in the wounded with soft tissue defects at the levels of medical care has improved functional results: increase the proportion of good from 46.9% to 53.7%, reduce the relative number of unsatisfactory from 18.8% to 11, 6%.

Key words: differentiated surgical tactics; gunshot wounds; Mine injuries; Soft tissue defects; Surgical care.