APPLICATION OF “DAMAGE CONTROL SURGERY” FOR FIRE INJURIES OF THE INTESTINE

Abstract

Introduction. The current situation with the armed conflict in the east of the country is characterized by the presence of a significant number of patients with gunshot wounds in general. In the proposed article, the authors summarize the materials presented in the world literature and their own experience in the treatment of wounded servicemen with combat wounds to the abdomen, accompanied by injuries of the small and large intestine, often with traumatic shock, significant blood loss and high mortality. Taking advantage of the opportunities to apply the field or military experience of NATO medical services, we drew attention to the tactics of “Damage control surgery” (DCS), the use of which can significantly improve the effectiveness of treatment and provision of phased medical care in armed conflicts. Material and methods. DCS management were introduced in NATO military field surgery. Its essence is that in severe abdominal injuries, accompanied by traumatic shock III–IV degree, surgery is not performed simultaneously in full, but is divided into several stages. The first stage consists of a minimal amount of surgical interventions aimed at stopping intra-abdominal bleeding and preventing contamination of the abdominal cavity with intestinal contents. To do this, the damaged area of the colon or small intestine is either stitched with a stapler, or tied with a thick ligature, or sutured with one of the types of sutures, but the primary anastomoses are not formed. The internal organs are covered with sterile polyethylene, and the abdominal wall is temporarily closed in one way. The results of the analysis of the effectiveness of surgical treatment of wounded servicemen with gunshot wounds to the abdomen and intestines indicate the effectiveness of staged surgical tactics within the applied DCS tactics. Note that the proven effectiveness and positive results of treatment of the above significant contingent of patients is largely due to the development and use of the original clip, the use of which is convenient, fast, prevents contamination of the peritoneum during the intraoperative period and thus causes the corresponding positive effects of surgical treatment of gunshot wounds or small intestine by the tactics of “Damage control surgery” during the immediate postoperative period. Conclusion. The use of “Damage control surgery” tactics in wounded servicemen with gunshot wounds to the colon or small intestine avoids unwarranted surgical interventions and reduces the time spent on the operation itself and the postoperative period, which in this case runs faster and with fewer complications. The use of the original intestinal clip is effective in performing surgical interventions on wounded servicemen with gunshot wounds of the colon or small intestine according to the tactics of “Damage control surgery”. Key words: combat trauma, Damage control surgery, colon or small bowel injury.