COMBINATION OF THE MULTIMODAL ALGORITHM AND THE RECONSTRUCTIVE-RESTORATIVE LADDER IN THE TREATMENT OF THE WOUNDED WITH FLAMMABLE DEFECTS SOFT FABRIC

Abstract

Resume. Most wounds formed as a result of a gunshot wound require staged, and in some cases, multistage reconstructive and restorative operations and rehabilitation.
 Materials and methods. During treatment at the Military Medical Center of the Republic of Poland for 6 months (from 24.02.22 to 10.09.22), reconstructive and surgical treatment of 54 wounded soldiers was carried out using the principles of reconstructive and plastic surgery. The treatment process was based on a multimodal approach - dynamic screening of gunshot wounds with soft tissue defects, which was used in the pre-, intra- and postoperative periods.
 Results and their discussion. A total of 54 wounded people were included in the study. Methods of closure that were used during the recovery process: spontaneous epithelization — 3 (5.6 %) of the injured, secondary sutures — 10 (18.5 %), PHO with the use of a split skin flap - 12 (22.2 %), sliding flaps – 12 (22.2 %), propeller flaps – 17 (31.5 %). When using full-layer flaps (sliding, propeller) in wounded patients, inflammatory complications were not observed in the postoperative period, but the phenomena of venous stasis, marginal necrosis of the distal part of the flap were noted. The average number of postoperative bed days before independent movement or self-care was 7.5 days. The aesthetic component in wounded patients with the use of flaps increased by 1.8 times compared to the RSK technique.The functional component was restored in 35 % during further observation.
 Conclusions. As the experience of the VHP in previous military conflicts has shown, primary closure of a gunshot wound is not possible, and in some cases even harmful. Therefore, in our opinion, the preparation of a gunshot defect of soft tissues, based on multimodal monitoring, can be considered as a bright addition to the reconstructive-plastic ladder. Performing reconstructive and plastic closure of gunshot wounds with propeller flaps is an actual method of restoring the damaged anatomical area, which allowed to obtain better aesthetic, as well as anatomical and functional results, in some cases - without additional wound surfaces (places for the collection of RAS).