TREATMENT OF PURULOUS-INFLAMMATORY COMPLICATIONS OF BULLET AND MINE EXPLOSIVE INJURIES OF EXTREMITIES

Abstract

The aim of the study. To provide an analysis of the development of purulent-inflammatory complications in gunshot wounds and mine-explosive trauma and to develop tactics for the treatment of infectious complications at the stage of specialized medical care.
 Materials and methods. An analysis of the treatment of 57 patients with purulent-inflammatory complications of the limbs after gunshot bullet wounds and mine-explosive trauma was conducted. Of them, 34 (59.6%) military personnel and 23 (40.4%) civilians were treated in the bone-purulent surgery department. 44 (77.1%) of the patients had a mine-explosive injury, and 13 (22.9%) had bullet wounds.
 Research results. It was revealed that the cause of infectious complications was severe trauma, and in some cases irrational both general and local treatment during the evacuation stages. The therapy was not aimed primarily at the elimination of signs of traumatic shock, anemia, and detoxification of the body. In most of the victims, the initial surgical treatment of wounds was performed poorly and insufficiently, repositioning and stable fixation of fractures was not performed. As a result of the treatment, 2 (3.5%) patients with severe mine-explosive injuries of the lower limbs, pelvis and spine died, 6 (10.5%) victims underwent limb amputation at the level of the middle third of the thigh. The rest of the patients from the first day of hospitalization received complex treatment aimed at eliminating the purulent-inflammatory process of the extremities. In 41 (71.9%) fractures were fixed with external fixation devices. After elimination of the inflammatory process, all patients were transferred to outpatient treatment in a military hospital or at their place of residence.
 Conclusion. Modern combat trauma of the limbs in the course of treatment is complicated by severe purulent-inflammatory processes in 35% of cases. According to the clinical course, gunshot wounds differ significantly from mine-explosive injuries. One of the formidable infectious complications is gunshot osteomyelitis, the course of which exhausts the body and leads to sepsis and death. Stabilization of fractures against the background of purulent-inflammatory processes should be performed with external fixation devices.