Explosive Trauma Research Articles

A shrapnel migration from a peripheral vein to the right ventricle: case report

Abstract Background Foreign bodies that migrate into the heart may include medical devices dislodged from their original location or, rarely, external particles (shrapnel and other foreign bodies) that penetrate the vein, remain intraluminal, and migrate via the venous blood flow to the right heart. Most reported entry sites of these external foreign bodies were in the torso, thigh, or neck; none of them penetrated through a distal extremity of the body. We report a case where shrapnel was found in the right ventricle (RV) following penetrating injury to the hand. Case summary An otherwise healthy 24-year-old man presented with an isolated shrapnel injury to his right hand and forearm from an explosion trauma. Computed tomography demonstrated multiple small metal objects in the forearm, hand, and wrist. Additionally, a 3 × 3.5 mm metal object was found in the RV, consistent with a metal shrapnel embolus from the forearm. Echocardiography indicated the fragment to be in a fixed position within the RV, without any additional pathology. Discussion Even shrapnel that penetrates through the hand or forearm may migrate to the heart. In this case, following a multidisciplinary discussion, a conservative approach was recommended based on the following condition: lack of symptoms, small size of the foreign body, no obstruction of venous effluent, low risk of significant embolization to the pulmonary vasculature, absence of fever or endocarditis, no current evidence or risk of valve dysfunction, and no myocardial irritation indicated by arrhythmia. The patient was instructed to avoid magnetic resonance imaging scans.

The Need to Introduce the Mine Explosion Trauma Station in Pre-Hospital Emergency Medicine Competitions

The Need to Introduce the Mine Explosion Trauma Station in Pre-Hospital Emergency Medicine Competitions

Forensic characteristics of injuries from thermo-baric explosive device

Since the beginning of the Russian Federation's invasion of Ukraine in 2022, explosive trauma has become an extremely urgent problem, as the main source of bodily injury among both the military in the combat zone and the civilian population in cities has been the impact of explosive devices. The aim of the study is the examination of the forensic characteristics of damage to biological objects that were formed from thermal exposure and shock wave as a result of the explosion of a cumulative munition and in the conditions of an experimental explosion model. The objects of the study were the materials of two examinations on the death of Ukrainian soldiers who died in the war zone (archival "Conclusions of the medical examination" of the Kyiv City Clinical Bureau of Forensic Medical Examination in 2023). Under the conditions of the experiment, studies of pathomorphological changes in the liver and small intestine of 30 white outbred rats from the action of an artificially created air shock wave with an overpressure of 31.62±4.84 kPa were carried out. The injuries were examined macroscopically and using standard laboratory histological techniques. Microscopy of histological sections was performed using an Axio Imager 2 microscope (Zeiss, Germany) at magnifications of ×200 and ×400. Statistical processing of the obtained quantitative results was carried out using the STATISTICA 6.1 software product. Under the condition of the explosion of the ammunition with the cumulative effect of the rocket-propelled infantry flamethrower "Bumblebee" on sectional incisions of the skin and muscles of the thigh in the projection of areas of redness, a picture of a gelatinous consistency of bright red color was macroscopically determined due to abundant blood impregnation of muscles and subcutaneous fat and partial loss of muscle structure with the release of myoglobin. The bright red color of the skin of the thigh and pelvis without burning the hair may indicate the superficial thermal effect of the explosive device and the protection of the skin by clothing. Diffusely located numerous both paired and single abrasions and shallow wounds, small rounded, oblong, circular in shape, which are the result of fragments of a rocket-propelled grenade equipped with a fire mixture, were also determined. The effect of an air shock wave with an overpressure of 31.62±4.84 kPa on the liver parenchyma of rats was determined by focal hemorrhages with rupture of the terminal central vein of the hepatic lobule, edema of the parasinusoidal spaces, and sludges in the sinusoids. In the wall of the small intestine, acute hemodynamic disorders occurred in the form of vasodilation of arterial vessels, venular and capillary stasis. There was layering and swelling of the small intestine wall, rupture of veins, focal hemorrhage. Thus, the revealed characteristic pathomorphological signs of the destructive effect of overpressure as a result of a blast wave (barotrauma) are typical and common both in the areas of the human thigh and pelvis, and in biological objects of experimental animals. The obtained results are consistent with the pathomorphological manifestations of barotrauma in areas of the human body as a result of the action of an explosive device with a cumulative effect.

The use of computer stabilometry for the diagnosis of MSA lesions of servicemen of the Armed Forces of Ukraine after explosive trauma (contusion), spinal cord injuries and in rehabilitation and monitoring its effectiveness (analytical review of scientific literature)

The use of computer stabilometry for the diagnosis of MSA lesions of servicemen of the Armed Forces of Ukraine after explosive trauma (contusion), spinal cord injuries and in rehabilitation and monitoring its effectiveness (analytical review of scientific literature)

Forensic-medical characteristics of penetrating wounds as manifestations of explosive trauma in the case of decomposed bodies examination

The Russian invasion of Ukraine in 2022 caused a significant spike in the number of deaths from blast injury. The impossibility of evacuating the bodies of dead servicemen or civilians from the battlefield for a long time leads to the fact that forensic experts often have to deal with the examination of bodies in a state of decomposed changes. At the same time, the material and technical support of forensic medical institutions in different parts of Ukraine is heterogeneous: most experts do not have access to laboratory or instrumental research methods and can only rely on macroscopic research data. This article provides an overview of the cases of expert examination of cases of explosive trauma of decomposed bodies using macroscopic, microscopic, chemical and instrumental research, which indicates the high efficiency of their use for the purpose of solving expert questions of various nature. At the same time, the identified morphological characteristics of the damage are not purely specific and indicate the action of a blunt solid object with a limited contact surface, which had high kinetic energy and significant penetrating capacity.

BLAST INJURI. ANESTHESIA AND INTRAOPERATIVE INTENSIVE CARE AT THE EARLY HOSPITAL STAGE (ADVANCE NOTICE)

Summary. Explosive injury is a combat multifactorial injury that occurs as a result of the combined damaging effect on the human body of a shock wave, gas jets, fire, toxic products of explosion and combustion, ammunition casing fragments, secondary projectiles. The hostilities taking place in Ukraine present many questions to anesthesiologists regarding the provision of medical care to victims of blast injuries. This type of injury is often associated with damage to 2-4 anatomical sites and sometimes more. Moreover, most of the hospital care is provided in civilian hospitals located close to fighting.
 The aim of study. The choice of anesthesia technology and intraoperative intensive therapy in victims of explosive trauma depending on the severity of the explosive trauma and the condition of the patients.
 Material and method. During the period March-December 2022, 226 (195 men, 31 women) patients of explosive injuries were admitted to the Zaporizhzhya Regional Clinical Hospital and assessed according to the GKO scale (standardized system for assessing the severity of injuries and the condition of patients.
 The results. Before the operation, there was normotension and moderate tachycardia. However, in 25 patients, the systolic blood pressure was less than 90 mm Hg, which required the use of sympathomimetics and infusion therapy with crystalloids and colloids. During the operation, sympathomimetics continued to be used in 42 patients. Norepinephrine was used in 37 patients in a dose of 0.1 to 0.4 μg/kg/min. Phenylephrine – in 5 patients in bolus doses of 20-100 μg.
 The indicators of systolic, diastolic, pulse, mean arterial pressure and heart rate at the stage of completion of the operation did not differ significantly from the initial ones. Before the operation, the patients had subcompensated metabolic and respiratory acidosis, hyperoxemia, and increased lactate concentration. At the stage of the operation, the phenomenon of metabolic acidosis increased, as evidenced by a significant increase in the BE indicator. Respiratory acidosis and hyperoxemia persisted. The concentration of lactate in the blood decreased significantly, on average by 21 %, but on average was (4.1±0.1) mmol/l.
 Conclusion. Assessing the severity of the patients on the GKO scale allows you to choose the anesthesia technology considering the influence of the drugs used for anesthesia on hemodynamics. At the stages of treatment of the patients of the blast trauma, it was possible to maintain normotension. Mixed decompensated acidosis and increased lactate at the end of the operation indicate oxygen debt.

Features of blast-induced traumatic brain injury

Traumatic brain injury, despite its prevalence and study, is the most urgent issue of medicine in clinical, social and military-medical significance. In Russia, about 500 thousand people receive a traumatic brain injury every year, and the damage to the country’s economy exceeds 500 billion rubles a year. Traumatic brain injury is damage by mechanical energy to the skull and intracranial contents (brain, meninges, vessels, cranial nerves), accompanied by clinical symptoms and, in most cases, morphological changes. Recently, blast-induced traumatic brain injury has acquired particular importance, which is due to the change in modern tactics of warfare and the predominance of explosive trauma in the structure of all injuries. The features of blast-induced traumatic brain injury are associated with a variety of factors affecting a person (shock wave, light, heat radiation, fragments, etc.). Such a multifactorial effect on a person makes it difficult to identify a blast-induced traumatic brain injury, especially a brain concussion. This is due to a possible combination of damage to different organs and systems of a person during an explosion, which can simulate or mask a brain concussion. When diagnosing a traumatic brain injury, it is especially important to assess the circumstances and information from witnesses of the event, which often presents a certain complexity in the conditions of hostilities. Currently, methods for detecting symptoms of instability, visual and disorders of other sensory systems involved in maintaining balance are considered as a promising direction for the diagnosis of mild traumatic brain injury. It is also important to note that patients who have suffered a traumatic brain injury have a risk of developing neurodegenerative diseases. All this further emphasizes the relevance of traumatic brain injury and the existing need to develop an optimal algorithm for the examination of such patients.

Случай центральной серозной хориоретинопатии после взрывной травмы

Relevance. Over the past decade, clinical cases of central serous chorioretinopathy after an eye injury have increasingly appeared in the press. Purpose. Currently, there are no cases of description of central serous chorioretinopathy after an explosive injury in the literature available for review. Presenting our clinical case, we will try to fill this gap. Methods. A 41-year-old man with concomitant injuries was admitted to inpatient treatment at a multidisciplinary clinic after a close detonation of a high-powered explosive device. At the end of the second week from the moment of injury, against the background of an improvement in the general well-being of the patient, the «flickering spot» in front of the gaze of the left eye began to actively disturb. On the 21st day after injury, both eyes were examined using an optical coherence tomograph with a rocking source (OCT) DRI OCT Triton by Topcon (Japan). In the lower quadrants on the edge of the macula of the left eye, a serous detachment of the neuroepithelium was detected with dimensions of 5310×5253 μm and a maximum height of 706 μm with two detachments of the retinal pigment epithelium. On the 28th day from the moment of injury, during the control OCT study, flattening was noted, but with an increase in the area of serous detachment of the neuroepithelium and the preservation of detachments of the retinal pigment epithelium. In connection with the professional requirements for the patient's state of health, delimiting laser coagulation of the retina was performed against the background of the treatment of concomitant pathology. Results and discussion. On the 33rd day after the injury, complete adherence of the serous detachment of the neuroepithelium and detachments of the retinal pigment epithelium was noted with the disappearance of the patient's complaints. Conclusion. The presented clinical case is of great interest, since eye trauma and, in particular, explosive trauma are quite rare causes of the development of central serous chorioretinopathy. Key words: clinical case, serous chorioretinopathy, neuroepithelial detachment, pigment epithelium detachment, blast injury, post-traumatic retinopathy, eye injury

Prediction of late results of surgical treatment of traumatic retina detachment in eye injury of multiple origin

Purpose. To evaluate the possibility of predicting the anatomical and functional results of surgical treatment of traumatic retinal detachment (RD) in trauma of various geneses, taking into account the clinical picture and the severity of the proliferative syndrome based on large clinical data.Materials and methods. A comprehensive analysis of the clinical picture (using 22 features) and long-term results of surgical treatment of 427 patients with traction traumatic RD (TRD) after open and closed eye injury was carried out. The patients were divided into 7 groups depending on the mechanism of injury. The observation period was 5 years.Results. The most severe proliferative syndrome was observed in TRD after an open injury: OEI A (contusions with scleral rupture), OEI D (double puncture wound) and OEI E (explosive trauma with scleral rupture), when both the process of mooring and PVR are present, as well as with CEI A (contusion) in the event that after the first operation PVR continued to progress. We found a direct dependence of PVR activity in TRD on the area of the detached retina and the presence of a traumatic cataract, and the inverse dependence on the presence of intraocular foreign body (IFB), its size and the ability of IFB to cause metallosis. A direct dependence of long-term functional results of treatment on the PVR stage, the area of detached retina and the diagnosed retinal rupture during the first vitreoretinal surgical intervention was established.Conclusion. In order to make the surgical treatment of TRD more effective, it is worth using antiproliferative drugs intravitreally during vitreoretinal surgery, especially in OEI A, OEI D and OGI E, when the proliferative syndrome is caused both by PVR and mooring, as well as in CEI A in the case of a pronounced PVR stage.

SURGICAL TREATMENT OF DAMAGE TO THE ORGANS OF THE CHEST CAVITY AS A RESULT OF AN EXPLOSIVE INJURY

Abstract. Some features of surgical treatment of injuries to the chest cavity against the background of explosive trauma are considered. The principles of providing hospital and hospital care to the wounded with explosive wounds are presented. Considerable attention is paid to vital, absolute and relative indications for the removal of foreign bodies with a thorough description of their removal technologies.
 It is concluded that the terms of performing operational interventions in case of explosive trauma with predominant damage to the chest organs are determined taking into account the type of damage, localization and number of injuries, the general condition of the patient, the presence of certain life-threatening complications. Surgical interventions can be either resuscitation, aimed at eliminating life-threatening conditions, or delayed, that is, aimed at preventing severe secondary complications of the wounded.

The Integration of Point-of-Care Ultrasound into Practical Trauma Training in Ukraine: A Case Study Highlighting Feasibility, Satisfaction, and Pre- and Post-Training Comfort with the Technology

Introduction:As of October 2022, the civilian casualty count of the invasion of Ukraine is reported to be 16,295, with actual figures believed to be considerably higher. As explosive trauma continues to terrorize populations, frontline medical personnel are faced with escalating resource constraints including transport, imaging modalities, and electricity. Point of care ultrasound (POCUS) is considered the gold standard in acute trauma evaluation, but very few hospitals or pre-hospital medics have access to or training in POCUS.Method:In collaboration with the Ukrainian Ministry of Health, the World Health Organization, and the Global Health Program at Butterfly Network, Team Rubicon developed and conducted 64 practical trauma trainings and donated 50 Butterfly iQ+ portable ultrasound devices in Ukraine between August and October, 2022. Of these trainings, 19 specifically focused on the use of POCUS for trauma. Pre- and post-surveys were deployed to determine demographics, comfort level with POCUS for trauma care, and usefulness of the course.Results:In total, 149 individuals were trained in POCUS for trauma. Of these, 130 were physicians, 15 were paramedics, three were RNs, and one was a pharmacist. Only 14.8% of these clinicians self-reported any previous POCUS training. All participants reported an increase in comfort level, with an average pre- and post-course comfort scores of 1.9 and 3.3 (4=very comfortable), respectively. General satisfaction with the training was high (average score of 9.8/10). Qualitative feedback commended the quality and novelty of this training, requested further examples of pathology, and endorsed more POCUS trainings, generally. The most critical lesson learned was the need to re-orient training around the foundations of POCUS given low levels of experience and training.Conclusion:Access and training in POCUS for trauma is critical for resource-constrained medical personnel operating in conflict-affected communities. A one-day POCUS practicum-oriented course is feasible to support awareness and proficiency.

A clinical case of transient diabetes insipidus with high spinal trauma

BACKGROUND: Diabetes insipidus is characterized by the kidneys inability to absorb water and concentrate urine, which is based on a defect in the synthesis or secretion of vasopressin and is manifested by severe thirst and excretion of large volumes of diluted urine. Data on diabetes insipidus in adults with isolated spinal injury are presented in single works of foreign authors, and no domestic and foreign publications have focused on diabetes insipidus in children. Available publications are descriptions and evaluations of the diseases clinical picture according to clinical and laboratory abnormalities and analyzed therapy in the postoperative period.
 CLINICAL CASE: This study presents a clinical case of transient diabetes insipidus in a 12-year-old patient with high-level spinal cord injury after shrapnel and explosive trauma. A detailed description of the clinical picture is provided.
 DISCUSSION: Polyuria, polydipsia, and low urine density were noted on day 14 after surgical correction and stabilization of post-traumatic spinal deformity with spinal cord rupture at the CVICVII level. The condition was considered a transient diabetes insipidus. Clinical and laboratory recovery was achieved on day 12 after surgery thanks to treatment by desmopressin.
 CONCLUSIONS: This clinical case presents that diabetes insipidus may develop in pediatric patients with isolated spinal injury. Given the insufficient understanding of the causes of this rare disease, differential diagnosis is necessary for pediatric patients with high-level spinal cord injuries associated with polyuria and low urine density. Moreover, treatment with desmopressin should be prescribed appropriately.

Pyroban on New Year's Eve 2020 & 2021 - Analysis of firework-related injuries over the last 12 years

There is an increase of firework-related injuries in Germany at the turn of the year. With regard to hearing, a distinction is made between blast (BT) and explosion trauma (ET). The study examines the prevalence and characteristics of firework-related injuries and the impact of the COVID-19-pandemic pyrotechnic ban on New Year's Eve 2020/21 and 2021/22 compared to the 10-year period prior to the pandemic.A retrospective chart review of all patients who presented themselves with the diagnosis blast trauma (H 83.3) or explosion trauma (T 70.8) at the Charité emergency service in the last 12 years from Dezember 28 to January 5 was performed.276 patients were recorded, 77% of whom were male. 1/3 each were assigned to the age group 10-19 and 20-29 years. 21% of the patients were admitted to the hospital. There was an isolated BT of the ear in 67%, hand injuries in 11%, head injuries in 8% and eye injuries in 4%. 87% had ear involvement with hearing loss; 5% of these with ET.8% of the patients underwent surgical interventions. The treatment of a tympanic membrane perforation was carried out by: 54% splinting, 38% tympanoplasty. Therapy with a glucocorticoid was administered i.v. in 48%. and initiated orally in 20%. Overall, there was a nearly 75% decrease in injuries in 2020 and 2021 compared to the previous 10-year period.The use of fireworks leads to increased utilization of health care resources. The ban on the sale of pyrotechnics as well as the introduction of pyro ban zones in 2020 and 2021 led to a relevant decrease in injuries. 2020 and 2021 were the only years in which there were no injuries in children. The BT of the ear is the most common firework-related injury.

PROSPECTS FOR THE USE OF IMMUNOHISTOCHEMISTRY METHODS IN THE STUDY OF THE PATHOMORPHOLOGY OF EXPLOSIVE AND GUNSHOT TRAUMA

Improving the methods of prevention of various types of fatal and non-fatal injuries, exogenous intoxication, sudden death, improving the quality of medical and diagnostic work are reflected in the results of forensic medical examination. Forensic diagnostics of gunshot and explosive injuries are a little-studied aspect. The article is devoted to the prospects of using immunohistochemistry methods in the study of the pathomorphology of explosive and gunshot trauma. The results of a brief analysis of the literature and their own scientific developments allowed the authors to outline the prospects for the use of immunohistochemistry methods in the study of the consequences of gunshot and explosive trauma. The authors propose a number of possibilities for using immunohistochemistry methods in the study of pathomorphosis and morphogenesis of these types of trauma. The study allows us to analyze a significant range of changes in purulent- resorptive fever, sepsis, which often complicate the course of gunshot and explosive trauma when using modern lethal weapons. The presented materials emphasize the relevance of the study of gunshot and explosive trauma by methods of immunohistochemistry. The use of immunohistochemistry methods can enrich the pathology of explosive and gunshot injuries with new knowledge that would be of interest to the practice of military field surgery for such lesions.

Diagnostics of the prescription of damage to the pancreas in explosive trauma and gunshot wounds during a military conflict

Diagnostics of the prescription of damage to the pancreas in explosive trauma and gunshot wounds during a military conflict

Upper Limb Salvage Surgery Due to Explosion Using Vacuum-Assisted Closure: A Case Report

High trauma injuries of the forearm frequently present with complex bone and soft tissue defects. Early repair is required to retrieve the extremity and restore its function, As the advance of surgical repair and reconstruction technology, limbs damaged by high energy trauma that might have needed to be amputated in the past can now be saved by surgical reconstruction
 This is a case report of 36 year old man with left upper limb injury after high energy explosion trauma where a large soft tissue defect of the forearm with exposure of the vital structures and fracture of the ulna and radius and the fracture of radius and ulna were fixed by Elastic Nail to maintain their alignments and length, and put a cerclage on the fracture site of the radius to hold a fragment. The large soft tissue was reconstructed by a primary tendon and muscle repair, with vacuum assisted closure followed by split thickness skin graft. And at 6 Weaks physıotherapy was started wıth dynamıc hand splınt by slıgthly flexıng the fıngers
 The application of VAC as temporary coverage of large tissue defects in upper limbs supports wound conditioning and facilitates the definitive wound closure.

A CASE OF ACCELERATED RIGOR MORTIS

Introduction. Rigor mortis is the tension of skeletal and smooth muscles that occurs after death and fixes the body in a certain position. It is one of the signs of biological death and usually develops in 1.5 - 3 hours, starting from the lower jaw. The full development of rigor mortis is observed in 12 - 24 hours after death. But in rare cases, its development can be significantly accelerated. Clinical case. A 34-year-old man was in the department of anesthesiology and intensive care for 4 days with a diagnosis of explosive trauma, neck injury with damage to the right carotid artery, hemispheric ischemic stroke. In the setting of multiple organ failure, moderate coma, central hyperthermia (40.3 °C), resistant to antipyretics, he went into a cardiac arrest. Resuscitation measures (including triple defibrillation) for 50 minutes were without effect. During the ascertainment of biological death, the presence of rigor mortis was noted in the lower jaw, neck and extremities, which was absent during the first 30 minutes of resuscitation and at the beginning of the asystolic rhythm. Discussion. The occurrence of rigor mortis is explained by the release of calcium ions from myocytes and the depletion of muscle adenosine triphosphate, which leads to the formation of a stable bond between actin and myosin. Instant or accelerated rigor mortis is rare. According to the literature, high body temperature, strenuous exercise before death, electric shock, convulsions and muscular dystrophy contribute to the acceleration of rigor mortis. Conclusions. In our case, the patient had severe hyperthermia (40.3 ° C), and defibrillation was performed during resuscitation, ie the body was exposed to electric current. Probably, these factors caused the accelerated development of rigor mortis.

The War in Europe: An Elsevier Academic Publishing Company Cordially Supports Oral and Maxillofacial Surgeons and Scientists in Ukraine

ScienceDirect® is a registered trademark of Elsevier B.V.―an academic publishing company headquartered in Amsterdam, Netherlands with offices worldwide. ScienceDirect contains more than 18 million articles and chapters and >2,650 peer-reviewed journals. Multiple peer-reviewed journals from the subject categories “Oral Surgery,” “Surgery,” and “Otorhinolaryngology” are always in the field of view of the Ukrainian oral and maxillofacial surgeons. Many of those journals are published by Elsevier B.V., and for the wartime period this international publishing company gave to surgeons in Ukraine a full access to all its journals. Such opportunity is limitless useful due to the possibility to absorb international data and surgical techniques without subscriptions or payments. Russian terroristic invasion to Ukraine increased a need for Ukrainian oral and maxillofacial surgeons, trauma and plastic surgeons to manage significant number of severe ballistic and explosive trauma cases. Implementation of modern surgical principles into wartime practice is crucial for life-saving surgeries. Thus, the scientific support of Elsevier company will definitely contribute to lives` preservation and health of the Europeans.

Features of microcirculation and metabolism in the skin and soft tissues of the injured area in experimental explosive trauma

Time, nature, and duration of changes in microcirculation and metabolism, as well as their differences in skin and muscle tissue of the injured area during experimental explosive trauma in rats in different wound process phases, are evaluated. Experimental explosive damage was simulated on 30 Wistar rats. The total condition of rats, their activity, interest in food and water, wound area with characteristic wound healing time calculation, the volume of injured pelvic limb, and changes of microcirculation and metabolism in the skin and skeletal muscles of the paravulnar region were evaluated. The explosive damage has led to a deterioration of microcirculation and metabolism in the skin, and especially, in the muscles of the injured area. Compared to the intact group, the microcirculation deterioration resulted in a decreased constant component of perfusion in the skin and muscles by 57.6% and 40.9% and a decreased vial by 76.9% and 76.5%, respectively (p 0.05), as well as in reducing the fluorescent oxygen intake in the skin and muscles by 25.7% and 51.8% and a complex indicator of effective oxygen exchange by 81.1% and 91.9%, respectively (p 0.05). During the experiment, the microcirculation and metabolism were gradually restored, which is more pronounced in the skin, except for the repeated deterioration of the non-vascular regulation of microcirculation in the muscle (a decreased vial by 29.3% of the norm, p 0.05). Changes in the main indicators of microcirculation and metabolism indicate normal skin defect healing and unsatisfactory muscle defect repair (decreased volume of the injured limb (68% of the norm, p 0.05)), accompanied by the recurrence of extravascular disorders in the muscle. Developing new and improved existing methods of delivering biologically active drugs and drugs to the area of muscular damage in the early days after the injury, which strengthen the local blood flow and create conditions for damaged muscle regeneration, reduce the wound healing time without forming pathological scars.

Medical and social features of providing medical care for population with mild traumatic brain injury due to blast wave action

Due to the war in Ukraine, the number of servicemen and civilians with a mild form of traumatic brain injury (TBI) caused by the blast has increased. Pathogenesis, clinic, treatment, rehabilitation of patients with TBI differ from these parameters in patients with trauma in peacetime (mainly road and sports). The aim of this study was to establish the relationship between the pathogenesis, clinic and features of the treatment of trauma caused by the blast wave, with the organization of medical care for this category of patients. The article also highlights some issues of quality of life of patients and the social significance of the consequences of the disease in light of the prevalence of pathology. The methods of system analysis and bibliosemantic method were used in the research. Statistical data and scientific publications on the incidence and consequences of TBI, its long-term consequences, features of treatment and rehabilitation have been studied. The main consequence of the explosive trauma is concussion, the reverse state, the pathogenesis of which is based on temporary functional disorders. Such concussions are accompanied by cerebral symptoms (without further focal neurological symptoms), autonomic vascular reactions, temporary loss of consciousness and memory. General practitioners, physical therapists, neurologists, neurosurgeons, psychia­trists, psychologists, traumatologists, resuscitators, otolaryngologists, and rehabilitation specia­lists should be involved in providing medical care to the victims. Medical facilities providing medical care to victims should be provided with drugs for the treatment of headache (tension pain and migraine pain), dizziness, vertigo, loss of consciousness, tinnitus, sleep disorders, cognitive disorders. Given the importance of the regime for the successful treatment and rehabilitation of patients, physicians should have sufficient time to consult patients, which should be taken into account when planning his workload. Keywords: traumatic brain injury, medical and social consequences, the quality of life of patients.