OUR EXPERIENCE IN THE TREATMENT OF LARGE SOFT TISSUE WOUNDS WITH PERIPHERAL NERVE DAMAGE RESULTING FROM BLAST INJURY

Abstract

Resume. The number of victims with explosive wounds, which is what characterizes modern war, is increasing daily. Therefore, the experience of treating any explosive wounds is extremely important among the issues of military field surgery in Ukraine. Aim. To improve the treatment of victims with large-area soft tissue wounds with peripheral nerve damage resulting from explosive injuries, to improve the quality of life of such patients and to reduce their periods of incapacity. Research materials and methods. The results of surgical treatment of 43 victims with large soft tissue wounds with peripheral nerve damage resulting from explosive injuries were analyzed. The patients were treated in the surgical department of the Communal non-commercial institution of the Kharkiv Regional Council “Regional Clinical Hospital” in 2022-2023. Research results. In the course of treatment, we applied to all 43 patients a step-by-step algorithm for the treatment of large-area soft tissue wounds with damage to peripheral nerves that occurred as a result of an explosive injury. The first stage of treatment from the moment of hospitalization was to stop the bleeding, debride the wound with the removal of foreign bodies. After limiting the area of necrosis, a necroctomy was additionally performed. The second stage involved neurolysis of the affected nerve, followed by the subsequent formation of a muscle bed for the affected nerve. In the third stage, VAC-bandages were installed according to the shape of the wound on the muscle layer for active drainage. The next step was to remove the VAC -dressing and prepare the surface for skin grafting by mechanically treating the wound repeatedly to the level of “blood dew”. And the final stage was autodermoplasty of the defect with a perforated skin flap. Discussion of research results. The use of VAC-therapy in the treatment of blast wounds is a modern, innovative method of wound treatment that significantly improves the course of all stages of the wound process. While autodermoplasty is a common method of skin “transplantation” and represents the reproduction of a damaged area of tissue in cases where tissue regeneration occurs slowly or is not possible to the full extent. Conclusions. The use of VAC-therapy in the treatment of blast wounds is a modern and innovative method of wound treatment, which significantly improves the course of all stages of the wound process. While autodermoplasty is a common method of skin “transplantation” and represents the reproduction of a damaged area of tissue in cases where tissue regeneration occurs slowly or is not possible to the full extent.