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Background. The problem of treating wounded patients with defects in soft tissues and bones of the extremities continues to remain relevant. One of the ways to close soft tissue defects, especially with loss of bone tissue, with open fractures of the bones of the extremities, is acute shortening and the creation of artificial angular deformation of the segment. The aim of the study – show the possibility of using the technique of acute shortening and angulation of the segment to replace soft tissue and bone defects in the treatment of a patient with a gunshot wound to the leg. Case description. A 30-year-old wounded man was admitted to the clinic with an extensive defect in the soft tissues and bones of the lower leg in the middle third. In order to reduce the size of the wound, acute shortening and angulation of the leg was performed. The intentional angular deformation of the tibia was 24º, shortening up to 8 cm. The next stage, after closing the residual soft tissue wound defect with local tissues and split skin autograft, was fixation of the tibia with an Ilizarov hinge-distraction apparatus, followed by gradual correction of the angular deformity. At the next stage - osteotomy of the tibia to eliminate shortening using the Ilizarov method (distraction rate 1 mm per day). After restoring the length of the tibia, in order to replace the defect along the anterior surface of the tibia, a marginal “flake” was formed from the displaced fragment. At a follow-up examination after 14 months. after injury, the patient walks with full weight bearing on the injured limb without additional means of support, and continues to perform military service duties in accordance with his position. Conclusions. The clinical case we presented demonstrates that acute shortening of a limb segment with the formation of an artificial angular deformity is a safe and effective method for temporarily closing a gunshot defect in soft tissues.
Background. The problem of treating wounded patients with defects in soft tissues and bones of the extremities continues to remain relevant. One of the ways to close soft tissue defects, especially with loss of bone tissue, with open fractures of the bones of the extremities, is acute shortening and the creation of artificial angular deformation of the segment. The aim of the study – show the possibility of using the technique of acute shortening and angulation of the segment to replace soft tissue and bone defects in the treatment of a patient with a gunshot wound to the leg. Case description. A 30-year-old wounded man was admitted to the clinic with an extensive defect in the soft tissues and bones of the lower leg in the middle third. In order to reduce the size of the wound, acute shortening and angulation of the leg was performed. The intentional angular deformation of the tibia was 24º, shortening up to 8 cm. The next stage, after closing the residual soft tissue wound defect with local tissues and split skin autograft, was fixation of the tibia with an Ilizarov hinge-distraction apparatus, followed by gradual correction of the angular deformity. At the next stage - osteotomy of the tibia to eliminate shortening using the Ilizarov method (distraction rate 1 mm per day). After restoring the length of the tibia, in order to replace the defect along the anterior surface of the tibia, a marginal “flake” was formed from the displaced fragment. At a follow-up examination after 14 months. after injury, the patient walks with full weight bearing on the injured limb without additional means of support, and continues to perform military service duties in accordance with his position. Conclusions. The clinical case we presented demonstrates that acute shortening of a limb segment with the formation of an artificial angular deformity is a safe and effective method for temporarily closing a gunshot defect in soft tissues.
The purpose of the study. To analyze the structure of the incoming flow in conditions of conducting large-scale military operations at the stage of emergency specialized surgical care and to determine the predictors of an unfavorable outcome in patients with severe combined wounds. Materials and methods. A retrospective cohort study of medical data was performed in seriously wounded during a special military operation who were admitted to the department of anesthesiology, intensive care and intensive care of a level 3 military medical organization with severe combined wounds and trauma in 45 seriously wounded. Depending on the outcome of treatment, the seriously injured and injured were divided into 2 groups: survivors (n=30, 66.6%) and deceased (n=15, 33.4%) within a 30-day period from the moment of injury. Results. In the structure of seriously injured people in need of resuscitation, gunshot wounds predominate 84.5% (fragmentation — 95.4%, bullet — 4.6%), surgical diseases account for 7.2% of cases, closed trauma occurs in 5.1% of cases, thermal lesions — 3.2%. Combined and multiple wounds were diagnosed in 96.2% of cases. Upon admission, the predictors of death are hypothermia (p-value=0.011), the time elapsed from injury to qualified surgical care (p-value=0.035), the severity of the condition on the APACHE II scale (p-value=0.047). During treatment at the stage of emergency specialized surgical care, the predictors of death are the laboratory assessment of total bilirubin (p-value=0.006), the SOFA scale (p-value=0.015), an increase in creatinine levels (p-value=0.018), the appearance of metabolic acidosis (p=0.022), an increase in the dose of norepinephrine (p-value=0.015).value=0.033), as well as an increase in potassium levels (p-value=0.041). Conclusion. The result of the study showed a high frequency of combined injuries admitted to the OARIT. The predictors of an unfavorable outcome at admission were hypothermia; the time elapsed from the moment of injury to the provision of qualified surgical care; the severity of the condition on the APACHE II scale. And during intensive therapy, the predictors were: an assessment on the SOFA scale, an increase in creatinine levels, total bilirubin, potassium levels and metabolic acidosis.
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