Revascularizative surgery in the treatment of combat surgical trauma
Authors: Merkulov D. S. , Fistal E. Ya. , Demchuk V. O. 
Published: July 2024

Objective. High-energy injuries, such as gunshot wounds, combined with the general serious condition of the victim, cause difficulties in choosing tactics for providing surgical care, especially when functionally significant areas are affected. Failure to perform primary surgical treatment of such wounds or its excessive delay inevitably leads to the formation of extensive necrosis, accumulation of pus in confined spaces, disruption of physiological barriers and the development of wound infection. One of the effective methods for more radical cleansing of wounds is the use of low-frequency ultrasound. The study was based on the principle of wound treatment using low-frequency ultrasound, in particular the implementation of ultrasonic cavitation when performing primary surgical treatment with simultaneous repair of a wound defect. Depending on the location and general condition of the victim after primary surgical treatment, fasciocutaneous, muscle, or musculocutaneous flaps were used to eliminate soft tissue defects. In the event that the patient's condition did not allow wound closure using complex flaps, wound treatment was performed using ultrasonic cavitation, and wound closure was performed after stabilization of the condition, on average 2–3 days after repeated surgical treatment using ultrasonic cavitation. The tactics of using revascularization flaps in the primary surgical treatment of gunshot wounds using high-frequency ultrasound as a radical debridement in preparing wounds for plastic closure are substantiated.

Purpose of the study: to improve the methods of primary surgical treatment in patients with combat surgical trauma.

Material and methods. The study included 34 men aged 20–60 years old (average age (39.2 ± 2.4) years old) with post-traumatic soft tissue defects. All patients were treated with methods of closing wound defects using flaps on the axial circulation in the early stages after injury. On average, the time it took to deliver a wounded person to a specialized center was (18.0 ± 2.2) hours. All study participants were injured as a result of combat operations: isolated shrapnel wounds – 20 people, 14 people were admitted with combined mine-explosive trauma.

Results. In 3 patients, injuries were accompanied by open compound fractures (type III in the Gustilo classification). 8 patients had exposure of bone structures, 7 patients had exposure of tendon tissue, 1 patient had exposure of bone structures of the lower jaw, an open fracture of the upper jaw with damage to the maxillary sinus, and a fracture of the zygomatic bone. 8 patients had extensive injuries to both lower and upper extremities, 2 patients had traumatic amputation of the lower extremity, 5 also had burns of varying severity in combination with shrapnel wounds. The optimal time for reconstruction was considered to be the first 72 hours from the moment of injury. However, adhering to damage control tactics, the acceptable time for reconstruction was considered to be days from the moment of injury, taking into account that during this period wound infection does not develop and bacterial contamination is minimal.

Conclusions. Our data allows us to conclude that the use of ultrasonic cavitation is effective, which allows the use of revascularization flaps to close the wound surface in the early stages after combat surgical trauma.