PECULIARITIES OF PROVIDING MEDICAL ASSISTANCE TO CIVILIAN VICTIMS OF EXPLOSIVE INJURIES
Authors: Prokopenko K.A. 
Published: December 2024

Introduction. On February 24, 2022, Ukraine faced a stark new reality as war reshaped the lives of its people, including the medical community. In today's world, where wars and conflicts have become an unfortunate part of reality, the management of injuries sustained during combat operations has gained critical importance. Civilians, often unintended victims of conflict, lack the protective measures afforded to military personnel.
Treating wounded civilians presents unique challenges, as they frequently suffer from comorbidities that complicate both medical care and rehabilitation. These factors necessitate tailored approaches to diagnosis, treatment, and recovery.
The aim of this study was to analyze the injuries caused by blast trauma among the civilian population and to develop an algorithm for the diagnosis and treatment of patients affected by such trauma.
Materials and methods. Medical records of 94 inpatients with explosive injuries treated in the surgical departments of the Communal Non-Commercial Institution of the Kharkiv Regional Council “Regional Clinical Hospital” and the Communal Non-Commercial Institution of the Kharkiv City Council “City Clinical Multidisciplinary Hospital No. 25” between 2022 and 2024 were analyzed. Among the patients, 36 (38.3%) were women aged 21 to 87 years, and 58 (61.7%) were men aged 23 to 86 years.
Results and Discussion. Soft tissue injuries were observed in all 94 patients admitted to the hospital. Of these, 45 patients (47.9%) sustained soft tissue damage to one or more anatomical regions without involvement of thoracic, abdominal, or pelvic organs. All patients underwent surgical treatment of wound, which included hemorrhage control, removal of visible foreign bodies, and wound debridement. For patients with traumatic limb amputations, surgical treatment included the formation of limb stumps. Patients with bone injuries underwent immobilization of the affected areas. Subsequently, dynamic monitoring of the wounds was conducted to assess healing and detect complications. Internal organ damage was identified in 49 victims (52.1%). All patients with intrapleural complications underwent Bülau drainage of the pleural cavities as the initial intervention. The second stage of care for victims with combined trauma involved laparotomy, during which the extent of the surgical procedure was determined intraoperatively. The third stage focused on wound management. During the primary operation, interventions were limited to wound debridement, hemostasis, and tamponade of wound channels. Subsequent procedures included repeated wound treatments, the primary delayed closure, or the use of vacuum-assisted closure (VAC) systems in cases of extensive soft tissue damage. For such cases, the final step involved autodermoplasty.
Conclusions. The experience of managing these victims highlights the importance of a stepwise approach to treating blast injuries, integrating modern surgical and resuscitation techniques. This structured approach has demonstrated its potential to yield favorable outcomes. Despite the severity of injuries and the presence of comorbidities, all patients were discharged in satisfactory condition, underscoring the high efficacy of the proposed treatment strategy.