THE USE OF NEGATIVE PRESSURE VACUUM THERAPY IN THE TREATMENT OF SOFT TISSUE DEFECTS IN THORACIC INJURY
Creators: name: Zarutskyi Ya.
name: Aslanyan, S.
name: Kravchenko К.
name: Vovk, M.
name: Honcharuk, V.
Publisher: name: Norwegian Journal of Development of the International Science
Year: 2021
Subjects: combat surgical injury
combat thoracic injury
soft tissue deffects
negative pressure wound therapy

description: Thoracic injury accounts for 6-8% of all traumatic injuries and belongs to the category of particularly severe lesions of the body. About 90% of victims with thoracic injury are of working age, whose treatment and rehabili-tation are quite long due to the large number of purulent-septic complications (up to 20%), which often lead to disability or cause high mortality (17-30%). In peacetime, closed thoracic injuries are more common in the road accidents and in industries that are accompanied by multiple rib fractures and damage to internal organs. The mortality of the closed thoracic injury reaches 5-17%, and with a severe injury 40%. In modern military armed conflicts, the frequency of combat thoracic injury (CTI) is 8-12% [2]. During the JFO (Joint Forces Operations) in Eastern Ukraine, CTI accounted for 11.7% of the combat casualties of the surgical profile, from which 79.4% were nonpenetrating, and 20.6% were penetrating and usually with damage to internal organs [1]. Severe CTI is accompanied by massive blood loss, traumatic shock, acute respiratory failure, other complications and high mor-tality to 37% [8]. Large and very large wounds of the chest damages not only skin and hypodermic cellulose, but also fascia, muscles and other important anatomic structures of the chest. In such cases, these are soft tissue defects. Treatment of gunshot wounds of the chest wall complicated by purulent process has a number of features, which are the development of infection in the wound and the occurrence of complex soft tissue defects, which is deter-mined by the phase of the wound process. Peculiarities of the course of the wound process in this category of wounded are the development of traumatic disease, which affects the prolongation of all phases of the wound process and the accession of surgical infection [1,2,6]. During the JFO 9.3% of wounded with CTI, who had significant damage of the chest soft tissues. The pecu-liarities of combat surgical injury of the chest during the JFO in eastern Ukraine that they were all high-energy, received by bullets with high flight speed. Such injuries were characterized by the formation of a soft tissue defect, multiple fragmentary fractures with a bone defect. Combat surgical injury of the chest, given the different ballistic characteristics by the wounding shells, refers to severe damage of the chest, which in addition to the occurrence of defects in the chest wall causes severe damage of the chest internal organs. Despite the large number of such wounded with significant soft tissue defects, a clear classification of wounds based on their metric parameters has not yet been [3]. In the complex of systemic surgical treatment of wounded and injured with soft tissue defects in thoracic injury an important place is occupied by the treatment of complications both postoperatively and clinically by the chest: the development of purulent-necrotic processes, pleural empyema, broncho-pleural fistulas, infection chest wall wounds. Treatment of such wounds at CTI and a thoracic injury of peace time with soft tissues damage includes primary, repeated and secondary surgical debridements with the subsequent imposing of bandages. There-fore, the purpose of surgical treatment of such patients with soft tissue defects is fast closure in the simplest way with minimal losses, which involves the widespread concept of "reconstructive ladder", which reflects the distri-bution of plastic wound closure depending on the technical complexity of surgery [5]. This allows to replace small, large soft tissue defects in almost every anatomical area from the imposition of linear sutures to displaced pieces of soft tissue resistant to functional loads. Modern principles of the treatment of wound defects of soft tissues of the chest are based on the following provisions: reduction of necrobiotic processes in damaged tissues, reduction of infectious complications, reduction of treatment time, reduction of disability of the wounded. One of the modern world standards in the treatment of chest wounds with large soft tissue defects is the widespread using of VAC therapy (Vacuum Assisted Closure), or more known as NPWT (Negative pressure wound therapy), the treatment of soft tissue wounds by the negative pressure with the formation of vacuum dress-ings in the wounds (VAC-dressings) [4]. In the complex surgical treatment, this method allows to effectively clean and prepare to close the wounds of the chest soft tissues by stimulating granulation and reducing the area of the wound defect dermotension [6]. Therefore, the main purpose of the treatment of such wounds is to reduce the frequency of purulent complications, reduce the duration of treatment and fast returning wounded to service, or to recovering and other working activities. [7].