Mamedov D. Prediction of outcomes of fire skull and brain wounds

The thesis is based on the results of research and surgical treatment 222 patients with fire wounds of a skull and brain from Armenia-Azerbaijan conflict and during peace-time. 203 patients have received wounds in battle operations, 19 - during peace-time. Is definded, that the battle wounds were more often fragment wounds, and peace-time wounds were bullet wounds. Bullet wounds were more often penetrating wounds as a results special ballistic properties of a bullet. Bullet wounds caused very large damages of a skull and brain and seriously ill condition of the patients. At a stage of the qualified medical care (medsanbat, region hospital) the surgical debridment of the wounds were insufficient and often (59%) patients required surgical debridment of the wounds in specialized neurosurgical hospital. Optimal time for primary surgical debridment of the wounds is 12-24 hours after wounding with antibiotic treatment. In fire wounded persons we have seen infection (14%) and noninfectious (31,1%) complications. The patients with bullet wounds and with insufficient surgical debridment were more often complicated. The lethality in bullet wounded patients were 30,8% and in patients with fragment wounds -19,7%. Unpenetrated wounds characterized low iethality (11,2%). Penetrated wounds are accompanied by a high lethality: radiar wounds - 38,5%, diagonal wounds - 43,3% and transparent wounds - 88%. The prognosis ot consequences of fire wounds of a head depends from the level of consciousness. Among patients entered in the hospital in clear consciousness the lethality was 2,6-11,1%. The lethality was 38,1-78,3% among the patients entered in coma. The results of the research have shown, that the primary surgical debridment of the fire wounds of the skull and brain should be done in specialized neurosurgical hospitals.