The thesis presents a theoretical generalization and a new solution to the current modern military field neurosurgery - improvement of the results of treating the wounded with gunshot wounds of the cranial vault soft tissues by improving and optimizing medical care at the stages of medical evacuation in combat operations in the eastern Ukraine. The results of clinical and instrumental examination, medical assistance in the system of medical-evacuation support of 311 wounded men with gunshot wounds of the cranial vault soft tissues, which were treated in military medical units and institutions 2-5 levels for the period 2014 to 2017 are presented.From 311 wounded with gunshot wounds of the cranial vault soft tissues, the bulk of 77,1% were young servicemen aged 18 to 30 years. According to the type of injuring agent shrapnel wounds prevailed - 95,8%, by nature of the wound channel: blind - 40,8% and tangent - 36,6%. The wounded with intracranial pathological changes - with an average and high risk of developing intracranial complications accounted for 40,5%. In 32,5% of the wounded of this category, concussion was diagnosed, in 18,2% brain contusion and in 1,6% ? subdural compression by the subdural hematoma on the background of a severe brain contusion.Since the beginning of armed conflict in the east of Ukraine, for the first time in the new combat conditions the Armed Forces of Ukraine have created and perfected a system of medical evacuation, adapted to NATO standards. Six levels (types) of medical assistance were implemented on an evacuation-consistent basis.It is proved that at the pre-hospital stage, medical care for the wounded with gunshot wounds of the cranial vault soft tissues should be limited to the actions that stop bleeding from the wound of soft tissues, restore the patency of the upper respiratory tract, support vital functions and timely evacuation to the military mobile hospital.The feasibility of tomographic studies at level 2 in the first 24 hours after injury has been established, which makes it possible to identify the features of intracranial brain damage.The optimal variants of primary surgical treatments of the cranial vault soft tissues, depending on the nature of the wound, type of the wound channel and the localization of the wound were developed. Surgical interventions conducted in accordance with the proposed methods in hospitals at the 2 and 3 levels, which allowed to achieve 100% of the positive result. Surgical purulent complications were observed in only 0,3%, which was associated with the primary burn of soft tissues in the wounded area, which healed by secondary tension. There were no lethal outcomes.The optimal variant of the medical evacuation system for rendering medical assistance in the case of gunshot wounds to the cranial vault soft tissues is a system in which a medical institution of the 2nd level, in both mass admissions of the wounded and single incomes, qualified medical care with elements of specialized wounded with low development risks intracranial complications is provided by a general surgeon who has received a primary specialization in neurosurgery or a neurotraumatologist. Wounded with medium and high risks must be evacuated to specialized institutions of the 3 level.The use of sorting methods at the stages of medical evacuation, the timely evacuation of the wounded, and the use of rational methods of primary surgical treatment of a soft-tissue gunshot wound made it possible to obtain optimal results of treatment-recovery and return of all 311 (100%) of the wounded.
