Kompaniiets A. Vacuum dressings in the surgical treatment of wounded with soft tissue defects in a combat injury

The dissertation is devoted to the problem of classification, tactics of treatment and closure of defects of soft tissues, as well as the study of the influence of negative pressure wound therapy (hereinafter - NPWT) on the course of traumatic illness caused by combat trauma. In dissertation clinical and nosological structure of the combat trauma with soft tissue defects was analyzed in the conditions of the anti-terroristic operation (Eastern Ukraine, 2014). A classification has been developed that takes into account the size of soft tissue defects and their localization in cases of combat trauma. This allowed to determine the surgical tactic during the provision of medical care at ІІ, ІІІ, ІV roles. The concepts of small, medium, large and extensive wound defects and methods of their surgical treatment on roles are defined. The clinical-organizational approach was developed, which allowed to determine the method of surgical treatment of wounded with a combat trauma, depending on the level of medical care, the location and size of wound defects. The introduction of clinical-organizational approach on the basis of a reconstructive ladder allowed to leave some wounded at II and III roles of medical care and quickly return them to duty that has tremendous operational-tactical and economic effects. On the other hand, the wounded who needed complex specialized treatment were sooner delivered to the respective roles and did not waste time in the previous stages of medical evacuation. Clinical parameters of wound defects in combat trauma were defined, which were used in mathematical processing of treatment course of combat trauma. A mathematical formula was developed that allow to predict terms of wound preparation before closure using vacuum therapy in the treatment of combat trauma. The analysis of clinical parameters, pathomorphological and microbiological features of the wound process in wounded with soft tissues defects caused by combat trauma was conducted. The difference between groups of research in formation of granulation tissue during the first phase of the wound process under the influence of NPWT during complex treatment of combat trauma is shown. Antibacterial efficiency of NPWT in treatment of gunshot wounds was proved. The methods of treatment of wounded patients with soft tissue defects caused by combat trauma, features and indications for the use of NPWT are presented. The efficiency of using NPWT in the complex treatment of wounded with defects of soft tissues in cases of combat trauma was proved.