Mikhaylusov R. Diagnostic and treatment of gunshot wounds of soft tissues (experimental and clinical research)

The dissertation is devoted to increase of efficiency of diagnostics and treatment of gunshot wounds of soft tissues on the basis of analysis of features of the course of wounds and provision of stage medical care to the wounded during the antiterrorist operation (ATO) in the east of Ukraine. In the experimental part of the study at the first stage a model was developed to determine the type of weapon and the distance from the place of the shot (blow up) to the object of damage with the use of non-biological materials. In the second stage of the experi¬ment, the simulation of gunshot wounds in live animals was performed and the dynamics of the wound process depending on the type of injury and the characte¬ristics of local wound healing were studied. It was established that the largest destruc¬tion of soft tissues is observed in mine-explosive injuries, which leads to a significant increase in the duration of wound healing, with the preservation of dystrophic and destructive changes in myosimplasts until the 60-th day after injury. The most effective method of treatment of experimental blast-explosive injuries was WAC therapy. In the clinical part of the study, an analysis of the provision of medical care to 1059 wounded, received for treatment during 2014–2016 years, was performed at Surgical Clinics of the Military Medical Clinical Center of the Northern Region of the Ministry of Health of Ukraine, in which 3203 gunshot wounds were diagnosed. The peculiarities of medical care during the ATO were analyzed and typical errors during evacuation, surgical and local wound treatment were determined. According to the results of the analysis, a comprehensive diagnostic and treatment algorithm with the use of new methods and devices for improving the quality of wounds revision, wound debridement and its local treatment was suggested and implemented, which increased its efficiency.