Borzykh N. Surgical treatment of the wounded with polystructural gun traumas of the upper limb and their consequences

Dissertation is devoted to solving the actual problem – to develop the system of surgical tactics for treatment of wounded men having polystructural gun damages of the upper limbs. Such problematic issues as the replacement of defects of soft and bone tissues, replacement of fixation methods, restoration of nerves and segment functioning, forecasting the results of treatment, developing an individual rehabilitation program are considered. Their realization dictated clinical (220 wounded with gun polystructural damages of the upper limb) and experimental (32 mature rabbits) components. In the experimental part of the work were studied the structural-and-functional changes in the neuromuscular apparatus of a limb at high (at shoulder level) damage of a median nerve in the experiment; there was proved the efficacy of the developed method of “protected seam” – anastomosis between donor and traumatic nerves by the Martin-Gruber type. The clinical part of the work presents the multiaspect assessment of the wounded. The developed classification of severity of gun polystructural damages of the upper limbs, the distribution of defects by depth and square are presented. There were revealed the progressing demineralization, re-distribution of macro- and microelements, ultrastructural changes of bone tissue after fire fracture and was proved osteoporosis-like bone destruction which consisted in the presence of microcracks (from 390 nm to 1.7 μm) with twice the density 1.20 ± 0.34 unite/test zone, than in household fractures, on the basis of which were substantiated the principles of treatment of the wounded with multifragment fractures and defects in bone tissue. It has been proved that the wounded with gun polystructural damages of the upper limbs need the differentiating multistage treatment at minimal terms and ways for evacuation. The developed, proposed, implemented system of tactics for surgical treatment of the wounded calls for differentiating approach on the basis of defining the stage of trauma severity, assessment of rehabilitative potential of a patient with the aim to make prognosis of functional result, determination of the optimal time to perform the staged surgical interventions with their components, making orthopedic corrections, with future individual rehabilitation program, assures the improvement of anatomic-and-functional results, the optimization of terms for the military to return to service.