SUMMARY
Vovk M.S. Surgical treatment of chest wall tissue defects in thoracic trauma. – Qualifying scientific work on the rights of the manuscript.
The dissertation on competition of a scientific degree of the doctor of philosophy in the field of knowledge 22 Health care on the specialty 222 Medicine
(specialization 14.01.03 "Surgery"). - Ukrainian Military Medical Academy of the Ministry of Defense of Ukraine. - Kyiv, 2021.
The dissertation is devoted to the problems of complex surgical treatment of chest wall tissues and plastic closure of tissue defects in thoracic trauma, as well as the study of the influence of negative pressure of vacuum therapy (NPWT) on the clinical course of traumatic disease in thoracic trauma and its complications.
The study is based on a comparative analysis of the results of diagnosis, clinical course and treatment of the wound process in patients with defects of chest wall tissues using various diagnostic and therapeutic technologies.
The total number of clinical observations included wounded and injured in the chest, the course of injury or wound process which was complicated by inflammation and the formation of defects in the chest wall caused by combat surgical trauma to the chest and thoracic trauma in peacetime. Patients were divided into two groups of clinical observation.
The first group (main, 54 persons) are wounded and injured with soft tissue defects of the chest wall as a result of wounding or injury which was used NPWT (negative pressure treatment with vacuum therapy), ultrasonic cavitation and miniinvasive technologies (intrabronchial endoscopic intervention, puncture or drainage under ultrasonic navigation). The second group (comparison, 73 persons) are wounded and injured with soft tissue defects in the diagnosis and treatment of thoracic trauma or thoracic component of combined trauma, they used traditional methods. The total number of examinations of wounded and injured with defects of chest wall tissues was 127 persons.
By the age, sex, mechanism of injury, severity of injury, stereometric characteristics of wound defects of the chest wall, localization of damaged AFA, consequences and complications of thoracic injury, the main and comparison group were homogeneous, comparable, did not differ statistically.
The stereometric characteristics of chest wall tissue defects were determined with the definition of metric characteristics, which included length, area and volume, which in both groups of observations, respectively, the vast majority were 59.8% of defects of medium size and 33.4% of large sizes. Taking into account the stereometric characteristics of defects of the chest wall tissues and their connection with the pleural cavity, as well as the occurrence of post-traumatic pathological processes in the pleural cavity and lungs determined the tactics of surgical treatment of patients.
In studying the clinical course of healing of chest wall defects in patients of the studied groups under the influence of various treatment tactics, first of all attention was paid to the dynamics of the wound process: wound infection, wound cleaning, appearance and maturation of granulation tissue, its contraction or retraction - changes in sizes. Also a mandatory step was the detection of pathological changes in the pleural cavity and lungs on the side of defects in the tissues of the chest wall, as well as systemic manifestations of wound disease.
Methods of plastic closure of chest wall tissue defects in both observation groups were chosen on the basis of the concept of "reconstructive ladder", which took into account the sizes and location of wound defects of the chest wall. It was found that the widespread using of modern methods of dermotension in plastic closure of the wound defect allowed to reduce the area of mobilization of the donor flap - surgical trauma, reduce the load on the line of adaptive sutures and prevent further failure.
Thus, the introduction of new methods of complex treatment in patients with defects of chest wall tissue significantly reduced the healing time of wounds after plastic closure, which was 26.5 ± 2.0 days in the comparison group and 18.6 ± 1.6 days in the main. Accordingly, the average duration of general treatment of patients in the clinical observation groups also differed significantly, which was 37.9 ± 3.7 days in the comparison group and 25.9 ± 2.8 days in the main group.
