Kalynovych N. Differential surgical tactics for post-traumatic soft tissue defects of the hand.

The study was conducted to improve the treatment of patients with post-traumatic defects of the soft tissues of the hand by improving the diagnosis of their anatomical features, differential choice for plastic and the use of biological and physical technologies for good functional and aesthetic results. The dissertation research is based on the analysis of surgical treatment of patients with traumatic injuries of the hand, who were in the MNE "8th City Clinical Hospital of Lviv" from 2015 to 2021. In total, 134 patients appropriate for the inclusion / exclusion criteria, were included in the study and divided evenly into the control group (2015-2018) and the main group (2018-2021) according to the study design. Medical care was provided to patients of the control and main groups in accordance with the recommendations of the Ministry of Health of Ukraine for this category of injuries. However, during the treatment of the main group a differentiated approach to the choice of sequence, volume and stages of surgery was used depending on the number and severity of injuries, the severity of the patient's condition, the nature and distribution of lost covers of hand and the condition of adjacent soft tissues. For optimal restoration of the lost soft tissue of the hand, the method of plastic was chosen depending on the location, area, depth of the defect and the availability of suitable for plastic tissues. In addition, the main group of patients underwent biological and physical procedures for rehabilitation at the Novoderm Medical Center to restore the function of the injured hand and improve its aesthetic appearance.The developed anatomical classification of post-traumatic defects of the soft tissues of the hand helps to choose he most optimal method of plastic closure, sequence, volume and time frame of surgery. Assigning symbols to the characteristics of traumatic injuries of the hand allows you to create an electronic database for objective evaluation of the results of treatment of homogeneous injuries. The use of photothermometry with the FLIR C2 device allows to assess the survival of the tissues of the injured hand before and after plastic closure of soft tissue defects and to prevent possible complications. The introduction of damage control technology for patients with severe polystructural and combined hand injuries will allow to perform step-by-step restorative and reconstructive operations and improve the functional result without endangering the life of the injured. The use of platelet-rich plasma injections in the postoperative period will reduce the incidence of complications of plastic soft tissue defects of the hand. Lipolysis of lipotropic flap using neodymium laser allows to minimally invasively reduce the thickness of lipotropic flap and improve the cosmetic result with minimal invasions . The developed quality of life questionnaire allows to analyze the long-term results of medical treatment for patients with post-traumatic soft tissue defects of the hand according to both functional and aesthetic criteria.