ABSTRACT
OBJECTIVE: To demonstrate the approaches' implementation of specialized multidisciplinary and high-tech medical care in multistage complex treatment of patient with multiple trauma including combined severe trauma of the maxillofacial region such as minimally invasive surgical tactics with early and delayed osteosynthesis (e.g. selection of optimal surgical tactics within the periodization of traumatic disease concept). Moreover, the implementation of rational advanced intensive pathogenesis drug therapy with the prevention of infectious complications in cast of severe injuries. MATERIAL AND METHODS: The tactics, approaches and results of multistage complex specialized treatment of patient K., 56 years old who has got severe concomitant injuries to various areas of the body and extremities (including multiple maxillofacial trauma) after falling from a height are presented. CONCLUSION: Rational surgical tactics and the timely initiation (immediately after admission of the victim to 1st level trauma center) of pathogenesis intensive therapy with modern drugs and antibiotics contributed to the exclusion of infectious complications in the third period (the period of maximum likelihood of complications) of traumatic illness. Comprehensive treatment of a victim with multiple trauma based on the principles of specialized, multidisciplinary and high-tech medical care is able to provide a favorable clinical outcome - the recovery with the restoration of the damaged anatomical structures functionality and the absence of cosmetic defects.
Subject(s)
Accidental Falls , Multiple Trauma , Fracture Fixation, Internal/adverse effects , Humans , Middle Aged , Minimally Invasive Surgical Procedures , Multiple Trauma/therapy , Treatment OutcomeABSTRACT
The authors described the variants of initial surgical d-bridement on the basis of experience of treatment of 183 patients of multistaged treatment program.
Subject(s)
Craniocerebral Trauma/surgery , Debridement/methods , Facial Injuries/surgery , Fracture Fixation, Internal/methods , Multiple Trauma/surgery , Skull Fractures/surgery , Adult , Craniocerebral Trauma/diagnosis , Emergency Treatment/methods , Facial Injuries/diagnosis , Female , Hemostasis, Surgical/methods , Humans , Male , Middle Aged , Minimally Invasive Surgical Procedures/methods , Multiple Trauma/diagnosis , Outcome and Process Assessment, Health Care , Patient Care Planning , Skull Fractures/diagnosis , Trauma Severity IndicesABSTRACT
The treatment of maxillofacial gunshot wounds in peacetime is an urgent and difficult problem. The emergence of new types of civilian weapons and relatively small current clinical experience does not allow generating recommendations for the treatment of this pathology. It presents a statistical analysis of injuries in St. Petersburg 2004-2014 restricted firearms destruction and experimental study of the harmful effect of these weapons on the fabric maxillofacial experimental animals (pigs). The features of the clinical picture, diagnosis and surgical treatment of wounds of the maxillofacial region, caused by a firearm -restricted lesions and wounds with extensive tissue damage maxillofacial caused a hunting weapon are considered.
Subject(s)
Maxillofacial Injuries , Wounds, Gunshot , Firearms , Humans , Maxillofacial Injuries/diagnosis , Maxillofacial Injuries/pathology , Maxillofacial Injuries/therapy , Wounds, Gunshot/diagnosis , Wounds, Gunshot/pathology , Wounds, Gunshot/therapyABSTRACT
It is important to improve the medical care system and treatment of victims, introduce new methods of treatment and attract the multidisciplinary specialists in the cases of multitrauma. An integrated approach is required for the identification of different character and severity of multiple craniofacial injuries and the development of rational surgical strategy on this base. Different scales such as AIS, CRIS, ISS, PTS, TRISS, TRISSCAN, CRAMS et.al, were created abroad. Another approach to medical strategy was developed in the department of military surgery of Kirov Military Academy in the late nineties. It was based on investigating of possibilities of surgical strategy optimization by application of objective evaluation of the severity of injuries (military surgery--SP, SG, SS). Given treatment strategy of victims with multiple craniofacial trauma resulted in double reduction of quantity of suppurative and septic complications (from 10.5% to 4.1%). It gave the possibility to reduce the lethality from 6.4% to 4.0%. At the same time a hospital stay was shortened and the strategy allowed obtaining satisfactory functional results of treatment and avoiding reinterventions for removal of posttraumatic facial deformations.
Subject(s)
Facial Injuries , Head Injuries, Penetrating , Osteomyelitis/prevention & control , Postoperative Complications/prevention & control , Skull Fractures , Video-Assisted Surgery , Adult , Endoscopy/adverse effects , Endoscopy/methods , Facial Injuries/diagnosis , Facial Injuries/mortality , Facial Injuries/surgery , Female , Fracture Fixation, Internal/adverse effects , Fracture Fixation, Internal/methods , Head Injuries, Penetrating/diagnosis , Head Injuries, Penetrating/mortality , Head Injuries, Penetrating/surgery , Humans , Intraoperative Neurophysiological Monitoring/methods , Male , Multiple Trauma/diagnosis , Multiple Trauma/mortality , Multiple Trauma/surgery , Osteomyelitis/etiology , Russia , Skull Fractures/diagnosis , Skull Fractures/mortality , Skull Fractures/surgery , Trauma Severity Indices , Treatment Outcome , Video-Assisted Surgery/adverse effects , Video-Assisted Surgery/methodsABSTRACT
Dynamics of mean value indices and mean dispersion doesn't exclude the feedback (Mayanskiy D.N., 2008) in process of study the disease according to cooperative processes using system leukocyte-monocyte-lymphocyte (L+M+LM). The authors investigated a dynamic balance between these cell substratums and collagen formation. Acute inflammatory processes in tissues of maxillofacial area accompanied by leukemoid response of peripheral blood in the form of leukocytosis (10 x 10(9)-15 x 10(9)/l and more). The authors completely agree with the opinion of M.M. Solov'yov (2012) and N.K. Artyushenko (2008) that mechanism of this reaction is associated with both the leukocyte redistribution in the inflammation zone and with changes of hematopoietic rostock which aimed to balance the affected compensatory mechanisms of nonspecific resistance.
