[Using tactics of damage control in complex treatment of the abdominal cavity organ injuries and pancreatitis complicated by severe bleeding and vasodilatation shock].

The results of surgical treatment analysis was conducted in 39 injured persons, aged 16-74 yrs, who suffered severe trauma and pancreatitis and in whom the Damage Control tactics (DCT) was applied for massive bleeding and vasodilatation shock occurrence. According to TRISS scale for injured persons, suffering severe trauma, operated on using the DCT principles, the primary "approximate" prognosis of the death ("blunt") had constituted (37.4 +/- 24.7)% at average (range, 10.7-89.7%, mediana 31.7%); the primary "accurate" ("penetrating") prognosis--(39.56 +/- 22.14)% (range, 12-91.3%, mediana 39.65%); the severity of general state according to APACHE II scale was estimated as (19.54 +/- 7.65) points at average (range, 12-36 points, mediana 16 points). The characteristic for main principles of operation performance, using the DCT, was suggested. Of the total of 39 injured persons 12 (30.8%) did not survive. Postoperative complications had occurred in 18 (46.2%) of patients.

[Treatment of fractures of long bones associated with extensive skin avulsion]. / Lechenie perelomov kostei, cochetannykh s obshirnymi skal'pirovannymi ranami.

The work analyses the experience in the treatment of 46 patients with fractures of long tubular bones and extensive wounds with avulsion of the skin at the department of emergency traumatology from 1983 to 1988. The method of choice in the treatment of fractures of the long tubular bones in this category of patients is functionally-stable osteosynthesis mainly with external fixation apparatuses on a nail or rod basis. A rational succession of the manipulations for surgical debridement of the extensive wound was determined, which made the surgeon's work much easier and reduced the time needed for the operation. The skin defects in extensive wounds were repaired by Krasovitov's method in 16 patients, in 30 patients reimplantation of the skin was carried out by means of a split avulsed graft measuring 0.3-0.5 mm in thickness. A complex approach to the treatment of patients of bot groups was applied in the postoperative period, which improved the outcome of the treatment considerably. From comparative analysis of the immediate and late-term results of healing of the reimplanted grafts the authors conclude that dermatomic (0.4-0.5 mm) plastics with a split avulsed graft is preferable.

[Classification of complications of combined injuries of abdominal organs and long tubular bones in traffic accidents]. / Sistematizatsiia oslozhnenii pri sochetannoi travme organov briushnoi polosti i dlinnykh trubchatykh kostei pri dorozhno- transportnykh proisshestviiakh.

The outcomes of treatment of 386 victims with abdominal trauma and fractures of the long tubular bones were studied. The authors systematized the typical complications developing after the trauma, both on the part of the injured organs of the abdominal cavity and true pelvis and the fractures of the long tubular bones. This allowed the developed complications to be divided according to time into early, late, and sequelae of trauma. The early complications of injuries to the organs of the abdomen and true pelvis are as follows: suppuration of postoperative wounds, postoperative wound dehiscence with or without eventration, recurrent intracavitary hemorrhage, progressing local peritonitis, incompetence of anastomoses, intestinal obstruction, abdominal abscesses and infiltrates, abscesses and infiltrates in the true pelvis, intestinal paresis, large hematomas, phlegmons of the anterior abdominal wall. The late complications are: sluggish wounds of the anterior abdominal wall, formation of ligature fistulas, postoperative ventral hernias, suppuration of intraorganic and interstitial hematomas, subclinical forms of sepsis and sepsis, thrombophlebitic complications, chronic venous insufficiency, persistent wounds, and other complications. The sequelae of injury to the organs of the abdominal cavity and true pelvis are: intestinal fistulas, functional intestinal disorders, gastric disease, the dumping syndrome, cicatricial changes of the anterior abdominal wall, posttraumatic disease, venous insufficiency, pneumosclerosis, chronic pneumonia, pulmonary emphysema, chronic vascular insufficiency, etc. The early complications in fractures of long tubular bones in the group of studied patients: suppuration of osteomuscular wounds, recurrent displacement of bone fragments, bone necrosis in open type IIIC, IIID fractures, gangrene of the limb consequent upon crushing of skin and subcutaneous tissue, subluxations, secondary subluxations of limbs.(ABSTRACT TRUNCATED AT 250 WORDS)

[Treatment of diaphyseal femoral fractures in patients with associated and multiple traumas]. / Lechenie diafizarnykh perelomov bedrennoi kosti u postradavshikh s sochetannoi i mnozhestvennoi travmami.

There has been analysed an outcome of treatment of diaphysial fractures of femur in 124 victims with associated and multiple damages. The analysed group of victims has been urgently subjected to intramedullary nailing osteosynthesis by means of a rod of our construction. Developed and officially approved method of nailing osteosynthesis not only eliminates application of bulky plaster bandages, skeletal traction systems, but ensures mobility, possibility of carrying out the repeated diagnostic and treatment--and--prophylactic measures and, in the indicated cases, repeated operative intervention. Clinical approval of the method of nailing osteosynthesis by means of the rod of our construction allowed to reduce the term of treatment, number of complications, temporary invalidity and invalidism as compared with the group of patients, subjected to conservative treatment.