RESUMO
AIM: To improve the results of surgical treatment of woundeds with combined thermomechanic injuries in local armed conflict. MATERIAL AND METHODS: It was analyzed treatment of 93 victims with thermomechanic injuries. In 29 (31.2%) aptients only Early Total Care protocol (ETC) was used up to 2001. These victims received complete surgical care. Since 2002 diffirentiated approach of multi-stage surgical treatment (Damage Control Surgery) has been applied. ETC tactics was used if systolic blood pressure was more than 90 mm Hg (30 woundeds, 32.2%). DCS protocol was preferred in case of blood pressure less than 90 mm Hg or multiple-organ failure (34 patients, 36.6%). RESULTS: Diffirentiated surgical approach decreases mortality rate from 13.8% to 7.8% (p=0.453) compared with group of conventional one-stage care.
RESUMO
Peculiarities of surgical treatment of wounded with combined thermomechanical injuries of the lower extremities under conditions of counter-terrorist operation. The authors analysed results of treatment of 67 wounded with injuries of the extremities, combined with burns. Two therapeutic approaches to surgical treatment were used. The first therapeutic approach (Early total Care - ETC) involved providing of a complete surgical care (the whole body is examined) during the first emergency operation and was used in 24 (35,8%) injured. The second therapeutic approach implied a differentiated approach to the treatment of wounded and treatment of injuries and was used in 43 (64,2%) patients. If arterial blood pressure was above 90 mm Hg, ETC approach was used in 19 (28,4%) wounded. If systolic blood pressure was less than 90 mm Hg programmable surgical approach Damage Control Surgery (DCS) was used in 24 (35,8%) patients. The use of differential surgical approach has led to increase in the number of complications from 45,8 to 55,8% (p=0,044) and decrease in mortality c 12,5 to 9,3% (p=0,039) compared with the group of wounded, where was used only traditional approach of single-stage treatment.
