THE MANAGEMENT OF THE VICTIMS WITH GUNSHOT WOUNDS OF THE EXTREMITIES WITH EXTENSIVE DEFECTS OF THE SOFT TISSUES AT THE LEVEL OF QUALIFIED MEDICAL CARE. CASE-SERIES.

OBJECTIVE: The aim: To highlight the original experience of diagnosis and treatment of patients with gunshot wounds of the extremities with extensive defects of the soft tissues. PATIENTS AND METHODS: Materials and methods: The total number of treated patients with massive gunshot wounds from February 2022 to March 2023 was 60 males. Basic labo¬ratory tests, X-rays of the affected limbs were performed to all patients. USS of the vessels with color Doppler was performed to those casualties who had no peripheral pulses on the wounded extremity. All injured persons underwent wound debridement and fasciotomy on the day of admission, 8 more casualties underwent surgical interventions on the major vessels and nerves. RESULTS: Results: Good treatment outcomes for patients with extensive soft tissue injury were achieved by early surgical intervention to remove non-viable tissue. Limb preservation was achieved in 98.3% of cases. CONCLUSION: Conclusions: The study's conclusion emphasizes the importance of a multidisciplinary approach to treating patients with gunshot wounds to the limbs with extensive soft tissue injury. Early surgical interventions with the removal of non-viable tissues are necessary for good outcomes. Revascularization of the affected limb is essential in case of major vessel injury if there is no thread to the life.

METHODS FOR QUANTITATIVE ASSESSMENT OF COLLAGEN ACCUMULATION PROCESSES IN DAMAGED TRAUMATIC INTEGUMENTARY TISSUES.

OBJECTIVE: The aim: To study the level of expression of type I, III collagen under conditions of traumatic damage to integumentary tissues and to develop quantitative criteria for collagen formation processes for choosing the volume of reconstruction of a wound defect. PATIENTS AND METHODS: Materials and methods: Studies were performed for 62 victims. Clinical group 1 (n = 16) - patients with wound surface sizes of the body surface area, group 2 (n = 32) consisted of patients who received integumentary tissue defects due to or together with damage osteoarticular apparatus of the limb, group 3 (n = 14) - patients with combined trauma. RESULTS: Results: In the skin samples of patients of groups 1 and 2 of the affected groups, a statistically significant difference was established between the indicators of the relative accumulation area of type I, type III collagen (W = 675, p = 0.01 and W = 697, p = 0.03, respectively). In patients of groups 2 and 3, when analyzing relationships, a direct moderate strength was observed between the areas of collagen deposition of type I, type III (rs = 0.52 and 0.54). Collagen deposition coefficient (Кd) was used as a quantitative criterion for assessing the prognosis of the results of restoration of integumentary tissues according to the proposed scale, which made it possible to obtain postoperative complications in only 3.2 % of cases. CONCLUSION: Conclusions: A positive treatment result taking into account the quantitative criterion (Kd) was obtained in 96.8 % of the examined patients.