Features of complex surgical treatment of gunshot wounds of major vessels’ combat trauma

Introduction. The frequency of wounds and injuries of the great vessels in modern military conflicts has increased significantly (7.5-9.0%). At the same time, 90% of combat vascular injuries are injuries to the arteries and veins of the extremities. During hostilities on the territory of Ukraine, gunshot wounds and closed injuries of the great vessels account for 4.5-8.0%. In more than 90% of cases, vascular injuries are classified as severe, and in 8% - as extremely severe. In particular, gunshot wounds to the arteries often have concomitant injuries to the great veins (40-50% of cases), nerve trunks (30-70%), and bone fractures (40-60%). Depending on the weapon used and the nature of the injuries, modern combat surgical trauma is characterized not only by damage to the great vessels, but also by massive bacterial contamination of gunshot wounds, damage to other important anatomical structures of the body, and the occurrence of early and late complications, which worsens the patient's clinical course and increases the duration of treatment. Purpose: to demonstrate the features of complex surgical treatment of gunshot wounds in combat trauma of the great vessels using a clinical example. Materials and methods. A retrospective analysis of the complex surgical treatment of 64 wounded with gunshot wounds in combat trauma of the great vessels in the period 2022-2023 was carried out. The analysis was carried out on wounded servicemen with the involvement and conduct of a certain amount of clinical and diagnostic examination and surgical interventions in complex surgical treatment on the basis of the National Military Medical Clinical Center “GVKG”. Two clinical observation groups were defined: the main group and the comparison group. The main clinical observation group included 42 patients who underwent various modes of negative pressure intensity of vacuum therapy during staged surgical procedures, and the comparison group included 22 patients who were treated according to the traditional scheme with emergency and planned surgical interventions with staged surgical procedures. Results. In the course of complex surgical treatment of patients with gunshot wounds in combat trauma of the great vessels, it was determined that during staged surgical procedures with the proper use of VAC therapy, it significantly contributes to better wound healing, reduction of the risk of arosive bleeding and further preservation of the restored blood flow of the injured limb. Conclusion. This clinical observation describes that gunshot wounds in combat trauma of the great vessels require timely diagnostic examination, as well as in the process of complex surgical treatment, repeated staged surgical procedures using low and medium intensity negative pressure vacuum therapy, constant bacterial cultures from gunshot wounds to determine the microflora and further selection of antibiotic therapy, which significantly reduces wound infection, improvement of their healing and, in the presence of massive defects, preparation for plastic closure. It was also determined that due to the reduction of the inflammatory process in the area of vascular reconstruction, the risk of arosive bleeding decreases and the process of preserving the restored blood flow of the injured limb improves.