TREATMENT OF TRAUMATIC AMPUTATIONS OF LOWER EXTREMITIES DUE TO EXPLOSIVE TRAUMA

Abstract. Aim. To identify unsatisfactory results of treatment of wounded with traumatic amputations of lower extremities and optimize them by applying the developed methodology of complex repeated surgical debridment and perioperative management of patients. Materials and methods. The subjects of the study were 190 patients who received explosive trauma during a combat encounter in 20222024 years and were undergoing inpatient treatment in the vascular surgery department of the minimally invasive surgery clinic of the Military Medical Clinical Center of the Central Region the third level of medical support. The causes of lower limb amputations were: avulsion of the lower limb (segment) in explosive trauma – in 101 (53.16 %), massive destruction of the lower limb with amputation at the second and third levels of medical support – in 48 (25.26 %), damage to the neurovascular bundle and critical ischemia of the lower limb – in 29 (15.26 %), prolonged tourniquet application time – in 12 (6.32 %) of the wounded. The proposed treatment involved the use of the developed method of perioperative management of patients with soft tissue defects of amputation stumps and the method of complex repeated (secondary) surgical debridment of soft tissue defects of amputation stumps in gunshot traumatic amputations of the lower limbs. Results and discussion. Purulent-inflammatory complications of amputation stumps with their secondary necrosis and suppuration were observed in 42 (22.11 %) patients, which required urgent secondary surgical debridment and additional repeated ones according to the proposed technique. Among other complications in the early postoperative period, erosive bleeding was observed in 5 (2.63 %) patients, which also required urgent surgical interventions. The use of the developed techniques allowed us to eliminate these complications as soon as possible and optimize treatment at this stage. We didn’t observe any mortality at the third level of medical care. In the late postoperative period, the following postoperative complications were observed: the formation of «defective stumps» in 18 (9.47 %) cases, the appearance of osteophytes in 3 (1.58 %), neurinoma in 4 (2.11 %) of the wounded, the development of phantom pain in 7 (3.68 %). Conclusions. Traumatic amputations of the lower extremities are severe complications of combat trauma and are characterized by a high level of mortality, complications and disability. The reasons of unsatisfactory treatment results in the early postoperative period are mainly purulent-inflammatory complications from the soft tissues of the amputation stumps of the lower extremities and the occurrence of erosive bleeding, and in the late period – the formation of «defective» stumps, the occurrence of osteophytes, neurinomas. The use of the developed method of complex repeated surgical debridment of soft tissue defects of amputation stumps and perioperative management of these patients will provide an opportunity to optimize the treatment and management of this contingent of patients and reduce the level of complications in both the early and late postoperative periods.