Resume. The experience of providing medical care during the anti-terrorist operation in eastern Ukraine has shown that in the structure of modern combat surgical trauma gunshot wounds with soft tissue defects are 64.9-68.2%, of which 36.4-37.5% small and medium, 28.5-30.7% are large and very large defects. Goal: To improve the results of surgical care for soft tissue defects by introducing differentiated surgical tactics for wound closure to each level. Material and methods. The total amount of the study was 136 wounded with shrapnel, bullet and explosive injuries from April 2014 to September 2018. Determination of surgical tactics for closing soft tissue defects was performed on the basis of metric classification, taking into account the area, volume and anatomical areas of the lesion. Results. The combination of metric characteristics of wound defects by area, volume and location of wounds in a single classification allowed to offer a comprehensive approach to sorting the wounded by the level of medical care and determine further reconstructive surgical tactics to close soft tissue defects. Conclusions. The introduction of differentiated surgical tactics in wounded with gunshot defects of the soft tissues at the all levels of medical care improved functional results: the proportion of satisfactory increased from 46.9% to 53.7%, the relative number of unsatisfactory decreased from 18.8% to 11.6%

Sumary. The aim is to investigate the features of pathogenesis in capsule formation around metallic foreign bodies of soft tissues. Materials and methods. The results of a study of 6 patients with metallic foreign bodies of soft tissues with a carrier period of 16 to 50 years were analyzed. 3 injured had foreign bodies of gunshot origin and 3 patients had foreign bodies as a result of personal injury. Used clinical, laboratory, instrumental, histological, immunohistochemical, X-ray spectrometric studies. Results. All foreign soft tissue bodies were removed with the capsule. By gender: 5 men and 1 woman. By localization - the lower extremity. Pain was present in all the victims. Radiography and ultrasound were informative, magnetodetection is informative only at the superficial location of a foreign body. The foreign bodies were made of gray cast iron and steel needle wire. Histologically, immunohistochemically and radiospectrometrically, it has been found that the capsule formation around the foreign body is affected by the mechanism and extent of damage to the soft tissues, the composition of the metal and its coating, and the carrier term of the foreign body. Conclusions. Depending on the composition of the metal and its coating, there is a different rate of oxidation of the foreign body in the soft tissues: oxidation of metal foreign bodies of fire origin is faster. The formation of the capsule around the foreign body is affected by the mechanism of tissue damage: when the needle penetrates, the soft tissues are destroyed minimally, in the case of gunshot wounds, they are destroyed more. Spectral analysis data in conjunction with morphological studies are the basis for the removal of a foreign body of inflammatory origin along with the capsule.

Summary: The aim of the study was to determine the dependence of the volume of air discharge from the pleural cavity on the choice of surgical treatment in patients with penetrating chest injuries. Materials and methods. Of the 39 observations, video-assisted thoracoscopy (VATS) was performed in 24 patients due to existing hemothorax. Results and their discussion. Among patients with penetrating chest injuries and early complications in the form of isolated pneumothorax on the first day, VATS was performed in three cases, due to increased air discharge from the pleural cavity. On the second and third day, 3 and 1 patient needed PBX, respectively. The article presents the experience of using a Coriolis flowmeter to objectify the diagnosis of lung injuries in victims with gunshot wounds penetrating the chest. Depending on the speed and volume of air discharge from the pleural cavity, the dynamics can be determined by the tactics of treatment. Conclusions: 1. Observation in the dynamics of the rate (

The aim. To investigate and used a multimodal diagnostic scheme during the first stage of reconstructive surgical treatment of wounded with soft tissue defects at the second level of medical care.Materials and methods. By identifying thermographic areas with gunshot wounds of the soft tissues, we observed at the second level of medical care during 4 months of 2020 (from March to July) 37 cases.Results. We used a multimodal scheme in the pre-, intra- and postoperative period helps to reduce the area of defects in 23 (62.2%) cases out of 37 against the background of restoration and preservation of microcirculation in the damaged structure, and the number of subjectively unsatisfactory military personnel in 4 (12.8%) of the total the number of wounded, a decrease in the loss of functional ability in 19 (51.2%) cases.Conclusions. The combination of dynamic digital thermography in combination with an audio doppler at the second level of medical care can improve the quality of primary surgical treatment by performing surgery with clear indications of the proposed technique; maintain a larger volume of viable tissues, reduce the area of the defect and the number of complications in the further treatment of the wounded.

According connection with the global trends, manifested by an increase in the number of illegal firearms, an increase in social, political, ethnic, racial and religious conflicts, accompanied by the use of firearms, the problem of treating gunshot wounds is becoming increasingly important. It is especially acute during local and widespread hostilities, during peacekeeping missions, anti-terrorist operations, in cases of massive gunshot wounds. The aim of the work is to improve the surgical tactics in the reconstruction of severe wounded with soft tissue gunshot defects due to the multimodal scheme. Improvement of dynamic audio and thermal imaging diagnostics of the damaged anatomical area, analysis and modeling of the shape and direction of movement of the donor flap. A clinical case of closure of a bullet-through bullet wound of the left thigh (03.25.19 year) with a gunshot multi-fragment fracture of the left femoral pigtail in the middle third, damage to the superficial femoral vein and marginal damage to the superficial femoral artery was demonstrated.In the preoperative period, the first stage was dynamic digital thermography of the surface of wounds and surrounding soft tissues, which allowed thermal imaging to assess the state of damaged structures, to identify areas of preservation of blood supply. The second stage was the audio control of the identified areas of the "supply" - perforating vessels with a comparison of the blood flow velocity. The results obtained formed the basis for modeling the donor zone and monitoring its movement. The described clinical case of soft tissue defect closure consisted of three stages: The first stage - preparatory (diagnostics and cleaning) - (9 days of inpatient treatment) - repeated surgical treatment of wounds using low-frequency ultrasound (cavitation of the wound surface), controlled negative pressure (in a pulsed mode - 125 mm Hg), the imposition of secondary early sutures, due to which the wound area decreased by 35% compared to the wound area at the time of admission to the VICC of the Southern region. The second stage - the final (reconstructive) - (12 days after the injury) - plastic reconstruction of the defect of the posterior surface of the middle third of the left thigh by moving a ball-and-socket flap from the outer surface of the thigh using the Keystone technique. Conclusions: A multimodal algorithm with dynamic control of changes in the perfusion of the defect zone and surrounding structures is at the heart of the successful reconstruction of a gunshot defect in the soft tissues of the lower extremities, which reduces the treatment time by 1.5 times.