SURGICAL TREATMENT OF A PATIENT WITH A COMBAT POLYSTRUCTURAL INJURY OF THE UPPER EXTREMITY

• DOI: 10.37699/2308-7005.2-3.2024.44
• Publication Date: 2024-06-28T20:37:12Z
• Authors: N. M. Honcharova; V. P. Kolesnyk; A. V. Sivozhelizov; P. V. Svirepo; V. S. Sova
• Keywords: 03 medical and health sciences; 0302 clinical medicine

Resume. Until now, the main shortcoming in the provision of medical care to the wounded with polystructural injuries of the shoulder is the lack of comprehensive approaches to determine the level and types, terms of performing reconstructive-plastic interventions and further rehabilitation of these patients. The goal is to improve the results of surgical treatment of patients with polystructural injuries of the upper and lower extremities. Materials and methods. The work has a clinical component and is presented by a clinical case of a patient with a polystructural injury of the right shoulder. Results and their discussion. The results of the treatment of a patient diagnosed with a blind shrapnel wound of the right shoulder with damage to the right axillary artery (arteria axillaris) and right axillary vein (vena axillaris) are presented, who underwent autovenous prosthetics of the right axillary artery and suturing of the defect of the right axillary vein at the second level of medical care. In the postoperative period, the patient showed signs of distal secondary lymphostasis of the superficial venous part of the right hand, during electromyography, a decrease in the asymmetry of muscle activity in the proximal muscle groups was determined (m. biceps brachii dexter up to 27% and m. triceps brachii dexter up to 30% ), by distal muscle groups (m. flexor digiti minimi dexter up to 34%), due to the hypotrophic component. After treatment and rehabilitation, a decrease in the asymmetry of muscle activity was determined by proximal muscle groups (m. biceps brachii dexter to 15% (-12%) and m. triceps brachii dexter to 17% (-13%)), by distal muscle groups (m. flexor digiti minimi dexter - up to 20% (-14%)). Conclusions. The system of surgical treatment of the wounded with polystructural injuries of the upper limb with the help of new and improved methods for the restoration of damaged structures, as well as a differentiated approach with establishing the degree of severity, predicting the rehabilitation potential and clinical outcome after surgery, is of great importance for modern combat surgery, because there was an opportunity to improve the efficiency and timeliness of treatment after traumatic recovery.