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SURGICAL TACTICS FOR PURULENT-SEPTIC COMPLICATIONS OF COMBAT BELLY INJURIES

Summary. Combat injury of the abdomen, according to the ATO / OOS is from 6.7 to 9 %. The specificity of gunshot wounds to the abdomen causes the development of functional disorders and complications (51–81 %) and, as a consequence, a high mortality rate (12–31 %). 
Objective: To improve the effectiveness of surgical treatment of purulent-septic complications in the wounded with combat trauma to the abdomen (BTC). 
Materials and methods. The Military Medical Clinical Center of the Southern Region (VMKC PR) analyzed the treatment of 86 wounded who were hospitalized with purulent-septic complications of BTZ from 2014 to 2020, taking into account the location, clinical manifestations and severity of injury, used modern treatment methods , namely: puncture and drainage interventions under the control of ultrasonography and installation of NPWT systems. Comprehensive treatment was supplemented with antibacterial therapy and oxygen barotherapy. 
First of all, the wounded underwent puncture and drainage interventions under ultrasonic navigation and gradual rehabilitation for diagnostic and therapeutic purposes. NPWT therapy was used in 11 patients with extensive wounds and purulent-septic complications of the soft tissues of the anterior abdominal wall. 
Thus, the use of interventional sonography, as the primary diagnostic and treatment method for the treatment of purulent-inflammatory complications of combat trauma to the abdomen, has improved the quality of diagnosis and reduced traumatic interventions, which has reduced postoperative complications and inpatient treatment. 
Results and discussion. Eleven (14.2 %) cases of puncture and drainage interventions were ineffective, in connection with which we had to resort to traditional methods of treatment — opening and drainage of purulent-inflammatory foci and the use of NPWT-therapy. Vacuum therapy is an effective method of treatment of purulent-septic complications of gunshot wounds of the soft tissues of the abdomen, which in combination with puncture-drainage interventions, can reduce by 2.5 times the number of repeated operations (mainly multi-stage surgical treatments), thereby reducing 1.8 times the length of stay of patients in the hospital. 
Conclusions. Thanks to the use of modern methods it was possible to improve the results of surgical treatment of purulent-septic complications in the wounded with purulent-septic complications of combat trauma to the abdomen. 
The use of the latest techniques has helped reduce the number of invasive treatments, accelerate recovery, reduce bed rest, reduce intoxication, and increase the rate of return of servicemen.