ALGORITHM FOR THE RESTORATION OF POST-TRAUMATIC DAMAGES OF THE UPPER LIMB

Abstract

According to various authors, damage to the upper limb is second among injuries of the musculoskeletal system and in most cases have multiple and combined nature, and in 24–50 % of cases lead to permanent disability. The complex anatomical structure of the upper limb and high conditions for the coordination of movements are one of the reasons for the difficulty in treating victims with traumatic injuries.

The aim of the study – to improve the functional and aesthetic results of treating patients with traumatic injuries of the integumentary tissues of the upper limb.

Materials and Methods. The treatment of 45 patients with various injuries of the upper extremities, accompanied by defects of the epithelial tissue, was analyzed. There were 5 women in the study (11.1 %), 40 (88.9 %) men, the average age was 46 years. The greatest number of patients of working age (younger and middle / mature): 25–60 years, respectively – (80 %) patients.

Results and Discussion. Depending on the size, depth and degree of damage to the soft tissues and other structures of the limb, all patients were divided into 4 groups. Group I – 13 (13/45; 28.9 %) patients with limited (up to 5 cm in diameter) area of ​​damage to the skin and underlying tissues to the deep fascia; 17 surgical interventions were performed. Group II – 7 (5/45; 15.5%) patients with an extensive wound surface and soft tissue damage below the deep fascia, 18 operations were performed. Group III consisted of 12 (12/45; 26.7 %) patients with defects of the epithelial tissue, which occurred together or as a result of damage of the osteo-articular apparatus (25 operations). Group IV – 13 (15/45; 28.9%) patients with combined or multiple trauma, accompanied by damage of the great vessels, nerves, partial or complete separation of the limb – 84 operations. Totally 144 surgical interventions were performed.

Conclusions.

1. The choice of the reconstruction volume for the restoration of injured tissues depended on the size, depth and extent of damage to the upper limb, while the objective assessment of microhemodynamics using laser Doppler flowmetry made it possible to reliably predict the possibility of postoperative donations of patients.

2. Using the proposed protocol of closing the defects of the integumentary tissues of the upper extremities allowed us to obtain a positive result in 98.6 % of cases.