THE INTERRELATION OF CHANGES IN LABORATORY PARAMETERS OF HOMEOSTASIS AND MORTALITY IN ELDER AGE GROUPS PATIENTS WITH POLYTRAuMA AND THE DOMINANT INJURIES OF THE MUSCULOSKELETAL SYSTEM

In this work the analysis of observations of patients with polytrauma of older age groups (95 patients) was performed, the control group consisted of patients with polytrauma in age from 20 to 40 years (55 patients). The aim of the study was to define a set of laboratory parameters and the degree of deviation from the norm, the changes of which most closely correlated with the dynamics of the patients' condition, allowing objectively justify the choice of treatment strategy on the stages of DCS. Among them are the blood count (RBC, HGB), total blood protein, blood albumin and abnormalities in blood coagulation system. Objectivization of assessing criteria of condition permitted to reduce the mortality rate by 9.6%

INTERRELATION BETWEEN COMORBIDITY AND MORTALITY RATES IN ELDER PATIENTS WITH POLYTRAUMAS

Regarding world wide tendency to population ageing, active life style of the elderly leads to growing various traumas, including severe concomitant injuries. Comorbidity does not only complicate diagnosis process and treatment in non-advanced medical centres, but in cases with concomitant injuries may result in unexpected decompensation of patient condition, down to unfavourable treatment results. Thus, coexisting somatic pathology is a serious challenge for the public health system as several accompanying diseases exacerbate management and diagnosis procedures.Objective. Value influence of accompanying pathology on probable lethal outcome in elder patients with polytraumas.Material and Methods. We analysed cases of elder patients with polytraumas (n = 163). To standardise studies and compare them properly we used Charlson comorbidity index.Results. Accompanying somatic pathology influences outcomes in patients with severe combined traumas: Charlson index >5, in patients older 60 years it’s prognostically unfavourable for life, irrespective of trauma severance.Conclusion. Application of comorbidity index allows to object life prognosis and possibility of surgical stage performance in elder patients with polytraumas regarding the concept of injury dynamic control

To the anniversary of Krasovitov plastic surgery with detached skin flaps – from creating a method to current relevance

The article describes the life path of a famous Kuban surgeon Vkadimir K. Krasovitov. The historical aspects of the creation of full-layer skin plasty technique according to Krasovitov are presented, the relevance of its use in our days is analyzed, and the development of new types of skin autoplastics is presented. In addition, the author describes the history of candidate dissertation of V.K. Krasovitov's, as well as the monograph ‘Primary plastic surgery with rejected skin flaps’

The effect of A-PRP-therapy on reparative regeneration of bone tissue with acute bone fractures of the limbs

Objective. To evaluate the effect of A-PRP-therapy on reparative bone regeneration in acute limb bone fractures. Material and Methods. The study consisted of two parts – in the first part we studied the effect of A-PRP-therapy on the model of a comminuted fracture created in the operating room, an experimental study conducted on 40 Mature rabbits of the Flander breed, all animals were divided according to the principle of analogues into 2 groups (20 animals): in the study group – on the 5th day after osteotomy, platelet-rich plasma was injected into the fracture area, in the comparison group – the fusion occurred without the influence of any drugs. The second part presents the results of clinical testing of A-PRP-therapy, analyzed the results of treatment of 16 women with low-energy fractures of the distal radius metaepiphysis. The study group consisted of 6 patients whose surgical treatment was supplemented by A-PRP-therapy on 7, 14 days after surgery. The control group consisted of 10 patients who underwent surgical treatment without A-PRP-therapy.Results. The use of platelet-rich plasma to stimulate reparative osteogenesis in accute fractures reduces the time of fracture consolidation by 9.5 ± 1.1%.Conclusion. Platelet-rich plasma (PRP) to stimulate reparative osteogenesis is an inexpensive, easy to perform and effective alternative to the methods considered. The possibilities of application of this technology in traumatology and orthopedics require further research in order to create protocols for the use of PRP-therapy to stimulate the maturation of bone calluses

Comparative analysis of local stimulation methods of reparative osteogenesis

Objective To determine the ratio of the main growth factors when using various methods of local stimulation of reparative osteogenesis.Material and methods The study consisted of two parts: in the first part a comparative analysis of the content of growth factors by ELISA was carried out (PDGF – platelet derived growth factor, TGF – transforming growth factor, VEGF – vascular endothelial growth factor, IGF – insulin-like growth factor, BMP6 and BMP7 – morphogenetic proteins 6 and 7), capable of stimulating reparative osteogenesis in blood plasma, plateletrich plasma, red bone marrow and bone autoregenerate. The second part presented the results of approbation of the autoregenerate obtained according to the original method in the framework of an acute experiment on animals.Results The most important cytokines affecting the process of reparative osteogenesis are fibroblast growth factor – FGF1 and bone morphogenetic protein 7 – BMP7. Based on the results of a comparative enzymelinked immunosorbent assay, it has been established that the autoregenerate, obtained by the original method, and a bone marrow aspirate concentrate have the highest osteogenic potential.Conclusion Autoregenerate is an effective and promising means of local stimulation of reparative osteogenesis, and its transplantation is a simple and highly effective procedure

OUTCOME ANALYSIS FOR PATIENTS WITH SEVERE COMPOUND FRACTURES OF LOWER EXTREMITY LONGITUDINAL BONES IN THE REGIONAL GENERAL HOSPITAL

Background. We have performed outcome analysis in patients treated for severe compound fractures of lower extremity longitudinal bones regarding a chosen treatment technique for initial surgical debridement and transfer terms in the regional general hospital.Material and Methods. We reviewed 151 patient reports treated in Scientific Research Institute – Ochapovsky Regional Clinical Hospital no. 1, Krasnodar, for 2012–2016. We defined four methods for initial surgical debridement at the first stage of surgery. Outcomes were analysed in patients regarding their initial surgical debridement and transfer terms into the regional general hospital from the primary admission sites.Conclusion. It is required to work out regional system for staged treatment in patients with severe compound fractures. At first stage initial surgical treatment is performed by techniques no. 2, 3 and then patients are transferred to the regional general hospital during the first day after being injured. In unstable patients initial surgical debridement should be divided in two stages

NON-FREE GASTROCNEMIUS MUSCLE FLAP APPLIED FOR LOW EXTREMITIES SURFACE DEFECT PLASTY

Background: We analyzed results in cases with surface defects covered with non-free vascularized gastrocnemius muscle flaps. We observed patients with various traumatological and orthopedic pathologies. Materials and Methods: in the present article we analyzed treatment results of 8 patients with soft tissue defects in the area of knee joints and upper third of shin. In all these cases we applied non-free vascularized muscle flaps taken from gastrocnemius muscle and simultaneous autodermoplasty. We described various techniques performed in patients with combined traumas. Conclusions: Transposition of non- free vascularized flaps from gastrocnemius muscle in patients with traumatological and orthopedic pathologies allows to achieve restoration of surface tissues in the area of knee joints and shin when defects occur after traumas and postoperative purulent complications

RESULTS OF TREATMENT OF OPEN FRACTURES IN PATIENTS WITH POLYTRAUMA IN A REGIONAL TRAUMA SYSTEM

Aim. To analyze options for treatment tactics for open fractures of bones, implemented in a regional trauma system in theKrasnodar Territory.Materials and methods. Retrospective analysis includes the results of treatment of 82 patients with polytrauma and severe open fractures of the shin bones aged from 18 to 60 years, of whom 23 in unstable or critical condition, hospitalized in 2016-2017 in the Scientific Research Institution – S.V. Ochapovsky Regional Clinical Hospital № 1.Results. Treatment tactics for patients with severe polytrauma and open fractures type IIIA and B according to the classification of Gustilo-Andersen adopted in trauma center of level I, reduces the total number of infectious complications to 9,09% for fractures of type III A and 53,84% of IIIB fractures compared to option treatment strategies adopted in trauma centres II, III where the level of infection reaches 58,06% fractures type III A and 93,75% of IIIB fractures. The typical mistakes made in primary surgical treatment in patients with polytrauma and severe open fractures were revealed: incomplete revision of the wound with leaving foreign bodies, non-viable soft tissues, unstable fixation of the fracture with the help of a skeletal traction system, incomplete external fixation of the fracture with a device or plaster bandage, suturing of the wound with relaxing skin incisions during soft tissue swelling, absence of drains or passive drainage of the open fracture.Conclusion. The usage of primary surgical treatment in a reduced volume, with the application of VAC-dressings, in patients with polytrauma and severe open fractures of the limb bones can reduce the overall incidence of infectious complications