Surgical treatment of firearms chest and abdominal injuries

The purpose of the study is to study the structure of combat gunshot injury during the Karabakh war and to analyze the results of treatment of victims with penetrating fire-shooting wounds of the chest and abdomen. Material and methods. The results of surgical treatment of 50 wounded with penetrating gunshot wounds of the chest and abdomen were analyzed, which amounted to 83,3% of the total number of victims (60) with a combat gunshot injury. Of the 50 wounded, isolated chest injuries were observed in 20 (40%), abdominal injuries in 22 (44%), combined chest and abdominal injuries in 3 (6%), combined thoracoabdominal injuries in 5 (10%). The spectrum of examination included general clinical, laboratory and radiation methods (radiography, ultrasound, CT, MRI) diagnostics, according to indications - thoracoscopy and laparoscopy. The severity of the damage was assessed in accordance with the criteria of quantitative gradation of the severity of the BOT on the scale of «VPHP» (military field surgery of damage). The severity of the condition of the wounded was assessed on the basis of two scales: «VPH-SP» (military field surgery - admission status) - to assess the severity of the condition upon admission to the medical evacuation stage; «VPH-SG» (military field surgery - hospital condition) - to monitor the condition of the wounded during intensive care. Results. Surgical tactics, the choice of the optimal volume and method of surgical intervention for penetrating gunshot wounds of the chest and abdomen were determined differentially, taking into account the localization, nature, clinical manifestation of damage to the organs of the pleural and abdominal cavities, as well as the severity of the condition of the victims. The optimal variant of surgical tactics for penetrating gunshot wounds of the chest was thoracocentesis with drainage of the pleural cavity by Bulau, which was performed in 24 (85,9%) of 28 victims. Emergency thoracotomy was performed in 3 (10,7%) of the wounded. One-stage and final elimination of damage was performed in 94% of the wounded. In 3 (6%) of the wounded with an isolated gunshot wound to the abdomen (1) and combined gunshot wounds to the chest and abdomen (2), the «Damage control» tactic was applied. Various complications in the postoperative period occurred in 30% of patients. The mortality rate was 2%.