ОКАЗАНИЕ СПЕЦИАЛИЗИРОВАННОЙ ХИРУРГИЧЕСКОЙ ПОМОЩИ В ЛЕЧЕНИИ РАН МЯГКИХ ТКАНЕЙ И ПОВРЕЖДЕНИЯХ КОСТЕЙ, ОСЛОЖНЕННЫХ ХИРУРГИЧЕСКОЙ ИНФЕКЦИЕЙ, У ДЕТЕЙ ПРИ МАССОВЫХ КАТАСТРОФАХ

SPECIALIZED SURGICAL TREATMENT OF SOFT TISSUES AND BONES COMPLICATED WITH SURGICAL INFECTION IN CHILDREN IN CASE OF MASS CASUALTIES

Purpose: To increase effectiveness of treatment of soft tissue and bone wounds complicated with surgical infection in children in case of mass casualties applying primary and early reconstructive or plastic surgery. Materials and methods: We treated 490 children suffering of earthquakes in Armenia (1988), Sakhalin (1995), Turkey (1999), Algeria (2003), Pakistan (2005) and Indonesia (2006 and 2009). The children were admitted to the nearest medical institution and were treated by a mobile, pediatric, multifunctional team which includes highly qualified specialists. All children had wounds on soft tissues of large size and various location. In 176 (35,9%) children Crash-syndrome was diagnosed. In 49 (10,0%) children there were open fractures of long bones. The authors have outlined mistakes typical for the first stage of surgical treatment. The authors have also determined steps for complex wound treatment: 1-radiacal surgical wound treatment; 2- intensive therapy; 3- extracorporal detoxication; 4- topical wound treatment with multicomponent ointments; 5- osteosythesis with outer fixation; 6 - early reconstructive and plastic surgeries. Healing with primary intension was seen in 96,6% cases. In 40 patients we had consolidation of long bone fractures. In 6 cases Ilizarov technique was successfully applied. Conclusion: Complex treatment of wounds on soft tissues and bones in children suffering of earthquakes must be conducted by pediatric multifunctional teams at hospitals. Primary and early reconstructive and plastic surgeries minimize the rate of disability and restore anatomical and functional integrity of the damaged segment. Keywords: wounds, fractures, children’s, earthquake, surgical treatment.