[EVALUATION OF THE VACUUM-ASSOCIATED METHOD EFFICIENCY IN TREATMENT OF BALLISTIC WOUNDS OF THE EXTREMITIES].

The aim of research - to study the wound process on the VAC-assisted background therapy in patients with multi-structure mine-explosive and comminuted wounds of the extremities in traumatological clinic. The study involved 34 middle-aged patients (32.9±1.5 years) with ballistic wounds of soft tissues complicated by compartment syndrome, large necrotic wounds and open fractures (according to the classification of R.B. Gustilo-Anderson,1984) which were treated at the State Institution «Dnipropetrovsk Regional Hospital» (2014-2016). Patients were divided into two wound management groups: the group with VAC-assisted treatment and the group with the conventional wound treatment with antiseptics and gauze saline-soaked dressings like a control group. Terms of the study: "0" (before treatment), on the 3rd and 7th day. The main research methods for controlling the dynamics of healing: general clinical assessment, hematological and biochemical parameters (VEGF concentration in blood serum), cyto-histological and immunohistochemical reactions with ultrastructural microscopic analysis and morphometry, a scale for subjective and objective assessment of changes in the quality of life of patients during treatment. According to the results of the study, it was reliably confirmed that in the group of the VAC-assisted method, wound healing occurs more intensively in comparison with the control group, using the "traditional" method. All applied control techniques demonstrated qualitative and quantitative positive changes in the direction of reparative processes, mainly within 3-7 day-checkpoints from the start of treatment. Due to conditions for the creation of uniform negative pressure (-125 mm Hg), it was accelerated the evacuation of the tissue debris throughout the wound bed, maturation of stromal and microcirculatory components throughout the wound channel. On the background of VAC-assisted therapy, it was accelerated the normalization of leukocytogram parameters as the result of decrease the volume of necrotic processes, as well as a significant decrease of the bacterial load in the wound. The stimulation and acceleration of the processes of angiogenesis in the wound allows the preparation of the wound surface for reconstructive operations in 5.2±0.8 days, in comparison with the control group.