STRATEGY OF RECONSTRUCTIVE AND RESTORATIVE INTERVENTIONS FOR HAND TISSUE DEFECTS.

The article is devoted to the development of a strategy for reconstructive interventions in wounded after gunshot injuries of the hand with tissue defects, which will improve the anatomical and functional results. During the period from 2019 to 2020, 42 plasty of soft tissue defects of the hand (39 patients) with the use of rotary flaps on perforating and axial vessels were performed in the trauma department of the injury clinic of the National Military Medical Clinical Center «Main Military Clinical Hospital» for plasty of soft tissue defects of the hand, a radial flap was used in 15 (36%), a rotational dorsal forearm flap in 15 (36%), and an insular neurovascular flap in 12 (28%). Evaluation of the immediate (3 places after surgery) and long-term (1 year after surgery) results of treatment of patients with soft tissue defects of the hand who underwent flap transposition, according to the Disability of the arm, shoulder, and hand outcome measure scale (DASH) showed an average value of 32,0 (after 3 months) and 29,4 (after 1 year), which corresponds to good functional results of treatment. The main principle of successful treatment of gunshot wounds is the implementation of primary, repeated surgical treatments followed by early closure of defects. The main factors that determine the surgical tactics are localization, area, and volume of the wound defect.