Application of damage control tactics in combat injuries of limbs at the advanced stages of medical evacuation in modern war settings (literature review)

Abstract

Relevance. Limb injuries occupy the first place in the structure of modern combat injuries and are one of the main reasons for the decline in fitness for military service and disability. In the conditions of conducting largescale hostilities, the role of the advanced stages of medical evacuation, where surgical care is provided according to the principles of damage control, increases. Features of the tactics of damage control in combat injuries of the extremities determine the need for special training of military surgeons.The objective is to consider the features and effectiveness of the provision of surgical care according to the principles of damage control in combat injuries of the extremities at the advanced stages of medical evacuation in armed conflicts of the last two decades (in the countries of the Middle East and Africa, Afghanistan, Ukraine).Methodology. A search was made for scientific articles in the PubMed database and the Scientific Electronic Library (eLIBRARY.ru), published from 2013 to 2023.Results and Discussion. Modern combat trauma of the extremities is characterized by a high frequency of vascular damage, extensive destruction of soft tissues and bones from the impact of damaging factors of explosive ammunition. Surgical interventions for combat injuries of the extremities (external fixation of bone fractures with rod devices, ligation or temporary vascular shunt of damaged vessels, fasciotomy, amputation) were the most frequent of all operations performed at the advanced stages of medical evacuation during modern military conflicts. The volume of surgical interventions corresponded to the first stage of orthopedics and vascular control of injuries and was determined by the severity of the condition of the wounded, the degree of ischemia and severity of limb injuries, and the medical and tactical situation.Conclusion. Assistance at the advanced stages of medical evacuation according to the principles of orthopedics and vascular damage control can significantly reduce the frequency of amputations and improve the functional results of treatment for combat injuries of the extremities.