Tactics and general principles in the treatment of polytraumatized disaster victims

The authors reviewed their experiences of treating masses of victims after disasters in Arzamas, Armenia, and Ethiopia. To handle these vast numbers of victims, local hospitals were reorganized into specialized clinics with appropriate equipment and medical personnel. Some of the patients were evacuated to multispecialized clinics or rear hospitals. A complex of diagnostic and treatment modalities were used on these patients, including intrabone injections, immunoprophylaxis for purulent complications, skin and bone grafting and external fixation systems designed in Russia. The overwhelming majority of the patients was discharged with good results. To prevent common tactical, treatment, and surgical mistakes, it is necessary to improve medical education to train multispecialized teams in disaster medicine prepared to work under extreme conditions.

[Basic principles and methods of aid to patients with severe hand trauma]

Aid rendering to the patients with severe hand trauma is presented as a system of primary-reconstructive treatment, including individual approach to the surgical aid tactics, terms and volume selection, where the defining factors are the state of tissue blood circulation, application of the complex of conservative and operative measures aimed at the prophylaxis and therapy of circulatory and infectious complications, selection of rational methods of the lost anatomic formations reconstruction. There are described clinical criteria of tissue vitality evaluation and those obtained with application of instrument methods (infrared thermography, electric resistance thermometry, ultrasound indication of blood flow). If the state of the damaged hand tissues requires medicinal treatment it would be expedient to carry out the primary-postponed treatment, consisting of 2 stages. The first stage includes surgical manipulation, aimed at microcirculation improvement and wound surface isolation by means of watertight cover. The second stage is the final one. Its volume depends upon the compensation of tissue blood flow and is carried out for 2-5 days in planned order.

[2 methods of phalangization of the 1st metacarpal bone]

The author has elaborated two technics of phalangization of the first metacarpal bone based on transposition of four triangle skin grafts. The technic concerned was employed in 21 patients on 23 stumps with good functional results.