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The purpose of the study is experimental testing of Russian medical devices for the elimination of tension and open pneumothorax.Objectives of the research. Perform an analysis of the volume of therapeutic measures in the wounded and injured with open and tension pneumothorax. Conduct experimental testing of Russian samples to eliminate tension and open pneumothorax.Materials and methods. A retrospective analysis of the medical histories of 232 patients with polytrauma admitted for treatment at the war surgery department of the Kirov Military Medical Academy in the period from 2015 to 2019. An experimental study was carried out on large biological objects (pigs) to evaluate the effectiveness of eliminating open and tension pneumothorax using products from the UD-02f (paramedic) kit.Results. A retrospective analysis of the medical histories of 232 patients with polytrauma admitted for treatment at the clinic in the period from 2015 to 2019 was carried out. The incidence of tension pneumothorax was 11.6%. In 44.4% of cases, it was eliminated; in 55.6% of the ambulance teams, tension pneumothorax was not eliminated. Open pneumothorax was diagnosed in 21.1% of those admitted at the prehospital stage. In all cases, the elimination of open pneumothorax was carried out by applying an improvised sealing bandage to the chest. An experimental study of the effectiveness of the UD-02f set showed that the use of products included in this set allows to effectively eliminate the life-threatening consequences of wounds and chest injuries.Conclusion. Open and tension pneumothorax are severe life-threatening consequences of chest injuries with a development rate of up to 12.1% and 11.6%, respectively. The inclusion of a set for eliminating tension and open pneumothorax disposable, sterile (paramedical) UD-02f, in the complete equipment and training of medical personnel in the procedure for its use, will allow timely and effective elimination of tension or open pneumothorax at the prehospital stage of emergency medical care.

The biography of colonel of Medical Corps, professor Georgiy Nicolaevich Tsibuliak (19322020) is presented. In 1956 G.N. Tsibuliak graduated from the Kirov Military Academy being awarded with gold medal. When being a cadet, he got actively engaged in research. In 1961 G.N. Tsibuliak defended candidates dissertation on the injury treatment in casualties damaged by ionizing radiation, took part in the study of multiple injuries occurring in atomic tests. After graduating from the medical residency he stayed in War Surgery department of the Academy, was eventually assigned as a senior lecturer, the head of the research laboratory carrying out the study of shock and terminal state. In1966 he defended a doctorate in pathogenesis, clinical findings and treatment of tetanus. G.N. Tsibuliak became one of the leading advocates for the concept of traumatic shock in individuals. This fact that at present emergency physicians and surgeons dealing with traumatic shock consider to be an axiom, is scientifically based, and was gained through hard routine work in treating severely injured casualties. From 1976 to 1982 Georgiy Nicolaevich was Surgeon-in-Chief in Group of Soviet Forces in Germany. In 19901993 he was in charge of research laboratory dealing with combat surgical trauma in the Academy. Since 1993 G.N. Tsibuliak had retired from active duty, holding the position of a professor at the War Surgery department. He is the author of more than 200 scientific papers, including 7 monographs. G.N. Tsibuliak was closest associate of A.N. Berkutov in studying traumatic shock in casualties, took an active part in formation of a new clinical specialty resuscitation.

The analysis of injuries, life-threatening consequences and outcomes of treatment of wounded with penetrating chest wounds and the results of approbation of a prototype (medical) disposable set UD-02v for the elimination of strained and open pneumothorax, hemothorax, pleural drainage and collection of spilled blood with the possibility of subsequent reinfusion at the pre-hospital stage is presented. The prototype of the UD-02v set was created as part of the implementation of the state defense order in 2018. Its creation is due to the fact that despite the improvement of medical care at the stages of medical evacuation and the widespread use of individual armor protection, chest injuries currently remain a frequent type of combat surgical injury, accounting for 6 to 12% of all injuries. The main cause of death of injured and injured with chest injuries remains blood loss caused by continuing intrapleural bleeding and concomitant damage to other anatomical areas. Stressful pneumothorax, together with intrapleural bleeding, account for 93% of preventable causes of fatal chest injuries at the pre-hospital stage. Untimely elimination of the consequences of severe breast injuries should be considered as a negative factor affecting the outcome of treatment, and significant improvement in treatment results should be expected only in the case of early elimination of the most severe consequences of breast injuries. The developed set of UD-02v exceeds foreign medical devices in its medical and technical characteristics, and is the most promising for acceptance for the supply of the Armed forces of the Russian Federation as part of the samples of complete and service equipment.

451 lethal outcomes of 5581 casualties with gunshot wounds occurring at the medical treatment facilities have been analyzed. Total lethality rate was 8,1%. Lethal outcome time varied from 1 to 19 days (10,61,9). 50,3% of casualties died during the advanced trauma management (Role 2), 17,3% at the Role 3 hospitals, 32,4% at the Role 4 hospitals. The predominant injury localization causing death was abdominal wounds 34,8%, and head injuries 23,1%. The main cause of death of wounds casualties arriving at the medical treatment facilities was life-threatening injury consequences (34,8%) and developing complications (45,5%). Fatal injuries to the major organs and permanent blood loss were considered to be the cause of death in 19,7% of casualties. 37% of the total number of lethal outcomes died because of acute blood loss, in 77,2% of cases it was internal hemorrhage, in 22,8% external hemorrhage. In 1% of cases early death was caused by acute respiratory failure. In general, the development of more than one third of lethal outcomes could be prevented. Special medical products and equipment were developed by the Department of War Surgery Kirov Military Medical Academy, RF Ministry of Defense in cooperation with the leading research and educational establishments and production enterprises. They are: equipment for the prehospital hemorrhage control, asphyxia management, open and tension pneumothorax management, traumatic shock treatment and complication prevention, as well as activities for creating devices controlling internal hemorrhage. All these form the basis for elimination of life-threatening consequences of injuries at the prehospital stage. This allows us to discuss the development of the idea of a traumatic disease, being put forward by professor Ilia Deriabin, in terms of the concept of the early-stage pathogenetic treatment of the severe injuries and traumas.

Currently, explosive trauma is rare in peacetime injury surgery, but is of great importance in the work of surgeons. This is due to damage of a large number of anatomical areas, various damaging factors of the explosion and the simultaneous entering of several victims. The results of forensic medical examinations of 24 corpses of people who died as a result of terrorist acts in the subway of Minsk on 11/04/2011 and St. Petersburg on 03/04/2017 were analyzed. Incompatible with life injuries as the immediate cause of death were found only in 33,3% of cases. Profuse blood loss was the immediate cause of death in 66,7% of those killed. The most common (in 87,5% cases) cause of profuse blood loss was internal bleeding: in 7 (50%) cases - due to damage to organs and large vessels of the chest, in 6 (42,9%) cases - due to combined damage to the anatomical structures of the chest and abdomen, in 1 (7,1%) case - due to damage to the parenchymal organs of the abdominal cavity and retroperitoneal space. The leading role in thanatogenesis during the considered explosive peacetime injuries was occupied by blood loss, its specific gravity was 66,7%. Profuse blood loss in 87,5% of cases was due to damage to the organs of the chest and abdomen. Potentially salvable were 7 (29,2%) dead who received damage to the main vessels of the limbs, damage to internal organs without injuring the heart and large blood vessels. Thus, the development of new ways to stop intracavitary bleeding at the advanced stages of medical care for victims with explosive injuries and injuries is a priority aim.

Battlefield lethality remains the most underexplored problem from the surgical point of view. 540 battle­field fatalities during the military operation in the North Caucasus region of Russia (1994–1996) were ana­lyzed. It was found that 25.4% of all “Killed In Action” refer to the group of potentially survivable. Common causes of combat death in this group were prolonged hemorrhage (78.1%), tension pneumothorax (19.0%), and hemopneumothorax (2.9%). Reducing mortality can be attained due to introduction of new means of control for life-threatening consequences of injuries, improving tactical evacuation, as well as training mili­tary personnel in providing combat lifesaver care.

Traumatic shock is considered to be the most common clinical form of a severe patient’s condition (63%). Timely and adequate blood volume resuscitation is one of the most important procedures in providing medical care to critically injured casualties and patients at the forward medical evacuation stage. The key to this problem, especially when the infusion therapy is needed at the pre-hospital stage, is the development of alternative (extravascular) techniques of plasma volume expander administration. The article presents the results of testing of the first domestic medical devices for intraosseous infusion in critically injured casualties and patients. At present, on commission of the Russian Ministry of Defense and with the scientific support of Kirov Military Medical Academy, domestic enterprises developed test samples of medical devices to provide intraosseous infusions: a «Disposable device for intraosseous infusion of solutions if there is no intravenous access, which was designed on the basis of a spring drive» - the index «VKI-P», developed by limited liability company «Novoplast-М» and a set for intraosseous infusion using an electric drive - the index « VKI-E», developed by limited liability company «Research engineering company «Spetsproekt». Assessment of performance of test samples of the medical devices for intraosseous infusions «VKI-P» and «VKI-E» was carried out using pathophysiologic model of traumatic shock in 14 experimental animals (pigs) by creating artificial blood loss of medium severity, 25% of circulating blood volume (in average 440 ml), followed by its resuscitation with intraosseous infusion of 0,9% solution of NaCl. As a result of the performed tests it was found that the device «VKI-P» and the set «VKI-E» provide for NaCl infusion in major vessels (with an intraosseous infusion), 750 ml of volume during 45-50 min, and can be used as an alternative access to provide infusion as a part of anti-shock therapy, which solves the problem of volume resuscitation when giving care to severely injured casualties and patients at the forward medical evacuation stages. These samples may be recommended for inclusion into the medical service list of complete supplies and the Medical Corps supply support, the Armed Forces of the Russian Federation.

OBJECTIVE. The article presents the complex management of treatment in multiple trauma using endovideoassisted surgeries. MATERIAL AND METHODS. The authors demonstrated minimally invasive methods of treatment for victims with multiple trauma on the second stage of programmed multiple-stage surgery in order to eliminate life-threatening consequences and fix fractures of facial skeleton. These operations were performed during 12 hours after trauma. RESULTS. Programmed multiple stage treatment included the prevention or stop of asphyxia, bleeding and temporary fixation of fractures using extrafocal osteosynthesis and elements of primary plasty of soft tissues. Surgeons created conditions for intensive therapy (tracheostomy) using minimally invasive methods. CONCLUSIONS. Endovideo-assisted technique decreased trauma of surgical approach and allowed doctors to perform revision of complex anatomical structures, which were difficult to access. It expanded the volume and possibilities of surgical manipulations. Surgeons differentially removed foreign bodies and areas of necrosis. The method increased an accuracy of reconstructive surgeries and facilitated to monitoring of damaged structures.

The treatment of maxillofacial gunshot wounds in peacetime is an urgent and difficult problem. The emergence of new types of civilian weapons and relatively small current clinical experience does not allow generating recommendations for the treatment of this pathology. It presents a statistical analysis of injuries in St. Petersburg 2004-2014 restricted firearms destruction and experimental study of the harmful effect of these weapons on the fabric maxillofacial experimental animals (pigs). The features of the clinical picture, diagnosis and surgical treatment of wounds of the maxillofacial region, caused by a firearm -restricted lesions and wounds with extensive tissue damage maxillofacial caused a hunting weapon are considered.

The authors described the variants of initial surgical d-bridement on the basis of experience of treatment of 183 patients of multistaged treatment program.

Comparative characteristics of domestic and foreign means of the first aid on the battlefield and in the epicentre of emergency situation. The results of comparative analysis of domestic and foreign means of the first aid on the battlefield and in the epicentre of emergency situation are presented. It was found that the first aid means used in the Armed Forces are effective and allow performing specified activities, regardless of the qualifications and assisting skills. Modern innovative means of providing emergency and urgent care may be used on the stages of medical evacuation of military and military hospitals.

The authors described the variants of initial surgical d-bridement on the basis of experience of treatment of 183 patients of multistaged treatment program.

With the help of tests on 10 big biological objects (sheep) was studied a modern model of severe lateral damage (6 mm diameter) of femoral artery. Within 45 seconds blood loss was 432.5 +/- 258.2 ml. The usage of domestic local hemostatic agent--"Gemostop" based on zeolite and "Gemofleks" based on chitosan. The total three-hour mortality was 50%. Primary hemostasis was recorded only in 20% of biological objects, the final hemostasis in 60%. Thus, the model of standard 6-mm lateral damage of femoral artery with a free primary hemmorage during 45 seconds should be considered as. optimal for evaluating the effectiveness of modern hemostatic agents.

Massive intracavitary hemorrhage in case if severe concomitant injury is the most frequent cause of death. Necessity of blood loss replacement requires effective and safe methods. One of them is blood reinfusion - technically less complicated method. The article shows advantages of using the hardware and filtration methods of blood sampling and reinfusion, developed scale rapid diagnosis of the level of hemolysis of autologous blood. Using of the method of filtration blood sampling provides 2X minimal amount of free hemoglobin than using an aspirator and reinfusion of blood with the contents therein to free hemoglobin 2.0g/ L prevents the risk of developing the syndrome and massive blood transfusion reduces the incidence of deaths at 11%. In patients with massive intracavitary hemorrhage it is advisable to use the method of semi-quantitative rapid analysis of free hemoglobin color scale.

Ongoing intra-abdominal bleeding is the main life-threatening sequence of blunt abdominal trauma. The use of local hemostatic agents allows achieving fast and reliable hemorrhage control in case of parenchymatous organs injury. We investigated the efficacy of a dressing "Celox Gauze" in an experimental model of grade IV liver injury in large animals in the setting of coagulopathy. We used the following experimental model: 30-35% of blood volume was withdrawn followed by severe liver injury and hemostatic agent application. Laboratory tests were controlled in three endpoints. Hemostasis was evaluated in 2 days. "Celox Gauze" was effective for hemorrhage control in 100% of cases. All animals survived until the end of the experiment. Perihepatic packing with "Celox Gauze" applied is more effective to control hemorrhage than packing only. It has been noted lower volume of blood loss, lower decrease of red blood cells in animals of "Celox Gauze" group. We noted no adverse effects. Histological analysis showed the absence of any significant local hepatic damage. In whole the local hemostatic agent "Celox Gauze" has been shown highly effective in the model of parenchymatous bleeding. Additional studies with more number of animals are warranted to confirm our results.

Pathogenesis and early diagnosis characteristics of acute deep vein thrombosis (advt) have been studied in 323 polytrauma patients (iss: 29.4 +/- 2.0 score). Acute vein thrombosis, confirmed by us examination, was determined in 22.3% of patients (in the case of severe craniocerebral trauma--scct--12.6%, extremity trauma--60.5%, spinal trauma 75%, severe sepsis--25%). Despite the complex diagnosis and prophylaxis (thrombus removal, thrombosed veins ligation, external iliac vein and inferior vena cava clipping, permanent and removable cava-filters positioning) pulmonary artery thromboembolism (pate) developed in 3.1%. ADVT in patients with polytrauma developed as a pathogenic basis of systemic inflammatory response syndrome (sirs), which was observed to be associated with endothelium damage and thrombophilia. Hence, thrombophilia values (high levels of crp, f.viiia, D-dimer, low levels of antithrombin iii--at-iii), which are characteristic of sirs, lose their informativeness in the early diagnosis of advt and pate risks identification. In this regard, early advt diagnosis in polytrauma should be based on doppler study results, and the adequacy of anticoagulant and antiplatelet therapy should be determined by the levels of crp, f.viiia, D-dimer, activated partial thromboplastin time--aptt, anti- xa heparin activity, international normalized ratio--inr, platelet aggregation, thrombodynamic potential, at-iii.

A goal of this study is to review perspective technologies of surgical care to the wounded on the basis of an analysis of the experience in medical support in local armed conflicts and a study of the achievements of modern trauma surgery. The study is based on the analysis of personal experience, results of scientific researches being carried out in the Military Medical Academy and a comparison review of available papers and works in the field of our study. Perspective technologies of surgical care to the wounded are strongly dependent on the pre-hospital care: high technologies in personal medical equipment, special disposable devices used in case of life-threatening consequences of injuries and traumas during emergency medical care and advanced trauma management. The main innovation of the last ten years in war surgery is considered to be damage control surgery. Wide application of abbreviated surgical operations (the first phase of damage control surgery) makes the use of remote surgery (telesurgery) for treatment of the wounded more practicable. Increasing effectiveness of military surgeon education is based on the use of all possible achievements in education and information technologies. Feedback in surgical care to the wounded is supplied with analysis of its results in the medical Register of the wounded military.

The deaths happened as a result of wounds caused by non-lethal weapon (NLW) are mainly associated with severe and extremely severe damage of brain. However, vast number of specific problems occurs in cases of extracranial gunshot wounds caused by NLW. Taking into account little physicians' experience, and absence of standard approaches to treatment of these wounds till now. This paper embraces peculiarities of clinical signs, diagnosis and surgical treatment of cervical, truncal, and extremities wounds caused by NLW. Our investigation allowed to draw a conclusion that gunshot wounds caused by NLW have similar characteristics. These ones are the same with signs of wounds caused by small arms. Surgical treatment of wounds caused by NLW is based on the standard approaches to treatment of low-velocity missile wounds.

Acute massive blood loss (AMBL) of severe and extremely severe degree is still one of the leading causes of unfavourable traumatic disease. 95% of potentially preventable lethal outcomes in severe gunshot trauma is reported to depend largely on the adequacy of AMBL correction (Howard P., 2003). An alternate approach to the issue studied was the development of preparations of hyperosmotic saline solutions (7.5% sodium chloride) combined with hyperoncotic colloid solutions (dextrans, hetastarch). As a result, solutions were developed (so-called, hyperosmotic hyperoncotic volume expanders) allowing to achieve rapid and stable volemic and hemodynamic effect in case of low volume infusion (usually, 4 ml/kg of body weight). The present study allowed to conclude that "low infusion resuscitation" technique in patients with multiple trauma accompanied by acute massive blood loss of extremely severe degree enables to reduce lethality, to achieve early subcompesatory hemodynamic state in acute traumatic disease.

Results of treatment of 186 patients treated in the clinic in the period from 2000 through 2005 for infectious complications after severe combined injuries who underwent 264 operations have been studied. It was established that the endovideosurgical method of sanitation of the infection focus was used in 50% of cases at an average. The investigation of surgical treatment of infectious complications in patients with severe surgical pathology has shown high efficiency of endovideosurgical method for treatment of such complications in the third period of wound dystrophy. The proposed endovideosurgical methods of sanitation of the infection focus have a number of advantages over open ones--low traumatism, less number of postoperative infectious complications, less duration of the postoperative period.

Broad usage of helicopters for an evacuation of wounded from the battle orders and forward aid station directly to Multiprophyle Military Hospitals of 1-st level during armed conflicts on Northern Caucasus has essentially changed the purposes and nature of a medical care to wounded in Separate Medical Battalions (SMB) of divisions. The primary goal of SMB became valuable preparedness of wounded to an evacuation from the battle orders of a division, that was reached by moving out of the surgeons and anesthesiologists to regimental aid station and medical companies. For adding up during armed conflicts on Northern Caucasus of medico tactical conditions it was justified: 73% wounded, admitted in SMB with damages of minimal and mean severity and not required emergency operations, after rendering them of initial physician care were evacuated by helicopters to Multiprophyle Military Hospitals of 1-st level. The analysis of experience of three SMB in Armed conflict 1999-2002 has shown, that the measures of initial surgical care should appear only for saving life of injured under the specially designed indications and with observance of a number of the relevant technical features, directional on acceleration and decreasing of surgical operations severity.

The analysis of organization and contents of the first aid, premedical and initial medical care rendered to the wounded in the armed conflicts on the Northern Caucasus (1994-1996, 1999-2002) was conducted. It was established that the first aid was rendered to the most casualties who needed it (65% in the first conflict and 79% in the second conflict). The mean terms of rendering the first aid in the second conflict as compared with the conflict of 1994-1996 were decreased from 29 +/- 2 min to 18 +/- min. The role of premedical care was minimal in both conflicts: it was rendered to 3% casualties only. The premedical care was rendered in those cases when the first aid appeared to be ineffective, had obvious defects or in the delay of further evacuation of the wounded. The initial medical care became the central type or pre-hospital care in the combat zone. It was rendered to 56% casualties in the first conflict and to 59% in the second conflict. The mean terms of initial medical care rendered in the second armed conflict were 1.5 +/- 0.2 h. They have considerably decreased as compare with the first conflict (2.5 +/- 0.4 h). The introduction of the physicians with initial surgery and intensive care training in the staffs of regimental medical companies was resulted in significant improvement of initial medical care quality. It provided the adequate preparedness of the wounded for aeromedical evacuation to multipurpose military hospitals of the first level.