Technology of staged closure of the stump in victims with mine-explosive injuries of the lower extremities, Технологія етапного закриття кукси у постраждалих при мінно-вибухових пораненнях нижніх кінцівок

<jats:p>Background. Combat amputations of the lower extremities caused by mine-explosive injuries are characterized by significant soft tissue damage, a high risk of infectious complications, and the difficulty of forming a functionally suitable stump. One of the promising approaches in modern military surgery is staged closure surgery (SCS) with second look surgery, which corresponds to the concept of damage control traumatology. The purpose was to conduct a comparative assessment of the effectiveness of SCS and single-stage stump suturing after lower limb amputation in servicemen with combat injuries, to assess the frequency of early complications and the timing of stump readiness for prosthetic treatment. Materials and methods. A retrospective-prospective clinical study was conducted in 136 servicemen with combat injuries of the lower limb due to mine-explosive injuries. Patients were divided into 2 groups of 68 people each. In the main group, staged stump wound closure was used: the first stage was deep tissue closure with or without myodesis; the second stage after 36–48 hours was wound revision, repeated surgical treatment and skin closure. In the control group, one-stage stump closure was performed. The frequency of early postoperative complications, the number of surgical interventions and the time of readiness for prosthetic treatment were assessed. Results. The overall incidence of early complications after stump suturing was significantly lower in the main group — 1.5 % compared to 20.6 % in the control group (p &lt; 0.001). The average time of stump readiness for prosthetic treatment was significantly shorter in the main group: 43.0 ± 4.7 days vs. 68.0 ± 6.4 days in the control group (p &lt; 0.001). Kaplan-Meier analysis demonstrated faster achievement of stump readiness for prosthetic treatment in the main group (HR 2.85, 95 % CI 2.05–3.96, log-rank p &lt; 0.001). According to the results of multivariate analysis, the SCS approach was an independent predictor of a decreased risk of postoperative complications (OR 0.08, 95% CI 0.01–0.52, p = 0.02). Despite the need for a second stage of stump wound closure, the total number of surgical interventions per patient was lower in the main group (6.4 ± 1.2 vs. 7.1 ± 1.8, p = 0.02), which is due to the need for additional surgical interventions for complications in the control group. Conclusions. Staged stump suturing is an effective surgical tactic in combat amputations of the lower limb, which allows reducing the frequency of early complications, shortening the time of readiness of the stump for prosthetic treatment and reducing the need for repeated surgical interventions. The technique corresponds to modern principles of damage control traumatology and can be recommended for widespread use in military surgery.</jats:p>