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A retrospective analysis of treatment of 450 injured with traumas of the extremity vessels was made. These patients were subjected to reconstructive operations. In a considerable part of the patients there appeared thrombosis of the operated vessel. Experiments in dogs have shown that prophylactics of temporary prosthesis and injured artery should be based on the method of active treatment in order to eliminate the posttraumatic spasm of the arteries.

The authors share their experiences with diagnosing and surgical treatment of 1792 patients with mechanical combined traumas. The average age of the patients was (31.6 +/- 1.4) years. All the patients were divided into two groups according to the medico-diagnostic methods. The traditional methods of diagnosis and treatment were used in 811 patients of the first group. Complications took place in 39.2%, lethality was 28.4%. The diagnosis in 981 patients of the second group included an ultrasound investigation, computed tomography, videothoraco- and laparoscopy. The surgical treatment was based on the objective multifactorial assessment of the trauma severity and determination of the prognosis criteria. Complications developed in 24.8% of the patients. Lethality was 19.5%.

The article analyses results of treatment of 48 patients with severe posttraumatic decompensated ischemia of extremities. Operations were performed on 484 patients with injuries of 573 major vessels, 374 of them having traumas of the extremity vessels. All the patients were admitted to the hospital with severe hemorrhagic and traumatic shock of the III-IV degrees, 58% of them had combined traumas. The time from admission to operation was 0.5-24 hours. The "end-to-end" anastomoses were applied for the restoration of the vessels and prostheses with autovein and homoarterial prosthesis "Homograft" were used. Lethality was 16.7%. Reconstruction of the injured artery must be always made after performing "stable" osteosynthesis, predominantly with the apparatus of external fixation. Early start of active detoxication is of importance. Positive results with saved extremities were obtained in 68.8% of the patients. Multiprofile medical institutions with a 24-hours regimen of work of different diagnostic and medical units can give effective help to patients of this category.

The article proposes a standard model of the present-day gunshot wound for an experimental investigation of the wound process in small laboratory animals. It is shown that the microwave therapy of mild intensity is an expedient method to provide a noncomplicated course of the wound process and adequate regeneration of the tissues in complex treatment of gunshot wounds of soft tissues and burns of extremities.

A method for mathematical evaluation and prognosis of severity of ischemia is described on the basis of analysis of ischemic disorders in injured extremities in 195 patients.

Intraosseous anesthesia and associated anesthesia (a combination of intraosseous anesthesia and neuroleptic analgesia) were used in 120 traumatological patients. A comparative assessment of the anesthesia degree and the reaction of the organism to the operative agression was performed. The analysis of the results obtained shows advantages of the associated anesthesia over intraosseous anesthesia "per se". Fractionated infusion of phentanyl should be given in the dose 0,001 mg/kg of the body weight. The above variation of the associated anesthesia is supposed to be a perspective method in mass admission of patients.

An analysis of 16 cases of secondary hemorrhages in injuries of bones and soft tissues of the extremities is presented. The secondary hemorrhages occurred within the period from 16 hours to 27 days after the trauma. Angiographic study is a valuable adjunct for establishing the correct diagnosis. Arrosion of large arterial trunks was the adjunct for establishing the correct diagnosis. Arrosion of large arterial trunks was the basic cause of the secondary hemorrhage. In the prophylaxis of the latter a special importance is attached to a wide wound dissection in primary surgical treatment and to secure hemostasis, especially in the body portions having multilayer musculature.

An analysis of 246 observations has shown that in patients with crushed extremities accompanied by shock the amputation is the most important antishock measure. The amputation performed by the method of primary surgical treatment of the wound is the method of choice. The amount of postoperative complications can be considerably reduced by using the primarily delayed suture, carbon sorbents on the stump wound, temporary immobilization of the extremity stump.

The article describes the authors' experience with the treatment of open diaphyseal and intra-articular fractures of bones of the upper and lower extremities complicated by purulent infection, in 126 patients sorption methods being used (hemosorption, enterosorption, application of sorbents on the wounds). Results of the treatment were studied in 120 patients within the period from 1 year to 6 years. Good results were obtained in 44 patients (36.7%), satisfactory--in 60 patients (50%), unsatisfactory--in 16 patients (13.3%).

An examination of ABB constants of the capillary blood in dynamics in 45 patients with posttraumatic alterations of the blood circulation has shown a correlation between them and the degree of disturbances of tissue respiration. Results of experiments in animals point to an improvement of tissue respiration as a response to the administration of methylene blue to the ischemic extremity. The methylene blue along with other drugs improving the microcirculation and tissue respiration was used in 4 patients and resulted in its normalization and prevented ischemic contracture.

The experience with the treatment of 312 acute blood vessels trauma consecutive cases is generalized in this article. The problems dealing with differential estimation of reconstructive surgery, indications for reconstructive operations on patients with traumatic shock, blood loss and severe ischemia of the injured extremity are considered. Experimental studies on 35 dogs and clinical observations over 95 (30.4%) cases of traumatic shock and blood vessels injury permitted to reveal some peculiarities of homeostasis alterations when the ischemized extremity gets involved into the blood flow, and to show the grounds for using the differential tactics under such conditions.