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Absnract. The results of the study of intraoperative x-ray irradiation of the affected two arrays are presented: the main array using neuronavigation and the control group, where standard 2D fluoroscopy was used. The radiation load on the operating surgeon and auxiliary operating personnel was also evaluated. Intraoperative visualization was carried out using the second-generation iNtellect ENT Navigation rack of the Stryker company (United States of America) for the victims of the main array and the Ziehm Vision RFD optical-optical converter (Germany) of the company for the victims of the control group. The imaging option using an electron-optical transducer is especially important for minimally invasive procedures, where instrumentation is performed percutaneously without direct anatomical control, as opposed to open procedures or working with distorted anatomical structures during injuries. Biplanar fluoroscopy was one of the first intraoperative methods of imaging in real time, and remains one of the leading technologies in orthopedic and spinal surgery. However, radiation exposure from intraoperative fluoroscopy remains a serious problem for patients, surgeons, and operating support staff. The negative effect of ionizing radiation leads to cell damage through the induction of deoxyribonucleic acid and the release of reactive oxygen species. In this regard, cell death or genome instability occurs, which leads to various radiation-related pathologies. It was found that the use of neuronavigation reduces the number of errors, reduces intraoperative trauma, and significantly reduces intraoperative radiation exposure to the injured, operating surgeon and auxiliary operating personnel. The large-scale introduction of navigation technologies will reduce or completely eliminate the harmful effects of ionizing radiation on the injured and medical personnel.

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 underwent an analysis of doctrine changes of battle-field surgery. The terminology is specified, the ways of improvement of effectiveness and quality of medical care for the wounded, taking into account the new doctrine, are formulated. In accordance with Federal law No 323-FZ of 2011.11.21 the termreduced specialized care*is suggested for description of medical care at medical forward treatment unit instead of equalfied aid.

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

A brief 140-years history of the Mikhailovsky clinical hospital ("Willie Hospital") of the Kirov Military Medical Academy is presented. Today the department of military surgery, integrated into the system of emergency medical care, locates in historical building of the Kirov Military Medical Academy, and considered as part of multi-field regional center for the treatment of severe combined injuries, and is the only one injury care center of the first level in the Ministry of Defence of the Russian Federation. The hospital admits on treatment more that one million of severe injured patients annually; many patients with severe injuries are transferred from other regional hospitals. Every year more than two thousands of surgical interventions are performed in the hospital. Next renovation of the building is planned in the near future; it should provide further development of new medical technologies in the Kirov Military Medical Academy.

In severe abdominal trauma ultrasound provides fast and accurate diagnostics of damages and detect the source of internal bleeding. In the absence of trained professionals (in injury care centre of 2-3rd levels, In emergency situations) it is possible to use by the method of research in the reduced volume. The article presents a comparative analysis of the use of traditional methods and reduced ultrasound diagnostics of abdominal injuries on 56 victims. Concluded that reduced ultrasound is affordable, mobile, fast and accurate method of diagnosis, allowing to use it repeatedly.

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.

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 organization of surgical care for the wounded in various local wars and armed conflict has its own characteristics, the study of which is necessary to optimize the planning of medical evacuation support of troops. It is based on the concept on an early specialized surgical care. The paper discusses the problematic issues of medical care to the wounded in past peacekeeping operations, and analyze features of specialized surgical care.

One of modern tendencies of carrying out long ALV of patients with polytrauma is application of "early" tracheostomy. Thus optimum terms of early tracheostomy are defined indistinctly and vary from 2 to 10 days from beginning of ALV. It is established that at predicted long ALV of patients with polytrauma optimum terms of tracheostomy performance is the second period of traumatic illness (12-48 hours from the moment of getting trauma). Tracheostomy, executed for patients with polytrauma for the purpose of maintenance long AL V in early terms, promotes improvement of gases diffusion, microcirculation in lungs, improvement of system of external breath as a whole and it is accompanied by decrease in frequency of development life danger infectious pulmonary complications and lethality reduction.

The principle difference of the work of multiprofile military hospitals (MMH) of the Ist level during the armed conflicts on the Northern Caucasus, particularly during the second, was rendering specialized surgical care to the primary contingent of the wounded, evacuated during the nearest hours after a wound. The incoming flow to MMH of the 1st level - in connection with the primary entering of the wounded practically from a battle field - was characterized by severity (one third of the wounded had severe and extremely severe wounds) and the significant number of the wounded with multiple and combined injuries (up to 60% of the wounded). Effective treatment of the above-mentioned wounded can only be carried by specially trained surgeons in appropriately-equipped multiprofile medical hospitals. The rendered volume of specialized surgical care in MMH of the 1st level included the following operations: neurosurgical (2,4%), thoracoabdominal (19,8%), traumatologic (17,0%), angiosurgical (8,2%), special (otorhinolaryngologic, maxillofacial, ophthalmologic, urologic) - 17,7%, general surgery (35,4%). During the armed conflict of 1999-2002 due to the introduction of the early specialized surgical care concept three MMH of the 1st level in the advanced way executed 86,4 % of all complex operations in medical units and hospitals of the combat zone.

The indices of the endocrine system, systemic transport and consumption of oxygen, metabolism, hemostasis in the femoral artery, central and internal jugular veins were investigated in 144 patients with severe combined cerebro-cranial traumas (CCT) during the first 7 days after trauma. In 15 of them liquor was investigated. The results of the investigation have shown that in not severe CCT (FS-II: 0.50+/-0.25 scores) the ACTH level in blood was 1.9 times higher and cortisol 5.6 times higher than normal. In the cerebral tissue aerobic oxygenation of glucose prevailed (aerobic index: 90+/-2%): metabolic disorders were caused by extracranial injuries--the content of lactate, malon dialdehyde (MDA), middle molecular peptides (MCM238-302) was higher in the central vein than in the jugular vein. In patients with the superior truncal form of severe contusion of the brain (Field Surgery-II: 11.8+/-0.2 scores) in the cerebral tissue there was prevalence of anaerobic glycolysis (aerobic index: 60.1+/-3.5%), lactate oxygen index grew to 0.160+/-0.018. The inferior truncal form of brain contusion (FS-II: 18.8+/-0.2 scores) had sharply decreased both aerobic and anaerobic oxidation of glucose in the cerebral tissue. In cases of severe and extremely severe CCT there was a suppression of central regulatory mechanisms--in response to the trauma the elevation of the level of ACTH and cortisol in blood was insignificant. Thrombinemia and prevailing endotoxemia were noted in the jugular vein. Great concentrations of lactate, MDA, MCM were determined in the liquor. So, liquor sorption is thought to be expedient. Lower index of oxygenation (1.9+/-0.3), higher respiratory index (1.5+/-0.1) and alveolar dead space (37.7+/-7.2%) evidenced secondary injury of the lungs in cases of severe and extremely severe combined CCT.