title: [Multi-stage surgical treatment of woundeds with combined thermomechanic injuries in local armed conflict].
abstract: OBJECTIVE
  To improve the results of surgical treatment of woundeds with combined thermomechanic injuries in local armed conflict.
  
  
  METHODS
  It was analyzed treatment of 93 victims with thermomechanic injuries. In 29 (31.2%) aptients only Early Total Care protocol (ETC) was used up to 2001. These victims received complete surgical care. Since 2002 diffirentiated approach of multi-stage surgical treatment (Damage Control Surgery) has been applied. ETC tactics was used if systolic blood pressure was more than 90 mm Hg (30 woundeds, 32.2%). DCS protocol was preferred in case of blood pressure less than 90 mm Hg or multiple-organ failure (34 patients, 36.6%).
  
  
  RESULTS
  Diffirentiated surgical approach decreases mortality rate from 13.8% to 7.8% (p=0.453) compared with group of conventional one-stage care.
authors.affiliation: Chair of general and specialized surgery, Faculty of Fundamental Medicine, M.V. Lomonosov Moscow State University, Moscow.
authors.forename: V E
authors.initials: VE
authors.lastname: Dubrov
authors.affiliation: Main Military Clinical Hospital of the Internal Troops, Ministry of Internal Affairs of the Russian Federation, Moscow region, Balashikha.
authors.forename: A P
authors.initials: AP
authors.lastname: Koltovich
authors.affiliation: Military Medical Department of the General Command of the Internal Troops, Ministry of Internal Affairs of the Russian Federation, Moscow, Russia.
authors.forename: D R
authors.initials: DR
authors.lastname: Ivchenko
authors.affiliation: Chair of general and specialized surgery, Faculty of Fundamental Medicine, M.V. Lomonosov Moscow State University, Moscow.
authors.forename: M Yu
authors.initials: MY
authors.lastname: Khanin
authors.affiliation: Main Military Clinical Hospital of the Internal Troops, Ministry of Internal Affairs of the Russian Federation, Moscow region, Balashikha.
authors.forename: A A
authors.initials: AA
authors.lastname: Kukunchikov
authors.affiliation: Main Military Clinical Hospital of the Internal Troops, Ministry of Internal Affairs of the Russian Federation, Moscow region, Balashikha.
authors.forename: I A
authors.initials: IA
authors.lastname: Paltyshev
authors.affiliation: Main Military Clinical Hospital of the Internal Troops, Ministry of Internal Affairs of the Russian Federation, Moscow region, Balashikha.
authors.forename: F G
authors.initials: FG
authors.lastname: Gerejkhanov
authors.affiliation: Main Military Clinical Hospital of the Internal Troops, Ministry of Internal Affairs of the Russian Federation, Moscow region, Balashikha.
authors.forename: P Yu
authors.initials: PY
authors.lastname: Polekhov