ririРаны и раневые инфекции. Журнал имени проф. Б.М. КостючёнкаWounds and wound infections. The prof. B.M. Kostyuchenok journal2408-96132500-0594Regional non-governmental organization “Surgical society - Wounds and wound infections”10.25199/2408-9613-2021-8-3-6-10riri-251Research ArticleОБЗОРЫ, ЛЕКЦИИ, ИСТОРИЯ РАН И РАНЕВЫХ ИНФЕКЦИЙREVIEWS, LECTURES, HISTORY OF WOUNDS AND WOUND INFECTIONSОсобенности лечения боевой травмы конечностей у военнослужащих блока НАТО в период вооруженных конфликтов на территории Ирака и Афганистана (обзор литературы)Features of NATO’s soldiers limbs combat trauma treatment during armed conflicts on the territory of Iraq and Afghanistan (literature review)БесчастновВ. В.BeschastnovV. V.

Владимир Викторович Бесчастнов

603005, Нижний Новгород, пл. Минина, д. 10/1

10/1 Minina Sq., Nizhny Novgorod, 603005

vvb748@mail.ruФГБОУВО Приволжский исследовательский медицинский университет Минздрава России, Университетская клиникаРоссияUniversity Clinic of the Privolzhsky Research Medical University of the Ministry of Health of RussiaRussian Federation20212511202183812Copyright © Бесчастнов В.В., 20212021Бесчастнов В.В.Beschastnov V.V.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.riri.su/jour/article/view/251

В статье описываются проблемы, с которыми столкнулись военные медики стран НАТО при оказании медицинской помощи военнослужащим, участвовавшим в вооруженных конфликтах на территории Ирака и Афганистана. Совершенствование средств индивидуальной и коллективной защиты снизило смертность от огнестрельных ран на поле боя, но на фоне массивного разрушения тканей и большой кровопотери увеличилось количество местных инфекционных осложнений ран мягких тканей конечностей. Основной причиной летальности и раневых осложнений является антибиотикорезистентная микрофлора. Гнойные осложнения приводят к хронизации течения раневого процесса и длительному периоду специализированного лечения и реабилитации, что влечет за собой как трудности в социализации раненых военнослужащих, так и значительные финансовые затраты со стороны государства. При оказании медицинской помощи раненым военнослужащим широко применяется вакуум-терапия. Перспективным методом лечения инфекционных раневых осложнений является фаготерапия.

The article describes armed conflicts on the territory of Iraq and Afghanistan. Improvement of individual and collective protection equipment has reduced the number of cases of soft tissue wounds in the extremities. The main cause of mortality and wound complications is antibiotic-resistant microflora. Purulent complications lead to chronic treatment of the wound healing process and a long period of specialized treatment and rehabilitation, which entails difficulties in the socialization of wounded servicemen, as well as significant financial costs from the state. When providing medical care to wounded military personnel, it is negative pressure wound therapy. Phage therapy is a promising method for treating infectious complications.

локальные военные конфликтыбоевая травмаинфекцияместные раневые осложненияампутациягоспитальная микрофлорапатогенны ESKAPEтерапия отрицательным давлениемфаготерапияlocal military conflictscombat traumainfectionlocal wound complicationsamputationhospital microfloraESKAPEpatho-gensnegative pressure wound therapyphage therapyReferencesHolcomb J. B., Stansbury L. G., Champion H. R., et al. Understanding combat casualty care statistics. J Trauma. 2006; 60 (2): 397-401. Обзоры, лекции, история ран и раневых инфекцийHolcomb J. B., Stansbury L. G., Champion H. R., et al. Understanding combat casualty care statistics. J Trauma. 2006; 60 (2): 397-401. Обзоры, лекции, история ран и раневых инфекцийSchweizer M. A., Janak J. C., Stock-inger Z. T., Monchal T. Description of trauma among French service members in the Department of Defense Trauma Registry: understanding the nature of trauma and the care provided. Mil Med Res. 2019; 6 (1): 7.Schweizer M. A., Janak J. C., Stock-inger Z. T., Monchal T. Description of trauma among French service members in the Department of Defense Trauma Registry: understanding the nature of trauma and the care provided. Mil Med Res. 2019; 6 (1): 7.Holcomb J., Caruso J., McMullin N., et al. Causes of death in US Special Operations Forces in the global war on terrorism: 2001-2004. US Army Med Dep J. 2007; (1): 24-37.Holcomb J., Caruso J., McMullin N., et al. Causes of death in US Special Operations Forces in the global war on terrorism: 2001-2004. US Army Med Dep J. 2007; (1): 24-37.Weintrob A. C., Murray C. K., Xu J., et al. Early Infections Complicating the Care of Combat Casualties from Iraq and Afghanistan. Surg Infect (Larchmt). 2018; 19 (3): 286-297.Weintrob A. C., Murray C. K., Xu J., et al. Early Infections Complicating the Care of Combat Casualties from Iraq and Afghanistan. Surg Infect (Larchmt). 2018; 19 (3): 286-297.Stansbury L. G., Lalliss S. J., Branstet-ter J. G., et al. Amputations in U.S. military personnel in the current conflicts in Afghanistan and Iraq. J Orthop Trauma. 2008; 22 (1): 43-46.Stansbury L. G., Lalliss S. J., Branstet-ter J. G., et al. Amputations in U.S. military personnel in the current conflicts in Afghanistan and Iraq. J Orthop Trauma. 2008; 22 (1): 43-46.Krueger C. A., Wenke J. C., Ficke J. R. Ten years at war: comprehensive analysis of amputation trends. J Trauma Acute Care Surg. 2012; 73: 438-444.Krueger C. A., Wenke J. C., Ficke J. R. Ten years at war: comprehensive analysis of amputation trends. J Trauma Acute Care Surg. 2012; 73: 438-444.Stewart L., Shaikh F., Bradley W., et al. Combat-Related Extremity Wounds: Injury Factors Predicting Early Onset Infections. Mil Med. 2019; 184 (Suppl 1): 83-91.Stewart L., Shaikh F., Bradley W., et al. Combat-Related Extremity Wounds: Injury Factors Predicting Early Onset Infections. Mil Med. 2019; 184 (Suppl 1): 83-91.Grosset A., Pfister G., del’Escalopier N., et al. Risk factors and failures in the management of limb injuries in combat casualties. Int Orthop. 2019; 43 (12): 2671-2680.Grosset A., Pfister G., del’Escalopier N., et al. Risk factors and failures in the management of limb injuries in combat casualties. Int Orthop. 2019; 43 (12): 2671-2680.Juarez J. K., Pugh M. J., Wenke J. C., Rivera J. C. Infection Precedes Heterotopic Ossification in Combat Wounded. US Army Med Dep J. 2018; 2 (18): 1-5.Juarez J. K., Pugh M. J., Wenke J. C., Rivera J. C. Infection Precedes Heterotopic Ossification in Combat Wounded. US Army Med Dep J. 2018; 2 (18): 1-5.Casey K., Demers P., Deben S., et al. Outcomes after long-term follow-up of combat-related extremity injuries in a multidisciplinary limb salvage clinic. Ann Vasc Surg. 2015; 29 (3): 496-501.Casey K., Demers P., Deben S., et al. Outcomes after long-term follow-up of combat-related extremity injuries in a multidisciplinary limb salvage clinic. Ann Vasc Surg. 2015; 29 (3): 496-501.Murray C. K., Wilkins K., Molter N. C., et al. Infections complicating the care of combat casualties during Operations Iraqi Freedom and Enduring Freedom. J Trauma. 2011; 71 (1 Suppl): 6273.Murray C. K., Wilkins K., Molter N. C., et al. Infections complicating the care of combat casualties during Operations Iraqi Freedom and Enduring Freedom. J Trauma. 2011; 71 (1 Suppl): 6273.Tribble D. R., Conger N. G., Fraser S., et al. Infection-associated clinical outcomes in hospitalized medical evacuees after traumatic injury: Trauma Infectious Disease Outcome Study. J Trauma. 2011; 71 (1 Suppl): 33-42.Tribble D. R., Conger N. G., Fraser S., et al. Infection-associated clinical outcomes in hospitalized medical evacuees after traumatic injury: Trauma Infectious Disease Outcome Study. J Trauma. 2011; 71 (1 Suppl): 33-42.Tribble D. R., Krauss M. R., Murray C. K., et al. Epidemiology of Trauma-Related Infections among a Combat Casualty Cohort after Initial Hospitalization: The Trauma Infectious Disease Outcomes Study. SurgInfect (Larchmt). 2018; 19 (5); 494-503.Tribble D. R., Krauss M. R., Murray C. K., et al. Epidemiology of Trauma-Related Infections among a Combat Casualty Cohort after Initial Hospitalization: The Trauma Infectious Disease Outcomes Study. SurgInfect (Larchmt). 2018; 19 (5); 494-503.Murray C. K., Roop S. A., Hospen-thal D. R., et al. Bacteriology of war wounds at the time of injury. Mil Med. 2006: 171 (9): 826-829.Murray C. K., Roop S. A., Hospen-thal D. R., et al. Bacteriology of war wounds at the time of injury. Mil Med. 2006: 171 (9): 826-829.Blyth D. M., Yun H. C., Tribble D. R., Murray C. K. Lessons of war: Combat-related injury infections during the Vietnam War and Operation Iraqi and Enduring Freedom. J Trauma Acute Care Surg. 2015; 79 (4 Suppl 2): 227-235.Blyth D. M., Yun H. C., Tribble D. R., Murray C. K. Lessons of war: Combat-related injury infections during the Vietnam War and Operation Iraqi and Enduring Freedom. J Trauma Acute Care Surg. 2015; 79 (4 Suppl 2): 227-235.Boucher H. W., Talbot G. H., Bradley J. S., et al. Bad bugs, no drugs: No ESKAPE! An update from the Infectious Diseases Society of America. Clin Infect Dis. 2009; 48 (1): 1-12.Boucher H. W., Talbot G. H., Bradley J. S., et al. Bad bugs, no drugs: No ESKAPE! An update from the Infectious Diseases Society of America. Clin Infect Dis. 2009; 48 (1): 1-12.Rice L. B. Federal funding for the study of antimicrobial resistance in nosocomial pathogens: no ESKAPE. J Infect Dis. 2009; 197 (8): 1079-1081.Rice L. B. Federal funding for the study of antimicrobial resistance in nosocomial pathogens: no ESKAPE. J Infect Dis. 2009; 197 (8): 1079-1081.Brown K. V., Murray C. K., Clasper J. C. Infectious complications of combat-related mangled extremity injuries in the British military. J Trauma. 2010; 69 (Suppl 1): 109-115.Brown K. V., Murray C. K., Clasper J. C. Infectious complications of combat-related mangled extremity injuries in the British military. J Trauma. 2010; 69 (Suppl 1): 109-115.Mende K., Stewart L., Shaikh F., et al. Microbiology of combat-related extremity wounds: Trauma Infectious Disease Outcomes Study. Diagn Microbiol Infect Dis. 2018; 94 (2): 173-179.Mende K., Stewart L., Shaikh F., et al. Microbiology of combat-related extremity wounds: Trauma Infectious Disease Outcomes Study. Diagn Microbiol Infect Dis. 2018; 94 (2): 173-179.Campbell W. R., Li P, Whitman T. J., et al. Multi-Drug-Resistant Gram-Negative Infections in Deployment-Related Trauma Patients. Surg Infect (Larchmt). 2017; 18 (3): 357-367.Campbell W. R., Li P, Whitman T. J., et al. Multi-Drug-Resistant Gram-Negative Infections in Deployment-Related Trauma Patients. Surg Infect (Larchmt). 2017; 18 (3): 357-367.Dallo S. F., Weitao T. Insights into Acinetobacter war-wound infections, biofilms, and control. Adv Skin Wound Care. 2010; 23 (4): 169-174.Dallo S. F., Weitao T. Insights into Acinetobacter war-wound infections, biofilms, and control. Adv Skin Wound Care. 2010; 23 (4): 169-174.Heitkamp R. A., Li P, Mende K., et al. Association of Enterococcus spp. with Severe Combat Extremity Injury, Intensive Care, and Polymicrobial Wound Infection. Surg Infect (Larchmt). 2018; 19 (1): 95-103.Heitkamp R. A., Li P, Mende K., et al. Association of Enterococcus spp. with Severe Combat Extremity Injury, Intensive Care, and Polymicrobial Wound Infection. Surg Infect (Larchmt). 2018; 19 (1): 95-103.Geiger S., McCormick F., Chou R., Wangel A. G. War wounds: lessons learned from Operation Iraqi Freedom. Plast Reconstr Surg. 2008; 122 (1): 146153.Geiger S., McCormick F., Chou R., Wangel A. G. War wounds: lessons learned from Operation Iraqi Freedom. Plast Reconstr Surg. 2008; 122 (1): 146153.Couch K. S., Stojadinovic A. Negative-pressure wound therapy in military: lessons learned. Plast Reconstr Surg. 2011; 127 Supp 1: 117-130.Couch K. S., Stojadinovic A. Negative-pressure wound therapy in military: lessons learned. Plast Reconstr Surg. 2011; 127 Supp 1: 117-130.Atwood R. E., Bradley M. J., Elster E. A. Use of negative pressure wound therapy on conflict-related wounds. Lancet Glob Health. 2020; 8 (3): 319— 320.Atwood R. E., Bradley M. J., Elster E. A. Use of negative pressure wound therapy on conflict-related wounds. Lancet Glob Health. 2020; 8 (3): 319— 320.Freyberger H. R., He Y., Roth A. L., et al. Effects of Staphylococcus aureus Bacteriophage K on Expression of Cytokines and Activation Markers by Human Dendritic Cells In Vitro. Viruses. 2018; 10 (11): 617.Freyberger H. R., He Y., Roth A. L., et al. Effects of Staphylococcus aureus Bacteriophage K on Expression of Cytokines and Activation Markers by Human Dendritic Cells In Vitro. Viruses. 2018; 10 (11): 617.Engeman E., Freyberger H. R., Corey B. W., et al. Synergistic Killing and Re-Sensitization of Pseudomonas aeruginosa to Antibiotics by Phage-Antibiotic Combination Treatmen. Pharmaceuticals (Basel). 2021; 14 (3): 184.Engeman E., Freyberger H. R., Corey B. W., et al. Synergistic Killing and Re-Sensitization of Pseudomonas aeruginosa to Antibiotics by Phage-Antibiotic Combination Treatmen. Pharmaceuticals (Basel). 2021; 14 (3): 184.

The authors declare that there are no conflicts of interest present.