Experimental evaluation of the effectiveness of a damage control surgery in combined radiation-mechanical injuries

Relevance. Currently, damage control surgery (DCS) is actively used in polytrauma. However, data on the effectiveness of this tactic for combined radiation-mechanical injuries (CRMI) in the available literature was not found.

Objective. To develop a model of CRMI on small laboratory animals (rabbits), which allows studying the effectiveness of the use of DCS in comparison with the early total care surgery tactics.

Methods. A model of a severe CRMI was proposed. The animals were subjected to a generally uniform short-term gammairradiation, and then they suffered a liver injury on the background of blood loss of 40% of the blood volume and hypothermia. After modeling the lesion, a comparison was made of the effectiveness of the tactics of the DCS and the early total care surgery tactics. During the study, the following indicators were evaluated: the average life expectancy and mortality of animals, changes in the cellular composition of peripheral blood, features of behavioral reactions to irradiation, the amount of blood loss during the implementation of the surgical intervention.

Results and their analysis. The experiment showed that the tactics of the DCS have an advantage over the traditional tactics of a one-time exhaustive operation in the case of the CRMI. When performing DCS, there was no death of rabbits on the 1st day after the operation, when implementing early total care surgery - 3 rabbits died, besides, the mortality was absolute, while with DCS one rabbit survived (12.5%). The final operation at the DCS occurs prior to the beginning of the acute period of CRMI, which corresponds to the requirements of the instructions for the treatment of CRMI. In the course of the study, it was found that the proposed model of CRMI contributes to the formation of the phenomenon of mutual burdening and, as a result, complicates both the radiation and mechanical components of the lesion occurs.

Conclusion The proposed experimental model for the application of severe CRMI helps to explore DCS tactics in the treatment of this pathology. DCS is a promising method of surgical treatment of CRMI, however, for more accurate extrapolation of data from animal to human, additional research on large laboratory animals is required. 

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