Modern Technologies in the Treatment of Gunshot Injuries of Soft Tissues and Bones in Children

Summary: The manuals on military field surgery describe in detail the strategy and tactics for treating wounded soldiers in military conflicts. However, when children are provided with assistance during military conflicts and acts of terrorism, the situation reverses. Children become accidental or secondary participants in military operations and are admitted to civilian children’s hospitals, where the staff often has no experience treating such wounds. During the period from 2014-2024, 156 children with mine-explosive and gunshot wounds were treated at the Clinical and Research Institute of Emergency Pediatric Surgery and Trauma (Moscow, Russia), including patients injured in the acts of terrorism in Kerch (2018), Kazan (2021) and military conflict in Ukraine (2014-2024). The ages of the children ranged from 4 to 17 years old. There were 68.6% boys. The main locations of wounds were lower limbs - 134 (46.7%), upper limbs - 47 (16.4%), and head - 50 (17.4%). Thoracoabdominal injuries were detected (found) in 37 (12.9%), and spinal injuries in 19 (6.6%) children. Among all (the children, 25 traumatic limb amputations and 56 open bone fractures were noted. To improve the quality of treatment, surgical treatment of wounds was applied along with modern methods of physical treatment. Vacuum therapy was used in 72 patients, hydrosurgical treatment in 23, ultrasonic cavitation treatment in 45, and low-temperature argon plasma in 68. Satisfactory results were achieved in all of the observations. Compliance with the principles of military field surgery in the treatment of wounds during the provision of assistance to children with mine-explosive and gunshot wounds and the using modern technologies allow us to prepare the wound surface for the final stage of plastic closure in a short time, to preserve the rehabilitation potential and to return the child to the social environment.