perinatologyРоссийский вестник перинатологии и педиатрииRossiyskiy Vestnik Perinatologii i Pediatrii (Russian Bulletin of Perinatology and Pediatrics)1027-40652500-2228Ltd. “The National Academy of Pediatric Science and Innovation”10.21508/1027-4065-2025-70-2(p.2)-82-89perinatology-2164Research ArticleОБМЕН ОПЫТОМSHARING EXPERIENCESОшибки и осложнения в лечении ран у детей, пострадавших при землетрясенииMistakes and complications of wound treatment in children affected by earthquakeshttps://orcid.org/0000-0003-3764-1664МединскийП. В.MedinskiyP. V.

Мединский Павел Владимирович — детский хирург, зав. отделением гнойной хирургии.

119180 Москва, ул. Большая Полянка, д. 22

Moscow

pavmedin@yandex.ruhttps://orcid.org/0000-0003-3686-3708КешишянР. А.KeshishyanR. A.

Кешишян Размик Арамович — д.м.н., проф. кафедры Медицины катастроф РМАНПО; проф. кафедры госпитальной хирургии с курсом Детской хирургии РУДН; гл. науч. сотр. НПЦ специализированной медицинской помощи детям им. В.Ф. Войно-Ясенецкого.

125993 Москва, ул. Баррикадная, д. 2/1, стр. 1

Moscow

https://orcid.org/0009-0009-4585-9904НалбандянР. Т.NalbandyanR. T.

Налбандян Рубен Тигранович — к.м.н., рук. отдела ран и раневых инфекций.

119180 Москва, ул. Большая Полянка, д. 22

Moscow

https://orcid.org/0000-0002-3426-0682УсеиновА. В.UseinovA. V.

Усеинов Андрей Валентинович — студент VI курса.

119048 Москва, ул. Трубецкая, д. 8, стр. 2

Moscow

ГБУЗ «Научно-исследовательский институт неотложной детской хирургии и травматологии ДЗМ»РоссияClinical and Research Institute of Emergency Pediatric Surgery and TraumaRussian FederationФГАОУ ВО «Российский университет дружбы народов»; ФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава России; ГБУЗ «Научно-практический центр специализированной медицинской помощи детям им. В.Ф. Войно-Ясенецкого» ДЗМРоссияRussian Peoples’ Friendship University; Russian Medical Academy of Continuing Professional Education; Voino-Yasenetsky Scientific Center for Specialized Medical Care for ChildrenRussian FederationФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Минздрава России (Сеченовский Университет)РоссияSechenov First Moscow State Medical University (Sechenov University)Russian Federation202527042025702/28289Copyright © Ltd. “The National Academy of Pediatric Science and Innovation”, 20252025Ltd. “The National Academy of Pediatric Science and Innovation”Ltd. “The National Academy of Pediatric Science and Innovation”https://www.ped-perinatology.ru/jour/about/submissions#copyrightNoticehttps://www.ped-perinatology.ru/jour/article/view/2164

Представлен опыт организационно-лечебной работы в составе мобильной специализированной детской хирургической бригады в период ликвидации медицинских последствий разрушительных землетрясений. Проведен анализ лечения детей с открытыми переломами костей и повреждениями мягких тканей на всех этапах медицинской эвакуации, диагностированы и определены основные причины осложнений и неблагоприятных исходов. Особое внимание уделено лечебно-тактическим и хирургическим ошибкам, некорректно выполненным операциям и первичной хирургической обработкой ран, которые проводились на этапе стационарного лечения у детей до прибытия мобильной специализированной детской хирургической бригады. Во всех случаях представленные ошибки служили непосредственными причинами возникновения тяжелых гнойно-септических осложнений. Обоснован алгоритм хирургического лечения осложнений и особенности ведения данного контингента больных. Опыт лечения детей с осложненным течением повреждений мягких тканей и открытых переломов свидетельствует о необходимости у большинства пострадавших проведения сложных, многоэтапных операций под наркозом. Представлена разработанная и устойчиво применяемая специалистами мобильной специализированной детской хирургической бригады на практике рациональная схема лечебно-организационной и консультативной работы в общей системе медико-санитарного обеспечения детей в условиях чрезвычайных ситуаций, а именно взаимодействие стационара (основной стационар для сосредоточения и лечения детского контингента) базирования с другими лечебно-профилактическими учреждениями и госпиталями, куда после землетрясения поступали и находились на лечении травмированные дети.

The article presents the experience of organizational and therapeutic work as part of a mobile specialized pediatric surgical team during the period of liquidation of the medical consequences of devastating earthquakes. An analysis of the treatment of children with open bone fractures and soft tissue injuries at all stages of medical evacuation was carried out, the main causes of complications and adverse outcomes were diagnosed and identified. Special attention is paid to therapeutic, tactical and surgical errors, incorrectly performed operations and primary surgical treatment of wounds, which were carried out at the stage of inpatient treatment in children before the arrival of mobile specialized pediatric surgical team. In all cases, the errors presented were the direct causes of severe purulent-septic complications. The guideline of surgical treatment of complications and the features of management of this patient population are substantiated. The experience of treating children with complicated course of soft tissue injuries and open fractures indicates the need for complex, multi-stage operations under general anesthesia in most of the victims. A rational scheme of medical, organizational and advisory work in the general system of medical and sanitary provision for children in emergency situations, developed and consistently applied by mobile specialized pediatric surgical team specialists in practice, is presented, namely, the interaction of the hospital (the main hospital for the concentration and treatment of the children’s contingent) based with other medical institutions and hospitals where injured people were admitted and treated after the earthquake. children.

детимобильные хирургические бригадыземлетрясениехирургическое лечениеосложненияchildrenmobile surgical teamsearthquakesurgical treatmentcomplicationsАвторы выражают благодарность профессору Л.М. Рошалю, идейному вдохновителю, организатору, наставнику за создание, личное участие, руководство и поддержку мобильной специализированной педиатрической бригады НИИ неотложной детской хирургии и травматологии, оказывающей помощь детям, пострадавшим в стихийных бедствиях, катастрофах и войнах, начиная с землетрясения в Армении (1988 г.), сотрудникам НИИ неотложной детской хирургии и травматологии: д.м.н. В.Г. Амчеславскому, д.м.н. В.Г. Багаеву за организацию эффективной реанимационной-анестезиологической помощи, к.м.н. В.А. Митишу и другим коллегам, которые были вместе с нами в составе бригады в различных ЧС.ReferencesКрупнейшие землетрясения XXI века. ТАСС https://tass.ru/info/16986795?ysclid=m6t8gg0sf0669368508 / Ссылка активна на 11.01.2025The largest earthquakes of the XXI century. 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The authors declare that there are no conflicts of interest present.