КЛИНИЧЕСКОЕ НАБЛЮДЕНИЕ УСПЕШНОГО ЛЕЧЕНИЯ ПОСТРАДАВШЕГО С ПОЛИТРАВМОЙ И ОБШИРНОЙ ТРАВМАТИЧЕСКОЙ ОТСЛОЙКОЙ КОЖИ ЛЕВОЙ ГОЛЕНИ

Objective – to discuss the features of two-stage skin grafting by Krasovitov using vacuum compression to the area of the replanted skin autograft. Materials and methods. A clinical case of the surgical treatment of patient K., born on October 27, 1985, was reported as a result of an accident that received polytrauma (AIS / NISS – 21 points) and an extensive traumatic detachment of the skin of the left leg (5 %). In the primary treatment hospital (level 2 trauma center), the primary surgical treatment of wounds to the face was conducted, as well as skin suturing and placement of the active tube drain. Eight hours after trauma, he was transferred to Level 1 Trauma Center (Regional Clinical Hospital No.1, Krasnodar), where he was immediately subjected to a second surgical treatment of the wound of the left leg with cutting off of the detached skin flap, its treatment, preparation and fixation of the left lower extremity with use of external fixation device. 48 hours after stabilization, a staged, planned surgical treatment of the wound of the left leg was conducted. The wound revision did not show any signs of soft tissue necrosis. It allowed performing the skin plasty of soft tissue defects of the left leg according to Krasovitov with use of the prepared and preserved skin flap. In the end of the surgery, VAC-compression of skin autograft with negative pressure of 50 mm was carried out. After 5 days, ligation was performed with assessment of the state of the transplanted skin, repeated VAC-compression for two days. Results . As a result of the staged surgical treatment, it was possible to avoid necrosis of the rejected skin flap, the development of infectious complications, to restore the skin and to ensure optimal rehabilitation of the patient. Conclusion. The clinical observation suggests that treatment of patients with polytrauma and extensive traumatic skin detachment should be carried out in level 1 trauma centers. It is necessary to transfer such patients in the first days after the injury, in order to avoid the development of infectious complications and necrosis of the rejected skin flap. VAC-compression of a full-thickness skin flap with Krasovitov’s technique with a negative pressure of 50 mmHg contributes to its better adaptation to the underlying soft tissues and acceptance. Kraosovitov’s two-stage skin grafting in patients with polytrauma allows   stabilizing their condition, with minimal operational injury at the first stage, and performing the second stage in more favorable conditions of the patient’s stable condition.