General concepts of surgical treatment of severe multisystem injuries

This article is based on an investigation of the management of 1976 patients with multisystem injuries. Three hundred twenty-five patients with multiple trauma and 981 patients with single injury were studied. The surgical treatment of severe multisystem injuries is based on 3 main concepts. The first concept is the substantiated widening of the score of indications for surgical treatment of injuries. Surgical treatment is done in 68.9% of patients with multisystem injuries. Indications for surgical intervention (according to their significance) can be categorized as emergency, urgent, postponed, and planned operations; these were 59%, 17.2%, 23.5%, and 11.3%, respectively, of total surgical procedures. The second concept is assessment of the clinical state of injured patients by means of the BIIX-CI scale, which was developed to define a reasonable time for doing a surgical procedure and to define vital function stability. The 3 levels of clinical state are graded as compensated (range, 16-30 points), subcompensated (range, 31-40 points), and decompensated (> 40 points). The third concept is the reasonable succession in surgical procedures. It is advantageous to do similar operations simultaneously at compensated and subcompensated states. Dissimilar surgical interventions should be done in succession during the course of a single anesthesia or at different times according to the grading of emergency (urgent, postponed, and planned).