INTRODUCTION

The presence of foreign bodies, necrotic tissues, and closed cavities in the wound - all contributes to the development of wound infection. Military actions on the territory of Ukraine (2014-2022) have shown that there is no universal method and means for treating wounds, that is, not only means of inflicting wounds are evolving, but also medicines intended for wound treatment. Complications of the wound process - a wound contaminated with microorganisms. Infection can occur even after clean surgical operations, which can complicate the course of the postoperative period. To this day, the task of effective treatment of surgical infection has not been solved, despite the appearance of new antibiotics and antiseptics. This is due to the ability of microorganisms to improve - resistant forms of bacteria to antimicrobial medicines develop. The growth of antibiotic-resistant strains of microorganisms is caused, among other things, by the irrational use of antimicrobial agents, which negatively affects the clinical results of wound treatment.

MATERIALS AND METHODS

Treatment of infectious complications of wounds is complex, combining the knowledge and practical experience of specialists of various profiles: clinicians, physiologists, microbiologists, pharmacologists, pharmacists, health care organizers, etc.

Specialists consider the wound process (WW) as a conglomerate of deep physicochemical and biochemical changes in organs and tissues, pronounced clinical manifestations that significantly affect the quality of life. This is a set of molecular and cellular links that successively occur in the wound and are aimed at repairing the damaged tissue and restoring its integrity [1-5]. Accordingly, a wound is any mechanical damage to the body, which is accompanied by a violation of the integrity of the covering tissues - skin or mucous membranes. The appearance of clinical signs of wounds (pain, bleeding, gaping) depends on the localization of the wound, the volume, and depth of the lesion, as well as the general condition of the patient [6-11].

Treatment of infected wounds involves the creation of specific drugs for effective treatment and acceleration of tissue repair. However, the study of the pathogenesis of the wound process in general and in case of infectious damage, in particular, indicates the need to find the most effective tool from a wide arsenal of general and local tools aimed at optimizing the wound process and preventing the development of various complications, the most dangerous of which are infectious.

Improving the quality of wound treatment [12-14] is based on modern scientific achievements in the etiology and pathogenesis of wounds. The pharmacotherapeutic treatment makes it possible to purposefully create new effective drugs to influence the etiology and pathogenesis, as well as the symptoms of the wound process. Despite numerous studies, it is necessary to confirm the absence of a single therapeutic and diagnostic tactic and universal approaches to predicting the course of wounds [15-18].

RESULTS AND DISCUSSION

Analytical studies have proven that specialists distinguish three main interrelated sections in the science of wound and wound infection:

1. biological laws of wound healing and pathogenesis of wound infection;
2. objective assessment of the course of the wound process based on clinical and laboratory criteria;
3. local and general treatment of wounds [1, 3, 9, 10, 18-21].

Wound healing processes were characterized by scientists Rufanov (1954), Ross (1968), Struchkov (1975), Kuzynym. (1977), Datsenko (1985), Shalimov (2002).

The evolutionary development of the views of scientists on the phases of the wound process is shown in Table 1.

The biological processes occurring in the wound are complex and diverse in nature. Modern science studies the peculiarities of the course of the wound process. The study of Kalnikovsky (2015), in which the results of the study of physicochemical and biochemical changes in the wound were published, is of interest [25]. The works of Kornienko (2016) and Devyatkin et al. (2016) [9, 24] are devoted to the study of the morphological and physiological aspects of the wound process, where it is stated that the same cellular elements participate in all stages of the wound process, which in principle provide identical and general dynamics of the specified process [9]. The wounding process always occurs cyclically according to the development of functional and morphological changes in the wound and surrounding tissues, which can be divided into certain phases. In the pathogenesis of the wound process, there is a sequential development of the inflammatory and reparative reaction (Figure 1).

In a general biological sense, inflammation is a protective reaction of the body, as well as a biological (functions due to adhesion and phagocytosis) and mechanical (formed by fibrin shedding from the blood, blockage of blood and lymphatic vessels, the proliferation of connective tissue cells at the border of damaged and normal tissue) barrier [9, 26, 27].

When evaluating the clinical course of the wound process and predicting its healing, the correct choice of its criteria is of essential importance. Table 2 shows the classification of wounds depending on their signs [7, 28].

Modern wars, armed conflicts, and terrorist operations on the territories of various states of the world, including the territory of Ukraine, make it possible to analyze, systematize and summarize the defeats and combat injuries. Yes, by the authors Ziemba (2012) [29]; Hinsley et al. (2005) [30]; Schreiber et al. (2008), Eskridge (2012) and Chan et al. (2012) [31, 32]; Orman (2012); Schoenfeld et al. (2013) [33]; Breeze et al. (2011) [34]; Kotenko et al. (2014) [35]; Gorbulina et al. (2015) [36]; Badyuk and Haida (2018) [37] analyzed combat injuries among the armed forces received during military campaigns - in Afghanistan, Georgia, Iraq, South Africa, and Ukraine.

The author identified a characteristic feature of modern warfare: the presence of several factors that determine the nature of sanitary losses. The main classes of sanitary losses by etiology and types of damage are:

• Mechanical damage - bullet, mine-explosive, shrapnel, closed, etc.;
• Thermal damage - burns, frostbite;
• Radiation damage - acute, chronic, combined as a result of the action of nuclear weapons;
• Injury by poisonous substances - a consequence of the action of chemical weapons;
• Infection with bacterial agents - biological weapons;
• Reactive (psychogenic) states – reaction to severe stress and adaptation disorders, especially when using weapons of mass destruction.

The authors indicated the structure of sanitary losses: light injuries – almost 50%; injuries of medium severity - 30%, severe injuries - 18%, and 2% - extremely severe injuries.

Sanitary losses of a therapeutic profile occur in the same way as surgical losses. That is, a qualitatively different and previously unstudied category of sanitary losses arose, which is commonly called "combat therapeutic pathology" [9, 20].

As a result of the study of the structure of sanitary losses, the conditions of providing surgical care to the wounded by Zarutskyi and Bily (2018), the commonality of many problems was revealed, in particular, the nature of the lesion and the pathogenesis of the course of the wound and traumatic disease both in the wounded and in the theater of combat. as well as in victims during emergencies. At the same time, the most complex problem is polytrauma (severe multiple, combined, and combined injuries), the share of which in the structure of sanitary losses is 30% [9, 30-33, 38, 39].

According to the data in the Table 3, the specific weight of injuries to the extremities is 52% (including injuries to the lower extremities – 30.6%). A fairly significant part of sanitary losses is caused by wounds to the head and gunshot wounds to the soft tissues of multiple parts of the body.

It should be noted that gunshot wounds have certain differences (Vulnus sclopetarium) from other wounds: the presence of three injury zones, the complex anatomical nature of the injuries, and a high degree of infection. The authors  analyzed the results of the treatment of more than a thousand wounded and traumatized combatants in Ukraine. It has been proven that all gunshot wounds were caused by high-velocity bullets and are accompanied by a general reaction of the body to injuries (increased body temperature, leukocytosis), which are characterized by the formation of a soft tissue defect, and in the case of bone damage, multiple fragmentary fractures with a bone tissue defect.

The use of modern types of weapons during hostilities in Ukraine has changed the structure of surgical trauma, and the scope and content of treatment-diagnostic and triage-evacuation measures. Thus, according to Zarutskyi (2018), the vast majority of modern armed conflicts are mine-explosive injuries – 72% of cases. Comprehensive treatment of wounds, which is considered the most rational by specialists, includes both local and general therapeutic measures. Tactically, wounds are treated simultaneously with local and general measures or local measures against the background of general therapy.

The work of Krane (2015) analyzed the methods of treating wounds in recent years. Despite a large number of specific features of various wounds, the main stages of their healing are fundamentally the same: struggle with early complications; prevention and treatment of the infectious process in the wound; achieving healing in the shortest possible time; maximally complete restoration of functions of damaged organs and tissues.

The main principles of modern wound treatment are adherence to asepsis, surgical treatment, drainage, early closure of wounds (primary and secondary sutures, autodermoplasty), targeted antibacterial, and immunotherapy.

Among the more important principles of local treatment of infected wounds, the main one is the use of drugs according to the phase of the wound process [37]. Timely administration of the necessary drugs that fully correspond to the phase of the wound process allows you to quickly stop the purulent process, shorten the period of surgical treatment of wounds, and significantly reduce the length of the patient's stay in the hospital [2]. It should be noted that today there are no means and methods that would be equally effective in all phases of the wound process. This is due to the fact that the tasks presented to drugs in the inflammation and reparation phase are fundamentally different. The local application of the medicinal product should also take into account the individual characteristics of a specific patient [23].

The assortment of medicinal forms for the local treatment of wounds is expanding. We are talking about a variety of dispersal systems that are used when assisting the wounded (Figure 2).