STRUCTURE AND CLINICAL CHARACTERISTICS OF SOFT TISSUE CICATRICIAL CHANGES AND DEFORMITIES IN THE MAXILLOFACIAL REGION RESULTING FROM COMBAT TRAUMA

Abstract

In the context of the full-scale war in Ukraine, there is an unprecedented increase in the proportion of gunshot and mineblast injuries to the maxillofacial region. The long-term formation of severe facial and cervical scars leads not only to persistent functional impairments (microstomia, ectropion, contractures) but also to profound psychoemotional maladaptation of the wounded. Concurrently, the impact of the body’s baseline regenerative potential, particularly age-related involutive skin changes, on the trajectory of the fibrotic process under combat trauma conditions remains insufficiently studied, which complicates the selection of an optimal surgical correction strategy. Objective. To investigate the structure and clinical characteristics of soft tissue cicatricial changes and deformities in the maxillofacial region resulting from combat injuries to substantiate differentiated approaches to their surgical management. Materials and methods. An open cross-sectional observational study with an analytical component was conducted. The clinical sample comprised 97 patients aged 18 to 60 years with post-traumatic facial and cervical scars of combat etiology. To evaluate the association between age and the type of scarring, patients were stratified into three age cohorts (18–29, 30–44, and 45–60 years) based on an a priori author-defined stratification. Statistical data processing was performed using one-way analysis of variance (ANOVA) and Pearson’s chi-squared (χ2) test. Results. It was established that the atrophic type of scarring predominantly prevails in the overall structure of pathological scars and deformities following modern combat injuries (46.39 %). Clinically, this manifests as crater-like depressions due to massive primary necrosis and true tissue deficit. Hypertrophic and normotrophic scars were recorded less frequently, in 32.99 % and 20.62 % of cases, respectively. A statistically significant association between age group and clinical scar type was revealed: in young patients (18–29 years), the clinical picture was characterized by the formation of massive hypertrophic bands («plus-tissue») in 54.84 % of cases, p<0.01. Conversely, in patients of the middle (30–44 years) and older (45–60 years) age groups, deep atrophic defects («minus-tissue») were significantly more likely to form – in 52.08 %, p<0.01 and 61.11 %, p<0.05 of cases, respectively. Conclusion. Thus, it was established that the pattern of post-traumatic scarring in facial combat trauma exhibits pronounced agespecific characteristics. The dominance of hypertrophic scars in young individuals and the rapid increase in the incidence of atrophic scars and deformities in older patient groups indicate the limited effectiveness of a universal surgical approach. This suggests the expediency of implement differentiated, age-specific algorithms for plastic correction during the functional and aesthetic rehabilitation of the wounded.