Procedure for assessing rehabilitation measures for military personnel with skin injuries caused by thermobaric and incendiary weapons after reconstructive plastic surgery

Abstract

The recovery of Ukrainian Armed Forces servicemen after skin injuries caused by ammunition containing incendiary and thermobaric mixtures (white phosphorus, thermite, ethylene-based, propylene-based, and others) is a complex process that requires a comprehensive approach. Such injuries cause deep burns, leading to significant tissue damage and even loss of functionality in the affected parts of the body. Surgical intervention is only the first step on the road to recovery. Postoperative rehabilitation, which includes a complex of medical, physiotherapeutic and psychological measures, is key to achieving functional and aesthetic results and the full return of the serviceman to his duties. Assessing the effectiveness of these measures is a multifaceted process that requires the analysis of various indicators: physiological, psychological, functional and social. Despite the widespread use of multidimensional comparative analysis methods to evaluate such complex systems, most of them have a significant drawback – the assumption that each indicator is equally important. This limits the accuracy and objectivity of selecting the best rehabilitation programme, as different aspects of the patient's condition have unequal effects on their overall combat capability. The purpose of the article is to justify and describe the procedure for evaluating rehabilitation measures for military personnel with skin injuries caused by thermobaric and incendiary weapons after reconstructive plastic surgery. The study analysed the results of the application of rehabilitation programmes in 122 servicemen of the Ukrainian Armed Forces (men aged 25 to 58) who underwent reconstructive and plastic surgery after skin injuries caused by thermobaric and incendiary weapons. An algorithm for evaluation using the minimum distance method is proposed. This algorithm includes the selection of indicators, the formation of a reference object, data standardisation, and the calculation of the integral distance, modified by integrating weight coefficients. The weights reflect the relative importance of each indicator, allowing priority to be given to those aspects that are most critical for restoring combat capability. The study was conducted in accordance with the principles of bioethics and using standard software for statistical data processing. Analysis of the rehabilitation results of 122 servicemen confirmed that there are statistically significant differences between the compared rehabilitation programmes in terms of key clinical and functional indicators, such as time, aesthetic outcome (p<0.001) and functional recovery (p<0.001). The use of an improved method of multidimensional comparative analysis with the integration of weighting coefficients allowed for a more accurate ranking of programme effectiveness compared to the traditional approach. This justification is key to the objective selection of optimal rehabilitation techniques. The proposed improved method of multidimensional comparative analysis is an effective tool for the objective evaluation and comparison of rehabilitation programmes. Using three programmes as examples, their ranking was established based on the weighted distance to the benchmark: programme B was recognised as the best (R_B^w=0), programme C as intermediate (R_C^w=0.254), and programme A as the worst (R_A^w=0.34). The implementation of this method will optimize rehabilitation protocols and accelerate the restoration of military personnel's functional capacity, ensuring their full return to duty.