Взаємодія етапів Role 2 та Role 3 у збереженні реконструктивного потенціалу при пораненнях м’яких тканин кінцівок

Aim. To analyze modern approaches to the treatment of soft tissue defects of the extremities in military conflicts and to evaluate the role of synergy between Role 2 and Role 3 medical care levels as a key factor in effective functional wound closure and preservation of reconstructive potential. Materials and methods. A systematized search and critical analysis of relevant scientific literature published mainly between 2021 and 2026 was conducted. The search included publications indexed in major scientometric databases and electronic resources: PubMed, Google Scholar, and Web of Science. The analysis involved sources covering experience in treating combat extremity injuries, the principles of echeloned medical support according to NATO standards, modern methods of wound bed preparation, and soft tissue reconstruction technologies in conflicts in the Middle East, Afghanistan, Iraq, and during the full-scale Russo-Ukrainian War. Results. It was established that the primary factors complicating early soft tissue defect closure are biofilm-associated infections, the presence of devitalized tissues (“gray zone” of ischemia), and insufficient wound bed preparation. It was demonstrated that aggressive surgical interventions at the Role 2 level, specifically excessive debridement and disruption of vascular architecture, can significantly limit the options for applying local and regional flaps at Role 3. Conversely, a staged, tissue-sparing approach that preserves anatomical structures creates the necessary conditions for utilizing advanced wound bed preparation methods and effective reconstruction, ranging from simple local flaps to perforator flaps and, where indicated, free tissue transfers. Conclusions. Effective treatment of extremity soft tissue defects in military settings is only possible through close synergy between Role 2 and Role 3 and a clear delineation of their respective tasks. Focusing on the preservation of reconstructive options at the early stages, the application of modern wound bed preparation methods, and a staged approach to reconstructive decisions improve functional outcomes and increase the chances of returning the wounded to active life or military service.