Modern methods of surgical treatment of victims with limb gunshot injuries

O.A. Buryanov, Yu.O. Yarmolyuk, D.V. Los, M.V. Vakulych

Abstract


Background. The structure of sanitary losses during the antiterrorist operation shows that in the structure of gunshot injuries, injuries of the extremities occur most often (62.5 %). 35–40 % of them are accompanied by fractures, 2 % — by vascular injury, 11 % — by peripheral nerve injury, 20.8 % — by combined injuries, 2 % — by burns, the incidence of traumatic shock is 10 %. The high kinetic energy of wounding projectile (bullet, modern weapons shrapnel) leads to significant traumatic soft tissue defects of the skin, injuries of subcutaneous tissues, muscles, requiring prolonged hospital treatment for wound healing, numerous repeated surgeries, delays fracture fixation, leads to complications, such as suppuration (6–18 %), post-traumatic contractures (12 %), disability. Today, extremely urgent task is the implementation and evaluation of modern methods of the treatment for gunshot wounds. Materials and methods. The study included 254 patients (men), who were treated at the National Military Medical Clinical Center (Kyiv) and Military Medical Clinical Centre of Western Region (Lviv) in 2014–2015. The criteria for inclusion in the study were one or more wounds of the upper or lower extremities as a result of a gunshot wound. The average age of patients was 33 ± 12 years (from 21 to 45 years). All patients underwent clinical, laboratory and radiological examinations, culture from wounds to determine the flora and sensitivity to antibiotics in dynamics, microscopic examination of soft tissue wounds and computed tomography to clarify the nature of the fracture. Patients in both groups received similar treatment, but patients of the I group received additionally: negative pressure wound therapy, ultrasonic cavitation, local stimulation of reparative processes by introducing platelet-rich plasma, topical treatment of wounds (argoderm bandages with nanosilver, decasan, betadine, octenisept, gentaxan, hyaluronic acid ialuset). Results. The results of the introduction of staged treatment for gunshot wounds with modern treatments are: reduction in the average duration of wound care by 5.9 (20.9 %), of staged surgical treatments — by 3.9 (47 %), the incidence of the purulent necrotic complications decreased by 10.3 %. Conclusions. The analysis of treatment results showed that the method of comprehensive treatment for gunshot wounds of the soft tissues of the extremities using vacuum aspiration, ultrasonic cavitation for cleaning wounds, platelet-rich plasma for local stimulation of reparative processes allow to reduce treatment duration to 8.0 ± 2.8 days, to decrease the incidence of complications by 30.0 ± 1.2 % that made it possible to recommend its as the method of choice in the treatment of this disease.

Keywords


gunshot wound; ultrasound cavitation; negative pressure therapy; bacteriological researches

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DOI: https://doi.org/10.22141/1608-1706.2.18.2017.102555

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