SPECIFIC ASPECTS IN TREATMENT OF SUPPURATIVE-INFLAMMATORY COMPLICATIONS IN GUNSHOT WOUNDS OF EXTREMITIES
Summary. The aim of the study was to present an argument for treatment algorithm of patients with extremity gunshot injuries complicated by suppurative inflammation.
Materials and research methods. Examination and treatment of 163 patients with gunshot wounds of the extremities were performed. All the wounded were divided into 3 study groups. The patients of group 1 underwent conventional treatment of gunshot wounds. In group 2, negative pressure wound therapy was used. Wounded patients of group 3 received vacuum-assisted therapy supplemented by the proposed scheme of counter-drainage and flow-through flushing irrigation of wounds with antiseptic solutions of 0.02 % decamethoxine and 3 % hydrogen peroxide. Bacteriological study of wound exudate was carried out, and sensitivity of microorganisms to antibiotics was determined.
Results and its discussion. Wound microbiology analysis in victims of blast and mine-blast injuries demonstrated predominance of gram-negative bacteria in wound microbiocenosis — Acinetobacter spp. (53 % of cases) and Pseudomonas spp. (15 % of cases). Gram-positive cocci were isolated in 22.2 % of cases. Sensitivity study of nonfermentative gram-negative rods demonstrated them to have high level of resistance to most antibacterial agents. All strains of Acinetobacter and Pseudomonas spp. were sensitive to polymyxin B and colistin but resistant to inhibitor-protected and -unprotected amino penicillin.
Beneficial effect of vacuum therapy in patients of groups 2 and 3 was evidenced by significantly reduced time of wound healing and hospital stay. The use of suggested mixture of antiseptics resulted in decrease of inflammation in 94.45 % and 88.89 % of patients in groups 3 and 2, respectively. Besides, in group 3, duration of hydration phase in wound healing process decreased to 5.7 days. The period of complete wound healing was shorter by 2.5 days, and hospital stay decreased from 14.97 to 10.8 days.
Conclusions. Thus, predominance of gram-negative microorganisms in gunshot wounds as well as their high resistance to antibiotics should be considered when undertaking empirical antibiotic therapy in wounded patients. The proposed treatment algorithm involving negative pressure wound therapy supplemented with counter-drainage and flow-through flushing irrigation with a mixture of suggested antiseptics proved to be highly efficient in patients with extremity gunshot injuries complicated by suppurative inflammation.
2. Verba AV. Analiz likuvalno-evakuatsiinoho zabezpechennia operatyvno-taktychnoho uhrupuvannia «Luhansk» A.V. Verba Problemy viiskovoi okhorony zdorov’ia: Zb. nauk. pr. UVMA. K.: 2017; 41.21–36. Inv. 840. Taiemno. [In Ukr].
3. Kashtalian MA. Verba AV, Herasymenko OS. ta in Sovremennыe metodы lechenyia ohnestrelnыkh ran. Suchasni aspekty viiskovoi medytsyny: Zb. nauk. prats NVMKTs HVKH MO Ukrainy. K.:2016; 23. Dodatok.43–4. [In Ukr].
4. Korol SO. Kompleks likuvalnykh zakhodiv v systemi nadannia medychnoi dopomohy poranenym z pryvodu vohnepalnykh ta minno–vybukhovykh urazhen stopy. Klinichna khirurhiia.2015;11.65–7. [In Ukr].
5. Verba AV, Khomenko IP, Kondratiuk VM ta in. Vyznachennia dzherela infikuvannia nozokomialnoiu floroiu boiovykh poranen kintsivok na pidstavi analizu mikroflory na riznykh etapakh likuvannia. Suchasni aspekty viiskovoi medytsyny: Zb. nauk. pr. NVMKTs HVKH. K.:2016;23.69–76. [In Ukr].
6. ATTР 4-02. Army Health System Headquarters Department of the Army Washington, DC, 2011; 124 р.
7. Callaway DW, Smith ER, Cain J. et al. Tactical emergency casualty care (TECC): guidelines for the provision of prehospital trauma care in high threat environment. Journal of Special Operations Medicine. 2009;11,Ed. 3.104-22.
8. Korol SO. Analiz khirurhichnoho likuvannia poranenykh iz perelomamy kistok homilky pid chas antyterorystychnoi operatsii S. O. Korol Ortopedyia, travmatolohyia i protezyrovanye.2016;2.10-4. [In Ukr].
9. Homenko IP, Korol SA, Matvijchuk BV. Kliniko-organizacionnye osobennosti okazanija travmatologicheskoj pomoshhi ranenym s defektami mjagkih tkanej pri ognestrel’nyh i minno-vzryvnyh povrezhdenijah konechnostej Travma. 2018;19,5.125-28. [In Ukr].
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