Помилки та ускладнення при лікуванні постраждалих з вогнепальними пораненнями кінцівок

Abstract

SummaryThe aim of the study is to analyze the medical care support for victims withcomplicated gunshot wounds of the extremities at levels II–IV in order to improve theresults of the comprehensive treatment.102Materials and methods. Analysis of the comprehensive treatment of 175 patientswith gunshot wounds of the extremities at the levels of medical care was carried out. Inthe main group (86 patients), comprehensive treatment was used, namely repeatedsurgical dressings, vacuum (including washing) aspiration, ultrasonic cavitation ofwounds, stimulation of local reparative processes, local treatment of wounds withcolloidal dressings with nanosilver, antiseptics, antibacterial and symptomatic therapy.In the comparison group, the treatment was carried out according to the generallyaccepted methods. The results of treatment were assessed using the anatomical andfunctional full-scale Matisse-Lyuboshits-Schwarzberg.Results. At the II level of medical care, a direct relationship was establishedbetween the quality (timeliness, radicality, use of medical magnets, C-arch) of thesurgical treatment and the number of infectious complications. The bacteriological datarevealed the effectiveness of primary antibacterial therapy with ceftriaxone andciprofloxacin. The widespread use (58%) of infiltration anesthesia can limit the surgicalactivity in deep wounds and affect the quality of primary surgical care.At level IV, after the treatment in the main group, there was a faster clearance ofwounds, a reduction in the terms of inpatient treatment, a lower number ofcomplications (12.8% in comparison with 23.6% in the control group), includinginfectious 3.5% (control group 9%). The reasons for the impaired healing were the nonoptimal timing of surgical interventions (during the period of immunosuppression), theincorrectly chosen (simplest) method of wound closure (application of delayed sutureswith autodermoplastics), violation of the doctor’s recommendations by the patient.Conclusions. Improvement of the results of treatment of victims with gunshotwounds of the extremities at the II level of medical care requires shortening the terms ofevacuation, active use of modern methods for surgical treatments (medical magnets, Carch), appropriate methods of anesthesia (conduction, spinal, epidural anesthesia),adequate antibacterial therapy (ceftriaxone, ciprofloxacin); planning of restorativesurgical interventions taking into account the period of immunosuppression (4–21 days),anatomical, psychological characteristics of the patient, the choice of the appropriate(and not the simplest) method of wound closure.Analysis of treatment results proved the effectiveness of the developed method ofcomprehensive treatment of gunshot wounds of the extremities, which made it possibleto reduce the duration of treatment by (6.0±2.2) days, reduce the number ofcomplications by 10.8% and can be recommended as a method of choice in thetreatment of this pathology.