Advances in the treatment of combat trauma to the extremities: photodynamic therapy and methods of plastic wound closure

Abstract

Objective. To evaluate our own ten–year experience in the use of photodynamic therapy and plastic wound closure methods in the treatment of combat trauma victims using various photosensitizers and light sources, as well as tissue therapy.
 Materials and methods. In the Department of Acute Diseases of the Major Vessels of the Zaitsev Institute of General and Emergency Surgery, 36 patients with mine–blast and shrapnel wounds with damage to the major vessels underwent staged treatment of infectious wound complications using negative pressure wound therapy, photo– and photodynamic therapy, followed by wound closure with a fibroblast matrix. Bacterial contamination with the identification of strains, the timing of pathogen eradication in the wound, and the duration of wound healing were assessed.
 Results. As a local treatment, negative pressure wound therapy was initially used in a constant vacuum mode of –75 to –115 mm Hg for 4 to 5 days. In case of reduction/disappearance of soft tissue edema, the wounds after fasciotomy were sutured, and dermotension was used in 5 patients. After photosensitisation, the wound was irradiated with Korobov photonic matrices "Barva–Flex" with a wavelength of 660 nm (red light). During the staged treatment of wounds, complete eradication of pathogens in the wound was recorded on the 5th day, and complete wound healing was recorded within 17 days.
 Conclusions. Comprehensive treatment of infectious wound complications in victims with combat trauma using negative pressure wound therapy and photo– and photodynamic therapy, especially in the context of the formation of infectious pathogens resistance, led to better wound healing in a short time.