Current aspects of the treatment of combat surgical trauma

Abstract

Objective. The history of providing assistance to victims with gunshot wounds dates back more than one century, but nevertheless surgical treatment of gunshot wounds is still relevant to this day. High-quality primary surgical treatment of a gunshot wound is the key to a speedy recovery of the patient (N.I. Pirogov). The pathogenesis of gunshot wounds determines the specific tactics of surgical treatment. Gunshot wounds are zonal in nature. According to the results of morphological studies, it can be concluded that a significant part of the changes in the zone of molecular concussion of the wound canal are reversible, and the complexity of pathogenesis and the lack of reliable criteria for assessing the condition of tissues does not exclude the possibility of leaving areas with reduced viability in the wound after treatment. For maximum effect during surgical treatment of gunshot wounds, non-viable tissues should be removed with minimal damage to viable ones. To meet these requirements, it is often impossible to visually assess the boundary between damaged and parabiotic tissues objectively intraoperatively. The use of modern physical methods of wound wrapping and preparing them for plastic closure, such as low-frequency ultrasound, hydrosurgical methods and VAC therapy allows you to radically clean the wound surface with minimal damage to viable tissues and perform plastic closure operations on soft tissue defects at an early date.Purpose of a study: to improve the methods of primary surgical treatment in patients with combat surgical trauma using low-frequency ultrasound.Material and methods. Our study is based on the analysis of the treatment results of 93 patients aged 10 and 70 years old. All patients had combat surgical trauma of various etiology and localization. Of these, 36 (38.7%) patients in main group underwent ultrasound cavitation of the wound canal and wound defects during primary surgical treatment (PST), followed by primary or primary delayed plastic surgery within a period not exceeding 48 hours after PST. Methods of plastic wound closure were both flaps with axial circulation and autodermotransplantation. In the remaining 57 (61.3%) patients of comparison group, primary surgical treatment was not performed, or was performed at the stages of evacuation, with further conservative treatment. Upon admission to the clinic, he underwent secondary surgical treatment, opening of purulent lumps, as well as staged necrectomies, while wound plastic surgery was performed after wound cleansing and was mainly represented by autodermotransplantation.Results. It was revealed that in the main group, the treatment time of patients in the main group was reduced by 2 times compared with the comparison group (16.3 and 34.2 bed days, respectively). The effectiveness of engraftment of autodermotransplants was evaluated according to V.I. Petrov's scheme. Lysis of autodermotransplants was noted 1.9 times less frequently in the main study group. It was also noted that there were no purulent complications in main group, unlike comparison group – 20.6%, the number of marginal necrosis was 2.6% in main group and 22.4% – in comparison group, lysis of autodermotransplanates in main group was 7.8%, in comparison group – 13.8%.Conclusion. This study allows us to conclude that the advantage of using ultrasonic cavitation during the usual surgical treatment of gunshot wounds followed by primary or primary delayed plastic surgery.