The results of treatment of children with wound injury in different localization

Abstract

Objective: to analyze the treatment results of green wounds among childhood inpatients and to determine the best treatment and prevention method of possible complications in order to improve the responses to treatment. Materials and methods. There were analyzed the results of treatments of 653 children with green wounds aged 1 to 17, which were treated in the period from 2012 to 2016 in the Surgery and Traumatology departments of City Hospital No 9 (Sochi). Results. Surgical treatable was performed in an expedited manner on presentation to hospital in the following sequence: a) initial surgical d-bridement; b) if there were fractures – apposition and fusion of bone fragments; c) suture of great vessels, nerves and tendons; d) layer-bylayer adesmosis with using reconstructive surgery elements. During the initial surgical d-bridement they also used modern methods of treatment: vacuum treatment of the wound with detersion by antiseptic solution for 42 (6.4 %) patients; supersonic cavitation for 18 (2.6 %), active and passive drainage and antibiotic therapy based on the microorganisms’ vulnerability for 154 (23.6 %), and other methods. Different types of reconstructive and plastic surgery were applied. In making an assessment of treatment results the wound healing by first intention was achieved for 588 (90.0 %) patients in a period from 1 month to 1 year. There were noted: suppuration – for 25 (3.8 %) patients, suture line disruption – for 11 (1.7 %), local necrosis of wound edges – for 17 (2.6 %), acrocontracture – for 7 (1.1 %), the formation of cicatricial keloid – for 5 (0.8 %). Conclusions. Early initial surgical d-bridement for children and complex of surgical modern methods of wounds treatment are the most important ways to prevent and reduce the level of infection in the wound. Using of external fixation devices for children with vast wounds provides the most favorable conditions for the wounds healing and allows using different types of skin grafting. During the initial d-bridement for children it is needed to keep rational conservatism, to use atraumatic surgical techniques and minimally invasive methods, to take care about tissues, and it is also necessary to consider great opportunities of reparative processes of child’s organism in comparison with adults and perspective of further growth of the child.