Mistakes and complications during treatment of injured with extremity gunshot wounds

  • O. A. Burianov National Medical University named after A. A. Bogomolets
  • Yu. O. Yarmolyuk National Military Medical Clinical Center «Main Military Clinical Hospital»
  • D. V. Los National Military Medical Clinical Center «Main Military Clinical Hospital»
  • M. V. Vakulich Military Medical Clinical Center of the Western Region
Keywords: gunshot wounds of extremities, surgical treatment of gunshot wounds, vacuum aspiration, plastic closure of defects

Abstract

The aim of the study is to analyze the medical care support for victims with complicated gunshot wounds of the extremities at levels II–IV in order to improve the results of the comprehensive treatment.
Materials and methods. Analysis of the comprehensive treatment of 175 patients with gunshot wounds of the extremities at the levels of medical care was carried out. In the main group (86 patients), comprehensive treatment was used, namely repeated surgical dressings, vacuum (including washing) aspiration, ultrasonic cavitation of wounds, stimulation of local reparative processes, local treatment of wounds with colloidal dressings with nanosilver, antiseptics, antibacterial and symptomatic therapy. In the comparison group, the treatment was carried out according to the generally accepted methods. The results of treatment were assessed using the anatomical and functional full-scale Matisse-Lyuboshits-Schwarzberg.
Results. At the II level of medical care, a direct relationship was established between the quality (timeliness, radicality, use of medical magnets, C-arch) of the surgical treatment and the number of infectious complications. The bacteriological data revealed the effectiveness of primary antibacterial therapy with ceftriaxone and ciprofloxacin. The widespread use (58%) of infiltration anesthesia can limit the surgical
activity 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 of wounds, a reduction in the terms of inpatient treatment, a lower number of complications (12.8% in comparison with 23.6% in the control group), including infectious 3.5% (control group 9%). The reasons for the impaired healing were the nonoptimal timing of surgical interventions (during the period of immunosuppression), the incorrectly chosen (simplest) method of wound closure (application of delayed sutures with autodermoplastics), violation of the doctor’s recommendations by the patient.
Conclusions. Improvement of the results of treatment of victims with gunshot wounds of the extremities at the II level of medical care requires shortening the terms of evacuation, 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 restorative
surgical 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 of comprehensive treatment of gunshot wounds of the extremities, which made it possible to reduce the duration of treatment by (6.0±2.2) days, reduce the number of complications by 10.8% and can be recommended as a method of choice in the treatment of this pathology.

Published
2020-11-20
How to Cite
Burianov, O. A., Yarmolyuk, Y. O., Los, D. V., & Vakulich, M. V. (2020). Mistakes and complications during treatment of injured with extremity gunshot wounds. Current Aspects of Military Medicine, 27(2), 93-103. https://doi.org/10.32751/2310-4910-2020-27-31