Authors
Levchuk A.L., Ignatiev T.I., Vorobyova A.A.
Pirogov National Medical and Surgical Center, Moscow
Abstract
Rationale. The treatment of patients with gunshot wounds of soft tissues is a complex task for the entire healthcare system. Despite the achievements of modern medicine, the problem of purulent – septic complications of gunshot injury remains one of the most urgent. The development and application of new methods of gunshot wound treatment makes it possible to improve the results of specialized medical care for victims.
Objective: To evaluate the effectiveness and safety of using a medical device – carbon atraumatic wipes “InKar” and epidermal growth factor with silver sulfadiazine in the complex treatment of soft tissue gunshot wounds complicated by a purulent-necrotic process.
Materials and methods. A retrospective, randomized, single-center, clinical trial was conducted on two parallel groups of patients. The study involved 86 wounded with gunshot wounds to the soft tissues of the trunk and limbs, brought from the area of the SMO. The main group included 46 patients who, in the complex local treatment of gunshot wounds, used carbon absorbent and therapeutic wipes “InKar” (in phase I) with the treatment of wound surfaces with “Ebermin” ointment during bandages. The control group included 40 patients who received standard treatment. The criteria for assessing the dynamics of the wound process were: cytological and bacteriological studies of wound exudate, visual and photographic assessment of the appearance of granulation tissue in the wound, and the timing of its purification. The dynamics of the systemic inflammatory response syndrome was based on clinical and laboratory data, and quality of life was assessed using the SF 36 questionnaire.
Results. The use of carbon and therapeutic bandages for the local treatment of gunshot wounds in symbiosis with epidermal growth factor and silver sulfadiazine in the main group provided (twice) faster wound healing, the absence of complications (progression of the purulent -necrotic process, secondary infection) and a significant reduction in systemic inflammatory response syndrome and treatment time, according to compared with patients in the control group. An assessment of the quality of life of the wounded in both groups confirmed a faster recovery of functional, physical, and psycho-emotional parameters in the patients of the main cohort.
Conclusion: effective and safe treatment of gunshot wounds is possible with the rational and competent (depending on the phase of the wound process) use of modern wound coverings. At the same time, new prospects are opening up for the use of epidermal growth factors in broad clinical practice, which provide a reliable regenerative component in the healing of gunshot wounds complicated by purulent infection of various localization.
Keywords: gunshot wound, local treatment of purulent-necrotic complications, carbon wound coatings, epidermal growth factor, quality of life.
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