Features of surgical treatment of purulent-septic complications of gunshot and mine-blast injuries of extremities

Levchuk A.L., Ignatiev T.I., Jojua A.V., Anankin A.A., Grin N.A., Vorobyova A.A.

In modern military conflicts, limb injuries prevail in the structure of sanitary losses, which constitute the absolute majority of combat surgical pathology. Gunshot wounds inflicted by modern high-energy wounding projectiles are characterized by a large amount of damage to the tissues of the extremities, which determines the occurrence of severe purulent-septic complications, leading to long treatment periods, severe disability of the wounded and a significant decrease in their quality of life.

Objective: to analyze the cause and frequency of purulent-septic complications and the effectiveness of the treatment of gunshot injuries of the extremities by negative pressure in victims with mine-explosion injury in a military conflict.

Materials and methods: the results of complex treatment of 148 wounded men with combat injuries of the limbs, accompanied by extensive tissue defects from 50 cm2 to 140 cm2, complicated by a progressive inflammatory process (phlegmons, abscesses, osteomyelitis), were analyzed. Specialized medical care was performed in a multidisciplinary hospital and included secondary surgical treatment of wounds, staged osteosynthesis and PST amputations, VAC therapy, and the use of epidermal growth factor preparations.

Results: purulent-septic complications were diagnosed in 82.4% of cases. Soft tissue injuries were noted in 44.7%, of which 67.8% of the injured were the main group, 32.2% – the control group. Gunshot fractures of bones were diagnosed in 55.3% of the victims. The treatment of the subjects of the main group was carried out in compliance with the principles of “damage control” and traumatological gradation of stage-by-stage osteosynthesis. The treatment results of the victims of both groups were characterized by an increase in the average duration of fracture consolidation. The healing time of extensive gunshot wounds of the extremities in the main group was 17.9% faster than in the control group. The average duration of inpatient treatment for the wounded in the main group was 2.7 times less than in the control group, and amounted to 21.7±14.3 and 84.5±29.7 days, respectively.

Conclusion: multi-stage surgical and traumatological tactics for extensive wound defects of the soft tissues of the limb and gunshot fractures of long tubular bones should include: full surgical treatment, drainage, extra-focal osteosynthesis with rod devices. Medical care for victims with explosive and gunshot injuries should be based on the principles of multi-stage surgical treatment (damage control and medical resources).

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