RU2254813C2 - Method for treating gunshot wounds of limbs - Google Patents

Abstract

FIELD: medicine, surgery.

SUBSTANCE: after primary surgical treatment one should apply "Cotelex-ADL" napkins into wound's cavity to change them once during 2-3 d for 10-14 d, then one should place "Cotelex MEX" napkins into the wound till the moment of valuable granulations maturation; after secondary surgical treatment one should apply "Cotelex"-antiphlogistic" napkins onto the wound to change them in 1-3 d till the moment of healing. The present innovation enables to decrease the risk for availability of inflammatory, toxic and similar effects, create necessary concentration of antibiotics, antiseptics, antiphlogistic and stimulating remedies in lesion focus, that, in its turn, enables to normalize the flow of wound process and induce conditions for wound healing in optimal terms at development of normotrophic scars.

EFFECT: higher efficiency of therapy.

1 ex

Description

The invention relates to medicine and can be used to treat gunshot wounds.

Gunshot injuries are characterized by a number of morphological features: the presence of foreign bodies, dead tissue, the formation of new foci of necrosis in the next 5-7 days after injury. They are united by a common phenomenon - the appearance in the tissues at the time of passage of a wounding projectile of a temporary pulsating cavity with zones of excess pressure on the periphery. The greater the kinetic energy of the projectile, the more pronounced the pulsation of the temporary cavity and its longer existence. This factor explains the extensive tissue damage along the passage of the wounding projectile and the formation of interstitial hematomas, damage to blood vessels, nerves, bones away from the wound channel. After the passage of a projectile (bullet, fragment, etc.), three damage zones are formed in the tissues: the wound channel, filled with scraps of soft tissue, blood clots and exudate, the area of contusion and the zone of association.

Disorders of local homeostasis, microcirculation, the presence of non-viable tissues, primary bacterial contamination of wounds cause a violent inflammatory reaction, the development of wound infection, which leads to a protracted healing process.

In field surgery, there is a known method for treating gunshot wounds (Military traumatology and orthopedics. L., 1977, p.207-209, analogue); before suturing, the wound is loosely tamped in the first 5-6 days with gauze napkins moistened with 3-5% hypertonic solution of sodium chloride, then oil-balsamic emulsions are applied to the wound. After cleansing the wound, it is sutured, providing active aspiration drainage. Surgical treatment is completed by infiltration of the wound edges with an antibiotic solution, then a course of anti-inflammatory, immunocorrective therapy is carried out.

The disadvantage of this method is that the suction effect of gauze napkins is limited in time to 6-8 hours, after this period of time under the bandage thermostatic conditions for the growth of pathogenic flora are formed. After drying, the gauze napkin adheres tightly to the wound surface, its change causes trauma to soft tissues and increased pain. Local administration of antibiotic solutions to the edges of the wound is invasive, dangerous by allergization, unwanted side effects and complications in the form of toxic effects, dysbiosis, etc.

A known method of treating wounds with gunshot wounds of the extremities, including primary and secondary surgical treatment, sorption-application, stimulating therapy (Methodological recommendations “Biologically active dressings in the complex treatment of purulent-necrotic wounds” No. 2000/156, edited by V. D. Fedorov , M., 2000, p. 28-29, prototype). In this method, after the initial surgical treatment (PEC), draining sorbents, for example, Anilodiotevina or Anilodiovina, are used, then stimulation therapy is carried out, and gel dressings are applied to wound surfaces. After cleansing the wound and forming granulation tissue, secondary surgical treatment is also carried out, the wound is closed with sutures or skin grafting.

The disadvantage of this method is that granular sorbents that are poured into the wound must be carefully removed from it, especially in the presence of deep cavities and pockets with a pulsating stream of antiseptic or a sharp spoon daily. The closure of the edges of the wound, the prolonged presence of the sorbent mass in its depth can lead to the formation of fistulas, exacerbation of the purulent process. When applying the known method requires additional drainage of the wound with a gauze swab or turunda to prevent closure of the edges of the wound. Gauze loses its drainage properties on average after 6-8 hours of operation, turning into a “cork”, which prevents the outflow of wound discharge. Mechanical removal of the sorbent enhances the pain syndrome, lengthens the time of dressing, can cause repeated bleeding from the wound.

The objective of the present invention is to remedy these disadvantages due to differentiated sequential local application of atraumatic application dosage forms in the treatment of gunshot wounds of the extremities. Local non-invasive summing up of necessary drugs (LP) to the wound reduces the risk of undesirable consequences and complications (in the form of allergies, toxic effects, etc.) that can develop with the systemic use of these medications. The creation of the necessary concentration of antiseptics, antibiotics, anti-inflammatory and stimulants in the lesion site (gunshot wound) contributes to the normal course of the wound process, creates conditions for wound healing in optimal terms with the formation of normotrophic scars.

To do this, in the method of treating wounds with gunshot wounds of the extremities, including primary and secondary surgical treatment, sorption-application therapy, after the initial surgical treatment in the wound cavity, place a Coletex-ADL napkin with a change as necessary for 10-14 days, then apply Coletex-MEX wipes to the wound until full granulations mature, and after secondary surgical treatment, apply Coletex wipes - anti-inflammatory, replacing them after 1-3 days the time of healing.

Coletex-ADL wipes are most effective in the first phase of the wound healing process, which lasts from an average of 10 to 14 days, which depends on the individual characteristics of the body, its protective forces, immune status, the presence of additional factors (low and high temperatures, poisons, concomitant diseases). After complete cleansing of the wounds from purulent-necrotic tissues, it is necessary to stimulate reparative processes in the wound in order to reduce the maturation of full granulations, in terms of preparing the wound for secondary surgical treatment, restoring the integrity of soft tissues using one of the types of plastic, use a Coletex-MEX napkin.

Coletex napkin is anti-inflammatory, it allows to reduce exudation in the area of the postoperative wound, the release of inflammatory mediators, to create in the wound for a certain period of time the necessary concentration of anti-inflammatory, antimicrobial agents, antioxidants, agents that normalize protein, electrolyte metabolism, which have a local immunocorrective effect.

The treatment method is as follows. After the wounded person is brought to the limb from the stages of medical evacuation to the hospital, the injured segment is examined, the condition of the wounds is assessed, their revision and surgical treatment are performed, during which non-viable tissues are excised, foreign bodies are removed, sufficient limb immobilization is performed, in order to prevent additional soft injury tissues. After surgical treatment, adequate hemostasis (“Koleteks-SAFG-GEM”) is performed for 20-30 s, a napkin “Koleteks-ADL” with lidocaine and dioxidine is placed on the operating table of the wound. In the first three days after GKO, dressings are performed daily, re-inspection of wounds, removal of secondary foci of necrosis, blood clots, and non-viable tissues are performed. Subsequently, after reducing inflammation, exudation, dressings are usually performed at intervals of 1 time in 2-3 days, performed within 10-14 days. The use of Coletex-ADL Wipes allows to reduce pain impulses, prevent wounds from kantamination, and achieve the necessary drainage and sorption effect. Napkins do not stick to the wound surface, are easily removed, well modeled, provide sufficient steam and water exchange in the wound, a soft and smooth transition to the second phase of inflammation. By the end of the second week, when granulations begin to form in the wound, there is a regression of the inflammatory reaction and microcirculatory disorders, they switch to the use of dressings with a stimulating effect, using biopolymer drugs - “Coletex-MEX” until full granulations mature. Dressings are carried out in 2-3 days. In the presence of scanty discharge, in order to prevent drying of the tissue, the occurrence of unpleasant sensations in the area of wounds, dressings are moistened every 8-10 hours, while the tissue should not be removed from the wound surface. After secondary surgical treatment with suturing the wound in order to prevent purulent-inflammatory complications and the formation of normotrophic scars, Coletex-anti-inflammatory moistened wipes are applied with a prolonged therapeutic effect, which is usually changed once every 2-3 days until healing, moisturizing dressings 2 times a day.

Example.

Wounded X., 32 years old with a mine-explosive wound of the right foot, traumatic secession of 1 and 2 fingers, an extensive infected wound of the back and plantar surfaces of the foot.

The patient underwent primary surgical treatment - partial necrectomy of the tissues of the right foot, hemostasis during the operation using a Koleteks-SAFG-GEM napkin for 30 s, after which a Koleteks-ADL napkin with lidocaine and dioxidine was loosened in the wound. Oral antibiotic therapy was prescribed (for 7 days), symptomatic treatment, plaster immobilization of the foot was performed with a removable back span to ensure rest of the wound (for a period of 1 month). In the first three days after surgical treatment, dressings were performed daily, the formation of secondary foci of necrosis was not detected, the discharge from the wound is scanty, serous. Dressings were changed at intervals of once every 2-3 days for 10 days until the appearance of signs of granulation, disappearance of inflammation, and debridement of the wound surface. After that, the local treatment of the wound was continued with the use of “Coletex-MEX” until full granulations mature. Dressings are carried out after 2-3 days, the napkins were moistened 2 times a day with physiological solution of sodium chloride.

In order to replace the defect of the soft tissues of the foot, secondary surgical treatment of the wound was performed, and the wound was closed with displaced oncoming rags with suturing. The wound is sutured tightly, drained by rubber graduates for 1 day. A Coletex-anti-inflammatory moistened napkin was applied to the wound on the operating table. The next day, the napkin was slightly wet with blood, there was no discharge from the wound, the drainage was removed. The wound edges were slightly swollen, slightly hyperemic. The napkin was applied again for two days “ Coletex is an “anti-inflammatory”, which was also moistened with an isotonic sodium chloride solution 2 times a day. On the third day, the edges of the wound without signs of inflammation, there is no discharge from it. Subsequently, dressings were performed after three days. The wound healed by first intention, the sutures were removed on the 12th day. Wipes between dressings were moistened 2 times a day with a NaCl solution of 0.9%. Achieved a positive result. A scar was formed on the dorsal and plantar surfaces of the foot without signs of inflammation and ulceration, which does not interfere with the wearing of orthopedic shoes with a lining of the arch and correction of foot support.

Using this method, under conditions of the MCH of the Ministry of Internal Affairs of the Russian Federation, 56 injured in the limbs were treated, of which 32 were injured with extensive gunshot defects of the soft tissues. The control group consisted of 76 people with a similar pathology treated according to the generally accepted method using multicomponent ointments based on a polyethylene glycol hydrophilic base in the first and second phases of the wound healing process (Levomikol, Levasin).

All received from the stages of medical evacuation showed signs of purulent inflammation in the wound area, 242 surgical interventions were performed due to complications, the presence of foreign bodies, instability of fixation of fragments, vicious level of amputations, to close defects of the skin, muscles, and bones. When using the indicated method for treating gunshot wounds using the Coletex dressing, a positive result was recorded, the wound surface was sanitized 10-12 days later, which was 2-5 days earlier than in the control group. After secondary surgical treatment, the application of secondary sutures to the wounds of the limbs in 1.8% of cases, purulent complications occurred, in the control group they reached 3.9%.

Thus, the consistent use of Coletex dressings with prolonged healing properties can reduce trauma to wounds during dressings, provide the necessary conditions for wound healing at optimal times, and reduce the dose and frequency of administration of the drug systemically.

Claims (1)

A method of treating wounds with gunshot wounds of the extremities, including primary and secondary surgical treatment, sorption-application therapy, stimulating therapy, characterized in that after the initial surgical treatment, Kotelex-ADL napkins are placed in the wound cavity with a change of 1 time in 2-3 days for 10-14 days, then Kotelex MEX wipes are applied to the wound until the full granulation is matured, and after secondary surgical treatment, Kotelex wipes are applied to the wound - anti-inflammatory with the change of 1-3 days until healing.