Preview

Innovative Medicine of Kuban

Advanced search

Applicability of Ultrasonic Cavitation in Complex Treatment of Combat Surgical Trauma

https://doi.org/10.35401/2541-9897-2024-9-2-64-71

Abstract

Background: The history of gunshot wound treatment dates back several centuries. However, every new war or protracted armed conflict makes surgeons return to this issue. In recent years the nature of wounds changed: injuries become more severe, with a larger amount of damaged tissue. Among the wounded persons, blast and fragment injuries prevail over gunshot injuries. Gunshot wounds, as a rule, differ from wounds inflicted by old-style weapons in the scale, depth, and severity of anatomical destruction of soft tissue and bones. Modern physical methods of wound management and preparation of wounds for plastic closure, such as low-frequency ultrasound, enable to debride the wound surface with minimal damage to viable tissues and perform plastic closure of soft tissue defects as radically and as early as could be.

Objective: To improve methods of primary surgical debridement in patients with combat surgical trauma using low-frequency ultrasound.

Materials and methods: We studied treatment results in 176 wounded and injured people hospitalized in the burn unit and the division of plastic surgery and cell transplantation at the V.K. Gusak Institute of Emergency and Reconstructive Surgery (Donetsk, Russian Federation) between 2015 and 2023. All the patients were divided into 2 groups. Group 1 (main) included 86 patients who underwent surgical wound debridement with ultrasonic cavitation. Group 2 consisted of 90 patients who were operated on without ultrasonic wound debridement. The groups of patients were comparable.

Results: After surgical wound debridement, segmented neutrophils (78%-68%) were the main type of blood cells. After ultrasonic wound debridement, the amount of detritus decreased by 3.75 times. In the main group, the number of fibroblasts was 1.88 times higher than that in the comparison group. On day 4, the specific area of the granulation tissue was 1.7 times higher in the main group compared with that in the comparison group. Results of the morphometric control revealed that on day 4 the number of capillaries in the granulation tissue was 31.3  ±  2.5 units in the main group and 20.0  ±  1.12 units in the comparison group. Ultrasonic cavitation of wounds helps suppress wound infection by day 4-5 of treatment: in 82.2  ±  5.7% of the patients, the number of microorganisms per gram of tissue decreased below the “critical number”, whereas in the comparison group it was achieved in 28.9  ±  6.7% of the patients. According to laser Doppler flowmetry findings, we obtained a statistically significant increase in the mean blood flow value (M index) by 1.22 times 24-48 hours after surgical treatment. In the main group, 11.6  ±  3.4% of complications were reported, whereas in the comparison group it was 24.5  ±  4.4%, P <  .05. The mean number of operations per person was 1.6  ±  0.4 in the main group and 2.8  ±  0.5 in the comparison group, P  <  .05. The mean duration of inpatient treatment was 13.5  ±  3.4 days in the main group and 24.3  ±  2.5 days in the comparison group, P <  .01.

Conclusions: We can conclude that ultrasonic cavitation is advantageous in routine surgical debridement of gunshot wounds followed by primary or delayed primary closure.

About the Authors

D. S. Merkulov
“YuNA Estetik” LLC
Russian Federation

Danil S. Merkulov, Plastic Surgeon, Head of the Multidisciplinary Medical Center

ulitsa Ovnatanyana 29a, Donetsk, 283017



E. Ya. Fistal
V.K. Gusak Institute of Emergency and Reconstructive Surgery; M. Gorky Donetsk National Medical University
Russian Federation

Emil Ya. Fistal, Dr. Sci. (Med.), Professor at the Department of Thermal Injuries and Plastic Surgery, M. Gorky Donetsk National Medical University; Plastic Surgeon, President, V.K. Gusak Institute of Emergency and Reconstructive Surgery

Donetsk



V. O. Demchuk
M. Gorky Donetsk National Medical University
Russian Federation

Vladislav O. Demchuk, Plastic Surgeon, Assistant Professor at the Department of Emergency Medicine

Donetsk



References

1. Minnullin IP, Surovikin DM. Treatment of Gunshot and Explosive Injuries. MORSAR AV; 2001. (In Russ.).

2. Nechaev EA, Tutokhel AK, Gritsanov AI, Kosachev ID. The surgical aspects of the lessons of the war in Afghanistan. Voen Med Zh. 1991;(8):7–12. (In Russ.). PMID: 1755234.

3. Bodulin VV, Kheralov AK, Vorotnikov AA. Surgical aspects of gunshot injuries to the extremities. In: Proceedings of the Anniversary Scientific Conference Dedicated to the 90th Anniversary of the Birth of Professor M.S. Makarov. Stavropol State Medical University; 1998:120–123. (In Russ.).

4. Bogdanov SB. Types of Skin Autografting. Atlas : A Guide for Physicians. OOO “KLUB PECHATI”; 2018. (In Russ.).

5. Sokolovich GE, Ryazantsev VP, Bashirov RS. New aspects of pathogenesis and main directions in the treatment of gunshot wounds. In: Gunshot Wound and Wound Infection. VMedA; 1991:104–105. (In Russ.).

6. Fistal EYa, Bassov OI, Dolgoshapko ON, Fistal NN, Sobolev DV. Battlefield Medicine (Part 1): A Textbook. Vostochnyi izdatelskii dom; 2015. (In Russ.).

7. Nechaev EA, Gritsanov AI, Fomin NF, Minnullin IP. Mine Blast Injuries. Ald; 1994. (In Russ.).

8. Shaposhnikov YuG, Rudakov BYa. Current issues in the surgical treatment of gunshot wounds. Voen Med Zh. 1983;(3):12– 16. (In Russ.).

9. Lezhnev KK. Sravnitelnaya otsenka metodov opredeleniya zhiznesposobnosti tkanei pri ognestrelnykh povrezhdeniyakh. Dissertation abstract. S.M. Kirov Military Medical Academy; 1990. (In Russ.).

10. Lisitsyn KM, Shaposhnikov IuG, Rudakov BIa. Features of current wound ballistics which determine the character and extent of surgical treatment of gunshot wounds. Vestn Akad Med Nauk SSSR. 1979;(3):47–51. (In Russ.). PMID: 442796.

11. Kolesnikov IS, Lytkin MI, Chepcheruk GS. Prevention and treatment of purulent complications after chest wounds. Voen Med Zh. 1982;(12):39–41. (In Russ.).

12. Dedushkin VS, Artemyev AA. Is surgical debridement of gunshot fractures always necessary?. In: Gunshot Wound and Wound Infection. VMedA; 1991:131–133. (In Russ.).

13. Giannou C, Baldan M. War Surgery : Working With Limited Resources in Armed Conflict and Other Situations of Violence : in 2 Volumes. ICRC; 2010. (In Russ.).

14. Stein M, Hirshberg A. Medical consequences of terrorism. The conventional weapon threat. Surg Clin North Am. 1999;79(6):1537–1552. PMID: 10625992. https://doi.org/10.1016/s0039-6109(05)70091-8

15. Samokhvalov IM, Lyashedko PP, Tynyankin NA. Surgical treatment of gunshot wounds. In: Belskikh AN, Samokhvalov IM, eds. Instructions for Battlefield Surgery. Ministry of Defense of the Russian Federation; 2013:42–51. (In Russ.).


Review

For citations:


Merkulov D.S., Fistal E.Ya., Demchuk V.O. Applicability of Ultrasonic Cavitation in Complex Treatment of Combat Surgical Trauma. Innovative Medicine of Kuban. 2024;(2):64-71. (In Russ.) https://doi.org/10.35401/2541-9897-2024-9-2-64-71

Views: 410


ISSN 2541-9897 (Online)