Surgical treatment of isolated soft tissue gunshot shrapnel injuries by combining primary delayed sutures with platelet-rich autoplasma injections into mine-explosive wounds

Authors

DOI:

https://doi.org/10.14739/2310-1210.2023.4.269875

Keywords:

isolated gunshot shrapnel injuries, combined surgical treatment, platelet-rich autoplasma, primary delayed sutures, mine-explosive trauma

Abstract

Aim: to assess the treatment effectiveness in patients with soft tissue gunshot shrapnel injuries by applying primary delayed sutures in combination with platelet-rich autoplasma injections into wounds.

Materials and methods. The study included 60 (100.0 %) patients with soft tissue gunshot shrapnel wounds. All wounded were divided into two groups. The comparison group consisted of 30 (50.0 %) patients admitted to a hospital with primary delayed sutures (6–7 days). The main group included 30 (50.0 %) patients whose local treatment modification consisted in a combination of primary delayed suturing with platelet-rich autoplasma injection into a wound. A wound channel was observed on the 8th, 11th –14th days from the moment of injury using visual inspection, linear measurements and diagnostic ultrasound system (Mindray M6, 220A).

Results. 60 (100.0 %) patients were urgently hospitalized to the third stage of medical evacuation and treated according to standard treatment protocols for this pathology at the third stage of evacuation. According to a wound defect localization, the wounded of the comparison groups, 30 (50.00 %), were distributed as follows: a lower limb wound – 22 (73.33 %) patients, an upper limb wound – 6 (20.00 %), and a trunk wound – 2 (6.67 %). The main group also included 30 (50.00 %) wounded, whose treatment at the third stage of medical evacuation was modified by using a combination of primary delayed sutures and platelet-rich autoplasma injection. On the 8th day after an injury, a visual inspection of the wounds detected no hyperemia or suppuration in both groups. The visual inspection of wounds in the comparison group at 11.0 ± 3.9 days post-injury revealed 24 (80.00 %) patients with complications such as seromas in 17 (56.67 %) cases, hematomas with wound suppuration – in 7 (23.33 %). In the main group, 2 (6.67 %) cases of wound suppuration were detected (U = 120.00, p = 0.000001). The basic parameters of wound linear measurements according to the diagnostic ultrasound system data at the 11th–14th day post-injury after primary and delayed suturing in the studied groups: in the comparison group, upper limb wounds – S (mm2) 43.3 ± 12.6, V (mm3) 53.3 ± 13.9; lower limb wounds – S (mm2) 194.7 ± 50.7, V (mm3) 706.3 ± 190.4; trunk wounds – S (mm2) 20.5 ± 7.2, V (mm3) 22.5 ± 5.4. In the main group, upper limb wounds – S (mm2) 28.2 ± 8.5, V (mm3) 23.2 ± 7.1; lower limb wounds – S (mm2) 56.4 ± 19.6, V (mm3) 102.4 ± 21.1; trunk wounds – S (mm2) 12.3 ± 3.2, V (mm3) 10.4 ± 2.9. The total duration of inpatient treatment at the 3rd stage of medical evacuation in the comparison group wounded was 30.0 ± 2.3 days, and in the main group it was 12.0 ± 3.1 days (U = 290.00, p = 0.0354).

Conclusions. In the structure of gunshot shrapnel wounds in both groups, there were 43 (71.67 %) lower limb traumatic injuries, 11 (18.33 %) upper limb, and 6 (10.00 %) trunk injuries. The use of platelet-rich autoplasma in combination with primary delayed suturing stimulated wound healing and accelerated wound-healing process as evidenced by a significant decrease in the wound defect area and volume on the 11th–14th day post-injury in the main group compared to the comparison group. The method for treatment of gunshot shrapnel wounds developed by us reduced the frequency of postoperative complications since 24 (80.00 %) patients were diagnosed with complications in the comparison group, while only 2 (6.67 %) patients in the main group (U = 120.00, p = 0.00001). The use of platelet-rich autoplasma made it possible to reduce the length of hospital stay for patients at the third stage of medical evacuation: in the comparison group, this period was 30.0 ± 2.3 days, and in the main group, 12.0 ± 3.1 days (U = 290.00, p = 0.0354).

Author Biographies

S. M. Zavhorodnii, Zaporizhzhia State Medical and Pharmaceutical University, Ukraine

MD, PhD, DSc, Professor, Head of the Department of General Surgery and Postgraduate Surgical Education

O. I. Kotenko, Zaporizhzhia State Medical and Pharmaceutical University, Ukraine

MD, Postgraduate Student of the Department of General Surgery and Postgraduate Surgical Education

M. B. Danyliuk, Zaporizhzhia State Medical and Pharmaceutical University, Ukraine

MD, PhD, Associate Professor of the Department of General Surgery and Postgraduate Surgical Education

M. A. Kubrak, Zaporizhzhia State Medical and Pharmaceutical University, Ukraine

MD, PhD, Department of General Surgery and Postgraduate Surgical Education

References

Cabinet of Ministers of Ukraine. (2018, October 31). Pro zatverdzhennia Voienno-medychnoi doktryny Ukrainy [On the approval of the Military Medical Doctrine of Ukraine (No. 910]. https://zakon.rada.gov.ua/laws/show/910-2018-%D0%BF?lang=en#Text

Goregliad, A. N., & Naumenko, L. Yu. (2018). Kompleksnyi analiz perebihu zahoiennia skladnykh polistrukturnykh ran kintsivok pid diieiu lokalnoho zastosuvannia nehatyvnoho tysku [Complex Analysis of Healing Complex Poly-Structural Wounds оf Limbs with Local Application of Negative Pressure]. Ukrainskyi zhurnal medytsyny, biolohii ta sportu, 3(3), 78-82. [in Ukrainian].

Guryev, S. E., Lysun, D. M., Maksymenko, M. A., & Kurachenko, I. P. (2021). Kliniko-epidemiolohichni kharakterystyky postrazhdalykh unaslidok ATO na skhodi Ukrainy, yakym bulo nadano dopomohu na dohospitalnomu (taktychnomu) ta rannomu hospitalnomu etapi [Clinical and epidemiological characteristics of patients injured due to anti-terrorist operation in the Eastern Ukraine who received medical care at the prehospital (tactical) and early hospital stage]. Trauma, 19(2), 20-23. [in Ukrainian]. https://doi.org/10.22141/1608-1706.2.19.2018.130648

Zazirnyi, I. M., Kravchenko, D. D., & Andreev, Atanas. (2020). Likuvannia ran pry nehatyvnomu tysku (VAC) v ortopedychnii khirurhii (Ohliad) [Negative Pressure Wound Therapy in Orthopedic Surgery (Review)]. Visnyk ortopedii, travmatologii ta protezuvannia, (2), 52-60. [in Ukrainian]. https://doi.org/10.37647/0132-2486-2020-105-2-52-60

Zarutskyi, Ya. L., Aslanian, S. A., & Kompaniiets, A. O. (2018). Zastosuvannia vakuum-terapii pry poranenniakh i travmakh riznoi lokalizatsii [The use of vacuum therapy for wounds and injuries of various localization]. Plastychna, rekonstruktyvna i estetychna khirurhiia, (4), 40-47. [in Ukrainian].

Khomenko, I. P., Korol, S. O., & Matviichuk, B. V. (2021). Klinichno-orhanizatsiini osoblyvosti nadannia travmatolohichnoi dopomohy poranenym iz defektamy miakykh tkanyn pry vohnepalnykh ta minno-vybukhovykh ushkodzhenniakh kintsivok [Clinical and organizational peculiarities of providing trauma care to the patients with soft tissue defects in gunshot and mine blast injuries of the limbs]. Travma, 19(5), 125-129. [in Ukrainian]. https://doi.org/10.22141/1608-1706.5.19.2018.146655

Strafun S. S., Kurinnyi, I. M., Borzykh, N. O., Tsymbaliuk, Ya., V. & Shypunov, V. G. (2021). Taktyka khirurhichnoho likuvannia poranenykh iz vohnepalnymy travmamy verkhnoi kintsivky v suchasnykh umovakh [Tactics of Surgical Treatment of Wounded with Gunshot Injuries of the Upper Limb in Modern Conditions]. Visnyk ortopedii, travmatologii ta protezuvannia, (2), 10-17. [in Ukrainian]. https://doi.org/10.37647/0132-2486-2021-109-2-10-17

Teplyi, V. V., & Grebchenko, K. M. (2018). Metodyka vykorystannia vakuumnoi terapii dlia pryskorennia zakryttia ran, yaki zahoiuiutsia vtorynnym natiahom, ta profilaktyky patolohichnoho rubtsiuvannia [Vacuum-assisted therapy for wound closure acceleration in second intention healing and prophylaxis of pathological scarring]. Khirurhiia Ukrainy, (4), 48-53. [in Ukrainian].

Khomenko, I. P., Gumeniuk, K. V., Korol, S. O., Tsema, E. V., Mikhaylusov, R. М., Maidanyuk, V. P., Tertyshnyi, S. V., & Popova, O. N. (2021). Vyznachennia providnoho vydu urazhen viiskovosluzhbovtsiv u suchasnykh viiskovykh konfliktakh [Determination of the leading type of improvements of servicemants in modern military conflicts]. Kharkivska khirurhichna shkola, (2), 128-133. [in Ukrainian]. https://doi.org/10.37699/2308-7005.2.2021.23

Tsymbaliuk, V., Khomenko, I., Lurin, I., Usenko, O. & Boiko, V. (Eds.). (2018). Patomorfoz vohnepalnykh ran miakykh tkanyn [Pathomorphosis of gunshot wounds of soft tissues] (pp. 168-175). Kharkiv: Kolehium. [in Ukrainian].

Shvets, A. V., Horishna, O. V., Deputat, Yu. M., Rychka, O. V., Zhaldak, A. Yu., & Kikh, A. Yu. (2022). Prohnostychna otsinka potreby u medychnii reabilitatsii viiskovosluzhbovtsiv Zbroinykh Syl Ukrainy na osnovi danykh struktury yikh boiovoi travmy [Prognostic assessment of the need for medical rehabilitation among military officers of the armed forces of Ukraine based on the structure of their combat trauma]. Ukrainskyi zhurnal viiskovoi medytsyny, 3(3), 110-117. [in Ukrainian].

Yakimova, T. P., Nehoduiko, V. V. Patomorfoz miakykh tkanyn v diliantsi stronnoho tila vohnepalnoho pokhodzhennia v rizni terminy [Pathomorphosis of soft tissues in the area of a foreign body of gunshot origin in different terms]. Problemy viiskovoi okhorony zdorovia, 48, 290-297. [in Ukrainian].

Campbell, P., Pope, R., Simas, V., Canetti, E., Schram, B., & Orr, R. (2022). The Effects of Early Physiotherapy Treatment on Musculoskeletal Injury Outcomes in Military Personnel: A Narrative Review. International journal of environmental research and public health, 19(20), 13416. https://doi.org/10.3390/ijerph192013416

Ezzati, K., Laakso, E. L., Salari, A., Hasannejad, A., Fekrazad, R., & Aris, A. (2020). The Beneficial Effects of High-Intensity Laser Therapy and Co-Interventions on Musculoskeletal Pain Management: A Systematic Review. Journal of lasers in medical sciences, 11(1), 81-90. https://doi.org/10.15171/jlms.2020.14

Jakovljevic, M., Al Ahdab, S., Jurisevic, M., & Mouselli, S. (2018). Antibiotic Resistance in Syria: A Local Problem Turns Into a Global Threat. Frontiers in public health, 6, 212. https://doi.org/10.3389/fpubh.2018.00212

Mosleh, M., Dalal, K., Aljeesh, Y., & Svanström, L. (2018). Correction to: The burden of war-injury in the Palestinian health care sector in Gaza Strip. BMC international health and human rights, 18(1), 32. https://doi.org/10.1186/s12914-018-0171-5

Pietramaggiori, G., Kaipainen, A., Czeczuga, J. M., Wagner, C. T., & Orgill, D. P. (2006). Freeze-dried platelet-rich plasma shows beneficial healing properties in chronic wounds. Wound repair and regeneration, 14(5), 573-580. https://doi.org/10.1111/j.1743-6109.2006.00164.x

Reginelli, A., Russo, A., Maresca, D., Martiniello, C., Cappabianca, S., & Brunese, L. (2015). Imaging assessment of gunshot wounds. Seminars in ultrasound, CT, and MR, 36(1), 57-67. https://doi.org/10.1053/j.sult.2014.10.005

Talaber, I., Koron, N., Bucik, M., Baños, J., Sing, R. V., Štrumbelj, T., & Hreljac, I. (2021). Introduction to High Intensity Tesla Stimulation (HITS) with StarFormer® and Review of Electro-Magnetic Field Device clinical applications. Laser and Health Academy, 2021(1), 1-13. https://www.laserandhealthacademy.com/media/uploads/laha/docs/2021/articles/onlinefirst_talaber_laha2021.pdf

Yoshino, Y., Ohtsuka, M., Kawaguchi, M., Sakai, K., Hashimoto, A., Hayashi, M., Madokoro, N., Asano, Y., Abe, M., Ishii, T., Isei, T., Ito, T., Inoue, Y., Imafuku, S., Irisawa, R., Ohtsuka, M., Ogawa, F., Kadono, T., Kawakami, T., Kukino, R., … Wound/Burn Guidelines Committee (2016). The wound/burn guidelines - 6: Guidelines for the management of burns. The Journal of dermatology, 43(9), 989-1010. https://doi.org/10.1111/1346-8138.13288

Fomin, O. O., Kovalchuk, V. P., Fomina, N. S., Zheliba, M. D., Dobrovanov, O., & Kralinsky, K. (2019). Treatment of purulent-inflammatory complications in a combat gunshot trauma. Modern Medical Technology, (2), 34-39. https://doi.org/10.34287/MMT.2(41).2019.35

Published

2023-07-20

How to Cite

1.
Zavhorodnii SM, Kotenko OI, Danyliuk MB, Kubrak MA. Surgical treatment of isolated soft tissue gunshot shrapnel injuries by combining primary delayed sutures with platelet-rich autoplasma injections into mine-explosive wounds. Zaporozhye Medical Journal [Internet]. 2023Jul.20 [cited 2024Jun.18];25(4):339-45. Available from: http://zmj.zsmu.edu.ua/article/view/269875