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

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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 2026May18];25(4):339-45. Available from: https://zmj.zsmu.edu.ua/article/view/269875

Issue

Vol. 25 No. 4 (2023)

Section

Original research

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