Analysis of the treatment of gunshot wounds with tissue defects by the Vacuum-Assisted Closure therapy method

Abstract

Introduction. With the beginning of the full-scale invasion of the Russian federation on the territory of Ukraine, the number of patients with mine-explosive injuries of various nature in medical institutions has increased significantly. One of the modern and effective methods of treating soft tissue defects is VAK therapy. The aim of the study. Analysis of the effectiveness of treatment of patients with gunshot wounds of the extremities by using VAC therapy in complex treatment. Materials and methods. We conducted a comparative analysis of the treatment of 30 patients with mine-explosive injuries of various localization and degree of severity, who were delivered after the stages of medical evacuation to the department of orthopedics and traumatology on the basis of the A.Novak ZOKL Medical Center of the ZOR in the period from January to December 2023. All the wounded are male. Among these patients, about 37% had a blind wound, 60% – through, and 3% – a tangential wound. All subjects are conditionally divided into two groups. Patients with penetrating wounds were assigned to the first group, and patients with blind and tangential wounds to the second group. All patients received complex antibacterial therapy according to the results of microbiological research and determination of sensitivity to antibiotics. Results and discussion. Against the background of the use of VAK therapy, the wounds were prepared for closure 13–25 days after the start of treatment. . In the first group, a reduction in perifocal edema was noted after a 5–7-day session of VAS therapy, and in the second – on day 2–3 (one continuous procedure). Repeated necrectomy was performed during each replacement of the VAC system, and in the first group, wound debridement took place in the period from 8 to 12 days, an average of 9.3 days. In the second group of patients, wound healing was noted in the period from 6 to 11 days, an average of 8.5 days. The formation of fine-grained granulations in patients of the second group occurred on the 6th–8th day (after 2 procedures of VAC therapy), and on the 10th–12th day in the first group. Closure of the wound defect was carried out by secondary suturing, local tissue plastic and autodermoplasty. Conclusions. The method of treatment with VAK therapy provides quick cleaning of the wound surface, filling of the wound defect with granulation tissue, preparation of the wound for plastic closure. The use of VAK-therapy significantly improves the results of treatment of wound prolapse in victims with gunshot wounds complicated by a purulent process. The use of VAK therapy allows to significantly increase the effectiveness of complex treatment of wounded with soft tissue injuries.