TREATMENT OF ISOLATED GUNSHOT SHRAPNEL WOUNDS OF SOFT TISSUES USING AUTODERMOPLASTY

Abstract

The aim of the work: to evaluate the results of treatment of patients with isolated gunshot wounds of soft tissues by performing autodermoplasty.

Materials and Methods. The study was conducted on the basis of the Department of Thermal Trauma and Reconstructive Surgery of the City Hospital of Emergency and Emergency Medical Care. 40 (100.0 %) patients with gunshot wounds were included in the study, who underwent primary surgical treatment of wounds in the first and second stages of evacuation and were later transferred to the third stage of evacuation. According to localization, firearm injuries were determined on the front surface of the lower leg in 8 (20.0 %) patients, in 13 (32.5 %) – on the back surface of the thigh, in 8 (20.0 %) patients - on the shoulders, in 5 (12.5 %) patients, the wound was on the back surface of the hand, in another 4 (10 %) patients – on the inner surface of the forearm. On the buttock, the injury was localized in 2 (5.0 %) patients. Dermatoplasty was performed after preparation and cleaning of the wound location. The wound was considered ready for autodermoplasty, when the predominant area of the wound surface was covered by granulation tissue - pink-red shallow-grained, bumpy tissue that bleeds easily when touched. The viability of the skin flap was assessed on the 4th day visually, based on the color of the transplanted skin, the presence of secretions from under the skin flap, the inflammatory process around the skin graft zone (hyperemia, swelling), its fixation to the wound surface.

Results. The mean wound area measured by the linear method in patient data was 57.5 (16.0; 88.0) cm². The entire area of the wound defect was covered by granulation tissue for 22.0 (14.0; 27.5) days. Dermatoplasty with a free skin flap was performed on 25.8 (16.7; 29.6) days, the duration of surgery was 55.0 (45.0; 75.0) minutes on average. Postoperative complications were found in 8 (20.0 %) patients. Repeated surgical interventions were performed in 3 (7.5%) patients. Analyzing the localization of injuries, it was determined that autodermoplasty most often requires injuries on the front surface of the lower leg, the back surface of the thigh and the outer surface of the shoulder, which is related to the anatomical and functional features of these zones.

Conclusions. The granulation process is of crucial importance in the engraftment of the skin flap to the wound surface, because during the first days, the trophies of the skin flap are carried out by diffusion and osmosis. The main problem in the long-term treatment of patients who need autodermoplasty is preoperative preparation, namely the increase of granulations. The total duration of treatment in the study group was 28.9 days, of which 22 (76.1%) days were preoperative preparation. The search for methods of accelerating the growth of granulations in the preoperative period is the key to shortening the treatment period of these patients and reducing the risks of postoperative complications.