EXPERIENCE IN TREATMENT OF GUNSHOT WOUNDS OF LIMBS IN TRAUMATIC AMPUTATIONS DUE TO EXPLOSIVE TRAUMA

Abstract

Abstract. Aim. To improve the results of surgical treatment in patients with traumatic limb amputations by developing diagnostic and treatment strategy for managing patients with soft tissue wounds of amputation stumps. Materials and methods. 283 wounded in-patients of Military Medical Clinical Center of the Central Region with gunshot traumatic limb amputations or their segments as a result of explosive injury were retrospectively studied during the period of February 24, 2022 to February 24, 2023. Results and discussion. Being admitted to the third level of medical service, surgical clinic, full-scale medical aid was provided to 283 wounded servicemen including surgical interventions with continuous intensive therapy. If necessary, the strategy of damage control surgery was continued and extended. Diagnostic and treatment strategy consisted of mandatory primary examination of amputation stump in the dressing room, X-ray examination of the limb, ultrasonography and Doppler ultrasound of the extremity (stump) vessels, and spiral computer tomography. 52 patients (18.37 %) underwent emergency operations. In 231 patients (81.63 %) treatment consisted of staged repeated (secondary if indicated) debridement of amputation stump and gunshot wounds of the limbs, and placement of VAC systems using negative pressure therapy. Repeated debridement was carried out every 3-5 days, performing necrectomy and using sanitation with antiseptic solutions. Polyurethane sponges were used to fill wound defect of the stump tissue, followed by 3-4 dermatotension sutures, and then VAC bandage was formed by conventional method. The following early complications occurred: bleeding — in 8 (2.83 %) patients, development of tension hematomas in 7 (2.47 %) and purulent inflammation in the form of suppuration, phlegmon and abscess in 43 (15.19 %) patients, requiring a greater number of repeated and secondary surgical debridements and placement of VAC systems. Late postoperative complications were: "defective stumps" in 17 (6.01 %) patients, ligature fistulas in 11 (3.89 %), formation of osteophytes in 3 (1.06 %), neurinoma — in 2 (0.71 %) and phantom pain syndrome in 11 (3.89 %) patients. Conclusions. To decrease the number of complications associated with purulent inflammation in amputation stump, primary surgical intervention should be carried out in the form of radical primary surgical debridement of gunshot wound, leaving long stump with no sutures. Following clear diagnostic and treatment strategy in managing patients with wound defects of soft tissues of amputation stumps in gunshot traumatic limb amputations leads to decreased number of postoperative complications.