Effectiveness of the use of early secondary sutures and injections of platelet-rich autoplasma in isolated gunshot shrapnel wounds of soft tissues

Abstract

Annotation. The purpose of the work – to assess the effectiveness of treatment of patients with isolated gunshot – shrapnel wounds of soft tissues by applying early secondary sutures in combination with injections of platelet-rich autoplasma into the wound. The study included 62 (100.0%) with gunshot fragment wounds of soft tissues. Patients were divided into two groups. The comparison group consisted of 32 patients (51.61%), who were given early secondary sutures on the 8-15th day and continued conservative treatment and daily bandages according to the current standards of treatment of gunshot wounds. The main group consisted of 30 patients (48.39%), in whom local treatment was modified by combining early secondary sutures with PRP - platelet rich plasma. The evaluation of the wound process in the wound under the sutures was carried out on the 8th, 11th - 14th day from the moment of injury using visual inspection, linear measurement and diagnostic ultrasound system (Mindray - M6) 220A. Statistical processing of the results was carried out in STATISTICA 13.0 software packages, TIBCO Software inc. (License JPZ804I382130ARCN10-J) and MICROSOFT EXEL 2013 (License 00331-10000-00001-АА404) using parametric (М±m – in the case of a normal distribution of the characteristic under study and Me (Q1; Q3) – in the case of a distribution different from normal) and non-parametric criteria (Mann-Whitney (U) test for unrelated groups). All 62 patients (100.0%) were urgently admitted to a level 3 medical evacuation center. Visual inspection of the wounds in both groups on the 8th day after wounding showed that hyperemia and suppuration of the wounds were not observed. In the comparison group, visual inspection of the wound 11±3.9 days after the injury revealed complications in 7 (21.88%) patients, of which 4 (12.50%) had separation of the wound edges, and 3 (9.38%) – hematoma with suppuration of the wound. In the main group, seroma formation was detected in one patient (3.33%). (U= 220.00 p=0.0385). The duration of inpatient treatment at the stage of tertiary medical evacuation was 28±2.3 days in the comparison group and 19±3.1 days in the main group, U= 290.00, p=0.0354. So, the use of early secondary sutures in combination with PRP ensures effective growth of granulation tissue in the wound canal and reduces the frequency of wound edge separation. (comparison group of 4 patients - 12.50%, in the main group, the separation of the wound edges was not recorded, U= 230.00 p=0.0320. Antibacterial, anti-inflammatory properties of PRP in the treatment of gunshot blind shrapnel wounds reduce the frequency of development of wound suppuration and seroma formation (comparison group 3 patients (9.38%), in the main group seroma formation was detected in one patient (3.33%, U= 220.00 p=0.0310). The use of autoplasma saturated with platelets allows to reduce the length of stay of patients in inpatients at the third stage of medical evacuation: in the comparison group (28±2.3 days), in the main group (19±3.1 days, U = 290.00, p = 0.0354).