TREATMENT OF GUNSHOT WOUNDS AND STUMPS OF AMPUTATED LIMBS USING METHODS VAC-THERAPY AND PHOTODYNAMIC THERAPY gvkg2024@mail.ru

 

TREATMENT OF GUNSHOT WOUNDS AND STUMPS OF AMPUTATED LIMBS USING METHODS VAC-THERAPY AND PHOTODYNAMIC THERAPY

8

Russia

Oral or Poster

Modern ammunition causes multiple, extensive tissue damage.

Records of 50 wounded with gunshot skin defects ranging from 50 cm2 to 140 cm2 were analysed. In group 1 (n=26) VAC-therapy was used, in group 2 (n=24) VAC-therapy in combination with laser photodynamic therapy (PDT) was used. Upon admission, a culture of the wound discharge was performed to determine the flora with CFU and sensitivity to antibiotics. The negative pressure level VAC-therapy was set at 100 mmHg.Art. PDT sessions were carried out in a combined light mode (400nm+660nm with a power of 40 mW/cm2) for 20 minutes. After each change of the VAC-system, the dynamics of the wound process was assessed using wound area, percentage of granulation and wound decontamination.

The predominant species in the wounds were: Staphylacoccus epidermidis (32%), Enterococcus faecalis (28%), Klebsiella pneumonia (20%), Acinotobacter baumannii (13%) and others. Microbial contamination of wounds in all cases was significantly higher than critical and averaged (2.7±0.4)x108 CFU/ml. The microflora was resistant to most of the antibiotics (almost 100% resistance to penicillins, cephalosporins, and more than 55% to carbapenems). In group II wound decontamination was achieved 54% faster than in group I, and after two sessions it was achieved in all wounded. Granulations in group II appeared significantly earlier (p<0.01). The rate of wound healing in group II was higher than in group I.

VAC-therapy in combination with PDT reduces the duration of the phases of the wound process, the time required to prepare wounds for final closure, and accelerates their healing.