The experience of using of photodynamic therapy in complex treatment of injured with purulent complications of great vessels damages due to mine-blast and shrapnel wounds

Abstract

Introduction. Gunshot and mine-blast traumas are characterized with large size of wound squares and significant damage of tissues. Purulent complications of gunshot wounds occur in 25% of injured and lead to higher mortality. The damages of great vessels of limbs were diagnosed in 208 injured (1.6%) during military conflict in Eastern Ukraine. Purulent complications occurred in 30% of injured. The main components of preventing of wound infection spreading are surgical debridement of wounds and antibacterial therapy. The increasing multidrug antibiotic resistance of wound microflora is observed during last years. The research of methods of nonmedical ways of fighting with wound infection contagiums seems to be very actual. Phototherapy and photodynamic therapy are one of them.

The goal of research. To improve the results of treatment of purulent complications in injured with great vessels damages be mean of using of rational surgical tactics and using such methods of physical treatment as phototherapy and photodynamic therapy in complex treatment of wounded.

Materials and methods. The research is based on analysis of results of treatment of 9 patients with mine-blast, gunshot and shrapnel injures and great vessels damages of limbs, that were treated in GI “V.T. Zaycev Institute of General and Urgent Surgery of NAMS of Ukraine”. Specialized angiosurgical treatment, phototherapy and photodynamic therapy were used for complex treatment. Korobov’s photonic matrixes “Barva-flex” with wave lengths 660 nm, 470 nm, 525 nm and 405 nm were used for treatment of injured. Dimegin was used for photosensibilization. Phototherapy was used for treatment of all wounded, while photodynamic therapy was used in 3 patients with multidrug resistant wound microflora.

Results. The terms of treatment depended on wound condition. The decreasing of perifocal edema was observed to 2-3day after onset of suggested treatment, while the quality of granulations and stage of epithelisation were improved significantly to 5-7 day. The square of wound’s surface was 391,3100,42 sm2 on the average before treatment and decreased to 63,95± 100,42 sm2 on the average before treatment and decreased to 63,95±20,2 sm2 to 10-12 days from onset of treatment (p<0,01). The speed of wound healing was 1,58±0,44 on 5-7 day from onset of treatment and 4,72±0,63 to 10-12 day (p<0,01) The results of bacterial examination showed the decreasing of antibiotic resistance of pathogenic microflora when phototherapy was used. Significant bactericidal effect of photodynamic therapy was also established.

Discussion. The average terms of wound healing in injured without great vessels damage were 14- 17 days if traditional treatment was used. The possibility of using of photodynamic therapy for antibiotic resistant infections and blue light irradiation of wounds after photomodification in patients with combat trauma were shown by domestic and foreign authors. The using of suggested approach allowed to increase the time of wound healing, to decrease wound cleaning, the allows to prepare wound for closing, and to decrease the terms of wound healing on 21,4%, respectively.

Conclusion. The antibacterial effect of photodynamic therapy decreases risk of vessel anastomosis’ incompetence and arrosive bleeding appearance, that influence significantly on mortality and quantity of secondary amputations. The using of suggested approach is recommended in injured with multidrug resistant wound microflora, especially if problem group “ESKAPE” is present.