The Results of Treatment and Testing of the Developed Method of Complex Treatment of Wounds and Trophic Ulcers Based on the Our Experience of Treatment of Wounded with Military Trauma

Introduction: During the environmental protection in eastern Ukraine was recorded 243 cases, included damage of the artery in 113 cases (46.5%); in 27 (11.1%)—damage of the vein; in 103 cases (42.4%) - both. In 208 cases (85.6%) we identified satisfactory result, in 20 (8.2%)—the treatment resulted in amputation of lower extremities, in 11 (4.5%)—the treatment resulted in amputation of upper extremities, in 4 cases (1,7)—lethal. The presence of long-term non-healing wounds was the reason for improving the method of their treatment. The purpose of the work was to study the main structure and results of treatment of injuries of the main vessels of the lower extremities during the Joint Forces Operation (JFO) at the 4th stage of angiosurgical care and implement the developed method of complex treatment of patients with wounds and trophic ulcers.

Materials and Methods: The study was performed on the basis of the vascular surgery clinic of the National Military Medical Clinical Center (Kyiv), included 57 cases of patients’ treatment at the National Military Medical Clinical Center of Kyiv in the period from 2014 to 2019 during the environmental protection in eastern Ukraine. In retrospective and prospective mode, the study of medical records of patients who were in the 4th stage of medical evacuation in the clinic was conducted.

Results: Among all injuries, 88.2% were combat, and 11.8% - non-combat. Among injuries involved damage of the artery was in 20 cases (35/1%); in 6 (10.5%)—damage of the vein; in 31 c(54.4%)—both. The localization of the CGW was the following: in 46 individuals (76.5%) of the injuries were in femoropopliteal area, in 11 (21.6%)—peroneal, in 1 (1.9%) - both. There was performed 565 operations in 57 patients; 88 (15.6%) of them—on the main vessels, 15 (2.7%)—amputations and re-amputations, 383 (67.6%)—surgical treatments, 80 (14.1%)—other—on perforating main veins due to post-thrombotic disease. Analyzing the results of treatment in 43 cases(75.4%) there was identified satisfactory. In 44 (86.3%) of the injured had trophic changes, mainly in the soft tissues of the extremities, which complicated treatment. Correction of the main blood flow was the basis of success, but local treatment was crucial. The introduction of low-energy laser radiation in clinical practice significantly accelerates healing. It was important to use electrocoagulation using an electric welding machine for ablation of unsuccessful perforated veins in the area of ulcers of venous origin. A monopolar tool was created, which is used for this purpose under ultrasonic control. Our priority was the development of a comprehensive electric welding machine that allows you to remotely control the video camera to perform high-frequency electric welding for ablation of perforating veins with the supply of solutions to the area of its influence. Such a device was created and successfully used in the treatment of 18 (35.3%).

Conclusion: Trophic ulcers and wounds are caused by several factors, so their treatment should always be comprehensive: Estimation of wound area and trophic ulcer; Study of the genesis of trophic ulcers; Surgical treatment for the correction of blood flow disorders; Conservative treatment (antibiotic anticoagulant therapy, anti-inflammatory and analgesic drugs, antisecretory drugs);Rehabilitation of ulcers and stimulation of their healing with the use of topical agents; Leukocyte serum; Physiotherapeutic methods; Hyperbaric oxygenation; Ultrasonic cavitation using low-frequency ultrasound.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
10 June 2022