Applicability of Ultrasonic Cavitation in Complex Treatment of Combat Surgical Trauma

Abstract

Background: The history of gunshot wound treatment dates back several centuries. However, every new war or protracted armed conflict makes surgeons return to this issue. In recent years the nature of wounds changed: injuries become more severe, with a larger amount of damaged tissue. Among the wounded persons, blast and fragment injuries prevail over gunshot injuries. Gunshot wounds, as a rule, differ from wounds inflicted by old-style weapons in the scale, depth, and severity of anatomical destruction of soft tissue and bones. Modern physical methods of wound management and preparation of wounds for plastic closure, such as low-frequency ultrasound, enable to debride the wound surface with minimal damage to viable tissues and perform plastic closure of soft tissue defects as radically and as early as could be.Objective: To improve methods of primary surgical debridement in patients with combat surgical trauma using low-frequency ultrasound.Materials and methods: We studied treatment results in 176 wounded and injured people hospitalized in the burn unit and the division of plastic surgery and cell transplantation at the V.K. Gusak Institute of Emergency and Reconstructive Surgery (Donetsk, Russian Federation) between 2015 and 2023. All the patients were divided into 2 groups. Group 1 (main) included 86 patients who underwent surgical wound debridement with ultrasonic cavitation. Group 2 consisted of 90 patients who were operated on without ultrasonic wound debridement. The groups of patients were comparable.Results: After surgical wound debridement, segmented neutrophils (78%-68%) were the main type of blood cells. After ultrasonic wound debridement, the amount of detritus decreased by 3.75 times. In the main group, the number of fibroblasts was 1.88 times higher than that in the comparison group. On day 4, the specific area of the granulation tissue was 1.7 times higher in the main group compared with that in the comparison group. Results of the morphometric control revealed that on day 4 the number of capillaries in the granulation tissue was 31.3 ± 2.5 units in the main group and 20.0 ± 1.12 units in the comparison group. Ultrasonic cavitation of wounds helps suppress wound infection by day 4-5 of treatment: in 82.2 ± 5.7% of the patients, the number of microorganisms per gram of tissue decreased below the “critical number”, whereas in the comparison group it was achieved in 28.9 ± 6.7% of the patients. According to laser Doppler flowmetry findings, we obtained a statistically significant increase in the mean blood flow value (M index) by 1.22 times 24-48 hours after surgical treatment. In the main group, 11.6 ± 3.4% of complications were reported, whereas in the comparison group it was 24.5 ± 4.4%, P < .05. The mean number of operations per person was 1.6 ± 0.4 in the main group and 2.8 ± 0.5 in the comparison group, P < .05. The mean duration of inpatient treatment was 13.5 ± 3.4 days in the main group and 24.3 ± 2.5 days in the comparison group, P < .01.Conclusions: We can conclude that ultrasonic cavitation is advantageous in routine surgical debridement of gunshot wounds followed by primary or delayed primary closure.

Keywords

• ultrasonic cavitation
• low-frequency ultrasound
• gunshot wounds
• combat surgical trauma