Gunshot wounds of the abdomen are often accompanied by a significant destruction of the abdominal cavity with the development of peritonitis, and in the future — various complications (failure of anastomoses, abscess formation, repeated bleeding, etc.), which requires repeated surgical interventions, and as a consequence — the formation of postoperative ventral hernias. The aim of the study is to improve the results of surgical treatment of ventral hernias after gunshot wounds of the abdomen due to the use of laparoscopic techniques. The analysis of treatment of 21 patients with postoperative ventral hernias formed as a result of operations concerning gunshot wounds of the abdomen was carried out. 14 wounded suffered one operation on the abdominal organs in the past (66.7%), 5 — two operations (23.8%), 1 — three operations (4.8%), 1 — five operations (4.8%). The dimensions of the hernial gates and the risk of recurrence were determined according to the SWE classification: W1 — 9 patients (42.9%), W2 — 8 (38.1%), W3 — (9.5%), W4 — 2 (9.5% ). The third patients underwent laparoscopic allogernioplasty according to the IROM technique with a Teflon allograft, which was fixed in 2 cases with the help of a herniostepler, in the 1st — with transdermal separate seams with Teflon filament. Complications after laparoscopic operations were not. The use of laparoscopic techniques can significantly reduce bed-day, avoid the development of abdominal compartment syndrome, previously to activate the patient. Laparoscopic allogernioplasty according to the method of IPOM by the Teflon graft is considered to be the operation of choice.
Особливості хірургічного лікування вогнепальних поранень живота
Українська військово-медична академія вул. Московська, 45/1, Київ, 01015, Україна Військово-медичний клінічний центр Південного Регіону вул. Пироговська, 2, Одеса, 65044, Україна
Summary. Aim. NPWT-therapy (Negative-pressure wound therapy) or VAC-therapy (Vacuum Assisted Clousur) - a modern method of wound healing, which significantly improves the course of all stages of the wound process and is relevant today due to the large number of wounded during hostilities in eastern Ukraine. Often these injuries are combined and lead to the formation of large soft tissue defects. The aim of the study. Improving the results of treatment of the wounded with extensive defects of the soft tissues of the torso and extremities through the use of NPWT therapy. Materials and methods. Under our supervision in the period from 2017 to 2020 there were 60 wounded who were hospitalized in the surgical departments of the Military Medical Clinical Center of the Southern Region, who received vacuum therapy in the treatment of wounds. 38 (63.3%) had gunshot wounds to the extremities, and 22 (36.7%) had soft tissue injuries to the torso. The age of the wounded ranged from 19 to 58 years, among them young people under 30 years of age. Before installing the device, it was necessary to perform surgical treatment with excision of necrotic tissue and removal of fibrin layers. Negative pressure was set at -125 mm Hg. Art. in the non-stop mode for soft tissue defects of the extremities and variable pressure in the -40 mm Hg mode. Art. -70 mm Hg Art. for wounds of the anterior abdominal wall. The duration of treatment with NPWT therapy was from 5 to 25 days. The systems were replaced at least once every 3-5 days. Criteria for discontinuation of NPWT therapy were: cleansing the wound of necrotized tissues and fibrin, improving clinical performance, filling the wound defect with granulation tissue. Results and discussion. The use of this method of treatment allowed to close wound defects by autodermoplasty in 21 patients (35%), primary-delayed sutures in 11 (18%), secondary sutures in 15 (25%) and local tissue plastics in 13 (22%). Complications after NPWT therapy in the form of re-suppuration of the wound, bleeding or perforation of hollow organs and large vessels were not observed. Conclusions. The use of NPWT therapy can significantly increase the effectiveness of comprehensive treatment of the wounded with damage to the soft tissues of the torso and extremities. It allows you to quickly clean the wound surface, fill the wound defect with granulation tissue and prepare the wound for plastic closure.
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