Tactics and Technique of Treatment of Large Extremity Segment Avulsion in Polytrauma Patients

Abstract


At department of concomitant and multiple trauma of Scientific Research Institute of Emergency Care named after N.V. Sklifisovskiy 177 patients with polytrauma were treated from 1999 to 2009. All patients had avulsions and crushes of large segments of extremity including crus (66 patients - 37%), thigh (44 patients - 25%), foot (41 patients - 23%), shoulder (14 patients - 8%) and forearm (12 patients - 7%). In 99 patients (control group) the treatment was performed according to routine protocol: amputation by the type of primary surgical treatment (PST), topical treatment of wounds using antiseptic and salve dressings, autodermoplasty after wound granulation. In 78 patients (test group) new tactics of treatment was applied. Terms of performance and volume of amputation were determined based on the principles of injury control. In stable condition of patients amputation within the limits of intact tissues with stump formation and suturing was performed. In avulsion of extremity at the superior third of crus the amputation by type of PST was applied for preservation of knee joint. Sawing tibia surface was covered by gastrocnemius muscle and local wound treatment was performed with hydrohelium dressings and vacuum systems. After wound preparation autodermaplasty was carried out. In severe condition of patients the amputation by type of PST was performed at any level of avulsion. After stabilization of patients state topical wound treatment or reamputation within the limits of intact tissues was performed. Use of new treatment tactics allows decreasing the rate lethality by 6% versus 11% in control group, shortening the terms for patients' preparation for injured bone osteosynthesis, decrease of hospital treatment duration and terms of preparation for prosthetics and significantly improving functional treatment results.

References

  1. Бялик И.Ф., Клюквин И.Ю., Шишкин Б.В. Хирургическая тактика лечения больных с полными и неполными отрывами конечностей //Сов. мед. - 1987. - N 12. - С. 43-46.
  2. Бялик И.Ф., Клюквин И.Ю., Шишкин Б.В. Профилактика инфекции при лечении отрывов двух и более конечностей //Профилактика и лечение гнойных осложнений в хирургии и травматологии: Труды НИИ СП им. Н.В. Склифосовского. - М., 1988. - Т. 73. - С. 97-100.
  3. Гиршин С.Г. Клинические лекции по неотложной травматологии. - М., 2004. - С. 37-38.
  4. Дерябин И.И., Цагарешвили Е.А., Гуманенко Е.К. и др. Показания, способы и результаты ампутаций конечностей при изолированных, множественных и сочетанных травмах //Вестн. хир. - 1987. - N 6. - C. 129-133.
  5. Клюквин И.Ю., Шишкин Б.В., Андрианов В.А., Бялик И.Ф. Тактика лечения ран при травматических ампутациях //Раны и раневая инфекция: Материалы 2-й Всесоюз. конф. - М., 1980. - С. 118-119.
  6. Клюквин И.Ю. Результаты лечения больных с травматическими ампутациями конечностей //Гнойные осложнения в неотложной хирургии и травматологии: Труды НИИ СП им. Н.В. Склифосовского. - М., 1986. - Т. 67. - С. 69-72.
  7. Клюквин И.Ю., Золотухина И.Г. Формирование функциональных культей конечностей при тяжелой механической травме //Сов. мед. - 1989. - N 10. - С. 14-17.
  8. Andreassen G.S., Madsen J.E. A simple and cheap method for vacuum-assisted wound closure //Acta Orthop. Scand. - 2006. - Vol. 77, N 5. - Р. 820-824.
  9. Ebrahimzadeh M.H., Rajabi M.T. Long-term outcomes of patients undergoing war-related amputations of the foot and ankle //J. Foot Ankle Surg. - 2007. - Vol. 46, N 6. - P. 429-433.
  10. Fleischmann W., Strecker W., Bombelli M., Kinzl L. Vakuumversiegelung zur Behandlung des Weich-teilschadens bei offenen Frakturen //Unfallchirurg. -1993. - Bd 96, H 2. - S. 488-492.
  11. Hildebrand F., Giannoudis P., Kretteck C., Pape H.C. Damage control: extremities //Injury. - 2004. - Vol. 35, N 7. - P. 678-689.
  12. Pape H.C., Hildebrand F., Pertschy S. et al. Changes in the management of femoral shaft fractures in polytrauma patients: from early total care to damage control orthopedic surgery //J. Trauma. - 2002. - Vol. 53. - P. 452-462.
  13. Pozo J.L., Powell B., Andrews B.G. et al. The timing of amputation for lower limb trauma //J. Bone Jt Surg. - 1990. - Vol. 72. - P. 288-292.

Statistics

Views

Abstract - 37

Cited-By


Article Metrics

Metrics Loading ...

Refbacks

  • There are currently no refbacks.

Copyright (c) 2010 Sokolov V.A., Didenko O.A., Byalik E.I., Ivanov P.A., Smirnov K.S., Nevedrov A.V.

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies