Popov V A, Vorob'ev V V
Khirurgiia (Mosk). 1990 Jun(6):26-9.
The authors conducted experimental (130 rabbits) and clinical studies (249 persons) in gunshot wounds of the soft tissues. It was found that in 29% of cases, primary surgical debridement of the gunshot wound failed to be a radical intervention because zones of secondary necrosis of the tissues developed on days 3-4. In view of this, gunshot wounds must be examined without fail on days 3-5 to determine the indications for repeated surgical debridement. The indications for repeated surgical debridement are as follows: foci of necrotic tissues, unopened pockets, the presence of foreign bodies. Repeated surgical debridement of a gunshot wound, when indicated, reduces the number of purulent complications by 4 times and the duration of treatment by 1.5 times.
作者对软组织枪伤进行了实验研究(130只兔子)和临床研究(249人)。结果发现,在29%的病例中,枪伤的一期外科清创术未能成为根治性干预措施,因为在第3 - 4天出现了组织继发性坏死区域。鉴于此,必须在第3 - 5天对枪伤进行检查,以确定重复外科清创术的指征。重复外科清创术的指征如下:坏死组织灶、未开放的腔隙、异物存在。在有指征时,对枪伤进行重复外科清创术可使化脓性并发症的数量减少4倍,治疗时间缩短1.5倍。