Moscow State Medico-Stomatologikal University, Maxillo-facial Traumatology Department, Moscow, Russia.
J Craniomaxillofac Surg. 2013 Jan;41(1):e8-16. doi: 10.1016/j.jcms.2012.04.001. Epub 2012 Sep 19.
Over the period 1981-1985 the author treated 1486 patients with facial gunshot wounds sustained in combat in Afghanistan. In the last quarter of 20th century, more powerful and destructive weapons such as M-16 rifles, AK-47 and Kalashnikov submachine guns, became available and a new approach to gunshot wound debridement is required. Modern surgeons have little experience in treatment of such wounds because of rare contact with similar pathology. This article is intended to explore modern wound debridement. The management of 502 isolated soft tissue injuries is presented. Existing principles recommend the sparing of damaged tissues. The author's experience was that tissue sparing lead to a high rate of complications (47.6%). Radical primary surgical debridement (RPSD) of wounds was then adopted with radical excision of necrotic non-viable wound margins containing infection to the point of active capillary bleeding and immediate primary wound closure. After radical debridement wound infection and breakdown decreased by a factor of 10. Plastic operations with local and remote soft tissue were made on 14, 7% of the wounded. Only 0.7% patients required discharge from the army due to facial muscle paralysis and/or facial skin impregnation with particles of gunpowder from mine explosions. Gunshot face wound; modern debridement.
1981 年至 1985 年间，作者治疗了 1486 名在阿富汗战斗中面部枪伤的患者。在 20 世纪最后四分之一，更强大和更具破坏性的武器，如 M-16 步枪、AK-47 和卡拉什尼科夫冲锋枪，变得可用，需要一种新的枪伤清创方法。由于很少接触类似的病理学，现代外科医生在处理此类伤口方面经验有限。本文旨在探讨现代伤口清创。介绍了 502 例孤立性软组织损伤的处理方法。现有的原则建议尽量保留受损组织。作者的经验是，保留组织导致并发症发生率很高（47.6%）。然后采用激进的一期清创术（RPSD）对伤口进行激进清创，切除感染的坏死非存活的伤口边缘，直至出现活跃的毛细血管出血，并立即进行一期伤口闭合。激进清创后，伤口感染和破裂减少了 10 倍。对 14%的伤员进行了局部和远程软组织的整形手术。只有 0.7%的患者因面部肌肉瘫痪和/或面部皮肤被火药颗粒浸渍而需要从军队中退役。枪伤面部伤口；现代清创术。
