Disorders of Venous and Lymphatic Outflow Following Gunshot Wounds of The Extremities and Lymphological Methods for Their Correction
Dzhumabaev ES
ABSTRACT
Objective: To investigate blood and lymphatic circulation, antibiotic pharmacokinetics, and morphological changes in gunshot wounds (GSWs) of the extremities, and to determine the effect of lymphotropic antibacterial therapy combined with regional stimulation of lymphatic drainage on wound healing.
Materials and Methods: A total of 174 wounded patients were treated, and experimental studies were performed on 57 laboratory rabbits with bullet induced gunshot injuries of the extremities. In the experimental study, the status of venous and lymphatic outflow from the muscles surrounding the wound canal was assessed using a radionuclide method. Light microscopy, scanning electron microscopy, and transmission electron microscopy were used to identify characteristic structural changes in the tissues of the extremities affected by gunshot wounds. The pharmacodynamics of gentamicin in the tissues and lymphatic system of the injured extremity was investigated. In both experimental animals and clinical patients, conventional and lymphological approaches to the treatment of gunshot wounds of the extremities were compared.
Results: Radionuclide studies demonstrated that, on the first day after a bullet-induced gunshot wound, venous blood flow decreased 6.5-fold, from 5.2 ± 0.024 mL/min/100 g in intact animals (n = 7) to 0.81 ± 0.027 mL/min/100 g (P = 0.001), while lymphatic outflow decreased 2.4-fold, from 1.2 ± 0.07 mL/min/100 g in intact animals (n = 7) to 0.49 ± 0.05 mL/min/100 g (P = 0.004).
By day 5, improvement in blood flow (2.2 ± 0.048 vs. 3.9 ± 0.113 mL/min/100 g; P = 0.024) and lymphatic outflow (0.43 ± 0.03 vs. 0.96 ± 0.03 mL/min/100 g; P = 0.012) was observed in the group receiving lymphatic therapy. By day 9, substantial restoration of lymphatic outflow was observed in the lymphatic therapy group (0.98 ± 0.07 mL/min/100 g) compared with the control group (0.55 ± 0.04 mL/min/100 g; P = 0.024).
Morphological examination demonstrated that gunshot wounds were associated with impaired lymphatic drainage of the affected extremity, accumulation of edema fluid, dysmetabolic products, and microorganisms in the interstitial space. Following intramuscular antibiotic therapy, only trace amounts of the antibiotic were detected in the soft tissues and regional lymph nodes of the injured extremity as early as 6 hours after a single administration of the standard therapeutic dose.
Lymphatic therapy resulted in a significant reduction in edema and inflammation and accelerated tissue regeneration, while also providing prolonged accumulation of therapeutic antibiotic concentrations in the examined tissues for up to 24 hours (1.02 ± 0.22 μg/g; P < 0.005). The use of lymphatic therapy as part of the comprehensive treatment of wounded patients reduced the incidence of postoperative wound suppuration from 22.1% to 13.2%, osteomyelitis from 14% to 9%, and sepsis from 5.3% to 2.2% (P < 0.005).
Conclusion: Gunshot wounds result in an early and substantial reduction in blood flow and lymphatic drainage in the affected tissues, accompanied by pronounced edema and accumulation of dysmetabolic products and microorganisms in the interstitial space and lymphatic vessels. Conventional methods of antibiotic administration do not provide sustained therapeutic concentrations in the soft tissues and regional lymph nodes of the injured extremity. Compared with conventional treatment, lymphatic therapy accelerates the healing of gunshot wounds and reduces the incidence of postoperative complications.
