Experimental closure of gunshot wounds by fibrin glue with antibiotics in pigs.
2015
Background/Aim. Gunshot wounds caused by the automatic rifle M70AB2 (AK-47)
7.62 mm, after the primary surgical management, were closed with delayed
primary suture during the next four to seven days. This period coincides with
the fibroblastic phase of wound healing. Fibrin glue is used as a local
hemostatic and as a matrix for the local dosed release of antibiotics.
Antibiotics addition to fibrin glue resulted in continuous diffusion into the
surrounding next 4 to 7 days. The aim of this study was to create the
preconditions for gunshot wounds closing without complications by the
application of fibrin glue with antibiotics 24 h after primary surgical
treatment. Methods. A total of 14 pigs were wounded in the gluteofemoral
region by the bullet M67, initial velocity of 720 m/s. All wounded animals
were surgically treated according to the principles of the warsurgery
doctrine. Seven wounds were closed with primary delayed suture four days
after the primary surgical treatment (traditional approach). Fibrin glue with
antibiotics was introduced in seven wounds during the primary surgical
treatment and primary delayed suture was done after 24 h. The macroscopic
appearance and the clinical assessment of the wound were done during the
primary surgical treatment and during its revision after 24 h, as well as
histopathological findings at the days 4 and 7 after wounding. Results.
Gunshot wounds caused by the automatic rifle M70AB2 (AK-47) 7.62 mm, and
treated with fibrin glue with antibiotics after primary surgical management,
were closed with primary delayed suture after 24 h. In further wound
evolution there were no complications. Conclusion. Uncomplicated soft-tissue
wounds caused by an automatic M70AB2 rifle may be closed primarily with
delayed suture without the risk of developing complications if on revision,
24 h after primary surgery, there were no present necrotic tissues, hematoma,
and any signs of infection when fibrin glue with antibiotics (ceftriaxone and
clindamycin) was applied. The use of this method should be limited to
individual and strictly controlled cases in civil practice for now.
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