The aim of this study was to examine blood and lymphatic circulation, antibiotic pharmacokinetics, and morphological changes in a gunshot wound of the extremity, and to determine the effect of lymphotropic antibacterial therapy with regional stimulation of lymphatic drainage on wound healing. Material and Methods. A total of 174 wounded patients were treated, and experiments were performed on 57 laboratory rabbits with gunshot wounds of the extremities. In this experiment, the state of venous and lymphatic outflow from the muscles of the wound channel was studied using a radionuclide method. Using light, scanning, and transmission electron microscopy, characteristic structural changes were identified in the tissues of a limb with a gunshot wound. The pharmacodynamics of gentamicin were studied in the tissues and lymphatic system of the limb with a gunshot wound. Traditional (intramuscular antibiotic therapy) and lymphological (lymphotropic antibiotic therapy + lymphostimulation) approaches to treating gunshot wounds of the extremities were compared in experimental animals and in clinical settings. Results. Radionuclide studies have shown that a gunshot wound, in 24 hours, reduces venous blood flow by 6.5 times, from 5.2±0.024 ml/min/100 g (nintact.=7), to 0.81±0.027 ml/min/100 g (nintact.=0.001), lymph flow slows down by 2.4 times, from 1.2±0.07 ml/min/100 g (nintact.=7), to 0.49±0.05 ml/min/100 g (nintact.=0.004). On the 5th day, an improvement in blood flow (2.2 ± 0.048 comp.; 3.9 ± 0.113 ml / min / 100 g. lymph., P = 0.024) and lymph drainage (0.43 ± 0.03 comp.; 0.96 ± 0.03 ml / min / 100 g. lymph., P = 0.012) was observed in the group of animals where lymphotherapy was used. On the 9th day, a significant restoration of lymph drainage was observed in the group with lymphatic therapy - 0.98 ± 0.7 ml / min / 100 g, compared with the comparison group - 0.55 ± 0.04 ml / min / 100 g, (P = 0.024). Morphological studies have shown that a gunshot wound is accompanied by the development of lymphatic drainage insufficiency in the tissues of the affected limb, with the accumulation of edema fluid, metabolic waste products, and microbes in the interstitium. With intramuscular antibiotic therapy, only traces of the antibiotic are present in the soft tissues and regional lymph nodes of the affected limb within 6 hours after a single administration of the average therapeutic dose. Lymphatic therapy significantly reduces swelling and inflammation, accelerates tissue regeneration, and promotes prolonged (up to 24 hours) accumulation of therapeutic antibiotic concentrations in the examined tissues (1.02 ± 0.22 mkg/g (Pim<0.005)). The use of lymphotherapy in the comprehensive treatment of the wounded contributed to a decrease in the incidence of suppuration of the subcutaneous wound from 22.1% to 13.2%, osteomyelitis from 14% to 9%, and sepsis from 5.3% to 2.2% (P < 0.005). Conclusion. A gunshot wound leads to an early significant slowdown in blood flow and lymphatic drainage of the affected tissues, the development of severe edema, and the accumulation of metabolic products and microbes in the interstitium and lymphatic vessels. Traditional methods of antibiotic administration do not provide prolonged therapeutic concentrations in the soft tissues and lymph nodes of the wounded limb. Lymphatic therapy, when compared with traditional treatment, creates prolonged therapeutic concentrations of the antibiotic in the tissues and lymphatic bed of the affected limb, accelerates the healing process of the gunshot wound, and helps reduce the incidence of postoperative complications.

To be updated