Experiment Study On Primary Surgical Management After Gunshot Wounds On Swine's Extremities In Hot And Humid Environment

Objective (1) To compare the curative effect of three methods on primary surgical management ( (1) primary closure after meticulous debridement (2)open drainage following meticulous debridment (3) open drainage following limited debridment ) in certain time for missile injuries of swine extremities in hot and humid environment (2) To investigate the feasibility of primary closure and continual irrigation after limited debridment. (3)To observe the curative effect of primary closure by flap coverage with continual irrigation after limited debridment in repairing the skin and soft tissue defect on the swine extremities reduced by blast injury.Methods (1) To establish the animal model for gunshot wounds on swine's extremities in hot and humid environment. 18 swine fired on back extremities were put respectively in hot and humid environment for 2h and 4h. In each time, 9 swine were assigned randomly into primary closure after meticulous debridement group (3 cases, 61imbs) open drainage after meticulous debridement group (3 cases, 61imbs) and open drainage after limited debridement (3 cases, 61imbs) for operation and observation. At the time of preoperative point(0h) and postoperative ones of 8h, 24h, 48h, 72h and lw, the WBC counts were measured and the bacterial cultures and counts were performed as well as the wounds healing time were observed. (2) 12 swine fired on back extremities were put respectively in hot and humid environment for 4h and 8h. In each time, 6 swine were assignedrandomly into pen drainage after limited debridement (3 cases, 61imbs) and primary closure and continual irrigation after limited debridment (3 cases, 61imbs) . for operation and observation. At the time of preoperative point(0h) and postoperative ones of 8h, 24h, 48h, 72h and 1w, the endoxoxin level in blood were measured and the bacterial cultures and counts were performed as well as the wounds healing time were observed. (3) 10 swine fired on back extremities were assigned randomly into open drainage and second closure after limited debridement (5 cases, 10limbs) and primary closure by flap coverage with continual irrigation after limited debridment (5 cases, 10limbs) . for operation and observation after in hot and humid environment for 72h. At the time of preoperative point(Oh) and postoperative ones of 8h, 24h, 48h, 72h and lw, the endoxoxin level in blood were measured and the bacterial cultures and counts were performed as well as the wounds healing time were observed.Results (1) At 2h point time after injured, the curative effect of primary closure after meticulous debridement is better than other groups in wounds healing time, bacterial counts et al. The open drainage after limited debridement is taken second place. At 4h point time after injured, the open drainage after limited debridement is better than other groups in wounds healing time,bacterial counts et al. The open drainage after meticulous debridment is taken second place.(2) The curative effects of primary closure with continual irrigation and drainage after limited debridment at both 4h and 8h point time were better than open drainage after limited debridment in wounds healing time, bacterial counts, the infection rate of wounds tract, the endoxoxin level in blood. (3) Primary closure by flap coverage with continual irrigation and drainage after limited debridment compare with open drainage and second closure after limited debridment, the infection rate do not enhance and the wounds healing time reduce half of that.Conclusions (1) In common used of primary surgical managements,we find that the open drainage after limited debridment is more suitably for the limb gunshot wound in hot and humid environment. (2) By primary closure with continual irrigation and drainage after limited debridment, both the healing time of wounds can be shorten and the infection rate do not enhanced while the later gunshot wounds can be management by primary closure and more accord the principle of orthopaedics than open drainage after limited debridement. (3 ) The application...