Disorders of Venous and Lymphatic Outflow in Cases of Gunshot Wounds of Extremities and Use of Lymphological Therapies

The objective was to study the venous and lymphatic outflow of the limb in cases of gunshot wounds (GWs) and to assess the effect of lymphotropic antibacterial therapy with regional stimulation of lymphatic drainage on blood and lymph circulation. Materials and methods. Experimental studies were performed on 57 laboratory rabbits with a bullet gunshot injury of the limb, divided into three groups: in the test group (25 animals), lymphotropic antibiotic therapy and lymphatic drainage stimulation were used, in the comparison group (25 animals), standard of care (intramuscular antibiotic therapy) was used; 7 animals without GW and treatment were included in the control group. The state of venous and lymphatic outflow from the muscles of the wound channel was studied using the radionuclide scanning. Conventional and lymphological approaches in the treatment of limb GWs were compared. Results. Radionuclide studies showed that a gunshot bullet wound on Day 1 reduced 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 (pintact=0.001); lymphatic outflow slowed 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 (pintact=0.004). On Day 5, improvement in blood flow (2.2±0.048 mL/min/100 g in the comparison group; 3.9±0.113 mL/min/100 g in the test group; p=0.024) and lymphatic outflow (0.43±0.03 and 0.96±0.03 mL/min/100 g, respectively; p=0.012) was observed in the group of animals treated with lymphotherapy. On Day 9, there was a significant recovery in lymphatic outflow in the lymphatic therapy group vs. the comparison group: 0.98±00.7 vs. 0.55±0.04 mL/min/100 g, respectively (p=0.024). Conclusions. GWs result in early significant slowing of blood flow and impairment of lymphatic drainage of affected tissues. Regional lymphotropic antibiotic therapy with lymphostimulation leads to earlier recovery of the lymphatic and venous outflow from the wound channel compared with conventional treatment. The inclusion of lymphatic therapy in the complex treatment of limb GWs can accelerate the healing and reduce postoperative complications.

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