Photodynamic therapy in the treatment of patients with gunshot wounds of the extremities

Abstract

In press

Background. Gunshot wounds of soft tissues remain a major challenge in modern surgery. Their microbiological profile is characterized by polymicrobial contamination (≈50% of cases) with a predominance of Gram-negative flora (≈80%). The increasing antimicrobial resistance limits the effectiveness of conventional treatment approaches for gunshot wounds.

Aim. To evaluate the clinical efficacy of photodynamic therapy in the local treatment of gunshot soft tissue wounds.

Materials and Methods. A non-randomized comparative study was conducted involving 40 patients with combat fragmentation wounds of the soft tissues of the extremities. Patients were divided into two groups: the main group (n=20), treated with photodynamic therapy, and the comparison group (n=20), receiving standard treatment. Treatment effectiveness was assessed based on wound area dynamics, healing rate, level of microbial contamination, complication rate, and duration of hospitalization. Statistical analysis was performed using Epi Info 8.0 software (CDC, USA). The study was conducted within the framework of the research project with state registration number 0124U002908 and the author's dissertation.

Research Ethics. The study was conducted in accordance with the principles of the World Medical Association Declaration of Helsinki (1964–2024). Written informed consent was obtained from all patients. The study design and methods were approved by the Ethics Committee of Kharkiv National Medical University (Protocol No.2 of October 12, 2022).

Results. The use of photodynamic therapy resulted in a rapid reduction of microbial load: on day 5, contamination levels were [10²–10³] CFU/mL in 70% of patients in the main group versus 15% in the comparison group (p<0.01). A more pronounced reduction in wound area was observed: by day 14 – [55±3] mm² vs [75±5] mm² (p<0.01). The time to complete wound closure was [16.8±2.3] days in the main group compared to [18.4±3.1] days in the comparison group (p<0.05). The duration of hospital stay was shorter in the main group [16.5±1.8] days vs [19.2±2.1] days (p<0.05).

Conclusions. The obtained results indicate the effectiveness of photodynamic therapy. Its antimicrobial effect is combined with stimulation of reparative processes, leading to faster wound cleansing and healing. Photodynamic therapy effectively reduces microbial load in wounds and accelerates reparative processes. Its use shortens the time required for wound preparation for surgical closure and reduces the incidence of postoperative complications.

Keywords: surgery, photomodulation, wound healing, combat trauma.