| Abstrakt: |
War wounds of the extremities represent a particular clinical, diagnostic and therapeutic entity which differs significantly from the wounds acquired in peacetime circumstances. These are very complex wounds due to uncontrolled damage of tissue, various and numerous localizations, openings of sterile body spaces and contamination from enormous quantities of bacteria. Contamination of the wound is caused by the microflora of the host and exogenous microflora from the environment. These wounds are at a high risk of local or systemic infection. Infection will develop within six hours if adequate surgical treatment is not performed, and an application of antibiotics isn't applied immediately or within three hours of the wound occurring. Apart from exposure factors, numerous predisposing factors influence the development of infection (shock, loss of blood, hypoxia, haematomas, etc.). Etiologic agents of infection are predominantly gram-positive aerobic cocci: Staphylococcus spp, Streptococcus spp, Enterococcus spp, followed by gram-negative facultative aerobic rods: members of the Enterobacteriaceae family (Echerichia coli, Proteus mirabilis, Klebsiella pneumoniae, Enterobacter cloacae), gram-negative bacteria from the environment: Pseudomonas aeruginosa, Serratia marcescens, Acinetobacter baumannii, anaerobic gram-positive sporogenic rods (Clostridium spp) and gram-negative asporogenic rods (Bacteroides spp). The expected frequency of infection, according to literature is 35% - 40%. In delayed surgical debridement > 12 hours, or application of antibiotics > 6 hours since wounding, the war wound is primarily infected (early infection) in > 50% cases. During The Civil War in Croatia between August 1991 and December 1995 the Surgical Clinic of the 'Sveti Duh' General Hospital treated 515 patients wounded in battle. Of this number 126 had bone injuries which required external fixation as the means of treatment of fractures. Treatment complications in the 126 patients with external fixation were the following: infection in the tissue surrounding the pins (41), osteomalacia around the pins (21), inadequate position of bone fragments (8) and chronic osteomyelitis (9). The study comprised 59 patients with external fixation who developed infection. Of this number 40 patients (64.8%) were brought to the Clinic within five days of the injury. At the time of admission into the hospital 36 of the patients (61%) had infection; while another 23 (39%) acquired the infection in the hospital. The most frequent etiologic agents were Staphylococcus aureus, Pseudomonas aeruginosa, and Acinetobacter anitratus. [ABSTRACT FROM AUTHOR] |
