The role of regional lymphatic therapy in gunshot wounds of the extremities

Received: 2025-12-20 14:26:25

Published: 2026-02-27

Abstract

Cases of gunshot wounds of the extremities are increasing every year in the Republic of Uzbekistan and other countries of the world. The urgency of this problem is justified by the high rates of death, purulent-septic complications, and disability, especially given the progress in the development of new types of weapons with greater penetrating power. The purpose of this study was to conduct experimental regional lymphatic treatment and use the results of the protocol to manage patients with isolated and combined gunshot wounds of the extremities. To achieve the goal of the study, 169 patients with gunshot wounds of the extremities were examined and divided into four main groups receiving lymphotherapy and control subgroups receiving standard treatment. In experimental studies, gunshot wounds of the extremities on the first day after injury are characterized by volumetric swelling of the intercellular space with the accumulation of microbes and deposition of fibrin, cellular dentin, and necrobiosis products in the lymph nodes. The use of regional lymphatic therapy in the experimental groups showed an active and rapid process of soft tissue regeneration in the traumatized area compared to that in the control group. Timely sorting and transportation of the wounded to specialized medical institutions contributed to the high effectiveness of surgical and therapeutic treatment methods in the first hours after the injury. The use of lymphotropic antibiotic therapy with cephalosporins or aminoglycosides and lymphatic stimulation showed positive dynamics of connective tissue remodelling, consistently high and long-term concentration of drugs in the lymph nodes, and low rates of infectious complications. The data obtained can be used in military medicine, emergency medicine, and surgery to improve protocols for managing patients with gunshot wounds of the extremities and the introduction of tactics aimed at preserving the functionality of regional tissues and preventing infectious complications.

List of references

  1. Baum, G.R., Baum, J.T., Hayward, D., MacKay, B.J. 2022. Gunshot wounds: Ballistics, pathology, and treatment recommendations, with a focus on retained bullets. Orthopedic Research and Reviews, 14, 293-317.

  2. Goel, R., Zhu, X., Makhani, S., Petersen, M.R., Josephson, C.D., Katz, L.M., Shaz, B.H., Austin, R., Crowe, E.P., Ness, P.M., Gehrie, E.A., Frank, S.M., Bloch, E.M., Tobian, A.A.R. 2021. Blood transfusions in gunshot‐wound‐related emergency department visits and hospitalizations in the United States. Transfusion, 61(8), 2277-2289.

  3. Wang, Y., Chen, Q., Dang, X., Lu, W., Zhang, X., Yan, H., Niu, S., Yan, X., Yan, J. 2023. A bibliometric analysis on traumatic brain injury in forensic medicine of a half-century (1972-2021). Frontiers in Neurology, 14, 913855.

  4. Circo, G.M., Wheeler, A.P. 2021. Trauma center drive time distances and fatal outcomes among gunshot wound victims. Applied Spatial Analysis and Policy, 14, 379-393.

  5. Zeineddin, A., Williams, M., Nonez, H., Nizam, W., Olufajo, O.A., Ortega, G., Haider, A., Cornwell, E.E. 2021. Gunshot injuries in American trauma centers: Analysis of the lethality of multiple gunshot wounds. The American Surgeon, 87(1), 39-44.

  6. Abduraxmanovich, A.A., Alisherovich, U.X., Kodirkul ogli, T.Zh. 2021. Intestinal injury at combined abdominal injury. Academicia Globe: Inderscience Research, 2(6), 196-202.

  7. Yahyoev, S.O., Khodzhimatov, G.M. 2022. Diagnostic methods and surgical treatment of patients with thoracoabdominal traumas (review of the literature). Polish Journal of Thoracic and Cardiovascular Surgery, 19(4), 226-231.

  8. Okhunov, A.O., Boboev, K.Kh. 2023. Etiological factors leading to purulent mediastinitis. World Bulletin of Public Health, 18, 118-125.

  9. Benjamin, E. R., Demetriades, D., Owattanapanich, N., Shackelford, S.A., Roedel, E., Polk, T., Biswas, S., Rasmussen, T. 2022. Therapeutic interventions and outcomes in civilian and military isolated gunshot wounds to the head: A department of defense trauma registry and ACS TQIP-matched study. Annals of Surgery, 10-1097. https://pubmed.ncbi.nlm.nih.gov/35786669/

  10. Jakobsen, L.S., Christensen, M.T., Lundemose, S.B., Munkholm, J., Bugge, A.B.D., Lynnerup, N., Banner, J. 2021. Life-threatening danger assessments of penetrating injuries in Eastern Danish clinical forensic medicine. International Journal of Legal Medicine, 135, 861-870.

  11. Luria, S. 2022. Treatment of upper extremity palsies, gunshot wounds and scaphoid nonunion: my preferred approaches. Journal of Hand Surgery (European Volume), 47(6), 580-589.

  12. Strafun, S.S., Kurinnyi, I.M., Borzykh, N.O., Tsymbaliuk, Y.V., Shypunov, V.G. 2021. Tactics of surgical treatment of wounded with gunshot injuries of the upper limb in modern conditions. Herald of Orthopaedics, Traumatology and Prosthetics, 2(109), 10-17.

  13. Khomenko, I.P., Lurin, I.A., Korol, S.O., Shapovalov, V.Y., Hrebennikov, K.O., Halushka, A.M., Tertyshnyi, S.V., Matviichuk, B.V. 2020. Organization of sorting and surgery of wounds with soft tissue defects during the joint force surgery. Journal of Education, Health and Sport, 10(1), 259-269.

  14. Omid, R., Stone, M.A., Zalavras, C.G., Marecek, G.S. 2019. Gunshot wounds to the upper extremity. JAAOS-Journal of the American Academy of Orthopaedic Surgeons, 27(7), 301-310.

  15. Meade, A., Hembd, A., Cho, M.-J., Zhang, A.Y. 2021. Surgical treatment of upper extremity gunshot injures: An updated review. Annals of Plastic Surgery, 86(3), 312-318.

  16. Hlavaty, L., Roquero, L., Amley, J., Root, K., Ishikawa, M., Koopmeiners, A., Zhao, L., Sung, L. 2019. Discordance of gross and histologic findings in estimating the range of fire of gunshot wounds. Journal of Forensic Sciences, 64(5), 1399-1411.

  17. Maddry, J.K., Mora, A.G., Perez, C.A., Reeves, L.K., Paciocco, J.A., Clemons, M.A., Sheean, A., Kester, N.M., Bebarta, V.S. 2022. Characterization of long-range aeromedical transport and its relationship to the development of traumatic extremity compartment syndrome: A 7-year, retrospective study. Military Medicine, 187(1-2), 224-231.

  18. Ertekin, A. 2021. Analysis of patients admitted to the emergency department with gunshot wounds. Journal of Surgery and Medicine, 5(5), 482-485.

  19. Sabapathy, S.R., Venkatramani, H., Mohan, M. 2019. Initial assessment, debridement, and decision making in the salvage of severely injured lower extremity. Indian Journal of Plastic Surgery, 52(1), 10-16.

  20. Kumar, M., Khatri, J.P., Singh, C.M. 2021. High Velocity Gunshot Fractures of Humerus: Results of Primary Plate Osteosynthesis. Indian Journal of Orthopaedics, 55, 714-722.

  21. Clark, D.M., Napora, J.K., Eglseder Jr, A. 2020. Percutaneous plate osteosynthesis of ulnar shaft fractures: a surgical technique and case series. Techniques in Hand & Upper Extremity Surgery, 24(3), 119-125.

  22. Nguyen, M.P., Savakus, J.C., Simske, N.M., Reich, M.S., Furdock, R., Golob, J.F., McDonald, A.A., Como, J.J., Vallier, H.A. 2022. Single dose IV antibiotic for low-energy extremity gunshot wounds: a prospective protocol. Annals of Surgery Open, 3(1), e136.

  23. Zarutskyi, Ya., Aslanyan, S., Kravchenko, K., Vovk, M., Honcharuk, V. 2021. The use of negative pressure vacuum therapy in the treatment of soft tissue defects in thoracic injury. Norwegian Journal of Development of the International Science, 59, 17-23.

  24. Emmert, S., Bernhardt, T., Schäfer, M., Semmler, M.L., Bekeschus, S., Masur, K., Gerling, T., Wahl, Ph., Fischer, T., Boeckmann, L. 2022. Cold Plasma Treatment for Chronic Wounds. In: Textbook of Good Clinical Practice in Cold Plasma Therapy (pp. 141-160). Cham: Springer.

  25. Sharma, L.C., Jose, M.A. 2021. Gunshot injuries of the maxillofacial region. In: Oral and Maxillofacial Surgery for the Clinician (pp. 1267-1281). Singapore: Springer.

  26. Gonzalez, T., Briceno, J., Velasco, B., Kaiser, P., Stenquist, D., Miller, C., Kwon, J.Y. 2020. Gunshot-related injuries to the foot & ankle. Foot & Ankle International, 41(4), 486-496.

  27. Shestopal, N., Balazh, M., Kovelska, A., Kikh, A., Tomanek, M., Grygus, I. 2021. Effect of rehabilitation program on the quality of life of people with forearm or hand gunshot wounds using physiotherapy methods. Journal of Physical Education and Sport, 21(5), 2591-2600.

About the Authors

Kamal Mirzayev
Andijan State Medical Institute

License

Copyright (c) 2026 Medical science of Uzbekistan

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

How to Cite

1.
The role of regional lymphatic therapy in gunshot wounds of the extremities. MSU [Internet]. 2026 Feb. 27 [cited 2026 May 7];5(1):38-52. Available from: https://fdoctors.uz/index.php/journal/article/view/259

Similar Articles

You may also start an advanced similarity search for this article.


ISSN 2181-3612 (Online)