Predicting complications in patients with local cold injury

Mikhailichenko M.I., Shapovalov K.G., Mudrov V.A.

Backgraund: local cold injury in the general structure of traumatic injuries in peacetime in the zone with a moderate climate is about 1%, and in Siberia, the far East and the Northern regions reaches 6–20%. The significance of frostbite is due to the complexity of treatment, long - term disability and a high percentage of post-traumatic complications with subsequent disability of the victims. Early prognosis of the course allows for correction of treatment, which helps to reduce the total number of post-traumatic complications, and in some cases – and their prevention.

Aims: to evaluate the clinical effectiveness of the proposed method for predicting complications of local cold injury, based on the study of the dynamics of electroneuromiography in patients with local cold injury of III-IV degree.

Materials and methods: The study included 60 patients with frostbite of the III–IV degree of the lower extremities in the late reactive period. Measurement of bioelectric activity was performed on the 5th from the moment of injury, the presence of complications was assessed on day 30. All the victims were hospitalized in the regional center of thermal trauma on the basis of the city hospital No. 1 of Chita with local cold trauma of the distal segments of the feet in the period from 2018 to 2019. To assess the bioelectric activity of muscles used non-invasive cutaneous method of electroneuromyography.

Results: In the course of the study, it was found that patients with local cold trauma have a marked change in ENMG indicators. A significant decrease in the amplitude of the M-response indicates peripheral «acute» neuropathy, which is associated with increasing endothelial dysfunction and acute peripheral intravasal and extravasal inflammation. An increase in the level of limb damage is accompanied by an aggravation of changes in ENMG indicators.

Conclusions: The study of the parameters of peripheral innervation reflects the course of the post-traumatic period in patients with local cold trauma and allows us to identify differences between its uncomplicated and complicated course. The proposed method of forecasting contributes to the selection of a group of patients with a predicted complicated course of local cold injury, which contributes to the correction of the complex therapy, taking into account the likely pathogenetic disorders.

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