[Photodynamic inactivation of antibiotic-resistant microflora of gunshot wounds under fluorescence control].

Abstract

Objective: Antimicrobial photodynamic therapy or photodynamic inactivation (PDI) of antibiotic-resistant microflora seems to be a very promising alternative, including for the treatment of long-term non-healing wounds, due to its potential and extremely low possibility of resistance.

Material and methods: The authors describe an effective approach to preparing the wounds for delayed surgical treatment (secondary suturing, split-flap autodermoplasty, wound defect closure with local tissues), as well as healing by secondary intention of wounds using PDI of antibiotic-resistant microflora under spectroscopic control of fluorescence intensity in tissues. For this purpose, laser and LED radiation with wavelengths 660-680 nm was used. Various photosensitizers (methylene blue, aluminum phthalocyanine, chlorin e6 and their emulsion forms) were used. The study included 90 patients with various wounds.

Results: Positive treatment outcomes were obtained in most patients. The first PDI procedure decreased concentration of microflora by 3-4 times. There was significant or complete inactivation of bacteria by the end of the treatment. In all patients, concentration of photosensitizers significantly decreased by more than 75% after PDI. Surgical treatment was successful in 100% of cases (n=56; 62%).

Conclusion: PDI is a promising method for inactivating antibiotic-resistant microflora, including patients with long-term non-healing wounds. This method contributes to safe and high-quality surgical treatment. A great advantage of PDI is its multi-purpose mechanism and no resistance of microorganisms.