Use of a wound covering based on chitosan with immobilized chymotrypsin in the treatment of gunshot wounds

A gunshot wound is the most complex type of "acute" wound both in morphological and pathophysiological aspects, and in the efforts made to treat it. Studies of chitosan as a material for wound treatment are relevant, despite the large number of publications, due to its properties (bioinertness, biodegradability, hydrophilicity, antimicrobial and pro-regenerative activity).

Objective. To determine the efficiency of hydrophilic chitosan sponge with enzymatic activity in treatment of gunshot wounds.

Materials and methods. Patients with gunshot wounds of soft tissues of the extremities requiring local treatment were randomly divided into two groups. Patients of the main group (n = 25) used dressings based on chitosan sponge with chymotrypsin. Patients of the control group (n = 23) used gauze dressings with chymotrypsin lyophilisate and levomekol ointment. During treatment, planimetric, volumetric, thermometric measurements were performed, morphological characteristics of the wound were recorded, microscopic examination of smears-imprints from the wound was performed.

Results. In the first phase of the wound healing process, statistically significantly higher rates of wound healing were noted in the main group than in the control group (area decrease of 5.2 ± 2.1 % per day in the main group, area decrease of 3.8 ± 2.4 % per day in the control group, p ≤ 0.05). A significantly higher number of cases of change in the type of wound smear-imprint cytogram in the first phase of the wound healing process towards the regenerative type in the main group was revealed (p ≤ 0.05). A statistically significant difference was noted in the increase in the rate of change in the relative temperature of the wound in the first phase of the wound healing process (0.5 ± 0.7℃ per day in the main group, 0.0 ± 0.5℃ per day in the control group, p ≤ 0.01), which may indicate a decrease in the time of wound cleansing and tissue regeneration in the main group.

Conclusion. Chitosan sponge with enzymatic activity when used as a wound covering for gunshot wounds in the first phase of the wound healing process helps to reduce the time of wound cleansing and tissue regeneration in comparison with lyophilized chymotrypsin and Levomekol ointment based on a gauze bandage.

1. Volkova I. M., Korovina D. G. Three-dimensional matrices of natural and synthetic origin for cellular biotechnology. Biotekhnologiya = Biotechnology. 2015; 31 (2): 8–26.

2. Bryuzgina E. B., Vlasenko N. S., Klimov V. V., Bryuzgin E. V., Poroyskiy S. V., Navrotskiy A. V., Novakov I. A. Physical-Mechanical and Sorption Properties of Cross-Linked Chitosan Based Film Materials. Russian Journal of Applied Chemistry. 2024; 97 (7): 614–622.

3. Rytchenkov S. V., Poroisky S. V., Stepanova E. F., Tatarenko-Kozmina T. Yu., Pleten A. P. Pharmaceutical development of an adhesive gel based on a biodegradable natural complex. Voprosy biologicheskoy, meditsinskoy i farmatsevticheskoy khimii = Issues of biological, medical and pharmaceutical chemistry. 2024; 27 (5): 23–30.

4. Skryabin K. G., Mikhailov S. N., Varlamov V. P. Khitozan = Chitosan. Moscow: Center for Bioengineering of the RAS; 2013: 582 p.

5. Vladimirova O. V., Lavreshin P. M., Minaev S. V. Experience in using the "Hitokol" coating in the treatment of infected wounds of various etiologies. Glavnyy vrach Yuga Rossii = Chief Physician of the South of Russia. 2021; 80 (5): 38–40.

6. Gladkova E. V., Babushkina I. V., Belova S. V. Possibilities of using chitosan and metal nanoparticles in the regeneration of experimental wounds. Fundamentalnye issledovaniya = Fundamental research. 2013; 7–3: 530–533.

7. Gladkova E. V., Babushkina I. V., Mamonova I. A., Norkin I. A., Puchinyan D. M., Shchukovsky V. V. Features of reparative regeneration of experimental wounds using chitosan. Fundamentalnye issledovaniya = Fundamental research. 2014; 6–7: 1397–1400.

8. Bezhin A. I., Lipatov V. A., Blatun L. A., Fronchek E. V., Grigoryan A. Y., Naimzada M. D. Morphological evaluation of the effectiveness of the use of chitosan-collagen complex with silver nano-particles and chymotrypsin in the purulent-necrotic process in soft tissues. Wounds and wound infections. The prof. B. M. Kostyuchenok journal. 2020; 4: 14–21.

9. Samokhvalov I. M. Voenno-polevaya khirurgiya. Natsionalnoe rukovodstvo = Military field surgery. National guidelines. 2nd ed., revised. and add. Moscow: GEOTAR-Media; 2024: 1056 p.

10. Gostishchev V. K. Infektsiya v khirurgii: Rukovodstvo dlya vrachey = Infection in surgery: A guide for doctors. Moscow: GEOTAR-Media; 2007: 761 p.

11. Efimenko N. A., Lysenko M. V., Sternin Yu. I., Novozhilov A. A., Knorring G. Yu. Proteolytic enzymes in surgery: historical aspects and modern concepts of application. Russkiy meditsinskiy zhurnal = Russian Medical Journal. 2011; 19 (5): 368–372.

12. Mokhov E. M., Kadykov V. A., Sergeev A. N., Askerov E. M., Lyubsky I. V., Morozov A. M., Radaykina, I. M. Pain assessment scales and features of their application in medicine (literature review). Verkhnevolzhskiy meditsinskiy zhurnal = Verkhnevolzhsky Medical Journal. 2019; 18 (2): 34–37.

13. Pokrovskaya M. P., Makarov M. S. Tsitologiya ranevogo ekssudata kak pokazatel protsessa zazhivleniya ran = Cytology of wound exudate as an indicator of the wound healing process. Moscow; 1948: 44 p.

14. Borodina M. A., Naser N. R., Batyrshin I. M., Sklizkov D. S., Ryazanova E. P., Kozhevnikov V. B. Objective methods for assessing the dynamics of the wound process. Bulletin of Pirogov National Medical & Surgical Center = Bulletin of Pirogov National Medical & Surgical Center. 2021; 16 (2): 61–65.

15. Popova L. N. Kak izmeryayutsya granitsy vnov obrazuyushchegosya epidermisa pri zazhivlenii ran = How are the boundaries of newly formed epidermis measured during wound healing: Abstract of the dis. candidate of medical sciences. Moscow; 1942: 16 p.