Pub Date : 2024-02-19DOI: 10.25199/2408-9613-2023-10-2-32-40
V. A. Mitish, Yu. S. Paskhalova, A. A. Ushakov, S. D. Magomedova, S. A. Orudzheva, R. P. Terekhova, V. S. Demidova, L. G. Alkhimova, G. V. Khamidulin
The article presents a clinical observation of a successful comprehensive treatment of a phlegmon on the foot dorsum in a patient with idiopathic distal polyneuropathy. The authors demonstrate how the purulent process was relieved, then transferred to the wound healing state and to the regeneration state followed by the plastic surgery due to the technique of active surgical treatment of wounds and purulent-necrotic foci developed at the A. V. Vishnevsky Institute of Surgery (Moscow). The described wound has healed with primary intention even under the surgical infection. An important component of the active surgical treatment is local therapy, which is rapidly developing at present and which includes such methods as negative pressure, ultrasonic cavitation, laser technologies and others. However, classic bandaging of purulent wounds does not lose its relevance. Moreover, polyethylene glycol-based ointments, in particular, timed-proven Levomekol®, preserve their high activity and effectiveness both in the first (inflammation) and second (regeneration) stages of the wound healing process, for both eliminating the infection and preparing wounds for further plastic surgery.
文章介绍了对一名特发性远端多发性神经病患者足背痰肿成功进行综合治疗的临床观察。作者展示了化脓过程是如何得到缓解，然后转入伤口愈合状态和整形手术后的再生状态，这得益于 A. V. Vishnevsky 外科学研究所（莫斯科）开发的伤口和化脓坏死灶积极手术治疗技术。即使在手术感染的情况下，所描述的伤口也能按原意愈合。积极手术治疗的一个重要组成部分是局部疗法，目前这种疗法发展迅速，包括负压、超声波空化、激光技术等方法。不过，传统的化脓性伤口包扎法并没有失去其意义。此外，以聚乙二醇为基础的软膏，特别是经过时间验证的 Levomekol®，在伤口愈合过程的第一阶段（炎症）和第二阶段（再生）都能保持较高的活性和有效性，既能消除感染，又能为进一步的整形手术做好准备。
{"title":"The comprehensive treatment of a phlegmon on the foot dorsum in a patient with idiopathic distal polyneuropathy","authors":"V. A. Mitish, Yu. S. Paskhalova, A. A. Ushakov, S. D. Magomedova, S. A. Orudzheva, R. P. Terekhova, V. S. Demidova, L. G. Alkhimova, G. V. Khamidulin","doi":"10.25199/2408-9613-2023-10-2-32-40","DOIUrl":"https://doi.org/10.25199/2408-9613-2023-10-2-32-40","url":null,"abstract":"The article presents a clinical observation of a successful comprehensive treatment of a phlegmon on the foot dorsum in a patient with idiopathic distal polyneuropathy. The authors demonstrate how the purulent process was relieved, then transferred to the wound healing state and to the regeneration state followed by the plastic surgery due to the technique of active surgical treatment of wounds and purulent-necrotic foci developed at the A. V. Vishnevsky Institute of Surgery (Moscow). The described wound has healed with primary intention even under the surgical infection. An important component of the active surgical treatment is local therapy, which is rapidly developing at present and which includes such methods as negative pressure, ultrasonic cavitation, laser technologies and others. However, classic bandaging of purulent wounds does not lose its relevance. Moreover, polyethylene glycol-based ointments, in particular, timed-proven Levomekol®, preserve their high activity and effectiveness both in the first (inflammation) and second (regeneration) stages of the wound healing process, for both eliminating the infection and preparing wounds for further plastic surgery.","PeriodicalId":366300,"journal":{"name":"Wounds and wound infections. The prof. B.M. Kostyuchenok journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140450085","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-19DOI: 10.25199/2408-9613-2023-10-2-6-14
A. A. Tulupov, V. Beschastnov
Infection of burn wounds caused by antibiotic-resistant pathogens is the leading cause of systemic infectious complications in burned patients and a key link in the pathogenesis of burn disease, causing its course and outcome. The use of phage therapy to overcome antibiotic resistance of infection agents is a promising direction, the development of which can improve the results of treatment of burned. The article discusses: 1) features of the infectious process in burned; 2) the effect of antibacterial chemotherapy of burn wound infection on the microbiome and the processes of reparative regeneration; 3) principles of phage therapy; 4) ways of delivering bacteriophages; 5) development of resistance to bacteriophages 6) personalization of phage therapy.
{"title":"Phage therapy for burn wound infections in the era of antibiotic resistance","authors":"A. A. Tulupov, V. Beschastnov","doi":"10.25199/2408-9613-2023-10-2-6-14","DOIUrl":"https://doi.org/10.25199/2408-9613-2023-10-2-6-14","url":null,"abstract":"Infection of burn wounds caused by antibiotic-resistant pathogens is the leading cause of systemic infectious complications in burned patients and a key link in the pathogenesis of burn disease, causing its course and outcome. The use of phage therapy to overcome antibiotic resistance of infection agents is a promising direction, the development of which can improve the results of treatment of burned. The article discusses: 1) features of the infectious process in burned; 2) the effect of antibacterial chemotherapy of burn wound infection on the microbiome and the processes of reparative regeneration; 3) principles of phage therapy; 4) ways of delivering bacteriophages; 5) development of resistance to bacteriophages 6) personalization of phage therapy.","PeriodicalId":366300,"journal":{"name":"Wounds and wound infections. The prof. B.M. Kostyuchenok journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140452145","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-19DOI: 10.25199/2408-9613-2023-10-2-16-22
N. Teplova, O. M. Romashov, N. K. Patrushev
Objective: To evaluate clinical and microbiological effectiveness of the combined preparation Simprazole® (ornidazole 500 mg + ciprofloxacin 500 mg) in patients with skin and soft tissue infections.Material and methods. This prospective study was conducted in a multidisciplinary hospital from February to May 2023. Outcomes after treating patients with purulent wounds of the skin and soft tissues of various origins and location were analyzed. Patients with the extremely severe infectious processes and decompensated diseases of cardiopulmonary, respiratory and other vital systems were excluded from the study. Resistance and sensitivity of isolated strains to antibiotics was assessed in patients’ tests in 7 or 14 days. Patients with strains sensitive to ciprofloxacin were enrolled in the study. In addition to the antibacterial therapy, they had local treatment (dressings and wound debridement).Results. The involved 60 patients had a combined surgical treatment in the hospital. Clinical and laboratory findings have shown that the combined preparation consisting of ciprofloxacin and ornidazole has a high clinical and bacteriological effectiveness (95 and 96.7 %, respectively) in patients with purulent wounds of the skin and soft tissues regardless of pathogens etiology (aerobic or anaerobic) and anaerobic component, if these pathogens are sensitive to ciprofloxacin. The discussed preparation is well tolerated in 99 % of cases; no registered adverse reactions.Conclusion. The combined preparation Simprazole® (500 mg of ornidazole and 500 mg of ciprofloxacin) has a wide spectrum of action and original mechanisms of impact at microbes. It is an effective and safe drug for treating skin and soft tissue infections from both clinical and microbiological points of view.
{"title":"Combined preparation Simprazole® (ornidazole + ciprofloxacin) in patients with skin and soft tissue infections","authors":"N. Teplova, O. M. Romashov, N. K. Patrushev","doi":"10.25199/2408-9613-2023-10-2-16-22","DOIUrl":"https://doi.org/10.25199/2408-9613-2023-10-2-16-22","url":null,"abstract":"Objective: To evaluate clinical and microbiological effectiveness of the combined preparation Simprazole® (ornidazole 500 mg + ciprofloxacin 500 mg) in patients with skin and soft tissue infections.Material and methods. This prospective study was conducted in a multidisciplinary hospital from February to May 2023. Outcomes after treating patients with purulent wounds of the skin and soft tissues of various origins and location were analyzed. Patients with the extremely severe infectious processes and decompensated diseases of cardiopulmonary, respiratory and other vital systems were excluded from the study. Resistance and sensitivity of isolated strains to antibiotics was assessed in patients’ tests in 7 or 14 days. Patients with strains sensitive to ciprofloxacin were enrolled in the study. In addition to the antibacterial therapy, they had local treatment (dressings and wound debridement).Results. The involved 60 patients had a combined surgical treatment in the hospital. Clinical and laboratory findings have shown that the combined preparation consisting of ciprofloxacin and ornidazole has a high clinical and bacteriological effectiveness (95 and 96.7 %, respectively) in patients with purulent wounds of the skin and soft tissues regardless of pathogens etiology (aerobic or anaerobic) and anaerobic component, if these pathogens are sensitive to ciprofloxacin. The discussed preparation is well tolerated in 99 % of cases; no registered adverse reactions.Conclusion. The combined preparation Simprazole® (500 mg of ornidazole and 500 mg of ciprofloxacin) has a wide spectrum of action and original mechanisms of impact at microbes. It is an effective and safe drug for treating skin and soft tissue infections from both clinical and microbiological points of view.","PeriodicalId":366300,"journal":{"name":"Wounds and wound infections. The prof. B.M. Kostyuchenok journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139959261","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-19DOI: 10.25199/2408-9613-2023-10-2-24-31
E. O. Medusheva, Y. Fidorovskaya, M. A. Shchedrina, N. D. Oltarzhevskaya
Pain management at phase 1 of the wound process includes wound cleaning due to the lysis of purulent-necrotic masses, control of the pathogenic microflora, and evacuation of wound discharge. These factors are achievable with a new composite depo-material having the textile base, hydrogel composition based on biopolysaccharide sodium alginate with immobilized active components – proteolytic enzyme of plant origin- papain and antimicrobial salt-like silver. Biosynthesis of silver nanoparticles and its presence in the composition in the cation form increases efficacy and eliminates toxicity of the treatment due to low silver concentration.
{"title":"A modern polymer based wound care coating for wound management","authors":"E. O. Medusheva, Y. Fidorovskaya, M. A. Shchedrina, N. D. Oltarzhevskaya","doi":"10.25199/2408-9613-2023-10-2-24-31","DOIUrl":"https://doi.org/10.25199/2408-9613-2023-10-2-24-31","url":null,"abstract":"Pain management at phase 1 of the wound process includes wound cleaning due to the lysis of purulent-necrotic masses, control of the pathogenic microflora, and evacuation of wound discharge. These factors are achievable with a new composite depo-material having the textile base, hydrogel composition based on biopolysaccharide sodium alginate with immobilized active components – proteolytic enzyme of plant origin- papain and antimicrobial salt-like silver. Biosynthesis of silver nanoparticles and its presence in the composition in the cation form increases efficacy and eliminates toxicity of the treatment due to low silver concentration.","PeriodicalId":366300,"journal":{"name":"Wounds and wound infections. The prof. B.M. Kostyuchenok journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140449610","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-19DOI: 10.25199/2408-9613-2023-10-2-42-45
T. G. Turova, Yu. S. Paskhalova
The article provides a brief analysis of the action mechanisms of modern combinations by glucose-lowering drugs for type 2 diabetes mellitus, diabetic foot syndrome and obesity. Using the example of clinical observations, the positive dynamics of reducing body weight and glycated hemoglobin was demonstrated. It also shows how good control of type 2 diabetes makes it possible to effectively treat such a formidable complication as diabetic foot syndrome.
{"title":"Effective combinations of glucose-lowering drugs in patients with obesity and type 2 diabetes mellitus during the treatment of diabetic foot syndrome","authors":"T. G. Turova, Yu. S. Paskhalova","doi":"10.25199/2408-9613-2023-10-2-42-45","DOIUrl":"https://doi.org/10.25199/2408-9613-2023-10-2-42-45","url":null,"abstract":"The article provides a brief analysis of the action mechanisms of modern combinations by glucose-lowering drugs for type 2 diabetes mellitus, diabetic foot syndrome and obesity. Using the example of clinical observations, the positive dynamics of reducing body weight and glycated hemoglobin was demonstrated. It also shows how good control of type 2 diabetes makes it possible to effectively treat such a formidable complication as diabetic foot syndrome.","PeriodicalId":366300,"journal":{"name":"Wounds and wound infections. The prof. B.M. Kostyuchenok journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140451311","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-05-06DOI: 10.25199/2408-9613-2022-9-4-32-37
A. I. Anikin, O. A. Dedenkov, V. Knyazev, V. O. Samoylova
A clinical case of successful treatment of a patient with chronic calcaneus gunshot osteomyelitis and necrotic wound in the calcaneal region is discussed. A two-staged surgical management of the wound defect with a sural flap is described. It promoted a complete recovery of the patient.
{"title":"Management of chronic calcaneus gunshot osteomyelitis with a necrotic wound in the calcaneal region","authors":"A. I. Anikin, O. A. Dedenkov, V. Knyazev, V. O. Samoylova","doi":"10.25199/2408-9613-2022-9-4-32-37","DOIUrl":"https://doi.org/10.25199/2408-9613-2022-9-4-32-37","url":null,"abstract":"A clinical case of successful treatment of a patient with chronic calcaneus gunshot osteomyelitis and necrotic wound in the calcaneal region is discussed. A two-staged surgical management of the wound defect with a sural flap is described. It promoted a complete recovery of the patient.","PeriodicalId":366300,"journal":{"name":"Wounds and wound infections. The prof. B.M. Kostyuchenok journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128732037","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-05-06DOI: 10.25199/2408-9613-2022-9-4-24-31
G. O. Smirnova, A. Y. Tskaev, E. B. Denisov, T. A. Demicheva, A. P. Zalitis, A. V. Gavrilov
The article presents a clinical case of successful complex surgical management of a 62-year-old patient with chronic post-traumatic tibial osteomyelitis. A two-stage surgical treatment was aimed to sanitize a chronic purulent focus in the tibia lower third and to perform a complex reconstructive surgery aimed to correct bone and soft tissue defects. The reconstructive stage of the discussed complex surgical treatment consisted in combined plasty: a cavity in the bone was filled with bone grafts obtained from the iliac crest; and a skin and soft tissue defect was corrected with an islet sural musculocutaneous flap on the distal feeding pedicle. As a result, the surgeons could effectively correct tibia and soft tissues defects with good functional and cosmetic results.
{"title":"Combined Plasty in Post-Traumatic Tibial Osteomyelitis (Clinical observation)","authors":"G. O. Smirnova, A. Y. Tskaev, E. B. Denisov, T. A. Demicheva, A. P. Zalitis, A. V. Gavrilov","doi":"10.25199/2408-9613-2022-9-4-24-31","DOIUrl":"https://doi.org/10.25199/2408-9613-2022-9-4-24-31","url":null,"abstract":"The article presents a clinical case of successful complex surgical management of a 62-year-old patient with chronic post-traumatic tibial osteomyelitis. A two-stage surgical treatment was aimed to sanitize a chronic purulent focus in the tibia lower third and to perform a complex reconstructive surgery aimed to correct bone and soft tissue defects. The reconstructive stage of the discussed complex surgical treatment consisted in combined plasty: a cavity in the bone was filled with bone grafts obtained from the iliac crest; and a skin and soft tissue defect was corrected with an islet sural musculocutaneous flap on the distal feeding pedicle. As a result, the surgeons could effectively correct tibia and soft tissues defects with good functional and cosmetic results.","PeriodicalId":366300,"journal":{"name":"Wounds and wound infections. The prof. B.M. Kostyuchenok journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121457060","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-05-06DOI: 10.25199/2408-9613-2022-9-4-16-21
V. Petrov, S. Mukhacheva, A. Alimov, I. A. Alimov, F. Aliev, A. V. Efanov, N. S. Savelyev
The authors describe a clinical case of successful treatment of a patient with an ischiorectal abscess complicated by extensive purulentnecrotic phlegmon on the anterior abdominal wall and right thigh. Topical negative pressure wound technique (NPWT) was used. Its combination with surgical debridement and rational systemic antibiotic therapy has been shown to contribute to successful treatment of this life-threatening pathology.
{"title":"Local negative pressure therapy in a patient with acute ischiorectal paraproctitis complicated by the Fournier’s gangrene","authors":"V. Petrov, S. Mukhacheva, A. Alimov, I. A. Alimov, F. Aliev, A. V. Efanov, N. S. Savelyev","doi":"10.25199/2408-9613-2022-9-4-16-21","DOIUrl":"https://doi.org/10.25199/2408-9613-2022-9-4-16-21","url":null,"abstract":"The authors describe a clinical case of successful treatment of a patient with an ischiorectal abscess complicated by extensive purulentnecrotic phlegmon on the anterior abdominal wall and right thigh. Topical negative pressure wound technique (NPWT) was used. Its combination with surgical debridement and rational systemic antibiotic therapy has been shown to contribute to successful treatment of this life-threatening pathology.","PeriodicalId":366300,"journal":{"name":"Wounds and wound infections. The prof. B.M. Kostyuchenok journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114537883","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-05-06DOI: 10.25199/2408-9613-2022-9-4-6-15
V. V. Fedjushkin, S. N. Pjatakov, A. G. Baryshev, S. N. Pjatakova, S. N. Shсherba, I. V. Golikov, E. N. Shubrov, S. P. Muzhikov, M. Y. Eremenko, A. Shcherba
Infectious and inflammatory processes in sutured soft tissue wounds are met in 3–22% of cases despite the strict following of aseptic and antiseptic rules, application of new antiseptic agents with high bactericidal effect as well as improved techniques for prevention and management of wound infection.Objective. To perform a comparative analysis on healing processes in sutured soft tissue wounds after surgical interventions in which purulent-necrotic processes have developed.Materials and methods. All patients were divided into two groups – main and control. Patients from the main group (n = 58) had vacuum drainage of subcutaneous tissues in sutured wounds after surgery from June 2019 till November 2021. Case-histories of 80 patients from the control group were analyzed retrospectively; the researchers assessed outcomes after surgical management. In these patients, drainage of subcutaneous tissues in sutured wounds after surgery for purulent-necrotic processes in soft tissues was done using the traditional flow-washing technique. Both studied groups were comparable in sex, age and co-morbidity.Results. In the control group, complications in the form of suppurated lesions were noted in 17 (17.5 %) patients. In 10 (12.5 %) patients with marginal skin necrosis, there was suture dehiscence. None of 58 patients from the main group in whom surgical wounds were treated with the technique of vacuum drainage developed by us had any purulent-septic complications. In all cases, wounds healed with the primary intention.Conclusion. The technique of vacuum drainage developed by us allowed to achieve better outcomes at the early postoperative period.
{"title":"Vacuum therapy for the prevention of suppurations in sutured soft tissue wounds. First experience","authors":"V. V. Fedjushkin, S. N. Pjatakov, A. G. Baryshev, S. N. Pjatakova, S. N. Shсherba, I. V. Golikov, E. N. Shubrov, S. P. Muzhikov, M. Y. Eremenko, A. Shcherba","doi":"10.25199/2408-9613-2022-9-4-6-15","DOIUrl":"https://doi.org/10.25199/2408-9613-2022-9-4-6-15","url":null,"abstract":"Infectious and inflammatory processes in sutured soft tissue wounds are met in 3–22% of cases despite the strict following of aseptic and antiseptic rules, application of new antiseptic agents with high bactericidal effect as well as improved techniques for prevention and management of wound infection.Objective. To perform a comparative analysis on healing processes in sutured soft tissue wounds after surgical interventions in which purulent-necrotic processes have developed.Materials and methods. All patients were divided into two groups – main and control. Patients from the main group (n = 58) had vacuum drainage of subcutaneous tissues in sutured wounds after surgery from June 2019 till November 2021. Case-histories of 80 patients from the control group were analyzed retrospectively; the researchers assessed outcomes after surgical management. In these patients, drainage of subcutaneous tissues in sutured wounds after surgery for purulent-necrotic processes in soft tissues was done using the traditional flow-washing technique. Both studied groups were comparable in sex, age and co-morbidity.Results. In the control group, complications in the form of suppurated lesions were noted in 17 (17.5 %) patients. In 10 (12.5 %) patients with marginal skin necrosis, there was suture dehiscence. None of 58 patients from the main group in whom surgical wounds were treated with the technique of vacuum drainage developed by us had any purulent-septic complications. In all cases, wounds healed with the primary intention.Conclusion. The technique of vacuum drainage developed by us allowed to achieve better outcomes at the early postoperative period.","PeriodicalId":366300,"journal":{"name":"Wounds and wound infections. The prof. B.M. Kostyuchenok journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124155256","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-03-02DOI: 10.25199/2408-9613-2022-9-3-30-37
V. M. Bensman, A. G. Baryshev, V. V. Polovinkin, O. Sidorenko, V. N. Ponomarev
Objective. The aim of the study was to develop the safest technique for surgical disconnection of high, unformed jejunal fistulas, so as to avoid problems with detection the intestine leading to the fistula and to avoid complications of viscerolysis.Material and methods. The authors present their experience in surgical management of 35 patients with high delimited unformed debilitating jejunal fistulas. Of these, 22 patients were included in the comparison group; their fistulas were closed or disconnected with the known methods. Findings obtained from other 172 patients with adhesive intestinal obstruction after infectious complications of laparotomic wounds and topography of visceroparietal planar adhesions of the peritoneum were analyzed. After studying the nature and location of visceroparietal adhesions, the authors could develop a technique for proximal disconnection of high delimited unformed debilitating jejunal fistulas using posterolateral access which was applied in 13 patients from the studied group.Research results. The proposed technique of unilateral disconnection of high unformed jejunal fistulas reduces duration, damage and risk of prolonged bowel deserosing. As a result, a significant decrease in postoperative mortality from 59.1 ± 9.2% to 23.1 ± 11.2% (t=2.5; p<0.05) was registered. Due to the preoperative endoscopic marking showing direction to the fistula of intestinal loop and duodenojejunal junction, intraoperative orientation was more accurate and took much less time than in the comparison group. The posterolateral surgical approach to the fistula in the jejunal loop reduced the risk of its damage, since there was no need for extensive enterolysis anymore. Therefore, postoperative period in patients of the studied group was better and with fewer complications than in the comparison group.Conclusion. The posterolateral access prevented extended viscerolysis and allowed to put a reliable and atraumatic interintestinal anastomosis so as to disconnect the fistula. The unilateral disconnection of the jejunal fistula at postoperative intestinal paresis unloaded the interintestinal anastomosis, similar to Meidl’s definitive jejunostomy. The abovementioned positive aspects of the proposed surgical intervention allowed to significantly decrease postoperative complications and mortality rate, if to compare with outcomes after known surgical interventions with a similar purpose.
{"title":"Surgical disconnection of high delineated immature debilitating jejunal fistulas using posterolateral access","authors":"V. M. Bensman, A. G. Baryshev, V. V. Polovinkin, O. Sidorenko, V. N. Ponomarev","doi":"10.25199/2408-9613-2022-9-3-30-37","DOIUrl":"https://doi.org/10.25199/2408-9613-2022-9-3-30-37","url":null,"abstract":"Objective. The aim of the study was to develop the safest technique for surgical disconnection of high, unformed jejunal fistulas, so as to avoid problems with detection the intestine leading to the fistula and to avoid complications of viscerolysis.Material and methods. The authors present their experience in surgical management of 35 patients with high delimited unformed debilitating jejunal fistulas. Of these, 22 patients were included in the comparison group; their fistulas were closed or disconnected with the known methods. Findings obtained from other 172 patients with adhesive intestinal obstruction after infectious complications of laparotomic wounds and topography of visceroparietal planar adhesions of the peritoneum were analyzed. After studying the nature and location of visceroparietal adhesions, the authors could develop a technique for proximal disconnection of high delimited unformed debilitating jejunal fistulas using posterolateral access which was applied in 13 patients from the studied group.Research results. The proposed technique of unilateral disconnection of high unformed jejunal fistulas reduces duration, damage and risk of prolonged bowel deserosing. As a result, a significant decrease in postoperative mortality from 59.1 ± 9.2% to 23.1 ± 11.2% (t=2.5; p<0.05) was registered. Due to the preoperative endoscopic marking showing direction to the fistula of intestinal loop and duodenojejunal junction, intraoperative orientation was more accurate and took much less time than in the comparison group. The posterolateral surgical approach to the fistula in the jejunal loop reduced the risk of its damage, since there was no need for extensive enterolysis anymore. Therefore, postoperative period in patients of the studied group was better and with fewer complications than in the comparison group.Conclusion. The posterolateral access prevented extended viscerolysis and allowed to put a reliable and atraumatic interintestinal anastomosis so as to disconnect the fistula. The unilateral disconnection of the jejunal fistula at postoperative intestinal paresis unloaded the interintestinal anastomosis, similar to Meidl’s definitive jejunostomy. The abovementioned positive aspects of the proposed surgical intervention allowed to significantly decrease postoperative complications and mortality rate, if to compare with outcomes after known surgical interventions with a similar purpose.","PeriodicalId":366300,"journal":{"name":"Wounds and wound infections. The prof. B.M. Kostyuchenok journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127732879","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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