КЛИНИЧЕСКОЕ НАБЛЮДЕНИЕ МЕСТНОГО ЛУЧЕВОГО ПОРАЖЕНИЯ ТЯЖЕЛОЙ И КРАЙНЕ ТЯЖЕЛОЙ СТЕПЕНИ БОЛЬШОЙ ПЛОЩАДИ С НЕБЛАГОПРИЯТНЫМ ТЕЧЕНИЕМ РАНЕВОГО ПРОЦЕССА

Abstract

Purpose: to familiarize medical workers with the unfavorable course of local radiation injury (LRI) due to its depth and area, damage to underlying bone structures and internal organs, the presence of concomitant severe somatic disease, drug addiction and the impossibility of radical surgical intervention due to a lack of own tissues to hide the ulcerative defect. Material and methods: The article presents a clinical observation of a 46–year-old man who had accidental household contact with a radiation source of electric current RIT-90 with an activity of 30 kCu – a powerful source of bremsstrahlung. Results: The patient suffered severe acute radiation syndrome from extremely uneven beta-gamma irradiation (moderate bone marrow syndrome, acute posterior thoracic LRI of extremely severe degree (IV) – 5%, severe and moderate degree – 10% and both hands of mild degree (I) – 2%). He was admitted to the clinic for treatment 3 months after irradiation. On admission, against the background of pronounced hyperpigmentation and atrophy of the skin of the left and partly right half of the back, there were ulcerative defects in the form of a figure eight (diameter – 10 and 3 cm). The ulcers are covered with a thick layer of fibrin with scanty discharge. Within 3 months after admission to the clinic, pulmonary tuberculosis was treated with good clinical effect. 6 months after the irradiation, a phased surgical treatment was initiated. However, necrotization of transplanted autografts and infection of the ulcerative surface were almost constantly noted. Despite the ongoing supportive, detoxification and antibacterial therapy, multiple organ failure developed, which led to the death of the patient. Conclusions: With extensive and deep radiation lesions accompanied by severe damage to underlying bone structures and vital internal organs localized in anatomical areas that are not subject to amputation, in the presence of severe concomitant somatic pathology in the patient, surgical closure of the skin defect with a full-layer flap with axial blood supply capable of restoring trophicity of the affected tissues becomes an almost unsolvable problem. Covering with patient’s tissues is impossible, first of all, due to the complexity of the necessary size flap extraction. The remaining open skin defect is the gateway to infection with its further generalization and death of the patient. It is possible that the solution in this case may be the use of various collagen films or artificial skin, which will mechanically close the defect, however, the inability to restore trophicity in the area of affected tissues still makes the prognosis extremely unfavorable.