Сomprehensive treatment of the complicated phlegmona of the top limb on the background of sugar diabetes under hiv coinfection and virus hepatitis

Abstract

Despite the active development and introduction into clinical practice of new groups of antibacterial drugs, the basis for the treatment of purulent-septic diseases of soft tissues is the opening and surgical treatment of a purulent focus. When we analyzing the literature data on the treatment of purulent soft tissue diseases, the following factors can be identified that determine the progression of the purulent-inflammatory process even with an adequately uncovered purulent focus: the presence of common co-morbid diseases that reduce the body's resistance (infectious diseases and metabolic disorders) and attachment to the pathological process multidrug-resistant virulent hospital flora [1, 2]. Progression of the purulent-necrotic process takes place along anatomically determined paths of pus spread, and therefore the absolute necessity of firm knowledge of the topographic anatomy of the human body is obvious. Perhaps the most complete and thorough description of the clinical picture and methods of surgical treatment of phlegmon of the upper limb and thorax, based on anatomical principles, is given in the classic work of V.F. Voino-Yasenetsky [3], since the first publication of which it has been almost a century. Currently, due to the prevalence of antibiotic resistance even of "wild" microorganisms, the prevalence among infectious diseases affecting the immune status of the organism (hepatitis, tuberculosis, HIV), as well as the pandemic of diabetes, the urgency of surgical treatment of common purulent processes in the region upper extremity and thorax again increased.
 We present the clinical case of progression of the purulent process on the left upper limb from the lower third of the arm in the distal direction to the Pirogov-Paron space and in the proximal direction to the submentoral and pre-lobular cell spaces.