Purulent-necrotic Wounds Research Articles

Морфофункціональні особливості ранового процесу під час лікування гнійно-некротичних ран у щурів сучасними антисептичними засобами та колагеназою

Infected and purulent wounds remain both a medical and economic challenge for the healthcare system today. Scientific and practical interest leads to the use of collagenase enzyme in wound care products. Aim: to study and evaluate morphological changes in the wound process during the treatment of purulent-necrotic wounds in rats with drugs based on modern antiseptics and collagenase. Materials and methods. The object of study: purulent-necrotic wounds. The experimental study was performed on 64 white laboratory rats. The simulated wound was contaminated with a pathogenic strain of S. aureus in combination with P. aeruginosa. Rats were divided into 4 groups of 16 animals each: I - control group (without treatment); II - collagenase-based gel with myramistin was used to treat the wound; III - ointment based on chloramphenicol and methyluracil; IV - myramistin-based ointment. 2 days after the start of the experiment, the drug and an aseptic gauze bandage were applied to the wound surface of animals of the II, III and IV groups, in the control group - only an aseptic bandage was applied. The dressing was changed daily for 14 days in all animals. Tissues were collected for histological and morphometric examination by excision of a fragment of skin with underlying tissues from the location of the wound defect followed by fixation in a 10% solution of neutral buffered formalin. The prepared histological sections with a thickness of 4 μm were stained with hematoxylin and eosin. Results. It was found that in the II group, where collagenase was used, the number of leukocyte elements at the bottom of the wound defect from the 3rd day was significantly lower than in other groups. At the same time, the vascular component progressively increased. The obtained data correlate with the results of a histological examination: a faster reduction of the inflammatory process and the development of epithelialization. Complete coverage of the wound surface with the newly formed epithelium occurred already on the 10th day. Conclusion. The obtained data indicate the appropriateness of collagenase in the treatment of purulent wounds not only as an enzymatic debridement, but as a substrance affecting important aspects in the first and second phases of the wound process. The experiments with laboratory animals were provided in accordance with all bioethical norms and guidelines. No conflict of interests was declared by the authors.

Changes in the antibiotic-resistant properties of pathogenic microorganisms in patients with purulent-necrotic wounds against the background of type 2 diabetes when using a probiotic antiseptic

Antibiotic resistance remains a serious problem, leading to millions of deaths every year. The increasing prevalence of type 2 diabetes mellitus (T2DM) is contributing to the continued spread of this problem. Ukraine, like other countries, feels the consequences of this problem. Over the past ten years, the number of patients with T2DM has doubled, and diabetes is already the cause of disability and death for thousands of people. Complications of T2DM, such as diabetic foot syndrome, often require surgery and antibacterial therapy. New research shows the prospects of using probiotic antiseptics based on lactic acid bacteria of the genus Bacillus in the treatment of wounds, which may open new opportunities to combat this problem and improve treatment outcomes. Objective — to analyse changes in the antibiotic‑resistant properties of pathogenic microorganisms in patients with purulent‑necrotic wounds in type 2 diabetes mellitus. Materials and methods. The study, which was conducted at the Department of General Surgery No. 2 of Bogomolets National Medical University in Kyiv City Clinical Hospital No. 3, included 229 patients with purulent‑necrotic wounds and type II diabetes. A total of 229 patients were randomly divided into two groups, with one group receiving probiotic antiseptics and the other traditional chemical antiseptics, with subsequent analysis focusing on changes in antibiotic‑resistant properties against P. aeruginosa and K. pneumoniae. Antibiotic‑resistant properties were evaluated through microbiological examination, revealing significant changes in resistance patterns among patients treated with probiotic antiseptics compared to those using traditional chemical antiseptics, assessed using statistical methods including the Student’s t‑test and Wilcoxon W‑test. Results. When the first subgroups were compared on the first day, there was no statistically significant difference in the levels of P. aeruginosa wound contamination (p=0.671). On the seventh day, there was a statistically significant difference between contamination levels (p<0.05) and the emergence of sensitivity to reserve antibiotics (p<0.05). On the 14th day, there was a statistically significant difference between contamination levels (p<0.05) and the emergence of sensitivity to reserve antibiotics (p<0.05). Conclusions. Probiotic antiseptics have a statistically significant advantage over chemical antiseptics in terms of reducing contamination and emergence of antibiotic sensitivity in patients with purulent‑necrotic wounds in type 2 diabetes mellitus.

APPLICATION OF PROBIOTIC ANTISEPSIS FOR PURULENT COMPLICATIONS IN PATIENTS WITH TYPE 2 DIABETES MELLITUS.

The aim: To improve the results of surgical treatment of patients with type 2 diabetes and purulent-necrotic wounds by using probiotic antiseptics. Materials and methods: 66 patients with type 2 diabetes and purulent-necrotic complications took part in this study. Probiotic antiseptics were used for local treatment in the experimental group (n=31), and traditional antiseptics were used in the control group (n=35). The levels of pro-inflammatory markers in the blood (IL-6, TNF-a, CRP) were studied; microscopic material was taken to study the type of cytogram during bandaging, before wound treatment with antiseptics or debridement on admission to the hospital (1st day), on the 3rd day and on the 7th day. Results: Analysis of dynamic changes in pro-inflammatory markers between the first and seventh days proved that only in the experimental group there was a statistically significant difference (IL-6 (Р=0.004), TNF-a (Р=0.001), CRP (Р=0.018)). Detection of regenerative-inflammatory and regenerative cytogram types on the 7th day in the experimental group had a statistically significant difference compared to the control group (p=0.002 and p<0.001, respectively). Conclusions: the use of probiotic antisepsis accelerates wound healing in patients with type 2 diabetes and purulent-necrotic complications.

The role of myofibroblasts in the healing of chronic wounds

Surgical infection is one of the most important and important problems of modern medicine. The lack of a universal remedy and method of wound treatment, the difficulty of choosing universal tactics of management of patients with chronic wounds determines the need for further search for new treatments that stimulate reparative processes in chronic wounds, including morphological research methods. The role of cellular regulation in the pathogenesis of the restoration of the morphofunctional state of a chronic wound in the conditions of its damage remains undisclosed. Therefore, the aim of our study was to evaluate the role of myofibroblasts in the healing of chronic purulent-necrotic wounds in the treatment of mesenchymal stem cells using immunohistochemistry. In the experiment we obtained a model of chronic purulent-necrotic wound, which meets all the requirements for quality indicators in the study of morphological changes in chronic wounds and can then be used as a basis for preclinical research. The condition of chronic purulent-necrotic wounds in 120 rats was studied by histological and immunohistochemical methods. Chronic wound was modeled according to the original method of the author: during the formation of a standard skin defect in the interscapular area of the rat with a diameter of 1 cm, the surrounding tissue was superimposed ischemic metal structure to reduce blood flow in the wound area, which significantly slowed the delay. Treatment was started from 28 days from the beginning of wounding, which clinically and histologically corresponded to the chronicity of the wound process. Statistical processing of morphometric parameters was performed using the standard software package “Statistica 6.1”. It was found that the positive dynamics of healing of chronic wounds, using 0.025 % decasan solution, was observed mainly in the early stages (3-7 days), while mesenchymal stem cells (MSC) and MSC cloned in inert gases (MSC-IG) were effective at all stages of the study. The use of MSC and MSC-IG creates favorable conditions for the normal course of regenerative processes and epithelialization of wounds, providing anti-edema and anti-inflammatory effects with activation of myofibroblasts, which increases the healing efficiency of chronic purulent-necrotic wounds. Prospects for the use of MSC in the treatment of chronic wounds are shown.

Successful application of conditioned culture medium for the treatment of a chronic wound of an amputation stump: a clinical case

Background: Amputation of the lower extremities is a necessary procedure to save a patient with critical arterial and neurotrophic disorders in the lower extremities. The amputation stump-related complications develop in many patients with diabetes mellitus (up to 40% of the total population).&#x0D; Clinical case description: Patient Yu., 64 years old, was admitted on October 19, 21 for an outpatient treatment of purulent-necrotic wounds of the amputation stump of the right lower limb. А high amputation was performed on September 24, 2021 due to thrombosis of the femoral-tibial bypass, installed on September 08, 2021 (bypassing below the knee joint gap with a Vascutek 7 mm synthetic prosthesis on the right) and the development of critical ischemia of the right lower limb with necrosis of the distal phalanges of the right foot toes. The wound was assessed according to the Bates-Jensen scale (BJ) and examined according to the developed protocol. The wound treatment was carried out according to an individual plan using a conditioned culture medium from mesenchymal stem cells (CM-MSCs), which stimulates angiogenesis and improves remodeling and recovery in the wound area. CM-MSC application made it possible to reduce the healing time and achieve a scarless closure of the tissue defect.&#x0D; Conclusion: The use of CM-MSC can be an effective method for healing a purulent-necrotic postoperative wound resulting from amputation of a limb in patients with critical ischemia of the lower extremities.

MONITORING ASSESSMENT OF THE EARLY PROCESS ON THE BACKGROUND OF TES THERAPY.

The aim: To investigate and evaluate the effect of TEC therapy on the wound process. Materials and methods: On the models of clean, purulent and purulent-necrotic wounds in a comparative aspect, the wound process in the dynamics of wound healing in dental patients was studied in 233 patients, of which 105 were treated with TES therapy and 128 were treated with traditional treatment. A monitoring evaluation of the wound process was carried out based on the screening of the cytological picture of the wound contents, the study of the types of cytograms of smears-imprints from the wound on the 3rd, 6th and 9th days after surgical interventions. Results: It was established that against the background of TEC therapy, compared to traditional therapy, a positive trend of reparative processes in the wound was noted starting from the 3rd day. Destructive forms of granulocytes were significantly reduced with a simultaneous increase in the quantitative and qualitative composition of macrophages and an increase in the number of fibroblasts. The transition of the inflammatory phase to the regeneration phase was observed in the smear-imprints. Conclusions: The positive effect of TEC therapy on regenerative processes, both on clean and purulent and purulent-necrotic wounds at all stages of healing, has been estab¬lished. The cytological picture of the wound contents, the type of cytogram of smears-imprints are sensitive markers of regenerative processes in the wound, regardless of its type. These criteria for evaluating the course of the wound process can be successfully used for prognostic purposes.

MONITORING EVALUATION OF THE EFFECTIVENESS OF TES THERAPY AFTER DENTAL INTERVENTIONS

Introduction. The wound process after dental operations is the most frequent cause of complications, which requires monitoring evaluation, as well as the introduction of new non-drug therapy methods, which include TES therapy. The purpose of the study. Summarize information on the effect of TES therapy on the microcirculation of the gingival mucosa in the dynamics of wound healing. Material and methods. 233 patients participated in the study, who were divided into two representative groups: 105 – on the background of the use of TES therapy in the complex treatment of clean, purulent and purulent-necrotic wounds in dental patients, and 128 – during traditional treatment. A monitoring assessment of microcirculation was carried out against the background of wound healing on the 6th and 9th day after surgery. Laser dopplerometry (LDM) was used to assess microcirculation at the border of the defect (1–2 mm) from the edge of the gingival mucosa wound. During the study, the average values of gingival tissue perfusion (M, Kv ), neurogenic and biogenic tone (NG, MG) and precapillary shunting index (PS) were calculated. Research results and their discussion. Among all patients, positive changes were observed among the perfusion indicators (M, Kv ), neurogenic and myogenic tone (NG, MG) and precapillary shunting index, which indicates an improvement in blood supply and an increase in oxygenation of the periodontium. This had a positive effect on the rate of wound healing, as indicated by clinical observations. Conclusions . 1. The use of TES therapy in the complex treatment of the wound process in dental patients significantly improves the microcirculation of the wound, which contributes to faster healing. 2. Stabilization of microcirculation against the background of TES therapy is ensured by the effect of transcranial electrical stimulation on the subcortical structures of the brain. 3. Under the influence of TES-therapy, the neurogenic and myogenic tone of vessels of the microcirculatory channel is stabilized, which reduces shunting and improves oxygenation of periodontal tissues.

Monitoring evaluation of the effectiveness of TES therapy after dental interventions

Introduction. The wound process after dental operations is the most frequent cause of complications, which requires monitoring evaluation, as well as the introduction of new non-drug therapy methods, which include TES therapy. The purpose of the study . Summarize information on the effect of TES therapy on the microcirculation of the gingival mucosa in the dynamics of wound healing. Material and methods . 233 patients participated in the study, who were divided into two representative groups: 105 – on the background of the use of TES therapy in the complex treatment of clean, purulent and purulent-necrotic wounds in dental patients, and 128 – during traditional treatment. A monitoring assessment of microcirculation was carried out against the background of wound healing on the 6th and 9th day after surgery. Laser dopplerometry (LDM) was used to assess microcirculation at the border of the defect (1-2 mm) from the edge of the gingival mucosa wound. During the study, the average values of gingival tissue perfusion (M, Kv ), neurogenic and biogenic tone (NG, MG) and precapillary shunting index (PS) were calculated. Research results and their discussion. Among all patients, positive changes were observed among the perfusion indicators (M, Kv), neurogenic and myogenic tone (NG, MG) and precapillary shunting index, which indicates an improvement in blood supply and an increase in oxygenation of the periodontium. This had a positive effect on the rate of wound healing, as indicated by clinical observations. Conclusions . 1. The use of TES therapy in the complex treatment of the wound process in dental patients significantly improves the microcirculation of the wound, which contributes to faster healing. 2. Stabilization of microcirculation against the background of TES therapy is ensured by the effect of transcranial electrical stimulation on the subcortical structures of the brain. 3. Under the influence of TES-therapy, the neurogenic and myogenic tone of vessels of the microcirculatory channel is stabilized, which reduces shunting and improves oxygenation of periodontal tissues.

Experience in treating extensive purulent necrotic wounds in phase I of the wound process

Experience in treating extensive purulent necrotic wounds in phase I of the wound process

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

One of the urgent problems of modern surgery continues to be the increasing number of patients with purulent-inflammatory and purulentnecrotic processes of soft tissues – about 60.0 % of patients in the structure of specialized hospitals of a surgical profile. This is due to the adaptation of microorganisms – pathogens of wound infection to existing means for treating wounds. In addition, the number of patients with diabetes mellitus increases annually, and as a result, the number of people suffering from diabetic foot syndrome. Thus, the relevance of developing new modern tools for the local treatment of purulent-necrotic processes of the skin and soft tissues is not reduced.Materials and methods.The material for the study was a highly porous biodegradable sponge (chitosan-collagen) in the ratio of chitosan: collagen 2: 1 with the inclusion of colloidal particles of metallic silver and chymotrypsin. The experiment was performed on 50 Wistar rats that simulated a purulent necrotic wound. During the treatment, the state of the wounds was visually evaluated, the morphological features of the course of the wound process were evaluated after animals were withdrawn from the experiment and the wound material was taken on days 1, 5, 10, 15 and 21, the sections were stained with hematoxylin-eosin and/or according to Van Gieson.Results.By visual assessment, by the 10th day it was noted that necrotic tissues underwent lysis, the wound defect was covered with a scab, swelling of the surrounding tissues was not noted, and on the 21st day of treatment the wound defect was covered with epithelium and had an area of about 3 mm2 with the initial - in 250 mm2. When describing micropreparations, it was noted that on the 10th day the exudation phase passed its peak and the activity of proliferation processes increased from the center of the wound to its periphery and from the granulation surface in depth. On the 15th day, the proliferative phase of inflammation was at its height, and on the 21st day, the proliferation phase was completed and the processes of remodeling of dense fibrous connective tissue began.Conclusion.Based on a visual assessment of the state of wounds and a morphological study, the effectiveness of a chitosan-collagen complex with silver nanoparticles and chymotrypsin was shown to be applied locally to a purulent necrotic wound in an experiment.

Patients with purulent necrotic wounds treatment using by intravenous laser blood irradiation (405 nm)

Objective:to analyze the effectiveness of purulent-necrotic wounds management using intravenous laser irradiation of blood (405nm).Materials and methods. Object of study – patients with purulent-necrotic wounds. Clinical studies and analysis of the intravenous laser blood irradiation (405 nm) effect on the wound healing process and on the healing speed of purulent soft tissues wounds in patients with type 2 diabetes mellitus were carried out.Results.It was found that the use of intravenous laser blood irradiation (405 nm) is a highly effective method for the treatment of purulent soft tissues wounds, which allows to reduce the number of complications and shorten the time for complete epithelization of purulent wounds by 7–10 days compared with traditional treatment.

Prolonged regional analgesia in the complex treatment of extensive purulent-necrotic wounds on the background of decompensated arterial and venous insufficiency (case report

Objective:to demonstrate the successful complex treatment of a shin circular wound in a patient with intense pain due to critical limb ischemia and wound infection, which became possible against the background of prolonged peripheral blockade.Materials and methods.A 72-year-old patient with critical ischemia of the right lower extremity was treated for a circular purulent-necrotic wound of the shin leg from November 2016 to April 2017 at the Wounds and Wound Infections Department of FSBI “A. V. Vishnevsky NRC of Surgery” Ministry of Health of Russia. An examination revealed the impossibility of right lower limb arterial insufficiency surgical correction. The patient refused amputation of the lower limb. For the relief of pain, a long-term blockage of the sciatic nerve was used (infusion of ropivacaine 6.0–8.0 mg / hr into the perineural catheter, additional 100 mg ropivacaine boluses were used before performing traumatic daily dressings). The intensity of pain was evaluated on a visual analogue scale (VAS), sought to achieve a pain intensity of not more than 3 points at rest and not more than 4 points on – when moving.Results.Blockade of the sciatic nerve reduced the intensity of pain from 8–10 to 0–3 points, which made it possible to continue treatment. In total, the duration of sciatic nerve catheterization at the stages of treatment was 115 days (18 + 41 + 23 + 32), the maximum duration of one of the peripheral nerve catheterizations was 41 days. Complications associated with nerve catheterization were not observed in the patient. The pain syndrome is stopped, the area of the wound defect is reduced in size. Discharged for outpatient treatment.Conclusion.Long-term peripheral analgesia made it possible to gain time necessary for cleansing the wound surface from necrotic tissues, therapy with drugs that improve arterial blood supply to the limbs, as well as for performing reconstructive and reconstructive operations after the wound process has passed to the reparative stage. Long-term peripheral blockade is a prerequisite for the successful treatment of extensive wounds of the lower extremities caused by insufficient arterial blood supply at the stage of critical limb ischemia, accompanied by intense pain.

Ultrasonic cavitation in the treatment of purulent wound occurring against the background of juvenile diabetes mellitus and massive immunosuppressive therapy. Clinical case

The article presents a clinical case of a successful comprehensive treatment 29-years-old patient with a purulent necrotic wound of the hand, which occurs against the background of type I diabetes mellitus and massive immunosuppressive therapy (prescribed to prevent renal transplant rejection). The use of ultrasound cavitation as a part of the complex treatment after radical surgical debridement helped to normalize the wound healing process, to reduce the microbial contamination of the wound and to activate repair.

Endovascular revascularisation in patients with necrotic wounds and extended infrainguinal arterial disease

To report own experience of endovascular interventions in patients with extended occlusive lesion (TASC II D) of the femoral-popliteal and tibial arteries and concomitant purulent-necrotic wounds. We have analyzed literature data and own experience of endovascular interventions in patients with extended occlusive lesion (TASC II D) of the femoral-popliteal and tibial arteries and concomitant purulent-necrotic wounds. Endovascular strategy is preferable in a certain subgroup of patients with extended infrainguinal lesions. Considering own data, we assumed the need for routine correction of outflow pathways (simultaneous angioplasty of at least 2 tibial arteries). Primary results are encouraging, but further research is required.

Патогенетическое обоснование терапии синдрома диабетической стопы на современном этапе

Цель. Изучение влияния экзогенного серотонина и стволовых клеток жировой ткани на репаративные процессы гнойно-некротических ран мягких тканей при ишемической форме синдрома диабетической стопы (СДС).&#x0D; Материалы и методы. В исследование включено 35 больных, из которых 20 имели ІІ стадию, 15 - ІІІ стадию ишемической формы СДС по классификации Фонтейна-Покровского на фоне сахарного диабета 2-го типа. Контрольную группу составили 15 здоровых людей, при обследовании которых не были выявлены признаки поражения артерий нижних конечностей. О степени выраженности атеросклероза судили по данным липидограммы и рентгенографии дуги аорты. В эксперименте изучено влияние стволовых клеток жировой ткани на регенеративные процессы в хронической язве кролей.&#x0D; Результаты. Внутривенное введение серотонина адипината улучшало кровоток в нижних конечностях, что может быть связано, во-первых, с механизмами эндотелиальной зависимости вазорелаксации, во-вторых, с усилением выработки эндотелиальных вазодилататоров. Проведенные экспериментальные исследования по изучению влияния стволовых клеток жировой ткани на репаративные процессы в хронической язве показали потенциальные возможности применения этих клеток в лечении пациентов с язвенно-некротическими дефектами.&#x0D; Выводы. Внутривенное введение серотонина адипината благоприятно влияет на патогенетические механизмы развития ишемии атеросклеротического генеза. Клеточная терапия стволовыми клетками жировой ткани у животных с хроническими язвенными дефектами улучшает репаративные процессы в поврежденных тканях. Это позволяет заключить, что такая терапия обладает потенциальными возможностями в лечении больных с гнойно-некротическими ранами мягких тканей.

The «Propeller»–technique in plastic surgery of the extensive wounds of distal leg and the foot

Objective. To increase the efficacy of plastic surgery in treatment of the extensive soft tissue defects, applying “sparing” resection of the lower third of the shin and foot for consequences of mechanical and/or thermal trauma or infectious–necrotic processes. &#x0D; Materials and methods. We conducted a retrospective evaluation of the “Propeller”–technique application for the elevation of the skin islet flaps on sural neurovascular pedicle in 11 patients, who underwent surgery between 2014 and 2017. The task for investigation was to eliminate the shin and foot defects, developed due to large–scale tissue damage. The Group 1 was organized for patients with the mine–blast trauma and the coal mine occupational injuries (2 patients followed in each category). Management of purulent–necrotic wounds (Group 2) was required in cases of amputation and resection of the foot due to either osteomyelitis (3 patients followed) or frostbites (4 patients followed). &#x0D; Results. All the patients had an adequate vascular supply of the affected limbs, even in 3 patients from the Group II, who had only one artery preserved. In all cases a secondary surgical debridement, necrectomy and the soft tissue defect repair were performed during the same operation. &#x0D; Conclusions. Using of the tegument tissues mobilization complex “Propeller”– technique is an effective instrument for sealing of deep complex defects of different etiology, localized in distal part of the lower extremity.

EXPERIENCE OF THE USE OF ANTIADHESIVE METHODS AT ADHESIVE DISEASE AS A COMPLICATION AT THE HARD POLYTRAUMA AT THE CHILDRENS

The clinical case of a serious field of injury, which is complicated by adhesive disease in a child with a diagnosis: penetrating wounds of the abdominal cavity, is presented. Damage to the small and large intestines. Separation of the lateral surface of the pelvis and thigh to the left, traumatic amputation of the left idiopathic bone and left femur. Fracture of the caudal and bronchial bones on the right. Fractures of the S5-L1 vertebrae bodies. Hemorrhagic shock of the III degree. Hypovolemic shock of the III degree. Traumatic shock. The postoperative period was complicated: purulent-necrotic wound of the lateral surface of the abdominal wall and the formed cult; necrotic fasciotocellulitis and myositis; wound by sepsis; septicemia; abnormal suction and short loop syndrome, abdominal adhesion’s. The basic principles of patient's surgical treatment are substantiated. The three-stage provision of assistance has been identified: Stage I – life-saving; ІІ – correction of complications of polytrauma and adhesion disease; III – restoration of the function of the damaged organs.

Morphological justification of the effectiveness of ultrasonic cavitation with 0.2

Structural and functional analysis of cells from purulent-necrotic wounds in patients with diabetic foot syndrome undergoing ultrasonic treatment with 0.2% Lavasept solution. It is presented morphological/ultrastructural analysis of wound specimens in 90 (DFS) patients aged 27-80 years with diabetic foot syndrome and purulent-necrotic complications who were hospitalized in the department of wounds and wound infections of the Vishnevsky Institute of Surgery in 2013-2016. Main group consisted of 75 patients, control group - 15 patients. Mean age was 58.4±8.2 years. All patients had diabetes mellitus type II for previous 13±4.5 years. Severity of foot tissue damage was assessed according to Wagner classification (F. Wagner, 1981). 46 (51.1%) patients had Wagner III-IV, 44 (48.9%) patients - Wagner II. Complex treatment included radical surgical management of purulent lesion, surgical revascularization for critical limb ischemia and foot reconstruction at the final stage. Additional measures were complete unloading of the foot, correction of carbohydrate metabolism and concomitant diseases. Topical treatment between surgical stages included dressing with 1.0% betadine solution (once a day). Ultrasonic cavitation was additionally applied in the main group. Electron microscopic examination of specimens was used before treatment, after 3-5 and 7-10 days in order to assess effectiveness of ultrasound cavitation for purulent-necrotic complications of DFS. Ultrasound cavitation with 0.2% Lavasept solution effectively cleans wounds from microbial and cellular detritus, destroys cellular membranes of biofilm-forming microorganisms, prevents their redo development and reinfection of the wound. Effective management of the wounds accelerates reparative processes that allows to perform foot reconstruction early.

Особливості хірурґічної обробки та фіксації шкірного клаптя після малих ампутацій у хворих з синдромом стопи діабетика

Aim.&nbsp;Based on the proposed methods, to improve the quality of surgical treatment of patients with diabetic foot syndrome by improving the method of surgical treatment of the stump and fixation of the skin after phalangeal amputation. Materials and Methods.&nbsp;The analysis of the results of treatment of 114 patients treated in the surgical department of the TL of Ternopil during 2014-18 years for purulent-necrotic lesions of toes in type II diabetes mellitus was carried out. The age of patients ranged from 44 to 75 years. The following methods are supported by patents for utility model. Results and Discussion.&nbsp;Usually, during small amputations, the necrotic part of the bone phalanx of the finger is removed with the help of Liuer or Liston cutters. The indicated methods have certain disadvantages, as they cause additional traumatization of healthy tissue within which amputation is carried out. Removing necrotic tissue with manual mechanical amputation tools requires the application of force and compression, which leaves microcracks and splinters at the immediate location of the instrument on the healthy residual bone tissue and also injures the surrounding tissue, adversely affecting the wound healing process and treatment as a whole. However, the fixation of the skin after the amputation of the phalanx of the finger is preceded by the removal of the necrotic part of the phalanx or the entire phalanx, the cleansing of the open wound surface of fine particles of destructive tissue, treatment of the wound with an antiseptic on a water basis (chlorhexidine, decasan), removal of liquid tissues, blood, lymph and amorphous component, wound tamponade, or seam fixation. The methods of surgical treatment of the foot and the fixation of the skin flap proposed by us improve the existing other methods, where the execution of amputation of the dead part of the phalanx of the finger or even the heads of the metatarsals is carried out using a cut-off metal disk rotating at a speed of 20,000 rpm (revolutions per minute), followed by gradual polishing of the cutoff point of healthy bone tissue. The fixation of the skin flap is carried out by seamless method after preliminary treatment with certain aqueous solutions of antiseptics and an even distribution of the amorphous component, which is formed as a result of mechanical treatment of the stump with a corundum grinding nozzle up to 10 mm in diameter in the form of a layer for 1-2 minutes at a speed of 10,000 rpm.&nbsp; Conclusion.&nbsp;The proposed method of amputation of the phalanx of the finger is characterized by rapid and qualitative cut off of the dead part of the phalanx, absence of additional traumatization of the stump of the bone and surrounding tissues. The method of fixing the skin flap after the amputation of the phalanx of the finger allows preserving the liquid tissues on the wound surface that provide nutrition and fixation of the transplanted skin flap closing the wound. This approach to treatment of purulent-necrotic wounds in patients with diabetic foot syndrome provides significant acceleration of wound healing, reduces the risk of implantation infection, eliminates additional tissue injuries during overlaying and sewing, and, accordingly, reduces the patient's stay in hospital treatment to 5 to10 &nbsp;days.

CLINICAL CASE OF TEENAGER’S SEVERE POLYTRAUMA

A clinical case of child’s severe trauma with the diagnosis of penetrating injury of the abdomen is presented. The small and large intestines are damaged. The condition before surgery: separation of the lateral surface of the pelvis and femur on the left, traumatic amputation of the left iliac and left femur, fracture of pubic and ischial bones on the right, fracture of the bodies of S5-L1 vertebrae, hemorrhagic shock III degree, hypovolemic shock III degree, traumatic shock. The postoperative period was complicated by: purulent necrotic wound in the lateral surface of the abdominal wall and formed stump; necrotic fasciocellulitis and myositis; wound sepsis; pyosepticemia; malabsorption syndrome and short loop syndrome. The basic principles of surgical treatment of the patient are substantiated. III stages of medical treatment are suggested: I stage – saving of life; II – correction of multiple injury complications; III – restore the functions of the damaged organs.