scholarly journals RESULTS OF TREATMENT OF OPEN FRACTURES IN PATIENTS WITH POLYTRAUMA IN A REGIONAL TRAUMA SYSTEM

2018 ◽  
Vol 25 (3) ◽  
pp. 28-33
Author(s):  
A. N. BLAZHENKO ◽  
S. N. KURINNYI ◽  
M. L. MUKHANOV ◽  
M. YU. AGEEV ◽  
A. V. GORBUNOV ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Soft Tissues ◽  
Trauma System ◽  
Treatment Strategies ◽  
Infectious Complications ◽  
Open Fractures ◽  
Skeletal Traction ◽  
Type Iii ◽  
Results Of Treatment ◽  
Traction System

Aim. To analyze options for treatment tactics for open fractures of bones, implemented in a regional trauma system in theKrasnodar Territory.Materials and methods. Retrospective analysis includes the results of treatment of 82 patients with polytrauma and severe open fractures of the shin bones aged from 18 to 60 years, of whom 23 in unstable or critical condition, hospitalized in 2016-2017 in the Scientific Research Institution – S.V. Ochapovsky Regional Clinical Hospital № 1.Results. Treatment tactics for patients with severe polytrauma and open fractures type IIIA and B according to the classification of Gustilo-Andersen adopted in trauma center of level I, reduces the total number of infectious complications to 9,09% for fractures of type III A and 53,84% of IIIB fractures compared to option treatment strategies adopted in trauma centres II, III where the level of infection reaches 58,06% fractures type III A and 93,75% of IIIB fractures. The typical mistakes made in primary surgical treatment in patients with polytrauma and severe open fractures were revealed: incomplete revision of the wound with leaving foreign bodies, non-viable soft tissues, unstable fixation of the fracture with the help of a skeletal traction system, incomplete external fixation of the fracture with a device or plaster bandage, suturing of the wound with relaxing skin incisions during soft tissue swelling, absence of drains or passive drainage of the open fracture.Conclusion. The usage of primary surgical treatment in a reduced volume, with the application of VAC-dressings, in patients with polytrauma and severe open fractures of the limb bones can reduce the overall incidence of infectious complications.

scholarly journals Multidisciplinary approach to surgical treatment and rehabilitation of patients with defects of the anterior tracheal wall

2021 ◽  
Vol 180 (1) ◽  
pp. 31-39
Author(s):  
O. D. Eshonkhodjaev ◽  
Sh. N. Khudaybergenov ◽  
R. Ya. Hayaliev
Keyword(s):  
Surgical Treatment ◽  
Soft Tissues ◽  
Scar Tissue ◽  
Endoscopic Examination ◽  
Diagnostic Methods ◽  
Tracheal Wall ◽  
Cervical Region ◽  
Results Of Treatment ◽  
Tracheal Defect ◽  
Microsurgical Techniques

The objective was to improve the results of treatment of patients with persistent defects of the anterior tracheal wall and soft tissues of the neck.Methods and materials. 220 patients with tracheal cicatrical stenosis were treated, of which 120 patients had defects of the anterior tracheal wall of various sizes. In 70% of cases, PCT was postintubation/posttracheostomy. Men predominated – 89 (74.2 %), women – 31 (25.8 %). After a routine examination, including endoscopic examination, MSCT of the chest with the capture of the cervical region, and general clinical diagnostic methods, all patients underwent surgical treatment.Results. According to the nature of the elimination of the defect of the anterior tracheal wall, patients were divided into several groups. Both local plastic surgery and the elimination of the tracheal defect with the use of microsurgical techniques were used. Circular resection of the trachea with the elimination of the defect was performed in 5 cases. In 2 cases, in the presence of a large persistent defect of more than 6 cm in size, a composite pre-fabricated deltopectoral skin-fascial-cartilage flap was used.Conclusion. The choice of a method for eliminating a persistent open defect of the anterior tracheal wall is determined individually in each case, it depends on its size, the depth of the airway lumen, and the condition of the surrounding tissues. The use of displaced skin-fascial flaps on the vascular pedicle for closing the tracheal defect allows to restore the mucous membrane of the tracheal defect area without using the surrounding scar tissue and close the defect with a second flap without straining the edges of the wound.

scholarly journals Treatment Tactics and Complications After Surgical Treatment of HIV-Infected Patients With Extra-Articular Fractures of the Long Bones of Extremities

2020 ◽  
Vol 9 (3) ◽  
pp. 369-376
Author(s):  
N. G. Doronin ◽  
S. N. Khoroshkov ◽  
M. V. Naumenko
Keyword(s):  
Comparative Analysis ◽  
Surgical Treatment ◽  
Postoperative Complications ◽  
Aseptic Loosening ◽  
Infectious Complications ◽  
Long Term Results ◽  
Long Bones ◽  
Results Of Treatment ◽  
Articular Fractures ◽  
Fracture Consolidation

The aim of the study is the comparative analysis of the long-term results of treatment of extra-articular fractures of the long bones in HIV-infected and non-HIV-infected patients.Material and methods. In the presented study, a comparative analysis of the results of surgical treatment of 90 HIV-infected and 112 HIV-uninfected patients with extra-articular fractures of the long bones of the extremities aged from 23 to 54 years was performed.Results. HIV-infected patients are mainly characterized by non-infectious complications from the postoperative wound (formation of seromas, hematomas, dehiscence of the edges of wounds, delayed healing), aseptic loosening and migration of fixators, and delayed consolidation of fractures. The presence of statistically significant relationships between the factors characterizing the course of HIV infection (stage of the disease, the number of CD4 + lymphocytes, the ratio of CD4/CD8 + lymphocytes, viral load) and the risk of postoperative complications was revealed.Conclusion. Thus, the use of standard algorithms for determining the tactics and method of treatment of extra-articular fractures of the long bones of the extremities in HIV-infected patients leads to a significant number of unsatisfactory treatment results (up to 31.1%). For HIV-infected patients, the most typical complications are postoperative wounds, impaired fracture consolidation processes and aseptic loosening of metal fixators, which can lead to the development of infectious complications without proper attention. Expansion of research in this area with an increase in the number of observed contingents will make it possible to develop a scientifically based scale for predicting the development of possible postoperative complications in this category of patients.

scholarly journals Modified method for reconstruction of thumb abduction function in children undergoing surgical treatment of thumb duplication

2021 ◽  
pp. 1-9
Author(s):  
Tong Zhou ◽  
Xu Zhang ◽  
Xiaofei Yu ◽  
Yanbin Bai ◽  
Huan Chen ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Soft Tissues ◽  
Stress Test ◽  
Joint Stability ◽  
Level Of Evidence ◽  
Type Iii ◽  
Modified Method ◽  
Thumb Duplication ◽  
Flexion Extension ◽  
Group A

Purpose This study was performed to evaluate a modified method of reconstructing the thumb abduction function in children undergoing surgical treatment of thumb duplication. Methods This retrospective study included 33 children (38 thumbs) with Wassel type III to VII thumb duplication who underwent excision of the polydactylism and osteotomy of the preserved thumb. Among them, 16 children (19 thumbs) underwent reconstruction of the attachment of the articular capsule and collateral ligament of the metacarpophalangeal joint, abductor pollicis brevis and flexor pollicis brevis by the anchor technique (Group A), while 17 children (19 thumbs) underwent suturing the attachment of the above-mentioned soft tissues to the periosteum (Group B). All children were followed up for six years after surgery. The appearance, function and joint stability of the preserved thumb were compared between the two groups; the bone alignment and development were observed. Results The deformity rate of preserved thumbs and the positive rate of lateral stress test were significantly lower in Group A than B (p < 0.05). The modified Tada score and the distance of first web were significantly higher in Group A than B (p < 0.05). Flexion, extension, adduction, abduction and palmar movement of the thumbs were good; bone alignment and development were good and no osteophyte or anchor shadow was left in the preserved thumbs in Group A. Conclusion Reconstruction of the abduction function using the anchor technique is effective in children undergoing surgical treatment for Wassel type III to VII thumb duplication and it may be superior to the conventional technique. Level of evidence III

Surgical Treatment of Lymphangiom in Children: Case Series

2019 ◽  
Vol 6 (1) ◽  
pp. 53-64 ◽  
Author(s):  
Igor’ V. Poddubnyi ◽  
Andrei B. Ryabov ◽  
Mikhail A. Abramyan ◽  
Vladimir O. Trunov ◽  
Mikhail Yu. Kozlov ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Abdominal Cavity ◽  
Lymphatic Vessels ◽  
Case Series ◽  
Expectant Management ◽  
Infectious Complications ◽  
Internal Organs ◽  
Results Of Treatment ◽  
Anatomical Localization ◽  
Radical Removal

Background. Lymphangiomas are non-specific malformations that develop from the lymphatic vessels. Usually, the disease is asymptomatic, but there may be complications requiring emergency care. In the literature there is no consensus about the method of choice in the treatment of these formations. Description of A Case Series. The article is devoted to the evaluation of the efficacy of surgical treatment of lymphangiomas in children. There are also several clinical cases showing mediastinal lymphangioma with a clinical picture of respiratory failure, lymphangioma of the abdominal cavity, imitating the symptoms of an acute abdomen and lymphangioma of a rare anatomical localization. The results of treatment of 48 children for the period from 2008 to 2017 were analyzed at «Morozov Children Municipal Clinical Hospital» (Moscow). The basis of treatment was the removal of education within healthy tissues. When the radical intervention was impossible in 5 (10.4%) children we used resection of the tumor with sparing coagulation of the surface of the formation. Infectious complications arose in 3 (6.3%), lymphorrhea — in 13 (27.1%) patients. Recurrences of lymphangiomas developed in 2 (4.2%) patients. In the case of lymphorrhea, expectant management and parenteral nutrition were used. The repeated operations were performed with recurrences. The catamnesis ranges from 6 months to 10 years. Conclusion. Radical removal of lymphangiomas of internal organs can be recommended to children of any age as an effective way to treat this disease.

scholarly journals Tactics of surgical treatment of deep intermuscular gluteal region phlegmons

2021 ◽  
Author(s):  
E.N. Byakova ◽  
V.K. Tatyanchenko ◽  
V.L. Bogdanov ◽  
Y.V. Sukhaya ◽  
Y.V. Krasenkov
Keyword(s):  
Surgical Treatment ◽  
Soft Tissues ◽  
New Technologies ◽  
Main Group ◽  
Gluteal Region ◽  
Control Group ◽  
Tissue Pressure ◽  
Results Of Treatment ◽  
Purulent Wound

Purpose. The purpose is to improve the results of treatment of patients with phlegmon of the gluteal region soft tissues by diagnosing the stage of tissue hypertension and determining the tactics of surgical treatment depending on this indicator. Materials and methods. Clinical studies were performed on 74 patients suffering from phlegmon of the gluteal region. All the patients were divided into 2 groups: in the main group (as opposed to the control group), acute tissue hypertension syndrome was diagnosed and decompressive fasciotomy was performed in tissue hypertension (30–35 mm Hg) (patent). The authors performed ultrasound cavitation and ozone therapy of a purulent wound. Results. With phlegmon of the gluteal region of soft tissues, an increase in tissue pressure by 25% above the norm is an indication for fasciotomy in the area of fascial nodes. The time of purulent wound cleaning against the background of normal tissue pressure (8–10 mm Hg) of the surgery in patients of the main group was reduced to 5 days (8 days in the control). In the long-term (0.5–1 years), good results were obtained in 92.8% of patients in the main group (64.7% in the control group). Conclusion. The developed tactics of treatment of patients with phlegmon of the soft tissues of the gluteal region are highly effective due to the development and application of new technologies for the diagnosis and treatment of tissue hypertension.

MODERN APPROACHES IN MANAGING WOUND DEFECTS IN CHILDREN WITH SURGICAL INFECTION

2020 ◽  
pp. 169-175
Author(s):  
Kuzmin A.I. ◽  
Munin A.G. ◽  
Zavyalkin V.A. ◽  
Barskaya M.A. ◽  
Terekhina M.I.
Keyword(s):  
Surgical Treatment ◽  
Hospital Stay ◽  
Soft Tissues ◽  
Local Treatment ◽  
Wound Management ◽  
Innovative Technologies ◽  
Surgical Infection ◽  
Results Of Treatment ◽  
Inadequate Antibiotic Therapy ◽  
Good Cosmetic

The results of treatment of 57 children with wound defects of soft tissues that have appeared at the background of surgical infections of various origins have been analyzed. The causes of the wound defects formation were analyzed according to the T.I.M.E. system.[7,8,9]. While treating the wound defects the strategy of creating the conditions close to the ones in an acute wound was followed («Wound bed preparation») [7,8,11]. We used several types of debridement aimed at shortening the phases of the wound process with the following closure of the wound defects by different methods [1,2,5,7]. The assessment of the effectiveness of local treatment was carried out taking into account the nature and severity of the phases of the wound process by the method of clinical observation of the state of the wound (the severity of symptoms of inflammation, the nature and amount of exudate, the presence and appearance of granulations, the presence of signs of wound epithelialization and scarring, the size of the wound), microbiological, cytological and histology and research [10]. The study revealed factors that disrupt wound healing during primary surgical treatment, in the management of foci of surgical infection, in the management of postoperative wounds, in the treatment of pressure ulcers in children with neurological pathology. During the initial surgical treatment of the received wounds, its inadequacy was noted - the abandonment of necrotic, defective tissues, foreign bodies, the presence of an undiagnosed infection, the absence or inadequate antibiotic therapy, constant tension of the skin edges, impaired blood flow and innervation, inadequate sanitation and drainage. The use of modern innovative technologies in wound management reduces hospital stay, reduces the duration of the use of antibiotics and other medications, contributes to a good cosmetic effect. Application of the current innovative technologies in wounds treatment shortens the hospital stay, decreases the duration of the use of antibiotics and other medicines, and contributes to better cosmetics effects [1,4,6]. The current trends in wounds treating with the choice of local treatment according to the phases of the wound process are presented in this article. The methods of active wound defects therapy and different types of debridement considering their pros and cons are analyzed.

scholarly journals COMPUTER PROGRAM DETERMINES THE TACTICS OF CONDUCTING PATIENTS WITH FRACTURES OF THE DISTAL TIBIA METAEPIPHYSIS

2019 ◽  
Vol 5 (2) ◽  
pp. 63-70
Author(s):  
L. A. Yakimov ◽  
S. G. Grigoriev ◽  
L. Yu. Slinyakov ◽  
A. G. Simonyan ◽  
S. O. Naniev ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Computer Program ◽  
Large Scale ◽  
Soft Tissues ◽  
Articular Surface ◽  
Distal Tibia ◽  
Main Idea ◽  
Practical Experience ◽  
Theory And Practice ◽  
Results Of Treatment

The improvement of tactics of surgical treatment of patients with tibial distal metaepiphysis fractures with the aim of improving treatment outcomes and reducing the number of complications seems to be a topical and priority task of treatment activity. This is due to the following reasons: a large number of unsatisfactory results, due to the massive destruction of the articular surface of the ankle joint; reduction of labor activity in victims with disability, and so on. Surgical treatment of victims of the profile under consideration is among the most complex tasks, the solution of which often causes objective difficulties, including the timing of the operation, the choice of rational access, osteosynthesis techniques, and the state of soft tissues. In modern conditions in various fields of medicine, advanced digital technologies are increasingly used. The main idea of their use is the possibility of excluding the «human factor” at various stages of medical care planning. As a result, medicine acquires completely new possibilities in modern conditions. In many activities, it is simply impossible to do without digital technology. This process invariably involves significant changes in medical theory and practice. In accordance with these trends, we first created a computer program for collecting, analyzing and evaluating data from a primary, follow-up examination and forecasting the results of treatment of victims with fractures of the distal tibial metaepiphysis. In the future, the developed computer program can form the basis of a large-scale platform on the Internet in order to exchange practical experience and jointly improve the ways of development in this area.

scholarly journals REMOTE RESULTS OF SURGICAL TREATMENT OF PATIENTS WITH PROXIMAL HUMERAL FRACTURES

World Science ◽  
2021 ◽  
Author(s):  
Мihail Gasko ◽  
Petro Kovalchuk ◽  
Serhiy Tulyulyuk ◽  
Svitlana Namestiuk
Keyword(s):  
Surgical Treatment ◽  
Shoulder Joint ◽  
Soft Tissues ◽  
Proximal Humeral Fractures ◽  
Humeral Fractures ◽  
Ability To Work ◽  
Aseptic Necrosis ◽  
Results Of Treatment ◽  
Pin Fixation ◽  
Negative Effect

Proximal humeral fractures constitute 5-8% of all the fractures of the limbs and 80% of fractures of the upper arm. To report about remote results of the suggested tactics of surgical treatment of proximal humeral fractures. Satisfactory results of treatment were found in 21 (80,7%) patients out of 26 (72%), who underwent closed reduction of fractures with pin fixation. This group of patients achieved consolidation in optimal terms, and the function of the shoulder joint was satisfactory with abduction angle of 90°. 2 (7,7%) patients experienced secondary dislocation of fragments and their QuickDASH score was 38.4. 3 (11,6%) patients achieved consolidation of fracture, but stable contracture of the shoulder joint occurred. Their QuickDASH score was 38.4. Osteosynthesis with plates was performed in 10 patients. 3 (30%) of them developed aseptic necrosis of the humeral bone head, 2 (20%) patients developed suppuration of the soft tissues which produced a negative effect of the patients’ ability to work ‒ QuickDASH score 42,7, 5 (50%) patients admitted satisfactory results of treatment ‒ QuickDASH score 21,5. Osteosynthesis with plates was performed in 10 patients. 3 (30%) of them developed aseptic necrosis of the humeral bone head, 2 (20%) patients developed suppuration of the soft tissues which produced a negative effect of the patients’ ability to work ‒ QuickDASH score 42,7, 5 (50%) patients admitted satisfactory results of treatment ‒ QuickDASH score 21,5. The tactics of surgical treatment of patients with proximal humeral fracturesdepends on the following: type of a fracture, patient’s age, concomitant pathology and osteoporosis available, and patient’s social needs.

Surgical treatment strategies for secondary peritonitis: Outcome in 278 patients

2001 ◽  
Vol 120 (5) ◽  
pp. A401-A401
Author(s):  
M BOERMEESTER ◽  
E BELT ◽  
B LAMME ◽  
M LUBBERS ◽  
J KESECIOGLU ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Treatment Strategies ◽  
Secondary Peritonitis

Surgical treatment of extensive perianal hidradenitis

2020 ◽  
Vol 99 (9) ◽  
Keyword(s):  
Surgical Treatment ◽  
Hidradenitis Suppurativa ◽  
Soft Tissues ◽  
Case Reports ◽  
Radical Excision ◽  
Skin Flaps ◽  
Perianal Area ◽  
Apocrine Glands ◽  
Patient Preparation ◽  
Two Stages

Introduction: Perianal hidradenitis suppurativa is a chronic recurrent inflammatory, suppurative, and fistulising disease of apocrine glands, adjacent anal canal and soft tissues. Perianal area is the second most common affected area after axilla. There are three grades of the disease. Hidradenitis suppurativa represents a chronic, recurrent, deep-seated folliculitis resulting in abscesses, followed by the formation of sinus tracts and subsequent scarring. Perianal hidradenitis suppurativa is the last and the most serious grade of the disease and a specific access is needed for patient preparation and surgical treatment alone. The currently preferred method of treatment for patients with extensive perianal hidradentitis is excision and closure with combination of skin flaps, primary suture and skin graft in one or two stages. Case reports: There are three case reports of perianal hidradenitis suppurativa in this article. The local and overall initial treatment of patients followed by a radical excision and closure with a rotation skin flaps and skin grafts is described. The final results were satisfactory, with no recurrence or serious complication.

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