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 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 RESULTS OF SURGICAL TREATMENT OF NON-PARASITIC SPLENIC CYSTS IN CHILDREN

2018 ◽  
Vol 22 (1) ◽  
pp. 32-35
Author(s):  
A. V. Myzin ◽  
Vasily G. Kuleshov ◽  
A. E. Stepanov ◽  
N. V. Gerasimova ◽  
K. Yu. Ashmanov
Keyword(s):  
Surgical Treatment ◽  
High Efficiency ◽  
Clinical Symptoms ◽  
Abdominal Cavity ◽  
Long Term Results ◽  
Surgical Interventions ◽  
Results Of Treatment ◽  
Splenic Cysts ◽  
Good Cosmetic

Introduction. Currently, there are different views on the treatment of non-parasitic spleen cysts in children. The choice of method of treatment is under discussion. The aim of our study was to evaluate and analyze the immediate and long-term results of surgical interventions performed on nonparasitic spleen cysts in children. Material and methods. There are presented results of surgical treatment of the 21 patient, who was on treatment at the Department of Abdominal Surgery of the Russian Children Clinical Hospital over the period from 2013 to 2016. Patients were examined by means of ultrasound of the abdominal cavity, CT, MRI. All patients have been operated. 22 surgical interventions were performed by using laparoscopic access, out of which 2 partial resections of the spleen, 1 splenectomy, 19 fenestrations of spleen cysts.Results. During the course of the operation and in the immediate postoperative period there were no complications. Patients were observed for the period of from 1 year to 3 years. Good results of treatment were obtained in 20 (95.2%) children. In a long-term period a relapse occurred in the one patient one year after the operation. The patient was reoperated, splenectomy was performed. Conclusion. The surgical treatment of spleen cysts is the basic one. It is indicated for cysts sized larger than 5 cm and cysts with clinical symptoms. Minimally invasive interventions in children are optimal because of their low traumatism and good cosmetic effect. Our study showed a high efficiency of laparoscopic operations in children suffered from non-parasitic spleen cysts with good long-term results.

Severe Carpal and Tarsal Shearing Injuries Treated With an Immediate Arthrodesis in Seven Dogs

2002 ◽  
Vol 38 (4) ◽  
pp. 370-380 ◽  
Author(s):  
John A. Benson ◽  
Randy J. Boudrieau
Keyword(s):  
Skin Graft ◽  
Soft Tissues ◽  
Plate Fixation ◽  
Wound Management ◽  
Management Technique ◽  
Skin Closure ◽  
Good Cosmetic ◽  
Term Evaluation ◽  
Cosmetic Outcomes ◽  
Grade 3

The medical records of seven dogs with severe, grade 3, open shearing wounds of the carpus or tarsus that were treated with an immediate arthrodesis were reviewed. Six dogs were managed with a transarticular external skeletal fixator (ESF), and one dog was treated with plate fixation. The soft tissues were managed simultaneously along with the definitive joint stabilization in all cases. Minor complications occurred in four dogs: one dog that required a skin graft, one dog in which a skin graft was recommended but not performed, one dog in which a secondary skin closure was performed, and one dog in which a delayed cancellous bone graft was placed. Major complications occurred in three dogs: two dogs that required restabilization of the arthrodesis and one dog that required implant (i.e., plate) removal due to infection. All dogs healed with acceptable functional and cosmetic results. Further long-term evaluation of five dogs revealed that all but one dog had either excellent or good functional outcomes, and the remaining dog had a fair outcome. Similarly, five dogs had either excellent or good cosmetic outcomes, with the remaining dog having a fair outcome. All owners were very satisfied with the overall results. This clinical study demonstrated that an immediate, definitive management technique, in which bone fusion and wound management are undertaken as simultaneous objectives, is a viable technique of managing severe periarticular shearing injuries. Transarticular stabilization with an ESF is the technique recommended.

scholarly journals Organizational problems and possible ways of its resolve when providing emergency surgical care to patients with comorbid status in a highly specialized medical institution

2020 ◽  
Vol 7 (2) ◽  
pp. 64-74
Author(s):  
I. M. Khokhlova ◽  
V. B. Kozhevnikov ◽  
K. N. Movchan ◽  
B. S. Artyushin ◽  
E. V. Bartashevich ◽  
...  
Keyword(s):  
Medical Care ◽  
Critical Limb Ischemia ◽  
Soft Tissues ◽  
Surgical Care ◽  
Limb Ischemia ◽  
Medical Organization ◽  
Surgical Infection ◽  
Results Of Treatment ◽  
Medical Institutions ◽  
Main Activity

Purpose of the study. To demonstrate the difficulties of objective interpretation of providing medical care to patients with critical limb ischemia.Materials and methods. The results of treatment of more than 29 thousand patients of one of the highly specialized medical organizations of St. Petersburg were studied, in which the main activity of the staff is the examination of patients with surgical infection of soft tissues (particularly, the critical limb ischemia).Results. It has been ascertained that, despite the unconditional success of providing medical care to patients with critical limb ischemia, a high frequency of unsatisfactory treatment results for this category of patients remains (in 2017, among 685 patients of the specialized department of the highly specialized medical organization, the proportion of cases of performing high amputations of limbs and mortality, respectively, was 11,7% (80) and 2,6% (18)). It has been demonstrated on clinical examples that the pronounced comorbidity of critical limb ischemia patients and the severity of their general condition (combined with organizational difficulties in providing them with providing medical care in conditions of highly specialized medical organization) contribute to the formation of complications (up to lethal outcomes) of not only the underlying, but also concomitant diseases. Difficulties in providing medical care of adequate quality in life-threatening conditions for patients of highly specialized medical organization in cases of critical limb ischemia necessitate a wider interaction between specialists in narrow and multidisciplinary hospitals as part of the emergency surgery service.Conclusion. When creating specialized medical centers outside of multidisciplinary medical institutions, the possibilities should be provided for the regulated involvement of highly professional consultants with a reasonable algorithm for routing patients in cases of the need for their emergency re-hospitalization to other medical institutions.

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.

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 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.

scholarly journals МОДИФИЦИРОВАННАЯ МАЛОИНВАЗИВНАЯ МЕТОДИКА ЛАПАРОСКОПИЧЕСКИХ ОПЕРАЦИЙ ПО ПОВОДУ ДОБРОКАЧЕСТВЕННЫХ ЗАБОЛЕВАНИЙ ПРИДАТКОВ МАТКИ

2021 ◽  
pp. 5-14
Author(s):  
Yu. E. Dobrochotova ◽  
I. A. Lapina ◽  
L. N. Aminova ◽  
А. G. Kozub ◽  
V. A. Alimov ◽  
...  
Keyword(s):  
Laparoscopic Surgery ◽  
Surgical Treatment ◽  
Postoperative Pain ◽  
Selection Criteria ◽  
Current Trend ◽  
Surgical Trauma ◽  
Benign Diseases ◽  
Results Of Treatment ◽  
Good Cosmetic ◽  
Cosmetic Effect

The article substantiates the feasibility of developing minimally invasive operations on the adnexa and minimizing surgical trauma. The technique of the modified laparoscopic surgery method proposed by the authors for benign diseases of the adnexa is described in details. The results of treatment of 37 patients operated on by the presented method are considered. The selection criteria for patients for the application of this method of surgical treatment are determined. It is shown that the presented method corresponds to the current trend of minimizing surgical trauma, has a good cosmetic effect, helps to reduce postoperative pain, and is also economically feasible, because it does not require the use of additional endoscopic instruments.

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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