Vacuum-assisted healing of various-aetiology wounds: A systematic review

Background. The ever-growing rate of man-made accidents and disasters entails high traumatism. Traumas and other injuries, including purulent necrotic lesions, often lead to extensive wound defects requiring special surgeries for closure and to restore skin integrity.Objectives. A comparative inter-specialty review in trauma surgery on the vacuum therapy application in healing wounds of different locality and aetiology.Methods. The review includes relevant cases of use experience in vacuum-assisted healing of various locality and aetiology wounds, indexed in the PubMed, ScienceDirect and eLibrary databases for years 2014–2020. The following research techniques were employed: online, content, historical and descriptive analyses with a focus on specific issues in aetiology, pathogenesis and vacuum-assisted healing of various-locality wounds.Results. Vacuum-assisted healing of various locality and aetiology wounds is a current standard acting in complex with adequate surgical treatment, antibiotic therapy and early rehabilitation measures.Conclusion. Manifold literature sources, colleagues’ publications and guidelines for vacuum-assisted closure (VAC®-therapy Guidelines) substantiate the effect and promise of the vacuum-based approach in complex treatment of various-aetiology wounds. Further studies into the mechanisms of action and the elaboration of indications list are warranted for this method

Analysis of the Outcomes of a New Method for Plastic Surgery for Postoperative Wound Of Sacrococcygeal Region after Excision of the Pilonidal Cyst: Randomized Trial.

Background. Despite a variety of existing methods of surgical treatment for sacrococcygeal pilonidal cyst, a universal technique has not been developed yet, due to the large number of postoperative complications and recurrences.Objectives. To improve the treatment outcomes of patients with pilonidal cysts through developing and implementing a new method for closure of the postoperative wound defect of the sacrococcygeal region.Methods. We conducted a randomized trial, involving 60 patients with sacrococcygeal pilonidal cyst. The control and main groups consisted of 30 people each. The study was carried out in the Purulent Surgery Unit of the Regional Clinical Hospital No. 1 — Research Institute, Krasnodar. The inclusion of patients in the trial was organized within 2019–2022 period. The duration of each patient’s follow-up period was equal to the hospitalization duration. The control group underwent the surgical treatment in the Moszkowicz (Moshkovich) modifi cation. The main group was treated by means of our own developed method. Postoperative wound complications were assessed according to Clavien—Dindo classifi cation. Statistical data processing was performed using Microsoft Excel 2013 with the add-ins Analysis package and AtteStat for statistical data.Results. The control and main groups included 30 participants each. The gender, age and body mass index (BMI) were not defi ned as statistically signifi cant. When analyzing the primary data, the treatment median time accounted for 10.5 (9.0; 13.8) days in the control group and 7.0 (7.0; 8.0) days in the main group, a signifi cant difference according to the Mann—Whitney test (p < 0.001). The number of postoperative complications (suture failure, wound abscess, necrosis of skin fl aps) in the control group was 16 cases, and in the main group — 1 case (signifi cance of differences under the chi-squared test p < 0.001). The number of recurrences in the control group comprised 7 cases, while in the main group there was 1 case (signifi cance of differences under the chi-squared test p = 0.023).Conclusion. The application of surgical treatment for pilonidal cysts in the authors’ modifi cation made it possible to reduce the time of hospitalization, the number of such postoperative complications as suture failure, wound abscess and necrosis of skin fl aps. The number of recurrences has also decreased significantly

Vacuum Therapy in Complex Treatment of Purulent-Necrotic Diseases of Soft Tissues: Clinical Cases

Background. Radical surgeries for phlegmons, abscesses, necrotizing infection are often followed by extensive wounds which require an individual approach to their rapid closure by means of plastic surgery methods. In such a case, the optimal wound therapy is primary healing with the use of vacuum therapy.Cases description. The study involved three clinical trials of patients with acute purulent-necrotic diseases of soft tissues of various localizations, volumes and grades, for which vacuum therapy was used as a part of complex therapy. Surgical interventions are proved to be urgently performed in acute purulent-necrotic diseases. Early reconstructive skin and bone plastic surgery aimed at closing post-operative wound defects is also very important.Conclusion. In the demonstrated clinical cases, the purulent process was stopped and wound therapy was performed by means of primary healing, which undoubtedly ensures medical and social rehabilitation of such patients. Notably, vacuum drainage is not an independent method, but an important component in the complex active surgical treatment of purulent wounds

Multidisciplinary Approach to the Management of Diabetic Foot Complications

Background: According to the International Working Group on the Diabetic Foot (2015), 28 % of diabetic foot ulcers result in major amputations. Over 30 % of patients with diabetic foot undergo major amputations that result in death in 13.0 %-14.0 % of the cases.   Clinical case: In our experience of treating a female patient with diabetic foot complications, we observed that such cases require a multidisciplinary approach to determine management strategies, as well as strict surgery staging. Early plastic and reconstructive surgery demonstrated its positive impact on postoperative wound closure.   Conclusions: We managed the infection and achieved the complete closure of the major wound and primary intention healing through the multidisciplinary approach and strict adherence to surgical staging (debridement, revascularization, reconstruction). Thus, patient quality of life and rehabilitation potential significantly improved

Treatment optimization of patients with epithelial coccygeal passage complicated by an abscess

Background: Despite the wide variety of epithelial coccygeal passage treatment methods, the choice of the type of surgery is still an issue to be discussed. It is due to the heterogeneity of the clinical material, the variety of pathological processes and development of the pathology. In spite of the absence of serious complications in most cases, it causes a significant deterioration of life quality and reduction of work capacity in patients of the most active age group.Objective: Improvement of the treatment results of patients with epithelial coccygeal passage complicated by an abscess by means of vacuum therapy of a sutured postoperative wound (Russian Patent 2764499 date 07.04.2021).Material and methods: The study included 59 patients: 19 people in the main group, who underwent surgical treatment of the epithelial coccygeal passage complicated by an abscess, using vacuum therapy according to the proposed method. A retrospective analysis of the medical histories of patients who underwent surgical treatment of the epithelial coccygeal passage complicated by an abscess has been carried out by means of the traditional method of wound closure with drainage. These patients were included in the control group of 40 people.Results: In the control group purulent-inflammatory complications were recorded in 4 (10%) patients. Out of 19 people of the main group operated on according to the method proposed by us, purulent-septic complications were not recorded in any of the patients. Wound bandaging has been performed 71 times in 19 patients of the main group, and 454 times in 40 patients of the control group. For 19 patients of the main group the duration of the antibiotic therapy lasted 96 days, for 40 patients of the control group - 306 days. The average number of bed-days for patients of the control group was 10.63, in the main group - 7.56.Conclusion: The use of the proposed method of surgical treatment of epithelial coccygeal passage complicated by an abscess, by means of vacuum therapy at all stages of treatment, made it possible to improve treatment results in patients of the main group

Пути снижения частоты высоких ампутаций, постампутационных осложнений и летальности при синдроме диабетической стопы

Despite the success in treatment, currently 30.0% of patients with diabetic foot syndrome (DFS) still undergo high amputations with a mortality rate of up to 54.0–68.0 %. The causes of high low limb amputations in 28.0 % of patients are infection, and in 46.0 % – arterial insufficiency in the stage of critical limb ischemia.Objective: to improve the results of patients treatment by reducing the number of high amputations of the lower extremities, reducing the occurrence of complications and deaths of the disease.Materials and methods. To study the results of treatment of patients with DFS, they were divided into two comparison groups and two main groups. From 1982 to 2019, the frequency of amputations, mainly at the hip level, was 71.0 % (177 amputations in 248 patients). These patients formed the first comparison group of observations. The second comparison group (1988–1994) included 58.3 % of patients in whom amputations were performed according to more stringent indications (157 amputations in 269 patients). The first main group of observations (1995–2013) included 9.9 % of patients with DFS who were amputated only for wet gangrene, incurable critical limb ischemia, and infection with a systemic inflammatory response (130 amputations out of 1312 patients). In ischemia with preserved blood flow through the deep artery of the thigh, amputation of the lower leg was performed in a sequential-two-flap method with removal of the soleus muscle. Amputations were completed with the imposition of drainage removable muscle-fascial sutures. The second main group (2014) consisted of 11.4 % of patients who underwent amputations only for sepsis or wet gangrene (124 amputations in 1083 patients). The difference between the second main group and the first was the division of the high amputation intervention into 2 stages.Results. Comparison of the treatment results in the main groups and in the comparison groups revealed a 6-fold decrease in the number of high amputations (from 64.6 to 10.69 %) and a significant improvement in the main quality indicators. This concerns a 6-fold decrease in mortality, which was a consequence of the introduction of a two-stage tactic for high amputation treatment of the most severe patients and the limitation of indications for amputation of the hip. Using of removable drainage muscle-fascial sutures decreased postoperative wound complications from 51.9 to 13.0 %, and the number of re-amputations decreased in 17th times.Conclusion. Amputation of the lower extremities for irreversible critical limb ischemia can be performed with a decrease in TcP02 of the stitched stump tissues to no more than 30 mm Hg. Preserving the knee joint improves the possibilities of prosthetics, which allows older diabetics to lead an active life. Methods of performing parallel- or sequential-two-flap high amputation improve the conditions for cutting out racquet-shaped wound flaps, which provides free displacement of the soft tissues of the stump connected by removable drainage sutures.Несмотря на успехи в лечении, в настоящее время у 30,0 % больных синдромом диабетической стопы (СДС) до сих пор выполняют высокие ампутации с летальностью до 54,0–68,0 %. Причинами ампутаций у 28,0 % больных служит инфекция, а у 46,0 % – артериальная недостаточность в стадии критической ишемии.Цель исследования: улучшение результатов лечения больных за счет сокращения числа высоких ампутаций нижних конечностей, снижения возникновения осложнений и летальных исходов заболевания.Материалы и методы исследования. Для исследования результатов лечения пациентов с СДС их разделили на две группы сравнения и на две основные группы. С 1982 по 2019 г. частота ампутаций, главным образом на уровне бедра, составила 71,0 % (177 ампутаций у 248 больных). Эти больные образовали первую группу сравнения наблюдений. Во вторую группу сравнения (1988–1994 гг.) включены 58,3 % пациентов, у которых ампутации выполняли по более строгим показаниям (157 ампутаций у 269 больных). В первую основную группу наблюдений (1995–2013 гг.) вошли 9,9 % больных СДС, которых ампутировали только по поводу влажной гангрены, неизлечимой критической ишемии и инфекции с системной воспалительной реакцией (130 ампутаций из 1312 больных). При ишемии с сохраненным кровотоком по глубокой артерии бедра ампутацию голени выполняли последовательно-двухлоскутным способом с удалением камбаловидной мышцы. Ампутации завершали наложением дренирующих съемных мышечно-фасциальных швов. Вторая основная группа (2014 г.) состояла из 11,4 % больных, которым ампутации выполнили только по поводу сепсиса или влажной гангрены (124 ампутации у 1083 больных). Отличие второй основной группы от первой заключалось в разделении ампутационного вмешательства на 2 этапа.Результаты исследования. Сравнение результатов лечения в основных группах и в группах сравнения выявило снижение числа высоких ампутаций в 6 раз (с 64,6 до 10,69 %) и достоверное улучшение основных качественных показателей. Это касается шестикратного уменьшения летальности, что явилось следствием внедрения двухэтапной тактики ампутационного лечения самых тяжелых больных и ограничения показаний для ампутации бедра. Благодаря использованию съемных дренирующих мышечно-фасциальных швов послеоперационные раневые осложнения сократились с 51,9 до 13,0 %, а количество реампутаций уменьшилось в 17 раз.Заключение. Ампутацию голени по поводу необратимой критической ишемии можно выполнять при снижении TcP02 сшиваемых тканей культи не более чем до 30 мм рт. ст. Сохранение коленного сустава улучшает возможности протезирования, что позволяет пожилым диабетикам вести активную жизнь. Методы выполнения параллельно- или последовательно- двухлоскутной ампутации улучшают условия для выкраивания раневых лоскутов ракеткообразной формы, что обеспечивает свободную смещаемость соединенных съемными дренирующими швами мягких тканей культи

PLATELET-RICH PLASMA FOR PERSISTENT ULCERS OF THE LOWER LIMBS

Background. Estimation of safety and efficiency of platelet-rich plasma in complex treatment in patients with persistent large ulcers.Material and methods. Two clinical cases of patients with long persistent ulcers of the lower extremities that were administered local injections of the autologic platelet-rich plasma in the wound area in combination with or without autodermoplasty.Results. In the first case the patient had a trophic ulcer after erysipelatous inflammation without dynamics to healing in the setting of the carried treatment. Surgery was contraindicated due to severe accompanying pathology. This patient had 6 PRP courses (once a week). The regional epithelialization appeared on the 2nd week. After 6 injections full wound healing was noted. In the second case the patient had a long persistent post-traumatic ulcer with 2% square. The autodermoplasty with local introduction of PRP was performed. We observed a full graft acceptance on the 6th day.Conclusion. PRP use will allow to improve outcomes of treatment persistent ulcers of the lower extremities. It represents extremely important to continue work on PRP application due to an absence of complications and obvious contraindications in this method for carrying out comprehensive analysis