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Treatment of Purulent Wounds
Abstract
The number of patients with acute purulent diseases of the soft tissues hasn't reduced and tends to rise, accounting for 35-40% of all surgical patients. The success of the surgical treatment of acute purulent diseases of soft tissues depends on radical surgical AIDS, performed with adequate anesthesia. Drainage of wound fluid is an factor important to successful wound healing in the incisional period. The use of antibiotics is included in a comprehensive treatment of patients with acute purulent surgical infection. The development of current methods of active treatment is related to the revision of the main points of the classical incision-drainage method and changing the very nature of the operation itself. They envisage a targeted radical surgery in the site of supportive focus to provide the effective and adequate drainage so as completely different, more aggressive therapy of purulent wounds in the inflammatory and regeneration phases. Any drainage system requires some special conditions. The necessity for early and rapid closing of purulent wound led to the search and creation of conditions for sutures and skin plasty. A new perspective way to overcome antibiotic resistance is considered to use probiotics. Another new direction in solving the issue of the treatment of chronic inflammatory processes of different localization is the inclusion of neuropeptides such as hypothalamic nanopeptid (oxytocin) in a comprehensive treatment.
... Физико-химические свойства антисептических средств: что мы не учитываем в лечении длительно незаживающих ран V.P. Bodduluri 1 ...
... The number of patients with purulent and long-term nonhealing wounds and the effectiveness of their treatment with the use of existing medical standards and medicines remain the same [1,2]. Therefore, the issue of developing new medicines and innovative methods of treating purulent diseases remains very relevant [3]. ...
The treatment of long-term non-healing wounds in the conditions of purulent surgery departments, widely uses solutions of chemotherapeutic and antiseptic agents. The most common are the solutions of 3-6 % hydrogen peroxide and solutions of 2-10 % sodium chloride. As a rule, solutions of these drugs are used to treat non-healing, particularly, pu-rulent wounds, bedsores and trophic ulcers. Therefore, solutions are injected into the wound area repeatedly in the form of course therapy. The findings show that the mechanism of action of these drugs and the effect of treating long-term non-healing wounds is largely determined by such physical and chemical factors of their local interaction as concentration of the main ingredients, osmotic, alkaline activity and local temperature. The findings point out the leading role of the local temperature and the dependence of the local effect on the concentration. They describe the essence of the innovative method of treatment. Keywords: purulent surgery, trophic ulcers, antiseptics, sanitization of purulent wounds, temperature, hydrogen perox-ide, sodium chloride For citation: Bodduluri V.P., Gurevich K.G., Urakov A.L. Physico-Chemical Properties of Antiseptics in Surgery: What is not Taken into Account in Treating Long-Term Non-Healing Wounds. Creative Surgery and Oncology. 2021;11(3):256-259. https://doi.
... Физико-химические свойства антисептических средств: что мы не учитываем в лечении длительно незаживающих ран V.P. Bodduluri 1 ...
... The number of patients with purulent and long-term nonhealing wounds and the effectiveness of their treatment with the use of existing medical standards and medicines remain the same [1,2]. Therefore, the issue of developing new medicines and innovative methods of treating purulent diseases remains very relevant [3]. ...
The treatment of long-term non-healing wounds in the conditions of purulent surgery departments, widely uses solutions of chemotherapeutic and antiseptic agents. The most common are the solutions of 3–6 % hydrogen peroxide and solutions of 2–10 % sodium chloride. As a rule, solutions of these drugs are used to treat non-healing, particularly, purulent wounds, bedsores and trophic ulcers. Therefore, solutions are injected into the wound area repeatedly in the form of course therapy. The findings show that the mechanism of action of these drugs and the effect of treating long-term non-healing wounds is largely determined by such physical and chemical factors of their local interaction as concentration of the main ingredients, osmotic, alkaline activity and local temperature. The findings point out the leading role of the local temperature and the dependence of the local effect on the concentration. They describe the essence of the innovative method of treatment.
... Общеизвестно, что лечение пациентов с фурункулами челюстно-лицевой области должно быть комплексным, то есть включать хирургические и консервативные методы [10,11]. Оно должно осуществляться в условиях стационара и его составляющие находятся в прямой зависимости от стадии и распространенности ИВП [12,13]. ...
... Articaini 4% -1 ml из центральной области инфекционно-воспалительного очага по принципу инцизионной биопсии в следующие сроки: 3, 7, 14 и 21 сутки после ПХО. Сроки патогистологического исследования были обусловлены фазами течения инфекционно-воспалительного процесса мягких тканей [12]. ...
The most common neodontogenic infectious and inflammatory processes affecting the skin are furuncles in the maxillofacial area. The task of effective treatment of patients with this disease is now becoming increasingly urgent which is largely due to the deterioration of the environmental situation, changes in the nature of nutrition and chronic stress. The purpose of the study is to make a comparative assessment of the results of the standard method of postoperative treatment and complex treatment using electroacupuncture based on the dynamics of the pathohistological picture of a purulent wound in experimental animals with a model of a boil in the head and neck. Materials and methods. Experimental studies were carried out on 20 guinea pigs of the same age and body weight, on which a model of a boil in the submandibular area was created. The boil was formed within 3 days, after which all experimental animals under local infiltration anesthesia underwent primary surgical treatment of the infectious and inflammatory focus with wound drainage. Then the animals were divided into two series. Series 1 received a standard treatment package in the postoperative period (antibiotics, daily dressings with mandatory drainage changes, instillation of the wound with antiseptic solutions). For series 2 of animals, the standard treatment was combined with an electroacupuncture treatment. The material for pathohistological examination was collected in the following terms: 3, 7, 14 and 21 days after the operation. Serial sections were made according to the standard procedure. The micro-preparations were examined using a light microscope. For comparison a descriptive method was used. Results and discussion. The most significant differences were found on the 21st day of observation when diffuse mononuclear cell infiltration of all layers of the dermis was detected in most of the series 1 micro-preparations which indicated the presence of productive inflammation. During the same period of observation, all the micro-preparations of series 2 showed a multilayered flat keratinizing epithelium without violating the integrity throughout. The papillary and reticular layers of the dermis showed no signs of inflammation. The appendages of the skin were traced throughout the entire field of vision without visible pathological changes. All of the above indicated no signs of inflammation. Conclusion. The results obtained clearly indicate the positive effect of electroacupuncture on both wound cleansing and the course of the processes of reparative regeneration of the skin
... Moreover, each wound infection could spread and cause severe consequences, up to life-threatening sepsis. According to statistical data, the incidence of purulent-inflammatory diseases and infectious complications occupies one of the main positions in the list of surgical diseases: the proportion of patients with purulent infection amongst all surgical patients is 35-40%, and mortality reaches 42% [1]. ...
A new approach to the treatment of wound lesions, which are complicated by the presence of polyresistant microflora and a possible immunodeficiency background has been proposed. It involves treating the wound surface with high-intensity pulsed optical radiation of a continuous spectrum, continuously covering the entire UV range (from 200 to 400 nm), visible and near infrared region of the spectrum. A pulsed xenon lamp is used as a radiation source. A description of the design and technical characteristics of the developed device for high-intensity optical irradiation "Zarnitsa-A", which implements the proposed medical technology for wound therapy, is represented. The results of preclinical studies of the apparatus in vitro and in vivo are represented hereinafter. The article shows that the apparatus exposure has pronounced bactericidal and wound-healing properties. The apparatus action reliably provides higher rates of wound healing compared to the use of only a typical antibacterial and wound healing agent – “Levomekol” ointment.
Цель. Изучить цитологические особенности процессов заживления у пациентов с флегмонами мягких тканей, с использованием программируемых санационных технологий. Материал и методы. В исследовании участвовало 245 пациентов с гнойными флегмонами мягких тканей, различных локализаций. Пациенты рандомизированы на две группы. В основной группе (n=127) в послеоперационном периоде проводили программируемые санации с использованием устройства АМП-01. После вскрытия флегмоны и хирургической обработки в раневую полость устанавливали трубчатые дренажи, рану ушивали наглухо, дренажи выводили через отдельные разрезы и подсоединяли к устройству, с помощью которого устанавливали параметры санации (скорость, время, объем используемых растворов при ирригации или аспирации). В группе сравнения (n=118) после операции пациенты получали традиционное местное лечение. Динамику процессов заживления гнойных ран оценивали по результатам цитологического исследования материала, взятого с использованием метода поверхностной или пункционной биопсии. Результаты. В основной группе пациентов отмечены более высокие значения скорости клеточных реакций и снижения дегенеративных форм нейтрофилов и регенеративно-дегенеративного индекса (p<0,001), указывающие на ускорение купирования воспалительного процесса. Также в основной группе статистически значимо сократились сроки появление макрофагов и фибробластов (p<0,001), что свидетельствовало о более высокой скорости пролиферативных процессов, а цитологическая картина к 9 суткам послеоперационного периода соответствовала регенеративному типу цитограмм. В группе сравнения отмечено удлинение фазы воспаления и фазы регенерации. Вывод. Цитологические исследования у пациентов с флегмонами мягких тканей позволили выявить более высокую скорость клеточных реакций при применении программируемых санационных технологий, которая свидетельствовало о сокращении фазы воспаления и ускорении репаративных процессов в ране.
In this paper, a new approach to treating infected wounds is proposed. It is based on treating the wound surface with high-intensity pulsed optical radiation with a continuous spectrum, continuously covering the entire UV range (from 200 to 400 nm) and the visible and near-infrared regions of the spectrum. A pulsed xenon lamp is used as a radiation source. A description of the design and technical characteristics of the device, “Zarnitsa-A”, is presented, implementing the proposed medical technology for wound therapy. The results of our studies of the apparatus in vitro and in vivo are also presented. The article shows that exposure to the apparatus leads to pronounced bactericidal- and wound-healing properties. The apparatus’s action reliably provides higher rates of wound healing compared with only a typical antibacterial or wound healing agent, such as “levomekol” ointment.
Aliphatic polyamines (putrescine, spermidine, spermine) are organic polycations that play an important role in wound healing by stimulating several cellular mechanisms. In a human skin wound sample, the activity of the enzyme ornithine decarboxylase, which regulates the rate of polyamine synthesis, rapidly increases along the wound edges and leads to the activation of the polyamine synthesis cascade. Under the influence of polyamines, some signaling systems are also activated in wounds, which are the main pathways for the release of cellular mechanisms, and thanks to them, the healing process begins in wounds. For example, spermine induces the synthesis of urokinase-type plasminogen activator, the binding of which to the corresponding receptor at the wound margins executes the urokinase-type plasminogen activator and its receptor signaling system, which is the main driver of keratinocyte migration. Eukaryotic cell proliferation depends on precise modification of the eukaryotic initiation factor 5A1, in which spermidine plays an indispensable role. However, in addition to the significant functions performed by polyamines in the human body, polyamines are also necessary for the normal growth and development of fungi and bacteria. Small amounts of some microorganisms have a positive effect on the healing of wounds, but their increase, on the contrary, leads to the impairment of the normal course of wound healing due to their enhanced synthesis of polyamines. On the other hand, many studies show that excess ornithine decarboxylase and polyamines increase the risk of skin cancer. Suppression of polyamine synthesis by pathogenic microflora during wound healing can contribute to both rapid healing and the prevention of skin cancer. In our study, we offer a way of inhibition of polyamine synthesis by wound microflora for rapid wound healing and prevention of subsequent cancer. The medicinal mixture “Armenicum/Eflornithine” is a mixture of the drug “Armenicum” and α-difluoromethylornithine.
Objective. To study the current Russian and foreign literature dedicated to the problem of application of organometallic compounds immobilized on drugdelivery in the treatment of purulent-inflammatory disease of the skin and soft tissues. Methods. The modern Russian and foreign literature, available in the Pubmed, Medline, Springer, Scopus, e-LIBRARY databases were reviewed according to the problems of purulent-inflammatory diseases, skin and soft tissue infections, the integrated approach to the treatment of purulent-inflammatory diseases, synthesis, immobilized organometallic compounds. Results. The observational study of the specificrecent achievements in the modification of antimicrobial biomaterials is presented. Metal ions havea broad range of antimicrobial activity (especially on proliferation and remodeling), possess by bacteriostatic and bactericidal effect, demonstrate multiple inhibitory effects against bacterial strains and havebeen proveneffectivein improvingwoundhealing in all its phases. Natural products and especially biologically active metals such as silver, copper, zinc and germanium, are believed to be an alternative for the development of perspective biomaterials with antimicrobial properties. In recent years, new approach for the production and application of therapeutic and diagnostic drugs based on the immobilization or grafting of drugsubstances on polymer carriers has been developed. At present, namely the immobilized compounds that have opened the way to the creation of prolonged-action drugs with low toxicity and allergenicity. Conclusion. Template synthesis of new organometallic drug compounds is considered to be a promising direction in the wound infection treatment, which requires further experimental and clinical study.
Lack of control over the course of the disease (diabetes), ignoring measures to prevent the development of complicated forms of diabetic foot, late referral of patients with existing complications on the foot, contributes to an increase in the number of patients with destructive forms of diabetic foot.
Purpose of the study. To evaluate the technique of vacuum instillation therapy (NPWTi) in comparison with the use of an isolated vacuum and the classical surgical method for treating purulentnecrotic forms of diabetic foot.
Materials and methods. The results of local treatment of 41 patients with purulent-necrotic forms of diabetic foot corresponding to III and IV stages (Meggitt-Wagner) were analyzed. The patients are divided into groups depending on the method of topical treatment. The cellular composition and microflora of the wounds were studied, and the change in the area of the wound surface was assessed before the start of treatment and in the 4–5th and 8–9th days.
Results and discussion. The use of NPWT showed better treatment results in comparison with group 1, where signs of phase II of the wound process were diagnosed by 8–9 days from the start of topical treatment in 83,3% of patients. The highest efficiency in topical treatment was noted in the 3rd group using the NPWTi method, where by the 4th–5th day, ½ patients were cytologically diagnosed with phase II of the wound process.
Conclusions. The NPWTi technique is most effective in the treatment of purulent-necrotic forms of diabetic foot, which makes it possible to reduce the time of wound cleaning, the time of the patient's stay in the hospital, and save the limb.
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.
Вступ. Лікування ран та ранової інфекції є важливою проблемою як для військової, так і загальнодержавної системи охорони здоров’я України. На сучасному етапі основоположним підходом до лікування гнійних ран є патогенетична спрямованість відповідно до фази ранового процесу, що включає наступні етапи: активну хірургічну обробку; додаткову обробку післяопераційної рани; раннє закриття ранового дефекту; дренування рани; антибактеріальну терапію; усунення факторів, що уповільнюють загоєння.
Мета дослідження - аналіз сучасних технологічних підходів до створення м’яких лікарських засобів для лікування гнійних ран.
Матеріали та методи дослідження. У роботі використані національні та міжнародні літературні джерела; застосовано методи системного аналізу і бібліо-семантичного дослідження.
Результати дослідження. Узагальнено підходи Державної фармакопеї України, Європейської фармакопеї, Фармакопеї США та інтегрованих класифікацій, запропонованих рядом науковців, щодо класифікації м’яких лікарських засобів.
Визначено основні фармацевтичні фактори, що впливають на ефективність та якість м’яких лікарських засобів: фізичні властивості активних фармацевтичних інгредієнтів та допоміжних речовин, природа та кількості основи-носія і допоміжних речовин, що входять до складу лікарського засобу, вид лікарської форми і технологічні операції, здійснені при її виготовленні. Основи-носії є важливими складовими м’яких лікарських засобів, оскільки становлять 90 % і більше від загальної маси та впливають на активність лікарських речовин і реологічні властивості лікарської форми. Визначено, що відповідно до вимог Державної фармакопеї України, класифікація основ м’яких лікарських засобів проводиться за ознаками спорідненості до води та типу дисперсної системи. Фармакопеєю США використовується додаткова диференціація за здатністю абсорбувати воду, що обумовлює виділення чотирьох класів основ для мазей: вуглеводневих, абсорбційних, водно-змивних та водорозчинних.
Проведений аналіз результатів досліджень показав, що клінічно обгрунтованим для місцевого лікування ранового процесу є використання мазей на гідрофільних та емульсійних основах, яким притаманні дегідратуюча дія та здатність ефективно проводити активні фармацевтичні інгредієнти до ранових каналів та порожнин.
Висновки. М’яким лікарським засобам належить провідна роль в місцевому лікуванні гнійних ран, оскільки вони забезпечують досягнення оптимальної концентрації активних фармацевтичних інгредієнтів в ділянці ураження, забезпечуючи високу терапевтичну ефективність та пролонговану дію з мінімальними проявами побічної дії складових компонентів. Вирішальне значення при розробці м’яких лікарських засобів для лікування гнійних ран мають фармацевтичні фактори: фізичні властивості лікарських речовин, природа та кількості основи-носія і допоміжних речовин, що входять до складу лікарського засобу, вид лікарської форми і технологічні операції, здійснені при її виготовленні. На сучасному етапі доцільною є розробка комплексних препаратів для певних фаз ранового процесу, що дозволяють одночасно впливати на декілька факторів патогенезу. Визначено, що для лікування гнійних ран в першій фазі ранового процесу доцільно застосовувати м’які лікарські засоби з сильно вираженою і тривалою осмотичною активністю, у другій фазі - з помірною осмотичною активністю, у третій фазі ранового процесу лікарські засоби повинні попереджати висихання ранової поверхні, захищати і стимулювати ріст грануляцій.
A Mathematical Wave Analysis was conducted to study the frequency-temporal characteristics of sleep spindles in idiopathic generalized epilepsy (IGE) with variable phenotypes in adults. In resistant generalized tonic-clonic seizures (GTCS), the maximum duration of the stationary part of the sleep spindle in the 10–12Hz frequency band in the frontal and parietal regions was greater with Juvenile Absence Epilepsy compared with Juvenile Myoclonic Epilepsy and IGE with isolated GTCS. In patients with GTCS remission who took antiepileptic drugs (AED’s) in the anamnesis, the frequency-time characteristics of the sleep spindle were not different. In the entire group, the maximum duration of the stationary part of the sleep spindles in patients with IGE with a variable phenotype receiving AED’s was significantly less than in patients who stopped receiving AED’s. The revealed differences in the duration of the stationary part of the sleep spindles are due to various pathogenetic mechanisms underlying the different types of generalized seizures in adults, and can be used to refine the subtype of the IGE and evaluate the efficacy of the AED’s.
Objectives. To optimize treatment of purulent wounds with the help of a wound coating with a multidirectional action that combines broad-spectrum antimicrobial effect, stimulation of regeneration, sorption activity and local anesthetic action. Materials and methods. The material for the study was a wound covering in the form of a film developed by the authors at Kursk State Medical University (Russian patent No. 2601897). Theexperiment was performed on laboratory animals (Wistar rats), which were divided into 2 groups (comparison and experimental), each group containing 36 animals. Purulent wound was modeled in the animals according to the method of P.I. Tolstykh. To evaluate the effectiveness of the treatment, the following methods were used: microbiological method (determination of areas of growth retardation and bacterial contamination in the wounds), Renier’s method (determination of local anesthetic activity), visual assessment of wounds, planimetric method (measurement of the wound area, percentage of area reduction and healing speed) and measurement of pH in the wounds. The statistical significance of the differences was determined with the nonparametric Mann–Whitney test. The differences were considered statistically significant at p ˂ 0.05. Results. Initially, high efficiency of the film was detected in vitro for the most common strains of test organisms, which werewound infection pathogens. The Renier index was 1.2 times higher in the film with chlorhexidine than in 2% lidocaine ointment, and the duration of general anesthesia was 25% longer. Following visual assessment of the wounds we revealed that purification and regeneration of the wounds first occurred in the animals in the experimental group; however, no statistical significance was detected. The maximal differences in the healing speed (1.6 times) were observed at 3–5 days, and the contamination of the wounds was 1.3 times lower in the experimental group than in the comparison group. According to the results of pH assessment, significant differences between the groups were noted only on day 15. Approximation of pH values to intact skin values also proved the effectiveness of treatment. Conclusion. The developed contact wound covering has high antimicrobial activity against a broad spectrum of wound infection pathogens, creates a fairly good local anesthetic effect, significantly speeds up the healing process and reduces bacterial contamination of the wound area. Thus, the developed wound covering can be recommended for further studies in the clinical setting for treatment of inflammatory processes in soft tissues.
Diabetes mellitus (DM) disturbs the maturation process of the granulation tissue of the wound and promotes the
development of its pathological changes (atrophy, hypertrophy, scarring). Histological signs of proliferation disorders
determine the need for an additional surgical wound treatment in patients with DM at the stage of preparation of a
chronic wound (CW) for autodermoplasty (ADP).
Aim. To determine the most optimal method of surgical treatment of pathologically changed granulations in
patients with CW and DM in preparation for ADP.
Material and methods. The results of the complex treatment of CW for 94 patients, including 73 patients with
DM, were studied. Several methods were used to prepare local wounds for ADP: excision of granulations using a
necrotome knife, hardware treatment (double wound bed treatment with low-frequency ultrasound using controlled
negative pressure between operations of the session) and a combination of these techniques (excision of granulations
was performed during the first ultrasound session).
Results. The smallest number of skin graft failure cases was obtained when using a combined method of chronic
wound bed preparation with surgical excision of pathologically altered granulations.
Conclusion. A combination of surgical excision of pathologically altered granulations and hardware treatment is
the most effective way chronic wound bed preparation for skin grafting in patients with DM.
Aim:
to evaluate the effectiveness of modern approaches to the treatment of purulent wounds with the use of foam-based wound coatings with the Hydrofiber technology in comparison with the traditional method of wounds.
Material and methods:
An analysis of the results of treatment of 34 patients with purulent wounds of various etiologies was performed. Patients were divided into two groups: control and basic. In the main group, local treatment of wounds was carried out using a foam-based wound coating with Hydrofiber technology. In the control group, local treatment of wounds was carried out using traditional methods with the use of gauze bandages.
Results:
With the use of foam-based wound coatings with Hydrofiber® technology, the inflammation process in the wound and surrounding tissues is more rapidly eliminated, the periods of purification and microbial decontamination in the purulent focus are reduced.
Optimal management of post-operative wounds in the community is important to prevent potential complications such as surgi-cal-site infections and wound dehiscence from developing. As such, general practitioners, who play an important part in the sub-acute management of post-operative wounds, should appreciate the physiology of wound healing and the principles of post-operative wound care.
The objective of this article is to update general practitioners on the important aspects of post-operative wound care. This includes a review of the physiology behind wound healing, an update on wound cleansing and dressing methods, as well as a guide on how common post-operative wound complications should be managed.
The key elements of post-operative wound care include timely review of the wound, appropriate cleansing and dressing, as well as early recognition and active treatment of wound complications.
The Alfred Hospital is a referral centre for necrotizing soft tissue infections (NTSIs) in the state of Victoria and receives around 20 such patients each year. We sought to compare our practice and outcomes against published data, and to examine management at referring hospitals to determine whether adjustments to current practices are required.
A retrospective chart review of patients admitted to the Alfred Hospital between 1 January 2001 and 31 December 2010 with a diagnosis of necrotizing fasciitis was conducted. Demographic, etiologic, treatment and outcome data were collected and analysed.
Two hundred and nineteen patients were identified with a mean age of 54.76 years and a preponderance of men (63.47%). The overall mortality rate for the patient group was 15.98%. More than 80% of patients were transferred from another facility. Nearly 40% of patients did not undergo surgical debridement within 24 h of presentation to a hospital and 30.6% were not debrided prior to transfer. Patients underwent a median of three procedures at the Alfred Hospital and the majority of patients required admission to the intensive care unit (68.95%).
NTSIs remain a surgical emergency with high rates of mortality and resource requirements. The mortality rate at our institution compares well with other published series. Many patients experienced delays before undergoing debridement and in many cases were transferred without debridement. The trend towards transferring NTSI patients to centres accustomed to treating burns and major trauma seems logical, but should not delay life-saving surgical debridement. Timing of transfer does not seem to affect mortality.
To ascertain the effect of larval therapy against bacteria associated with infected chronic wounds, and determine if larvae therapy actively reduces the bacterial load in chronic wounds.
An extended literature review was undertaken using online databases: Athens, Medline, EMBASE, British Nursing Index and Allied and Complementary Medicine via OV ID and Cumulative Index to Nursing and Allied Health. Key terms were searched worldwide from 1950 to 2011.
Four themes emerged: Gram-positive and Gram-negative bacteria, MRSA, quorum sensing: biofilm consideration and bacterial burden. This suggests larvae debridement therapy is differentially effective against both Gram-positive and Gram-negative bacterial strains, namely Staphylococcus aureus, Pseudomonas aeruginosa and meticillin-resistant Staphylococcus aureus.
The evidence supports the use of antimicrobial properties of larvae therapy against the bacteria of infected chronic wounds.
There were no external sources of funding for this literature review. This paper is based on an independent study submitted as part of the BSc Health Care Studies, (Tissue Viability), University of Nottingham, UK. The authors have no competing or financial interest to declare and ethical approval and funding were not required to undertake the study.
This study was conducted with the objective to assess, in real clinical conditions in primary care and geriatric centers, application and utility of nanocrystalline silver dressings dressings combined with hydrocellular in relation to the development during 20 shifts dressing or complete healing of the characteristics of the lesions included in the study
Prospective observational multicenter open, repeated measures. It could include injuries of different etiologies (pressure ulcers stage 11-111, lower limb and traumatic wounds or surgical origin), with clinical signs of local infection (at least three of the following: redness, purulent discharge, heat, edema and pain). Only one wound was included per patient. An analysis of effectiveness by intention to treat all lesions included.
We recruited 103 patients who met the inclusion criteria but were collected in which 77 patients were used for nanocrystalline silver dressings in some phase of the study, They had a median of 80 years of age and 58.4% were women. By type of injury: 53.2% pressure ulcers, 31.2% lower extremity ulcers and 14.3% traumatic or surgical wounds. Over 50% of the lesions was older than eight months and a larger area of 22.75 cm2. At first, 70.1% had redness, purulent discharge 64.9%, 37.7% heat edema 42.9% and 65.8% pain. Remained in the study a median of 42.5 days at a rate of change of dressing every 2.5. During this time in 96.1% of the lesions were removed for clinical signs of local infection in a statistically significant (p < or = 0.001). 27.3% healed from injuries and those not healed, 92.9% experienced improvement, and its healing curves were statistically significant (p < 0.05). 92.2% of clinicians assessed treatment with these products as good or excellent.
The use of the products used in this study consistent with the concept and PLH TIME, has proved useful in this type of injury reducing the clinical signs of infection, promoting granulation tissue and necrotic removing the burden being able to manage the exudate of an optimal healing and getting one out of three masses.
Diabetic foot infections frequently cause morbidity, hospitalization, and amputations. Gram-positive cocci, especially staphylococci
and also streptococci, are the predominant pathogens. Chronic or previously treated wounds often yield several microbes on
culture, including gram-negative bacilli and anaerobes. Optimal culture specimens are wound tissue taken after debridement.
Infection of a wound is defined clinically by the presence of purulent discharge or inflammation; systemic signs and symptoms
are often lacking. Only infected wounds require antibiotic therapy, and the agents, route, and duration are predicated on
the severity of infection. Mild to moderate infections can usually be treated in the outpatient setting with oral agents;
severe infections require hospitalization and parenteral therapy. Empirical therapy must cover gram-positive cocci and should
be broad spectrum for severe infections. Definitive therapy depends on culture results and the clinical response. Bone infection
is particularly difficult to treat and often requires surgery. Several adjuvant agents may be beneficial in some cases.
To identify overall costs generated by surgical site infections (SSI) patients, including indirect costs. A prospective study of case series of patients who have undergone major surgical treatment was undertaken. Patients who suffered SSI were compared with controls (nested case-control design). Centers for Disease Control and Prevention definitions were followed and SSI established. Overall costs and indirect related morbidity/mortality costs were estimated. The study was performed in a general, tertiary hospital (Valencia, Spain) for 4.5 years. Surgical site infections patients were 9.02% of the total people who underwent surgery. Their stays were prolonging by 14 days, and resources were used more intensely and for longer periods than in controls. Excess hospital costs were 97,433 per patient including indirect social costs. Studies merely assessing excess costs due to prolonged stays of SSI patients do not reflect the entire scenario as they simply represent 35% of real hospital costs. A comprehensive appraisal shows that total healthcare expenditures represent a tenth of overall costs, which strengthens the claims that investment in preventing SSI would be highly cost-effective.
Местное лечение постинъекционных абсцессов комбинацией окситоцина и антибиотиков
- В И Зак
Зак В. И. Местное лечение постинъекционных
абсцессов комбинацией окситоцина и антибиотиков / В. И. Зак, П. П. Курлаев // Хирургия. Журн.
им. Н. И. Пирогова. -1985. -№ 5. -С. 112-15.
Принципы закрытого аспирационно-промывного лечения загрязненных и нагноившихся ран / Н. Н. Каншин // Хирургия. -1989. -№ 6
- Н Н Каншин
Каншин Н. Н. Принципы закрытого аспирационно-промывного лечения загрязненных и нагноившихся ран / Н. Н. Каншин // Хирургия. -1989. -№ 6. -С. 112-15.
Вопросы оптимизации местного лечения гнойных ран / М. А. Халилов // Человек и его здоровье
- М А Халилов
Халилов М. А. Вопросы оптимизации местного
лечения гнойных ран / М. А. Халилов // Человек и
его здоровье. -2009. -№ 3. -С. 31-37.
Вакуум-терапия в комплексном лечении гнойных ран
- А Б Ларичев
Ларичев А. Б. Вакуум-терапия в комплексном лечении гнойных ран / А. Б. Ларичев, А. В. Антонюк,
B. C. Кузьмин // Хирургия. Журн. им. Н. И. Пирогова. – 2008. – № 6. – С. 22–26.
Экспериментальное обоснование применения программируемой магнитотерапии в лечении ран мягких тканей / А. А. Глухов, О. С. Скорынин // Вестн. эксперим. и клин. хирургии
- А А Глухов
Глухов А. А. Экспериментальное обоснование
применения программируемой магнитотерапии в лечении ран мягких тканей / А. А. Глухов, О. С. Скорынин // Вестн. эксперим. и клин. хирургии. -2009. -Т. 2, № 4. -С. 305-15.
Анаэробная клостридиальная и неклостридиальная инфекция в хирургии
- С Е Кулешов
Кулешов С. Е. Анаэробная клостридиальная и
неклостридиальная инфекция в хирургии / С. Е. Кулешов. – М. : Медицина, 1993.
Профилактика и лечение послеоперационных раневых инфекций пробиотиком споробактерином
- Н И Слепых
Слепых Н. И. Профилактика и лечение послеоперационных раневых инфекций пробиотиком споробактерином : пособие для врачей /
Н. И. Слепых, А. А. Стадников, А. А. Третьяков. –
Оренбург, 2001. – 39 с.
47. Никитенко В. И. Роль транслокации в патогенезе хирургической инфекции / В. И. Никитенко,
Гнойная инфекция в хирургии
- С М Курбангалеев
Курбангалеев С. М. Гнойная инфекция в хирургии /
С. М. Курбангалеев. – М. : Медицина, 1985. – 272 с.
Современное состояние вопроса хирургического лечения ран и раневой инфекции
- О Т Кочоров
Кочоров О. Т. Современное состояние вопроса
хирургического лечения ран и раневой инфекции /
О. Т. Кочоров, Ш. М. Чынгышпаев, Р. А. Турсунов //
Вестн. Авиценны. -2011. -№ 1. -С. 22-25.
Госпитальные инфекции, вызванные грамотрицательными микроорганизмами: клиническое значение и современные возможности терапии / С. В. Яковлев // Инфекции и антимикроб. терапия
- С В Яковлев
Яковлев С. В. Госпитальные инфекции, вызванные грамотрицательными микроорганизмами: клиническое значение и современные возможности терапии / С. В. Яковлев // Инфекции и антимикроб.
терапия. -2007. -№ 6. -С. 133-36.
Хирургические инфекционные поражения кожи и мягких тканей. Лечение длительно незаживающих ран
- К А Корейба
Корейба К. А. Хирургические инфекционные поражения кожи и мягких тканей. Лечение длительно незаживающих ран : моногр. / К. А. Корейба,
А. Р. Газиев. -Казань : Отечество, 2011. -253 с.
Полуоткрытый способ лечения гнойных ран мягких тканей / С. Г. Измайлов [и др Полимерный сорбент регенкур в лечении гнойных ран / В. К. Гостищев [и др Использование биологических свойств перфторана при местном лечении гнойных ран / Е. М. Мохов [и др
- D Blueman
- C Blueman
- Bousfield
Blueman D. The use of larval therapy to reduce the
bacterial load in chronic wounds / D. Blueman, C. Bousfield // J Wound Care. – 2012 May. – Vol. 21, N 5. –
P. 244–53.
34. Полуоткрытый способ лечения гнойных ран
мягких тканей / С. Г. Измайлов [и др.] // Соврем.
технологии в медицине. – 2010. – № 1. – С. 56–59.
35. Полимерный сорбент регенкур в лечении гнойных ран / В. К. Гостищев [и др.] // Хирургия. Журн.
им. Н. И. Пирогова. – 1993. – № 11. – С. 3–6.
36. Использование биологических свойств перфторана при местном лечении гнойных ран / Е. М. Мохов
[и др.] // Рос. мед. журн. – 2011. – № 3. – С. 10–13.
37. Мохов Е. М. Применение озонированного перфторана при лечении гнойных ран / Е. М. Мохов,
С. И. Воробьев, А. Р. Армасов // Вестн. эксперим.
и клин. хирургии. – 2012. – Т. V, № 2. – С. 324–30.
Учебник военно-полевой хирургии / А. Н. Беркутов. – 2-е изд
- А Н Беркутов
Беркутов А. Н. Учебник военно-полевой хирургии / А. Н. Беркутов. – 2-е изд., доп. и испр. – Л.,
1973. – 569 с.
Местное медикаментозное лечение ран. Проблемы и новые возможности их решения / Л. А. Блатун // Consilium medicum. Хирургия
- Л А Блатун
Блатун Л. А. Местное медикаментозное лечение
ран. Проблемы и новые возможности их решения /
Л. А. Блатун // Consilium medicum. Хирургия. -2007. -№ 1. -С. 51-59.
- E Shi
- E Maggot Debridement Therapy
- D Shi
- Shofler
Shi E. Maggot debridement therapy: a systematic
review / E. Shi, D. Shofler // Br J Community Nurs. –
2014 Dec. – Suppl. Wound Care. – P. S6–13. doi:
10.12968/bjcn.2014.19.Sup12.S6.
46. Слепых Н. И. Профилактика и лечение послеоперационных раневых инфекций пробиотиком споробактерином : пособие для врачей /
Н. И. Слепых, А. А. Стадников, А. А. Третьяков. –
Оренбург, 2001. – 39 с.
47. Никитенко В. И. Роль транслокации в патогенезе хирургической инфекции / В. И. Никитенко,
Современные представления о физиотерапевтических способах лечения хронических ран
- И Г Моторина
Моторина И. Г. Современные представления
о физиотерапевтических способах лечения хронических ран / И. Г. Моторина, Л. К. Куликов,
Т. И. Мелешко // Сиб. мед. журн. -2012. -Т. 114,
№ 7. -С. 8-11.
Раны и раневая инфекция
- Ю К Абаев
- Справочник Хирурга
Абаев Ю. К. Справочник хирурга. Раны и раневая
инфекция / Ю. К. Абаев. – Феникс, 2005. – 427 с.
Are we getting necrotizing soft tissue infections right? A 10 -year review / D. Proud
Are we getting necrotizing soft tissue infections right?
A 10 -year review / D. Proud [et al.] // ANZ J Surg.-2014 Jun. -Vol. 84, N 6. -P. 468-72 doi: 10.1111/
ans.12412.
Основные принципы местного лечения ран и раневой инфекции / В. В. Привольнев
- В В Привольнев
Привольнев В. В. Основные принципы местного лечения ран и раневой инфекции / В. В. Привольнев, Е. В. Каракулина // Клин. микробиол.
и антимикроб. химиотер. -2011. -Т. 13, № 3. -С. 214-22.
Учебник военно-полевой хирургии / А. Н. Беркутов. -2-е изд., доп. и испр
- А Н Беркутов
Беркутов А. Н. Учебник военно-полевой хирургии / А. Н. Беркутов. -2-е изд., доп. и испр. -Л.,
1973. -569 с.
Yew // Aust Fam Physician
- K Yao
- L Bae
K. Yao, L. Bae, W. P. Yew // Aust Fam Physician. -2013 Dec. -Vol. 42, N 12. -P. 867-70.
Анаэробная клостридиальная и неклостридиальная инфекция в хирургии / С. Е. Кулешов
- С Е Кулешов
Кулешов С. Е. Анаэробная клостридиальная и
неклостридиальная инфекция в хирургии / С. Е. Кулешов. -М. : Медицина, 1993.
К вопросу о лечении гнойных ран
- А Р Магомедов
Магомедов А. Р. К вопросу о лечении гнойных
ран / А. Р. Магомедов // Вестн. Оренбург. гос. унта. -2011. -№ 16. -С. 308-309.
Нозокомиальные инфекции: эпидемиология, патогенез, профилактика, контроль / Р. С. Козлов // Клин. микробиол. антимикроб. химиотерапия
- Р С Козлов
Козлов Р. С. Нозокомиальные инфекции: эпидемиология, патогенез, профилактика, контроль /
Р. С. Козлов // Клин. микробиол. антимикроб. химиотерапия. -2000. -Т. 2, № 1. -С. 16-30.
Роль транслокации в патогенезе хирургической инфекции
- В И Никитенко
Никитенко В. И. Роль транслокации в патогенезе хирургической инфекции / В. И. Никитенко,
Морфологическая характеристика раневого процесса у больных с диабетическими гнойно-некротическими поражениями стоп при воздействии окситоцином
- В Г Гавриленко
Гавриленко В. Г. Морфологическая характеристика раневого процесса у больных с диабетическими гнойно-некротическими поражениями стоп
при воздействии окситоцином / В. Г. Гавриленко,
В. К. Есипов, К. Г. Сивожелезов // Морфология. -2003. -Т. 124, № 5. -С. 24-28.