Authors
Krasenkov Y.V., Tatyanchenko V.K., Eliseev G.D., Voloshin R.N., Byakova E.N., Edilov A.V.
Rostov State Medical University, Rostov-on-Don
Abstract
Aim. Improvement of treatment results for patients suffering from deep intermuscular phlegmons of the extremities accomplished by optimizing the diagnostic and treatment approach based on evaluation of pain syndrome degree as affected by tissue hypertension.
An intratissular pressure measurement algorithm was suggested as an addition to diagnostics to estimate the severity of purulent inflammation in soft tissues of the extremities. Collected data served as the basis for diagnostics of compartment syndrome and decompressive fasciotomy performed in accordance with indications in the areas of fascial structures. The examination also included assessment of the degree of reparative processes in the surgical wound and microbial content level (CFU value) of the latter. The study involved 154 patients with deep intermuscular phlegmons subdivided in two groups: in Group II (81 patients), the developed diagnostic and treatment algorithm considering the expression of tissue hypertension and compartment syndrome was used. In Group I (73 patients), the traditional treatment methods were used.
The phlegmon diagnostics and treatment algorithm suggested by the authors and covered by RF invention patents No. 2578096, No. 2591829, and No. 2683855, considering the level of tissue hypertension allowed to improve the results of combined treatment and decrease the duration of postoperative rehabilitation for the patients.
Keywords: phlegmon, surgery, compartment syndrome, fasciotomy.
References
1. Vinnik YuS, Markelova NM, Tyuryumin VS. Sovremennye metody lecheniya gnojnyh ran. Sibirskoe medicinskoe obozrenie. 2013;(1):18–24. (In Russ.).
2. Gostishchev VK. Obshchaya hirurgiya: 4-e izd. 2009. M.: GEOTAR-Media. 848 p. (In Russ.).
3. Krasenkov YuV, Tat’yanchenko VK, Davydenko AV, Bogdanov VL. Lechenie flegmon kisti s uchetom ocenki stadii razvitiya ostrogo tkanevogo gipertenzionnogo sindroma (kompartment sindrom). Ural’skij medicinskij zhurnal. 2016;(5):95–100. (In Russ.).
4. Lipatov KV, Komarova EA, Gur’yanov RA. Diagnostika i hirurgicheskoe lechenie streptokokkovojnekrotiziruyushchej infekcii myagkih tkanej. Rany i ranevye infekcii. ZHurnal imeni professora BM Kostyuchyonka. 2015;(1):6–12. (In Russ.).
5. Privol’nev VV, Karakulina EV. Osnovnye principy mestnogo lecheniya ran i ranevoj infekcii. Klinicheskaya mikrobiologiya i antimikrobnaya himioterapiya. 2011;13(3):214–222. (In Russ.).
6. Tatyanchenko VK, Firsov MS, Davydenko AV. Sposob lecheniya ostrogo tkanevogo gipertenzionnogo sindroma pri flegmone yagodichnoj oblasti. Patent RF na izobretenie № 2581821. 20.04.2016g. Byul. № 11. (In Russ.).
7. Edilov AV, Tat’yanchenko VK, Krasenkov YuV, Bogdanov VL. Sposob lecheniya ostrogo tkanevogo gipertenzionnogo sindroma pri flegmone stopy. Patent na izobretenie №2683855. 02.04.2019. № 10. (In Russ.).
8. Keudell AG. et al. Diagnosis and treatment of acute extremity compartment syndrome. The Lancet. 2015;386(10000):1299–1310.
9. Ridha A. et al. Acute compartment syndrome secondary to rhabdomyolysis in a sickle cell trait patient. The Lancet. 2014;384(9960):2172.
