Differentiated tactics in the complex surgical treatment of carbuncles

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The results of the surgical treatment of 446 patients with carbuncles with primary localization on the back - 21%, neck - 20%, hip - 18%, buttock - 16%. The prevalence of inflammatory events is 20-180 cm2. In the initial microbiological study, Staphylococcus aureus predominated - 87.9%. Subsequently, in the process of treating postnecrectomy wounds, their contamination with gram - negative microflora was observed (7.2%), and more often (25.4%) in patients with diabetes mellitus (18.4%). Significant violations of microcirculation of the skin in the lesion were revealed, which correlated with the severity and prevalence of purulent - necrotic injuries. Differentiated surgical tactics were used depending on the location, nature, and incidence of inflammation, in which access to necrotic tissue was achieved either using a linear incision or two bordering incisions with excision of the necrotic skin. The third option (with small carbuncles and mobile surrounding skin) was excision of the carbuncle within healthy tissues with the application of the primary suture and adequate drainage. After the inflammation subsided, skin - plastic reconstructive operations were used according to indications: wound repair with local tissues by the method of simultaneous or metered stretching (28.1%), autodermoplasty with a free split graft (34.2%), combined plastic surgery using both previous techniques (37.7% ). Purulent postoperative complications were noted in 7.9% of the operated patients (most often among patients with diabetes mellitus - 15.4%), but they did not differ in severity. They did not significantly affect the positive results of treatment.

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