COMPLEX SURGICAL TREATMENT OF PATIENTS WITH PURULO-NECROTIC COMPLICATIONS OF REPLANTED EXTREMITIES

Aim. To raise the efficiency of treatment in patients with purulo-necrotic complications of replanted extremity segments. Materials and methods. The results of complex treatment of 65 patients with traumatic amputations of the hand and forearm and purulo-necrotic complications are presented in the paper. Treatment of patients of the main group (33 patients) in the postoperative period included, along with traditional, prolonged lymphotropic antibacterial therapy using 1% methylene blue combined with cephtriaxon. The results were estimated by means of standard clinicolaboratory investigations. Quantitative determination of microorganisms in 1 g of the tissue obtained from the wound with calculation of the number of colony-forming units (CFU) in 1 ml of the investigated material was carried out. Results. Clinical analysis of the main group of patients showed decrease in bacterial semination of the postoperative wound from 4,41±1,12×10 5 to 6,4±1,35×10 3 in 1 ml of the investigated material ( p <0,001) by the day 15, fall in initially existing purulo-necrotic complications to 18,2% versus 50% in the comparison group ( p <0,05) beginning from the day 30 and reduced average period of hospitalization from 40,1±3,16 to 33,5±2,76 days ( F =1,1, p =0,03). Conclusion. Lymphotropic therapy in complex treatment of patients with replanted extremities promotes decrease in purulo-necrotic complications by 31,8%, reduces the period of treatment by 16,5% and is an effective method for treatment of patients with purulo-necrotic complications of deep subfascial structures developed after replantation of extremities.

Microsurgery, extremity replantation, indirect antibacterial therapy, adults, human being