PECULIARITIES OF DIAGNOSTICS, SURGICAL TACTICS AND RESTORATION OPERATIONS IN NECROTIZING INFECTION OF SOFT TISSUES
Department of General Surgery № 2, Avicenna Tajik State Medical University, Dushanbe, Republic of Tajikistan
Objective: Improving diagnostic results and surgical treatment of necrotizing soft tissue infection.
Methods: Analyzed the results of diagnostics and treatment of 68 patients with various forms of necrotizing infection for the period 2010-2017. There were 32 men (53.8%), women – 36 (46.2%) at the age of 30-84. In 27 (39.7%) patients the necrotic form of erysipelas occurred, in 41 (60.3%) necrotizing fasciitis and myonecrosis. In 60.3% of cases, the pathological process was localized in the region of the lower extremities. More than 90% of the patients had concomitant diseases, among them diabetes mellitus (78.2%), arterial hypertension (83.3%), coronary artery disease (75.6%) and anaemia of varying severity (74.3%).
Results: The clinical picture of streptococcal necrotizing fasciitis (n=31) and myonecrosis (n=10) in the early stages was characterized by the absence of pathognomonic symptoms. The discrepancy between the severity of the general condition and local status in a number of cases led to the belated surgical intervention and, as a result, extensive postoperative wounds, requiring 16 cases of plastic closure. In 12 (75%) cases, full engraftment was noted, in 3 (18.7%) partial engraftment and in 1 (6.3%) observation – complete necrosis of the graft. Conditions of transplant engraftment were corrected carbohydrate metabolism, preserved regional hemodynamics and the presence of actively granulating wound surface.
Conclusions: Necrotizing infection, which is a nonspecific inflammatory process of soft tissues, is characterized by progressive necrosis, rapid spreading, difficulty in diagnosing in the early stages of the disease, pronounced intoxication and high lethality.
Keywords: Necrotizing infection , fasciitis , free skin grafting , surgical tactics.
- Vinnik YuS, Peryanova OV, Drobushevskaya AI, Khokhlova OE. Rezul'taty monitoringa sostava vozbuditeley khirurgicheskoy infektsii kozhi i myagkikh tkaney [Results of monitoring the causative agents of surgical infection of the skin and soft tissues]. Meditsinskiy akademicheskiy zhurnal. 2010;5:84-5.
- Proshin AV. Sostoyanie immunnogo statusa i dinamika ranevogo protsessa u bol'nykh s oslozhnyonnymi formami sindroma diabeticheskoy stopy [The state of the immune status and the dynamics of the wound process in patients with complicated forms of diabetic foot syndrome]. Vestnik Novgorodskogo gosudarstvennogo universiteta im. Yaroslava Mudrogo. 2012;67:74-7.
- Pastar I, Nusbaum AG, Gil J, Patel SB, Chen J. Interactions of methicillin resistant Staphylococcus aureus USA300 and Pseudоomonas aeruginosa in polymicrobial wound infection. PLoS ONE. 2013;8(2):56846.
- Yusupova ShYu, Nabiev MKh, Zokirov RA. Rasprostranyonnost' oslozhnyonnykh form sindroma diabeticheskoy stopy v Respublike Tadzhikistan [The prevalence of complicated forms of the diabetic foot syndrome in the Republic of Tajikistan]. Vestnik Avitsenny [Avicenna Bulletin]. 2015;4:13-8.
- Abdulloev DA, Yusupova ShYu, Begakov UM, Nabiev MKh, Saidov KM. Differentsirovannoe lecheniye sindroma diabeticheskoy stopy, oslozhnyonnogo gnoyno-nekroticheskimi protsessami [Differentiated treatment of the diabetic foot syndrome, complicated by purulent necrotic processes]. Vestnik Avitsenny [Avicenna Bulletin]. 2014;2:69-73.
- Grinyov MV, Korolkov AYu, Grinyov KM, Beybalayev KZ. Nekrotiziruyushchiy fastsiit – klinicheskaya model' zdravookhraneniya: meditsiny kriticheskikh sostoyaniy [Necrotizing fasciitis – clinical model of public health: medicine of critical states]. Vestnik khirurgii. 2013;2:32-8.
- Aliev SA, Aliev ES. Nekrotiziruyushchiy fastsiit: uzlovye aspekty problemy v svete sovremennykh predstavleniy [Necrotizing fasciitis: nodal aspects of the problem in the light of modern concepts]. Vestnik khirurgii. 2015;6:106-10.
- Belova OV, Arion VYa, Sergienko VI. Rol' tsitokinov v immunologicheskoy funktsii kozhi [The role of cytokines in the immunological function of the skin]. Immunopatologiya, allergologiya, infektologiya. 2008;1; 41-55.\ // Immunopathology, allergology, infectology. 2008;1:41-55.
- Vinnik YuS, Salmina AB, Drobushevskaya AI, Teplyakova OV. Osobennosti patogeneza dlitel'no nezazhivayushchikh ran [Features of the pathogenesis of long-term non-healing wounds]. Novosti khirurgii. 2011;3:101-10.
- Fattakhov VL, Vinnik YuS, Teplyakova OV, Blyoskina AV. Vliyanie kislotno- osnovnogo sostoyaniya sredy na techenie ranevogo protsessa pri sakharnom diabete [Influence of the acid-base state of the medium on the course of the wound process in diabetes mellitus]. Sibirskoe meditsinskoe obozrenie. 2009;6:35-8.
- Park NY, Lim Y. Short term supplementation of dietary antioxidants selectively regulates the inflammatory responses during early cutaneous wound healing in diabetic mice. Nutrition Metabolism. 2011;8:80-8.
- Vinnik YuS, Salmina AB, Teplyakova OV, Drobushevskaya AI, Pozhilenkova EA, Morgun AV, i dr. Kombinirovannaya ozonoterapiya v lechenii infektsionnykh zabolevaniy myagkikh tkaney u bol'nykh sakharnym diabetom [Combined ozone therapy in the treatment of infectious diseases of soft tissues in patients with diabetes mellitus]. Khirurgiya. 2015;2:63-9.
- Grinyov MV, Grinyov KM. Nekrotiziruyushchiy fastsiit [Necrotizing fasciitis]. Saint Petersburg, RF: Gippokrat; 2008. 136 p.
- Aliev SA, Aliev ES, Zeynalov BM. Gangrena Furn'e v svete sovremennykh predstavleniy [Fournier gangrene in the light of modern ideas]. Khirurgiya. 2014;4:34-9.
- Gostishchev VK, Lipatov KV, Komarova EA. Streptokokkovaya infektsiya v khirurgii [Streptococcal infection in surgery]. Khirurgiya. 2015;12:14-7.
- Sadasivan J, Maroju NK, Balasubramaniam A. Necrotizing fasciitis. Indian J Plast Surg. 2013;46(3):472-8.
Nabiev Muzaffar Kholnazarovich Candidate of Medical Sciences, Head of the Department of General Surgery № 2, Avicenna TSMU
Yusupova Shoira, Doctor of Medical Sciences, Full Professor, Professor of the Department of General Surgery № 2, Avicenna TSMU
Azimov Akhtamshoh Talabshoevich, Competitor of the Department of General Surgery № 2, Avicenna TSMU
Boronov Talabshoh Boronovich, Competitor of the Department of General Surgery № 2, Avicenna TSMU
Address for correspondence:
Nabiev Muzaffar Kholnazarovich
Candidate of Medical Sciences, Head of the Department of General Surgery № 2, Avicenna TSMU
734003, Republic of Tajikistan, Dushanbe, Rudaki Ave., 139
Tel.: (+992) 987 256060