Surgery

doi: 10.25005/2074-0581-2018-20-1-97-102
PECULIARITIES OF DIAGNOSTICS, SURGICAL TACTICS AND RESTORATION OPERATIONS IN NECROTIZING INFECTION OF SOFT TISSUES

M.Kh. Nabiev, Sh. Yusupova, A.T. Azimov, Т.B. Boronov

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.

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Authors informations:

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

E-mail: myzaffar.nabiev.2017@mail.ru

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