Purulent surgery: treatment of surgical infection of soft tissues and bones
What is purulent surgery
The concept of "purulent surgery" is a collective term that includes the treatment of diseases and complications involving pathogenic microorganisms and requiring surgical intervention. Infection can complicate the course of a wide range of diseases and surgical operations.
It is difficult to find a field of medicine in which surgical infection specialists do not work:
Traumatology:infected post-traumatic and burn wounds, post-traumatic osteomyelitis, purulent complications of metallosteosynthesis
Orthopedics: purulent arthritis, purulent complications of prosthetic joints and other orthopedic interventions
Abdominal surgery: complicated variants of intra-abdominal infection, infected pancreatic necrosis, purulent complications after "open" and laparoscopic operations on abdominal organs
Rheumatology:infected trophic ulcers on the background of systemic vasculitis and connective tissue diseases.
Endocrinology: infected forms of diabetic foot syndrome
Angiology: gangrene on the background of critical limb ischemia
Phlebology: trophic ulcers of the lower extremities on the background of chronic venous insufficiency
Dermatology: skin infections complicated by abscesses
Oncology: complications after surgical and radiation treatment of tumors of various localization
Plastic and aesthetic surgery:purulent complications after the use of medical implants, as well as the use of plastic surgery techniques to close extensive wounds.
Infectious diseases: diseases that occur with necrosis and inflammation of soft tissues
Neurology: pressure sores of various localization
Forms of diseases
Acute purulent diseases of soft tissues:
- abscess is a limited focus of inflammation with the formation of a purulent cavity;
- phlegmon is a diffuse purulent inflammation of soft tissues that does not have a formed capsule.The most dangerous variant of phlegmons is necrotizing soft tissue infection, which rapidly affects large areas of connective tissue within a few hours, muscles or subcutaneous tissue. In these cases, the patient's life directly depends on the speed and radicality of the surgical operation performed, as well as on well-conducted intensive care in a specialized institution. Previously, these diseases were called gas gangrene or anaerobic infection.
Chronic purulent diseases:
- trophic ulcers, infected wounds, purulent fistulas, gangrene are, in fact, not independent nosological forms, but complications of various diseases. Success in their treatment primarily depends on a well-established diagnosis and on the ability to influence the cause of wound formation and impaired healing.
With the generalization of infection (the transition of a local process to a general one, the development of secondary foci), sepsis develops, which is accompanied by dysfunction of internal organs and systems and, if unfavorable, can lead to the death of the patient.
Symptoms of diseases
- Pain in the affected area is the main symptom of acute purulent diseases of soft tissues.
- Violation of the integrity of the skin is a characteristic, but not an obligatory symptom, the so–called "entrance gate" of infection.
- Painful swelling.
- The skin above the focus of purulent inflammation is often hot, reddened, sometimes with a purple tinge.
- Increased body temperature, increased signs of intoxication.
It should be noted that a vivid clinical picture is not always observed, and sometimes extensive purulent processes occur with scant local manifestations. This is especially true for elderly and debilitated patients.
Symptoms of chronic purulent diseases: formation of non-healing wounds, ulcers, fistulas or necrosis of the skin and soft tissues.
Causes of diseases
The complex of causes that cause the formation and long-term existence of purulent foci includes:
- Infection, that is, a local and systemic inflammatory reaction of the body to pathogenic microflora. Infection usually occurs:
- in case of violation of the integrity of the skin (in case of injuries, surgical operations, injections),
- by contact (through intact skin or mucous membranes),
- hematogenous (with blood flow).
Infection is especially persistent in the presence of endoprostheses, implants and other foreign materials.
- Ischemia, or impaired tissue nutrition due to impaired blood supply. Necrotic tissues become an ideal breeding ground for wound microflora, which makes the pathological process uncontrollable.It can be extremely difficult to achieve relief of the purulent process without restoring blood supply.
- Venous insufficiency, which leads to the formation of long-term non-healing trophic ulcers.
- Diabetes mellitus, accompanied by impaired blood supply, innervation, and immune response. Surgical infection occurring against the background of diabetes mellitus is characterized by a persistent course and requires an integrated approach involving various specialists.
The most common pathogens of wound infections are gram-positive (staphylococcus, streptococcus, etc.) and gram-negative (Pseudomonas aeruginosa, proteus, Klebsiella) microorganisms.
It should be noted that in recent years there has been an increase in the number of antibiotic-resistant strains of wound infection pathogens. This makes it extremely important to prescribe initial antibacterial therapy and determines the need for bacteriological control of the wound microflora.
Diagnostics
Modern diagnostic methods are based on determining the condition of tissues, detecting foci of destruction (destruction of tissues), accumulations of pathological contents, and the presence of inflammatory changes.
Soft tissue ultrasound, computed tomography (CT), magnetic resonance imaging (MRI), and radioisotope scanning using labeled autoleukocytes are used to assess the prevalence of the purulent process. It is mandatory to study the cellular composition of the blood to identify a general reaction to inflammation, a bacteriological study to establish the nature of the microflora and determine the sensitivity of pathogens to antibiotics.
Treatment features
The basis for the treatment of all surgical infection options is radical surgical treatment of a purulent lesion, including removal of necrotic tissues and adequate wound rehabilitation. In the postoperative period, antibacterial therapy and local wound treatment are performed using modern ointments, wound coverings and dressings. After the inflammation is relieved and the wound enters the regeneration stage, the issue of surgical closure of the wound is resolved (with sutures, displaced full-layer flaps, or loose skin flaps). Self-healing of small wounds under a bandage is also possible, although this prolongs the duration of treatment and leads to the formation of a rougher scar.
Prevention
The prevention of surgical infection consists, first of all, in controlling the "entrance gates" of infection, using antiseptic methods to treat accidental wounds. Timely treatment of diseases that worsen the course of infection, primarily diabetes mellitus, diseases of the arteries and veins of the lower extremities, is important.
New technologies for wound diagnosis and treatment
In recent years, new methods of wound treatment have been developed and put into practice.
The methods that can significantly improve the results of treatment include the use of wound treatment with local negative pressure (NPWT – negative pressure wound treatment, V.A.C. - vacuum assisted closure). The use of this method makes it possible to optimize the course of all phases of the wound process, achieve rapid relief of inflammation, reduce bacterial contamination of the wound and contribute to a rapid reduction in the depth and size of the wound. This method of treatment does not require frequent painful bandages, the dressing is changed once every 3 to 7 days, depending on the phase of the wound process.
It is possible to dramatically improve the results of treatment of patients with diabetic foot syndrome using endovascular methods of restoring arterial blood flow in the lower extremities. The use of balloon angioplasty and stenting allows the limb to be preserved even with incipient gangrene.
Advantages of purulent surgery in EMC
The EMC Clinic is a modern medical facility with with all modern diagnostic and treatment capabilities. The round-the-clock operation of the medical and diagnostic complex allows us to comprehensively solve the problems that arise with severe surgical infection of soft tissues, perform a full-fledged examination and preoperative preparation as soon as possible. Radical surgical treatment is performed as soon as possible in modern operating rooms equipped with the best surgical and anesthetic equipment.
Wound dressings are performed using anesthesia. Wound coverings, topical wound treatments, and dressings from leading manufacturers are used.
The use of vacuum-assisted bandages makes it possible to maximize wound healing and reduce the number of dressings. Outpatient treatment with local negative pressure is possible with rare (once every 3 to 7 days) visits to the clinic.
The availability of modern methods of examination and treatment within the walls of one clinic, as well as leading specialists, allows for prompt restoration of blood supply, relief of background and concomitant diseases, while monitoring the condition of the infection site and comprehensive wound treatment.
Surgical wound closure is performed using plastic surgery techniques to achieve the maximum functional and aesthetic result.
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Doctors
Dmitriy Semenov
Doctor of Medicine, Professor
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Nechay Taras
Doctor of Medicine, Associate Professor, Professor
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Dmitry Ruchkin
Doctor of Medicine
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Igor Andrreytsev
Doctor of Medicine
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Chzhao Аleksey
Head of the Surgical Clinic, Doctor of Medicine, Professor
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Krishchanovich Olga
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Tsilenko Konstantin
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Evgeny Tarabrin
Chief Freelance Thoracic Surgeon of the Moscow Department of Health and the Ministry of Health of the Russian Federation for the Central Federal District, Doctor of Medicine
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Leval Pulad
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Ruben Metsaturyan
Doctor of the highest category, Ph.D. of Medical Sciences
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Sidnev Aleksander
Ph.D. of Medical Sciences
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Tsvetkov Vitaliy
Professor, Doctor of Medicine
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Ignatiev Roman
Surgeon, urologist, polyclinic and hospital, Doctor of Medicine, Doctor of the highest category
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Lafishev Elmurat
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Marina Bissessar
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Langner Aleksander
Ph.D. of Medical Sciences, Associate Professor
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Anvar Iuldashev
Ph.D. of Medical Sciences
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Kan Vladimir
Head of the Department of Emergency and General Surgery, Doctor of the highest category, Ph.D. of Medical Sciences
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Borodina Ekaterina
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Askerhanov Rashid
Ph.D. of Medical Sciences, Associate Professor
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Dmitriy Semenov
Doctor of Medicine, Professor
- Unique expertise is the first in In Russia, he performed laparoscopic decompression of the celiac trunk in patients with ischemic digestive system disease
- The first in In Russia, he performed laparoscopic kidney sampling during related transplantation
- He was one of the first in the world to perform suturing of a duodenal ulcer perforation
- He was one of the first in the world to perform...
Total experience
33 years
Experience in EMC
since 2023
