The importance of eliminating microcirculatory disorders in the complex treatment of common soft tissue phlegmon

Background. The treatment of purulent-inflammatory processes of soft tissues remains today an area of surgery that is not given enough attention by specialists of both inpatient and outpatient levels, with many unresolved problems. Of particular importance in the pathogenesis of purulent-septic processes are the emerging microcirculation disorders due to the formation of micro-clots. An important point that aggravates the course of the disease is the development of thrombohemorrhagic syndrome. As a result, even with a variety of antibacterial drugs and the ыavailability of  new treatment methods, it is often not possible to achieve positive results in the treatment of this heavy contingent of patients.

Aim: to improve the effectiveness of complex therapy of patients with extensive soft tissue phlegmon by relieving thrombohemorrhagic syndrome.

Materials and methods. Cryoplasma-anti-enzyme therapy in the composition of complex treatment was received by 59 (48.8 %) patients of the main group, 62 (51.2 %) patients of the comparison group received only the generally accepted treatment. In each group, there are three variants of the course of the disease – moderate, severe and septic.

Results. The analysis of the clinical course of the disease showed that in patients of the first group, wounds were cleared of necrotic masses and purulent discharge with filling them with healthy granulation tissue 5.3 days faster than in the second group (p˂0.001). The number of deaths decreased – 11.9 % in the first group against 27.4 % in the second group (p˂ 0.001). The number of deaths decreased – 11.9 % in the first group against 27.4 % in the second group (p˂ 0.001). The proportion of thrombotic and thromboembolic causes of death in the first group (14.3 %) was lower than in the second (17.7 %) (p˂ 0.05).

Conclusion. The use of cryoplasma-anti-enzyme therapy as part of complex treatment contributed to the effective relief of thrombohemorrhagic syndrome, the  elimination of microcirculatory disorders, which allowed performing plastic closure of  a  wound defect 1.6  times faster, prevented the progression of multiple organ failure, and contributed to a reduction in mortality. 

1. Gelfand BR. Surgical infections of the skin and soft tissues. Russian national recommendations. 2nd ed. Moscow: GEOTARMedia; 2015. (In Russ.).

2. Mironov MA, Blinova EV, Stepanenko IS, Blinov DS, Abrosimov AV, Kilmyakshina MF, et al. A promising approach to optimizing the healing of postoperative infected wounds. Russian Journal of Operative Surgery and Clinical Anatomy. 2018; 2(4): 23-28. (In Russ.). doi: 10.17116/operhirurg2018204123

3. Proshin AV, Sulimanov RA, Zavaliy IP, Rebinok АV. Reparative regeneration of pyonecrotic wounds in combined local treatment by physical methods and biologically active materials. Vestnik Novgorodskogo gosudarstvennogo universiteta. 2017; 3(101); 61- 65. (In Russ)

4. Litvitskiy P.F. Regional blood flow and microcirculation disorders. Regional blood circulation and microcirculation. 2020; 19(1): 82-92. (In Russ.). doi: 10.24884/1682-6655-2020-19-1-82-92

5. Rudnov VA, Kulabukhov VV. Sepsis-3: Updated main definitions, potential problems and next practical steps. Messenger of anesthesiology and resuscitation. 2016; 13(4): 4-11. (In Russ.). doi: 10.21292/2078-5658-2016-13-4-4-11

6. Dutkevich IT. Disseminated intravascular coagulation syndrome (DIC-syndrome), A guide for a practicing physician. Moscow – Saint Petersburg; 2013. (In Russ.).

7. Tseymakh EA. Correction of the functional state of proteolytic systems and phagocytes in the complex treatment of patients with acute pleural empyema: Dissertation Thesis of the Dr. Sc. (Med.). Barnaul; 1995. (In Russ.).