Plis I. Сomplex surgical treatment pressure ulcers of patients with the consequences of spinal cord injury

Thesis is devoted to the solution of the research and practical scientific task - to improve the efficiency of surgical treatment of pressure-trophic ulcers ( pressure sores) in the injured with the consequences of spinal trauma, by improving existing techniques and introducing into clinical practice the techniques of mud therapy and ozone therapy, VAC therapy in combination with ultrasound cavitations, intraoperative radical carving of the walls and the base of the ulcerative defect, anatomical and functional resection of the underlying bone, plastic closure of the defect by means of transpositional musculocutaneous flaps.The analysis of surgical treatment of 178 patients with pressure ulcersof various locations in the rehabilitation period of traumatic disease was provided. The first group included 76 patients who, together with stage surgical treatment of pressure sores, had general and local ozone and mud therapy. The second group included 44 injured, who were treated with the ultrasonic cavitations and V.A.C. therapy were used to prepare for plastic surgery. The comparison group included 58 injured, who underwent conventional preoperative preparation with the usage of: stage surgical treatments, ointment dressings, wound coverings. Patients of all groups were representative of age, sex, trauma, localization and duration of pressure sores.The microbiological, morphological, immunohistochemical studies defined the parameters of microcirculation in tissues ulcers. Analysis of the distribution of CD68 positive macrophages showed hyperfunction macrophage system tissue, the positive reaction of angiogenesis marker CD34 was determined. Based on the data suggested a comprehensive treatment strategy using pelotherapy and ozone therapy, demonstrated the effectiveness of anatomical and functional resection of the affected Ischium, proposed indications and contraindications for resection. By means of laser-Doppler flowmetry were identified key prognostic indicators of microcirculation in the transplanted graft. The increase in the density of the CD34-expressed vessels and the quantitative index of macrophages CD68+ - 40.8 ± 1.7, with the minimal advantage of the functionally active macrophages are the objective criteria of tissue readiness for plastic closure. The use of musculocutaneous flaps with axial blood supply in combination with anatomical and functional resection of the underlying bones was suggested as a method of plastic surgery of pressure-trophic ulcers, which reduced the number of early postoperative complications. Satisfactory and good results were achieved in 109 (90.8 %) patients.