Pakholchuk O. Surgical treatment of infected and purulent wounds in children on the basis of diagnostics of stages of wound process

The thesis is devoted to the urgent task of improving the results of treatment of children with infected and purulent wounds by studying the course of the wound process, developing and introducing new diagnostic methods and complex treatment. A study of 248 children with purulent and infected wounds was conducted at the clinic for pediatric surgery of the Zaporozhzhya State Medical University of the Ministry of Health of Ukraine from 2012 to 2016. The age of the children was from 1 to 17 years. Among them, 122 children were I group, who used an alternating magnetic field and liposomal solutions with a differentiated approach to the stages of the wound process. And 126 patients entered the II group, which treatment of purulent and infected wounds was performed according to conventional methods. The study of the course of the wound process was carried out with the help of clinical, cytological, bacteriological, immunological and methods for determining the level of microcirculation. The levels of parameters of laser Doppler flowmetry are determined, the microcirculation parameters of which are characteristic for each stage of wound healing. Correlation between the dynamics of changes in clinical, morphological data and indices of microcirculation during the wound process was found. The value of microcirculation indices during the wound process correlates inversely with the signs of wound cleansing (r=-0.71), and with the dynamics of the cellular composition of wounds (r=-0.63) and (r=-0.72). Taking into account the results of laser Doppler flowmetry, the effectiveness of using an alternating magnetic field and liposomal antibacterial solutions has been proved. It was found that in 79 (77.4%) children of group I the improvement of microcirculation in the purulent wound area, which was expressed in PM decrease and decrease in the difference between the pathological region and the symmetric intact site, occurred from the third day of treatment, whereas in 68 (64, 7%) of patients of the II group, this dynamics was detected on the 5th day. The microbial spectrum and the level of bacterial contamination of infected and purulent wounds were characterized by a significantly lower degree of microbial contamination of purulent wounds in the first group than in group II from 33.3% to 18.1% (p <0.05). The critical level of microcirculation parameters under which the probability of formation of non-viable areas of the edges of an infected wound is a coefficient K <0.03 relative units. The value of the coefficient K is positively correlated with the microcirculation index and is negatively correlated with an increase in the amplitude of the microcirculation oscillations. In patients with infected wounds, the choice of the volume of surgical treatment using microcirculation parameters ensures a reliable improvement in results, and a 28.4% reduction in the incidence of postoperative complications. The developed diagnostic algorithm for purulent and infected wounds in children with a differentiated approach to the staging of the wound process and the application of an alternating magnetic field and liposomal solutions made it possible to reduce the number of complications in the postoperative period and to shorten the treatment time for purulent wounds by 3.7 ± 1.5 days and infected 4.2 ± 1.3 days.