Brodska A. Prophylactic of wound complications in early postoperative period in abdominal surgery

This dissertation is devoted to the study and optimization of methods for the prevention of surgical site infections (SSI) in patients undergoing abdominal surgery. The issue of preventing the development of postoperative wound complications, in particular purulent and inflammatory processes, is one of the most urgent areas of modern surgery. The study aims to reduce the incidence of SSI through a comprehensive approach that includes preoperative, intraoperative and postoperative measures, including antibiotic prophylaxis, intraoperative irrigation, use of protectors, drainage and prophylactic negative pressure therapy. Relevance: The problem of preventing surgical site infections (SSIs) is one of the most acute in modern surgery, especially in the context of growing antimicrobial resistance. The study describes effective approaches to the prevention of postoperative wound complications, including antibiotic prophylaxis, mechanical methods of wound protection, and other measures to reduce the risk of complications. Purpose and objectives of the study The aim of the study was to develop a comprehensive approach to the prevention of wound complications that takes into account different levels of wound contamination, patient condition and complexity of the operation. The main objectives were: To evaluate traditional methods of preventing wound complications in the early postoperative period. Identify common pathogens of surgical infections depending on the type of surgery. Investigate the effectiveness of newer methods, including the use of negative pressure and wound edge protectors. Identify optimal approaches to the use of antibiotic prophylaxis. To develop a differentiated approach to the choice of prophylaxis methods for different types of surgical interventions. Overview of modern methods of prophylaxis The first section provides a review of the literature on current methods of preventing SSIs, including recommendations from the WHO and CDC (US Center for Disease Control). The review found that the most effective programs are integrated programs that take into account Preoperative measures: preoperative bathing with antiseptics, screening patients for colonies of microorganisms, preparation of the surgical field and surgeon's hands, optimal timing of antibiotic administration. Intraoperative measures: the use of wound protectors to prevent the ingress of microorganisms, as well as monitoring the conditions in the operating room (patient's body temperature, glycemic profile, oxygenation). Postoperative measures: adherence to the antibiotic prophylaxis regimen, removal of drains within a clinically reasonable time, and the use of antimicrobial coatings for dressings. Research methods The second section describes the study methodology and tools used to evaluate the effectiveness of preventive measures. Clinical, laboratory, instrumental, and statistical methods allowed for a detailed assessment of the wound condition of patients. The following methods were included in the study: Clinical observation: detailed tracking of patients in the postoperative period allowed us to objectively assess the effectiveness of preventive measures in patients of different age groups and with different surgical diagnoses. Laboratory tests: determination of the composition of the microflora of surgical wounds, as well as the susceptibility of pathogens to antibiotics, which allowed us to identify the main pathogenic microorganisms. Instrumental methods: ultrasound to monitor the presence of seromas, drainage cavities, and determine the thickness of subcutaneous tissue. Statistical analysis: correlation and factor analysis were used to establish the relationship between the type of surgical intervention, preventive measures taken and the incidence of wound complications. Main results of the study Chapter 3 presents the main results of the study, including: It was found that the use of wound edge protectors significantly reduces the incidence of wound complications in patients with conditionally “clean” wounds. The use of antibiotics before and during surgery (depending on the type of intervention) helps to maintain bactericidal concentrations of antibiotics in the tissues and reduce the risk of infections. The tested devices for abdominal laparotomy wound retraction and protection (according to the patent of Ukraine) have shown high efficiency in the prevention of ABI, which confirms the feasibility of their widespread use. Prophylactic wound drainage, especially with the use of active drainage systems, allows timely removal of discharge, which promotes faster healing and reduces the likelihood of suppuration. Practical significance and recommendations The prevention program developed in this thesis includes antibiotic prophylaxis, wound drainage, and the use of special devices, which can significantly reduce the rate of postoperative complications.