Osadchyi A. Substantiation of complex treatment of severe forms of acute paraproctitis complicated by Fournier's gangrene and necrotizing fasciitis

The dissertation is devoted to the problems of treatment of necrotic lesions of the fascial spaces of the perineum, anterior abdominal wall, extremities, genitals on the basis of severe forms of acute paraproctitis. The study was based on 502 patients with acute paraproctitis (AP), of which 50 (9.96 ± 1.34%) were diagnosed with necrotic fasciitis (NF). The main group (1.0.) 174 (34.66 ± 1.98%) patients diagnosed with GP who received treatment according to our methods, and the comparison group (2.0.) 328 (65.34 ± 2.43%) patients with diagnosis of GP, which are treated by conventional methods. The main subgroup (1.1.) 152 (30.27 ± 2.67%), the subgroup of comparison (2.1.) - 300 (59.76 ± 3.24%) patients with severe forms of GF without the development of NF. The main subgroup (1.2.) Of 28 (5.57 ± 1.02%) patients, in the treatment of which high-energy and modern approaches to the complex treatment of severe forms of GF complicated by NF were used. Comparison subgroup (2.2.) 22 (4.38 ± 0.90%) patients with GF complicated by NF who received treatment according to conventional methods. NF complicates the course of severe forms of GP in 9.96% of patients, with spread to the anorectal area and perineum (20%), urogenital area (34%), inguinal area (16%), anterior abdominal wall (12%), swimming on the anterior abdominal wall and lower extremities (8%), buttocks, thighs (14%). Based on regression analysis with increasing ROC curves, it was found that body mass index ≥35 and age ≥ 47 are predicted factors in the development of NF in patients with severe GF. Bacteriological examination of the aerobic microflora most often revealed enterobacteria with a high level of sensitivity to ozonated solution, which reduced the number of staged necrectomies from 7.23 ± 2.12 to 3.18 ± 1.62. The use of ultrasound cavitation and VAC therapy accelerates regeneration processes, accompanied by an increase in the proportion of phagocytic leukocytes and a decrease in lymphocytes in cytograms on the 5th day of the postoperative period and an increase in fibroblasts and a decrease in neutrophils on day 7.