Treatment of a purulent wound in the hydration phase. Which of the following means and methods should not be used in the treatment of purulent wounds in the hydration phase? Wound healing cream

4) purulent wound in the regeneration phase

004. There are remains of necrotic tissue in the purulent wound. A bandage with which medicinal substance is most indicated?

1) Vishnevsky ointment

2) proteolytic enzymes

3) antibiotics

4) sulfonamides

005. What phases of the wound process are currently distinguished:

a) inflammation

b) regeneration

c) hydration

d) dehydration

choose the correct combination of answers

006. The least effective drainages for a purulent wound.

1) tubular drainages

2) rubber graduates

3)gauze swabs

4) rubber gauze swabs

007. What should not be used for local treatment of purulent wounds in the inflammation phase

1) Vishnevsky ointment

2) proteolytic enzymes

3) rinsing with antiseptics

4) bandages with hypertonic solution

008. The wound is 1x0.5 cm, an infiltrate of 5x10 cm is palpable around it. On palpation there is sharp pain, thick pus is released from the wound as if from a tube. The issue of surgical intervention is being decided. Which research method is most valuable for this purpose in this situation?

1) percussion

2) probing

3) study of blood leukocytosis

4) fistulography

009. The wound discharge emits a sickly-sweet smell, and there are bluish spots on the bandage. Name the most likely microflora in the wound.

1) staphylococcus

2) Escherichia coli

3) Pseudomonas aeruginosa

4) streptococcus

010. Which of the following is not typical for the inflammation phase of a wound process?

1) development of inflammatory edema

2) leukocyte infiltration of tissues

3) development of the granulation shaft

4) development of tissue acidosis

011. What is the name of the suture placed after excision of the edges of a granulating wound?

1)provisional seam

2) early secondary seam

3) late secondary seam

4) primary delayed suture

012. What is the name of a suture applied without excision of the edges of a granulating wound?

1)provisional seam

2) early secondary seam

3) late secondary seam

4) primary delayed suture

013. During the inflammation phase, the wound is cleared of (choose incorrect)?

1) from infection

2) from foreign bodies

3) from excessive granulations

4) from necrotic tissues

014. A primary purulent wound is considered to be a wound:

1) after receiving an accidental injury

2) after opening the focus of purulent inflammation

3) as a result of an infectious complication of an aseptic wound

4) as a result of wound suppuration after PSO

015. The wound in the regeneration phase measures 20x20cm. Choose from the suggested ones medicinal products most shown

1) antibiotic therapy

2) skin graft

3) ointment dressings

4) stimulant therapy

016. For the development of clostridial anaerobic infection, the following types are used surgical treatment(choose wrong).

1) wide dissection of the wound

2) dissection of fascial sheaths

3) amputation with dissection of the stump

4) application of a tourniquet, amputation with suturing of the stump

017. In the tissues surrounding a purulent wound in the regeneration phase, it develops

2) alkalosis

3) neutral environment

4) everything is true depending on the patient’s condition

018. Proteolytic enzymes used for the treatment of purulent wounds include:

1) ampicillin and tetracycline

2) chymotrypsin and chymopsin

3) lipase and amylase

4) chlorhexidine and dioxidine

019. When probing a wound, the instrument effortlessly penetrates into a subcutaneous “pocket” 10 cm deep, from which a significant amount of pus is released. Select from the following therapeutic effects the most indicated

1) introduction of antibiotics into the “pocket”

2) additional incision (counter-opening)

3) physiotherapy

4) insertion of a tampon with an antiseptic into the “pocket”

020. A patient with heart failure has bluish, edematous granulations on the soft tissue wound of the leg. What to do to improve granulations?

1) cardiac therapy

2) red blood cell transfusion

3) vitamin therapy

4) antibiotic therapy

021. In the process of tissue regeneration when healing a purulent wound, the main importance belongs to

1) leukocytes

2) capillary endothelium and fibroblasts

3) macrophages

4) histiocytes and mast cells

022. Promotes healing of purulent wounds

1) the presence of crushed tissue in the wound

2) massive contamination of tissues with microorganisms

3) the presence of foreign bodies in the wound

4) maintaining good blood circulation in the wound area

023. The inflammation phase is characterized by everything except

1) exudation of plasma and lymph

2) exit and migration of leukocytes to the wound area

3) degranulation of mast cells

4) migration of fibroblasts to the wound area

024. Wound suppuration is usually caused by

1) streptococcus

2) staphylococcus

3) gonococcus

4) Pseudomonas aeruginosa

025. A secondary purulent wound is considered to be a wound:

1) after opening the focus of purulent inflammation

2) as a result of suppuration of an aseptic wound

3) as a result of wound suppuration after PSO

4) statements 2 and 3 are true

026. When treating a purulent wound in the regeneration phase, it is indicated

1) use of ointment dressings

2) antibiotics intramuscularly

3) sulfa drugs inside

4) hypertonic solution

027. In the first phase of the wound process, ointments are used for:

1) fat based

2) water-soluble base

3) any ointment at the discretion of the doctor

4) ointments are not used in phase I

028. When the wound suppurates, bleeding may occur

1) primary

2) secondary early

3) secondary late

4) all of the above

029. A purulent wound is a wound:

1) in which there is purulent inflammation

2) into which microorganisms have entered

3) after the operation, if during the operation the lumen of a hollow organ was opened

4) 1 and 2 statements are true

030. Tactics of a clinic doctor when diagnosing a purulent wound complicated by lymphangitis and regional lymphadenitis in the clinic:

1) antibacterial therapy

2) injection of inflammation with an antibiotic

4) urgent blood test

031. Active surgical treatment of purulent wounds consists of:

1) rational surgical treatment

2) the use of tubular drainages

3) surgical treatment, drainage, suturing with vacuum aspiration

4) surgical treatment, drainage, suturing with discrete flow-aspiration rinsing

032. Treatment of purulent wounds using the traditional open method is characterized by:

1) favorable course of the wound process

2) quick recovery time

3) the addition of a secondary infection

4) statements 1 and 2 are true

033. Types of wound healing

1) secondary intention

2) primary intention

3) healing under the scab

4) all of the above

034. One of the indications for prescribing general antibacterial therapy in the treatment of acute wounds is:

1) isolation of associations of microorganisms from wound exudate

2) complication of the wound process with lymphangitis, lymphadenitis

3) determination of the sensitivity of microflora to antibiotics

4) all of the above are true

035. Treatment of a wound in the first phase of healing includes

1) anti-inflammatory therapy

2) adaptation of wound edges, stimulation of granulation growth

3) stimulating wound cleansing processes, creating peace for the wound

4) correct 1) and 3)

036. When healing a wound by secondary intention, it is advisable in the second phase

1) anti-inflammatory treatment

2) stimulation of granulation growth

3) stimulation of wound cleansing processes

037. Active drainage of a purulent wound is

1) outflow of pus through the drainage tube by gravity

2) outflow of pus through capillary drainage

3) drainage of a sutured wound with constant vacuum aspiration

4) leaving a rubber graduate in the wound

038. Risk factors during anesthesia and surgery,

contributing to the development of purulent complications in the wound are

1) blood loss

2) deterioration of blood microcirculation

3) traumatic operation

4) all of the above

039. For local treatment of a wound infected with a stick of blue-green pus, it is advisable to use all of the following drugs, except

1) polymyxin solution

2) boric acid

3) oil-balsamic liniment according to Vishnevsky and methyluracil ointment

4) dioxidine

040.Active immunization with staphylococcal infection in the wound

should be carried out using

1) antistaphylococcal bacteriophage

2) native or adsorbed staphylococcal toxoid

3) antistaphylococcal plasma

4) antistaphylococcal immunoglobulin

041. A septic wound is characterized by the presence of the following signs

1) “juicy” granulations and marginal epithelization

2) copious purulent discharge

3) pronounced swelling of the wound edges

4) flaccid granulations

9. Standards of answers to test tasks

Shock, infection, disruption of the integrity of vital organs.

Pain occurs due to damage to receptors and nerve trunks, the intensity of which depends on: 1) the number of nerve elements affected; 2) the reactivity of the victim’s body and his neuropsychic state. So, with fear, unexpected injury, etc., the intensity of pain is greater; 3) the nature of the wounding weapon and the speed of injury. The sharper the weapon, the fewer cells and nerve elements are destroyed, and, consequently, the less pain.

The nature and number of vessels destroyed during injury determine the severity of bleeding. The most intense occurs when large arterial trunks are destroyed. The gaping of a wound is determined by its size, depth and disruption of the elastic fibers of the skin. Wounds with complete muscle dissection lead to a large divergence of the wound edges. The elastic fibers of the skin located transverse to the direction (Langer's lines) usually have a larger gape than wounds running parallel to them.

Treatment. General tasks: ability to anticipate and prevent wound hazards; reducing the number and virulence of infection; removal of dead tissue; strengthening regeneration processes; stimulation of immunobiological reactions of the body.

The surgical wound is applied during surgery under strict aseptic conditions, but a small amount of microbes can get into it from the air or from the patient’s skin, so the wound is conditionally sterile. Treatment boils down to restoring anatomical relationships by suturing tissue and applying a bandage.

Accidental fresh wounds are always infected, and there is always a danger of secondary infection. When examining the victim and providing first aid, this must be taken into account. Fresh wounds should not be probed or palpated, as this may introduce germs and move those already present in the wound to deeper areas. During first aid, the skin around the wound is cleaned of contamination with swabs soaked in ether or gasoline, and widely lubricated with 5% tincture of iodine. After this, an aseptic bandage is applied and the patient is urgently transported to the hospital for active primary surgical treatment with suturing. The best results are obtained by treatment in the first 12 hours after injury and consist of removing infected tissue, restoring the anatomical relationships of the damaged area and creating unfavorable conditions for the development of microflora. Any wound must be turned into a cut.

Primary treatment is not carried out in severe general condition (shock, acute anemia etc.), the deadline is postponed until the patient’s well-being improves; with a purulent infection in the wound.

In cases where the application of a primary suture is contraindicated (possibility of infection), a delayed suture is used. The wound is stitched with threads, which are left untied for several days; after the danger has passed, they are tied and the wound is sutured. For large wounds that are not sutured primary processing, after they are filled with granulations, secondary sutures can be applied without excision or with partial excision of granulations ( secondary processing wounds).

Treatment of purulent wounds. In the hydration phase, which is characterized by the delimitation and melting of dead cells and tissues and the presence of active inflammatory process, it is important to suppress the activity of microorganisms and promote rapid wound cleansing. The following must be ensured.

1. Rest the affected organ (immobilization, rare dressings).

2. The use of antiseptic substances both locally into the wound and orally or intramuscularly.

3. Detoxification of the body.

4. Stimulation of immunobiological reactions, primarily by enhancing the phagocytic activity of leukocytes, which is achieved by transfusions of small amounts of blood, improved nutrition, administration of staphylococcal toxoid, hyperimmune serums, etc.

5. Creating maximum outflow of wound contents by wide opening of the purulent focus and draining it.

6. Careful treatment of wound tissues and careful dressings, since injury leads to the breakthrough of microbes into internal environment body, absorption of toxins, which is manifested by a sharp increase in temperature, chills, and deterioration of well-being.

7. In the presence of purulent-necrotic tissues, drugs capable of lysing (destroying) non-viable tissues are indicated. Animal proteolytic enzymes are used as such agents and bacterial origin, applied topically in the form of solutions or powder (in the presence of copious purulent discharge). Enzyme preparations due to their necrolytic and anti-inflammatory effects, they significantly reduce the hydration phase of wounds. They are quickly cleared of dead tissue and covered with healthy, juicy granulations, which allows you to switch to the use of ointment dressings or to the application of an early secondary suture.

When inflammation subsides and regeneration develops, therapeutic measures should mainly be aimed at enhancing this process. In this phase (dehydration), a strong wound barrier has already been created, the number and virulence of microbes in the discharge are sharply reduced, the wound is cleared of decay products and filled with granulations. Measures are shown to protect them from injury and secondary infection, i.e. dressings with indifferent ointment. At this time, you cannot use dressings with hypertonic, antiseptic solutions, as they damage granulations, as a result of which wound healing is delayed.

For centuries, the art of applying bandages has been formalized into a special science - desmurgy. Conveniently and correctly applying a bandage is important not only for first aid to the victim, but also during treatment, as this promotes rapid healing of wounds and reduces the suffering of patients. IN last years for holding gauze and applied topically to the wound medications A special bandage was designed from an elastic mesh “retelast”. It is made from elastic and cotton thread and is produced in the form of a stocking tape in seven sizes (from 0 to 6), which allows you to quickly apply a bandage to almost any part of the body.

When treating patients with a purulent process, it is important to determine the nature of the disturbances in the general condition and carry out measures that help increase the body's reactivity in case of insufficient, sluggish reaction and reduce it in case of an overly violent reaction. At the same time, it is necessary to take care of preserving and restoring the function of the affected organ. The periods of immobilization and rest should not be delayed, replacing them in the dehydration phase with dosed ones, with gradually expanding volumes of physical therapy and physiotherapeutic procedures.

Examination of the patient;

Wound dressing according to the rules for treating purulent wounds in the hydration phase:

Treating the edges of the wound with an antiseptic solution;

Washing the wound with a solution of 3% hydrogen peroxide, which also has a deodorizing effect;

applying a sterile dressing with 10% sodium chloride solution to the wound.

Overlay elastic bandage on a limb.

Referral to the surgical department with the necessary accompanying documents.

The patient is instructed on the rules for applying an elastic bandage: The elastic bandage is applied in the morning, without getting out of bed, starting from the fingertips to inguinal fold so that each subsequent round of the bandage covers 1/3 of the previous round.

Treatment program

In this case, given the severity of varicose veins and the presence of ulcers, conservative therapy is not indicated.

If carried out diagnostic measures indicate the patency of the deep veins, then the patient is indicated for surgery to remove the large saphenous vein lower limb.

Before surgery, it is necessary to achieve maximum cleansing of the ulcer from necrotic tissue and reduce discharge from the wound, i.e. “transfer the process from the hydration stage to the dehydration stage.” This is achieved by daily dressings or by applying a “boot” of Unna paste or plaster. A plaster boot is applied to grip the foot, ankle joint and two thirds of the lower leg. The limb remains in a cast for 2 weeks. After removing the plaster, the ulcer either completely epithelializes or clears and decreases in size. This method is based on the action of bacteriophages that develop under a blind plaster cast. In addition, the plaster cast creates rest for the wound.

In the preoperative period, novocaine perirenal blockades are performed according to A.V. Vishnevsky with the aim of influencing the sympathetic nervous system.

The surgical operation consists of ligating and removing the saphenous veins and ligating the communicating veins of the leg supra- or subfascially, in combination with excision of the ulcer and replacement of the resulting skin defect with free skin autografts.

Postoperative management:

1. The patient is in bed for the first day after surgery with his leg elevated - the leg is on a Beler splint.

2. The next day, the patient is allowed to move the ankle and knee joints (this prevents the possibility of blood clots).

3. From 3-4 days the patient is allowed to walk.

4. On day 8, the stitches are removed.

Task No. 2

A woman who had been suffering from varicose veins in the area of ​​both legs for many years came to the FAP. About 2 days ago I felt unusual painful sensations in the upper third of the anterior-inner surface of the left leg along the varicose veins, intensifying with physical activity. A woman works as a weaver and is on her feet all the time. General condition is satisfactory, temperature 37.2°. On the anterior surface of the left leg along the great saphenous vein, a swelling is visible, the skin over which is hyperemic, the size of the area of ​​inflammation is 3x8 cm, and a dense painful infiltrate is palpated here. Swelling of the lower leg is minor. The patient had a sore throat two weeks ago.

Tasks

1.Formulate and justify the presumptive diagnosis.

2.Tell us about the factors that contribute to the development of this disease.

3.Tell us about a possible life-threatening complication of this disease.

4.Draw up a treatment program for outpatient and inpatient treatment.

Response standard

Diagnosis: Acute thrombophlebitis of the great saphenous vein of the left leg.

Factors contributing to the development of thrombophlebitis

Important role The following factors play a role in the development of thrombophlebitis: infection, traumatic injuries, slowing of blood flow, increase in the coagulation potential of the blood.

Complications of thrombophlebitis

A dangerous complication of superficial thrombophlebitis in the area of ​​the great saphenous vein of the leg is ascending thrombophlebitis of the great saphenous vein due to the threat of penetration of the floating part of the thrombus into the deep vein of the thigh, the external iliac vein, which can lead to pulmonary embolism.

Treatment program

Rest, elevated position of the limb, ointment dressings (Vishnevsky ointment, heparin ointment, heparoid). Avoid rubbing.

In conditions surgical department you can combine fibrinolic drugs such as streptokinase, trypsin, chymotrypsin and active anticoagulants, because constant monitoring of the blood coagulation system is possible. Fibrinolytic drugs dissolve blood clots, anticoagulants prevent their formation.

To improve the rheological properties of blood and microcirculation, it is recommended to prescribe drugs such as trental, troxevasin, venoruton, indomethacin. For the purpose of desensitization, diphenhydramine and suprastin are used. Reo-pyrin and butadione have a good anti-inflammatory effect. When the inflammation subsides, physiotherapeutic treatment is recommended.

Task No. 3

A FAP paramedic visited a 53-year-old patient at home who complained of severe pain in the left lower leg of a bursting nature, swelling of the foot and lower leg, and convulsive contractions. calf muscles, temperature rise to 38.5°. She has been sick for two days. Upon examination, the skin of the left foot and lower leg is hyperemic, tense, and shiny. The circumference of the left shin is 5 cm larger than the right. Palpation reveals pain along the vascular bundle, especially in the popliteal fossa.

Tasks

1. Formulate and justify the presumptive diagnosis.

3. Create an algorithm for providing emergency care with justification for each stage.

Response standard

Diagnosis: Acute deep thrombophlebitis of the left leg.

The diagnosis was made on the basis of clinical data: an increase in temperature to 38.5°C, severe pain in the left lower leg, swelling and hyperemia of the foot and lower leg, an increase in the circumference of the lower leg in comparison with a healthy one by 5 cm, palpation pain along the vascular bundle.

Algorithm for providing emergency care:

1. Painkillers (analgin) and desensitizing drugs (diphenhydramine, suprastin).

2. Antispasmodics (papaverine, platyphylline).

3. Anticoagulants direct action(heparin 5000 units intravenously).

4. Ointment compress on the lower limb to the s/w thigh.

5. Limbs are given an elevated position on pillows.

6. Broad-spectrum antibiotics (cephalosporins, aminoglycosides).

7. Transporting the patient by ambulance to the surgical department in a lying position with the sore limb elevated and placed on a Beler splint

Task No. 4

A 30-year-old man came to the FAP. He has been smoking for 20 years. Complaints of intermittent claudication - (after 100 meters he is forced to stop due to pain in the calf muscles). He considers himself sick for six months when intermittent claudication appeared after 400 meters. A month ago, pain appeared in the first toe of the right foot, then a deep necrotic ulcer appeared on the toe. The patient's shins are marbled in color, the distal parts of the feet are purple-bluish in color. Nails are dry and brittle. There is no pulse in the arteries of the foot; popliteal arteries weakened

001. Wounds are classified according to infection:

1) purulent, aseptic, poisoned;

2) aseptic, scalped, purulent;

3) bitten, freshly infected, aseptic;

4) clean, freshly infected, infected;

5) purulent, freshly infected, aseptic.

002. What explains the presence of a zone of molecular shaking during gunshot wound?

1) pressure on the tissue of the projectile;

2) pulsation of cells in the wound area;

3) wave-like movements of the canal walls;

4) change in osmotic pressure;

5) the mass of the projectile.

003. What determines the degree of wound gaping?

1) depth of damage;

2) damage to nerve trunks;

3) damage to the fascia;

4) damage to muscles and tendons;

004. After what time do microbes in a wound usually begin to become active?

005. Many factors contribute to the development of infection in a wound, except:

1) hematomas;

2) blood loss;

4) exhaustion;

5) absence of foreign bodies.

006. In developed granulations, 6 layers are distinguished. Which one is the fourth?

1) leukocyte-necrotic;

2) vertical vessels;

3) maturing;

4) horizontal fibroblasts;

5) vascular loops.

007. In a gunshot wound, all damage zones are distinguished, except:

1) wound canal zones;

2) zones of molecular shock;

3) areas of hemorrhage;

4) zones of primary necrosis;

5) zones of parabiosis.

008. Shrapnel wounds are characterized by everything except:

1) complexity of anatomical damage;

2) the presence of foreign bodies;

3) high degree of infection;

4) the mandatory presence of inlet and outlet openings;

5) uneven skin lesions.

009. In which wound is infection most likely to develop?

1) chopped;

2) bitten;

3) chopped;

4) located on the face;

5) scalped.

010. A bruised wound is distinguished from a chopped wound by everything except:

1) the presence of a bruise along the edge of the wound;

2) different depths of damage;

3) presence of crushed tissues;

4) violation of the integrity of nerve trunks;

5) less pronounced bleeding.

011. To accelerate healing when treating a wound in the dehydration phase, the following is necessary:

1) frequent dressings;

2) use of enzymes;

3) applying ointment dressings;

4) applying bandages with hypertonic solutions;

5) therapeutic exercises.

012. Primary surgical treatment of a wound should be understood as:

1) excision of the edges and bottom of the wound;

2) opening pockets and leaks;

3) removal of purulent discharge;

4) excision of the edges, walls and bottom of the wound;

5) washing the wound with an antiseptic; hemostasis.

013. The bottom of the wound is bone. How to perform primary surgical treatment of a wound?

1) excise the periosteum;

2) scrape out the bone with a sharp spoon;

3) remove upper layer periosteum;

4) trepanate the bone;

5) excise only the edges and walls of the wound.

014. There is a wound with a limited area of ​​necrosis of the skin edge. What needs to be done?

1) prescribe UHF to the wound;

2) apply a bandage with a hypertonic solution;

3) apply a bandage with Vishnevsky ointment;

4) drain the wound;

5) excise the dead skin area.

015. Specify the main indication for the application of a primary delayed suture:

2) large blood loss;

3) the inability to tighten the edges of the wound after surgical treatment;

4) the possibility of developing an infection;

5) nerve injury.

016. The primary delayed suture is applied to the wound within the following time limits:

1) 3-4th day;

2) 5-6th day;

3) 8-15th day;

4) immediately after primary surgical treatment;

5) 20-30th day.

017. In what case can you impose primary suture for a wound measuring 6x8 cm on the palmar surface of the forearm?

1) if there is no foreign body in the wound;

2) if there is no inflammation in the wound;

3) if there is no necrotic tissue in the wound;

4) when using antibiotics;

5) the primary suture cannot be applied.

018. Phase I of the wound process is characterized by everything except:

1) development of acidosis;

2) increasing the number of hydrogen ions;

3) increasing the number of potassium ions;

4) increasing vascular permeability;

5) development of alkalosis.

019. How does late primary surgical treatment differ from secondary surgical treatment?

1) surgical technique;

2) timing of the operation;

3) the number of previous dressings;

4) lack of primary surgical treatment;

5) use of drainage or refusal of it.

020.When ultrasonic treatment of a wound occurs:

1) acceleration of the process of rejection of necrotic tissues

2) sterilization of the wound surface

3) reducing the degree of bacterial contamination of the wound surface

4) immediate removal of all necrotic tissues

5) increasing the depth of penetration of the drug into the wound tissue

Select a combination of answers

Lecture 16. ACUTE PURULENT DISEASES OF SOFT TISSUE

Relevance: Purulent diseases of soft tissues occupy a leading place among surgical infections both in terms of frequency of development and possible complications.

Let's consider particular forms of diseases.

Furuncle – acute purulent inflammation of the hair follicle and sebaceous gland, with the involvement of surrounding fatty tissue in the process.

Clinic: the disease begins with the formation of an inflammatory infiltrate in the area of ​​the hair follicle. As the process progresses, necrosis of the fiber occurs, with the accumulation of pus and the formation of a purulent-necrotic rod in the area of ​​the hair head.

Outcomes and possible complications:

1. In the infiltrate stage, resorption is possible.

2. Abscess formation, breakthrough of pus, healing.

Complications: when localized on the face (above the corners of the mouth), meningitis and encephalitis may develop, when pus breaks into the veins of the face, and inflammation through the angular vein of the eye passes into the ophthalmic vein, and from there into the superficial sinus of the dura mater.

Treatment: in the infiltration stage, treatment is conservative, including lubrication with alcohol, iodine tincture, heat (UHF, UV), semi-alcohol compresses and dressings with ichthyol ointment.

In the stage of abscess formation - surgical treatment: opening of the abscess with removal of the purulent-necrotic core, drainage for 1–3 days.

Furunculosis – inflammation of several hair follicles simultaneously or sequentially. Often found in diabetes mellitus, vitamin deficiency, decreased immune forces of the body, chronic sepsis.

For effective treatment of furunculosis, it is necessary to examine the patient to identify the cause of the disease.

Treatment uses antibiotics, autohemotherapy, immunization of the body with staphylococcal toxoid, and ultraviolet radiation of the blood. Brewer's yeast is used in folk medicine.

Carbuncle – acute purulent-necrotic inflammation of several hair follicles merging into a single infiltrate, accompanied by necrosis of the skin and fiber.

The disease occurs with severe general intoxication of the body, especially in weakened patients.

Treatment: Usually surgical, the abscess is opened with a cross-shaped incision and necrotic tissue is removed - necrectomy. Subsequently, dressings are carried out with hypertonic solutions and water-soluble ointments. Physiotherapeutic lasers are used. When large defects form skin Skin grafting is performed.

Hidradenitis – acute purulent inflammation sweat glands. Most often localized in the armpits.

Clinic – the disease begins with the formation of a painful compaction in the axillary region, then skin hyperemia appears and an abscess forms.

Treatment - Before abscess formation, conservative treatment is possible: heat, UHF, injection with an antibiotic solution.

For abscess formation – surgical treatment:

1. opening and drainage, but this may leave a sweat gland capsule, which often causes relapses of hidradenitis.

2. excision of the inflamed sweat gland with the capsule and surrounding tissue, which eliminates the possibility of relapse of the disease.

Erysipelas - acute inflammation of the skin itself, and in in rare cases– mucous membranes.

Etiology: Streptococcus. Refers to infectious diseases, infection occurs through the entrance gate (wounds, cracks, microtraumas, calluses, diaper rash).

Shapes:

1. Erythematous - bright hyperemia of the skin with clear boundaries and uneven edges.

2. Bullous - the formation of vesicles (bullae) containing cloudy-serous or hemorrhagic fluid.

3. Phlegmonous – formation of serous-purulent exudate in subcutaneous tissue.

4. Necrotic – necrosis of the skin and underlying tissues.

Localization: face, limbs, perineum.

With the flow: 1. Acute form;

2. Recurrent form;

3. Migratory form.

Clinic– symptoms of general intoxication with high (up to 40–41 degrees) temperature predominate.

Treatment: For the erythematous form, conservative treatment: dressings with antiseptics, ultraviolet radiation, antibiotics (penicillin + streptomycin), sulfonamides, desensitizing therapy.

For other forms erysipelas– surgical treatment: in the bullous form – opening of the blisters, in the phlegmonous form – wide opening of the subcutaneous tissue, in the necrotic form – necrotomy (tissue dissection) and necrectomy, skin grafting to the defect.

Complications: 1. Trophic ulcer;

2. Lymphostasis, elephantiasis.

Phlegmon – acute diffuse inflammation of the tissue, with no tendency to demarcate.

Shapes:

By localization:

1. Subcutaneous

2. Subfascial

3. Intermuscular

4. Deep cellular spaces (for example: mediastinum - mediastinitis, phlegmon of the retroperitoneal space, pararectal space - paraproctitis, perinephric space - paranephritis).

By the nature of the exudate:

1. Serous

2. Purulent

3. Putrid.

Clinic: phlegmon is manifested by edema, hyperemia and pain in the lesion, dysfunction of the limb, and temperature.

Treatment: Only in the beginning form is conservative treatment possible.

The main treatment is surgical; the abscess is widely opened, leaks and low-lying areas are drained through counter-apertures (additional incisions). Immobilization is required.

Abscess (ulcer)– limited accumulation of pus in soft tissues and various organs, has a cavity with pus and a pyogenic capsule.

Etiology:

1. Due to any inflammatory process (phlegmon, lymphadenitis, pneumonia).

2. Suppuration of the hematoma.

3. Metastatic abscesses (with septicopyemia).

4. Post-injection (hypertonic solutions, magnesia, dibazole, calcium chloride).

5. Postoperative.

By localization

1. Superficial

2. Deep: a) abscesses internal organs: abscesses of the brain, lungs, liver; b) cavity abscesses - abscesses abdominal cavity: subphrenic, subhepatic, interintestinal, Douglas space.

Clinic: With superficial abscesses, local manifestations are all 5 signs of inflammation. With deep abscesses they appear general signs: high fever, in the infiltration stage - constant, with abscess formation - hectic, with chills, heavy sweating, increase in ESR, the appearance of proteins in the urine.

Signs of abscess formation of infiltrate:

1. The appearance of hectic temperature

2. Symptom of fluctuation (oscillation)

Shapes:

1. Acute – more pronounced clinical picture.

2. Chronic (usually in the lungs).

Treatment abscess surgical only:

1. Puncture method (including under ultrasound control)

2. Puncture-flow method

3. Open method - opening and draining the abscess

4. Radical method - removal of part or the entire organ with an abscess (for example: lobectomy - removal of a lobe of the lung with an abscess).

Complications:

1. Breakthrough of the abscess into free cavities, with the development of peritonitis, pyothorax, bacteremic shock;

2. Sepsis;

3. Kidney amyloidosis.

Mastitis – acute inflammation of the mammary gland. More often lactation (insufficient care of the mammary gland in nursing women, microtrauma, milk stagnation).

Classification:

By localization:

1. Subareolar – in the area around the nipple;

2. Subcutaneous – in the subcutaneous tissue of the gland;

3. Intramammary – in the thickness of the mammary gland;

4. Retromammary - behind the mammary gland.

Stages:

1. Infiltration;

2. Abscess formation.

By the nature of the exudate:

1. Serous;

2. Purulent;

3. Gangrenous.

Shapes:

1. Spicy;

2. Chronic (with a possible outcome in mastopathy, breast tumor).

Clinic: characterized by engorgement, soreness and redness of the mammary gland, high temperature.

Treatment: In the 1st stage (infiltrative) conservative: immobilization of the gland (rest is created by tight bandaging), expressing milk, penicillin-novocaine blockade in the retromammary space, antibiotics.

In the 2nd stage (abscess formation), surgical treatment: 1) the abscess is opened with one or several radial incisions; 2) for retromammary mastitis, a semilunar incision is made under the mammary gland in the transitional fold; 3) in the case of gangrenous form - multiple incisions or amputation of the mammary gland.

According to the latest data, surgical treatment is used even in the infiltration stage to reduce the likelihood of tissue necrosis.

Lecture 17. PURULENT DISEASES OF SEROUS CAVITIES

Purulent diseases of serous cavities include inflammation of the pleural cavity, abdominal cavity, and pericardial cavity.

Pleurisy – inflammation of the pleura. More often, pleurisy is secondary in nature, as a consequence of the transition of inflammation during pneumonia, with lung abscess. Less common as an independent disease. Separately, reactive pleurisy is distinguished, which develops with subphrenic abscess, pancreatic necrosis, due to the passage of inflammation through the diaphragm.

By the nature of the exudate distinguish:

1. Serous pleurisy

2. Hemorrhagic pleurisy

3. Fibrinous pleurisy

4. Dry pleurisy

5. Purulent pleurisy

6. Pleural empyema.

According to the prevalence of inflammation distinguish:

1. Basal pleurisy (inflammation of the sinuses)

2. Interlobar pleurisy

3. Encapsulated pleurisy

4. Diffuse pleurisy.

According to the course of the inflammatory process highlight:

1. Acute pleurisy

2. Chronic pleurisy.

Clinic: Pleurisy is characterized by pain in the chest, aggravated by deep breathing and coughing, increased body temperature, and chills. Breathing becomes shallow and rapid, affected side chest breathing lags; auscultation reveals wheezing and weakening of breathing; percussion reveals dullness in the sloping (lower) parts of the chest. X-rays show homogeneous darkening, the sinuses are not differentiated, exudate in pleural cavity can be defined as a horizontal level or as a Damoiseau line. To clarify the diagnosis, a diagnostic puncture of the pleural cavity can be performed.

Treatment:

1. Puncture method: therapeutic puncture is performed in the 7–8 intercostal spaces, along the upper edge of the rib (so as not to damage the intercostal nerves and vessels), along the axillary and scapular lines. After layering local anesthesia The pleural cavity is punctured, the exudate is evacuated, and an antiseptic solution is injected into the pleural cavity.

2. Puncture-flow method: using thick needles or trocars, a puncture of the pleural cavity is performed, 2 or more drains are installed for constant irrigation of the pleural cavity with antiseptics and simultaneous aspiration of the lavage fluid.

3. Closed surgical method: thoracotomy is performed, sanitation of the pleural cavity is performed, drainage of the pleural cavity is performed with suturing of the thoracotomy wound tightly.

4. Open surgical method: after thoracotomy, the wound is not sutured and left open. It is currently used extremely rarely, only for pleural empyema.

Peritonitis- inflammation of the peritoneum.

By origin distinguish:

1. Secondary peritonitis:

- as a consequence of acute surgical disease;

– as a consequence of perforation of damage to a hollow organ.

2. Postoperative peritonitis:

– due to failure of the sutures of hollow organs;

– due to the progression of the inflammatory process.

3. Cryptogenic peritonitis: when the source of peritonitis is not identified.

By the nature of the exudate distinguish:

1. Serous peritonitis

2. Hemorrhagic peritonitis

3. Fibrinous peritonitis

4. Purulent peritonitis

5. Putrid peritonitis

6. Fecal peritonitis

7. Biliary peritonitis

8. Urinary peritonitis.

According to the prevalence of the process distinguish:

1. Local peritonitis (occupies 1–2 adjacent anatomical areas)

– not delimited (not limited to the non-inflamed peritoneum);

– limited (infiltrate or abscess of the abdominal cavity).

2. Diffuse peritonitis (occupies 2–3 adjacent anatomical areas)

3. Diffuse peritonitis(takes at least 3 anatomical areas up to 2/3 of the peritoneum, or 1 of the floors of the abdominal cavity)

4. General generalized peritonitis (inflammation of the entire peritoneum).

By stages of development highlight:

1. Reactive phase

2. Toxic phase

3. Terminal phase.

Clinic: signs of peritonitis overlap with the manifestations of the underlying disease (acute appendicitis, acute cholecystitis etc.). It is characterized by increasing abdominal pain, symptoms of intoxication, nausea and vomiting, bloating, and hyperthermia. When examining the patient, a dry tongue, tachycardia are revealed, the abdomen is tense on palpation (“board-shaped abdomen”) and painful, symptoms of peritoneal irritation are determined (Shchetkin-Blumberg symptom, Razdolsky symptom). In the later stages, persistent paresis and paralysis of the gastrointestinal tract occur. Blood tests show leukocytosis, shift leukocyte formula to the left, toxic granularity of neutrophils, leukocyte index of intoxication increases, ESR increases.

Treatment. Treatment of peritonitis is only surgical, which consists of 3 main stages:

1. Elimination of the source of peritonitis, for example: appendectomy, cholecystectomy, suturing of gastric perforation, etc.

2. Sanitation of the abdominal cavity: consists of evacuation of exudate; in case of diffuse and general peritonitis, it is necessary to rinse the abdominal cavity with antiseptic solutions.

3. Adequate drainage of sloping areas of the abdominal cavity: subhepatic and subdiaphragmatic spaces, lateral canals, pelvic cavity.

After the operation, infusion detoxification therapy, antibacterial therapy, stimulation of gastrointestinal motility, stimulation of the body's defenses, and parenteral nutrition are performed.

Pericarditis – inflammation of the pericardial sac. More often it develops as a consequence of septic processes, less often – primarily.

By the nature of the exudate distinguish:

1. Serous pericarditis

2. Hemorrhagic pericarditis

3. Adhesive pericarditis

4. Purulent pericarditis

5. Fibrinous pericarditis (“shell heart”).

Clinic: The leading manifestation of pericarditis is a disturbance in the functioning of the heart, or heart failure, manifested by shortness of breath, cyanosis of the skin, palpitations, weakness, fatigue, swelling of the lower limbs. During the examination, tachycardia is detected, with auscultation - weakening of heart sounds, pericardial friction noise, and with percussion - expansion of the boundaries of the heart. An X-ray of the chest organs in 2 projections reveals a spherical shape of the heart.

Treatment: in the initial stages - conservative treatment. If exudate accumulates, a puncture of the pericardial cavity is performed. For fibrinous-purulent pericarditis, thoracotomy, pericardotomy with evacuation of exudate is performed. After puncture or surgery, antibacterial, detoxification, and cardiogenic therapy is carried out.

Lecture 18. PANARICIA, PHLEGMON OF THE HAND

Panaritium – purulent inflammation of the tissues of the finger. This is one of the most common purulent diseases. The pathogens, most often staphylococci, enter tissues through cuts, injections, splinters, and in girls, often after a manicure.

Classification:

1. By stages (by flow):

serous (edematous) stage – is reversible;

purulent stage - requires only surgical intervention.

2. By clinical form:

Cutaneous panaritium

Subcutaneous panaritium

Subungual panaritium

Periungual felon (paronychia)

Tendon panaritium

Articular felon

Bone panaritium

Pandactylitis.

Skin panaritium - characterized by the formation of an abscess in the thickness of the skin, under the epidermis. This is a superficial abscess, and for treatment it is enough to open the epidermis and remove the pus.

Subcutaneous panaritium - inflammation develops in the subcutaneous tissue. Inflammatory edema in the tissue of the finger leads to compression of the blood vessels, resulting in severe throbbing pain. Body temperature rises to 38 degrees, chills are possible.

Treatment: In the first stage - wound treatment, alcohol compress. Indicator of process transition to stage 2 – a sleepless night due to severe pain, which is an indication for surgical treatment. The operation is performed either under local conduction anesthesia according to Oberst-Lukashevich, or under intravenous anesthesia. When the inflammatory focus is localized on the terminal phalanx, a club-shaped incision is made in the area of ​​the middle and proximal phalanges– side slits.

Subungual panaritium – develops under the nail as a result of splinters. Pus accumulates under the nail, the nail peels off, bursting pain appears, the temperature rises, and pressure on the nail is sharply painful.

Treatment: surgical. For limited abscesses, a wedge-shaped resection of the nail is performed to remove the splinter and pus. If the nail is completely detached, it is removed.

Paronychia – inflammation of the nail fold, develops as a result of infection of microtraumas, including after a manicure. Swelling and hyperemia of the nail fold are observed; when pressed, there is a sharp pain and discharge of pus from under the edge of the nail fold.

Treatment: in the first stage, alcohol compresses and bandages with hypertonic solutions are effective. In the 2nd stage, an operation is performed - opening the abscess with two incisions parallel to the nail fold, the roller is peeled off and the pus is evacuated. Apply an ointment bandage.

Tendon panaritium - inflammation of the tendon sheath of the fingers. A severe form of felon develops most often as a consequence of late or poorly treated subcutaneous felon, or as a result of a finger injury with damage to the tendon sheath. The most dangerous are the tendon felons of the 1st and 5th fingers, since the tendon sheaths of these fingers extend to the wrist and forearm and are connected to the Pirogov-Paron space. Therefore, with tendon felons of the 1st and 5th fingers, there is a threat of inflammation spreading from the finger to the forearm.

Clinic: tendinous panaritium is characterized by severe pain along the entire finger, which intensifies when trying to straighten the fingers. The finger is swollen along its entire length, with swelling spreading to the hand.

Treatment: surgical treatment is indicated - opening the abscess with double incisions along the lateral surfaces of the finger, with through drainage carried out under the tendon.

Articular panaritium - purulent inflammation of the interphalangeal or metacarpophalangeal joints. Due to inflammation in the joint, the finger becomes flask-shaped and the finger is bent. When extending, there is a sharp pain in the joint, the pain intensifies with axial load on the finger. With prolonged inflammation, articular cartilage is destroyed, and the process spreads to bone tissue.

Treatment: if there is pus in the interphalangeal joint, an arthrotomy is performed - opening the joint cavity with 2 incisions. When the articular surfaces are destroyed, the articular heads of the bones are resected.

Bone panaritium – purulent inflammation of the bones of the fingers, or osteomyelitis of the bones of the hand. Develops as a result of a long course of other forms of panaritium. Suspecting the development of bone felon allows long-lasting swelling of the tissues of the fingers, prolonged purulent discharge from wounds of the fingers. The diagnosis is confirmed by x-ray of the hand, when osteoporosis and destruction are detected bone tissue, the formation of sequesters is possible.

Treatment: in the stage of osteoporosis, conservative treatment is possible - antibacterial therapy taking into account microflora and its sensitivity, laser therapy, sanitation of purulent leaks in soft tissues, radiotherapy. In case of destruction and sequestration of bone tissue, surgical treatment is indicated - wide exposure of the affected bone with necrectomy.

Pandactylitis – purulent inflammation of all layers and tissues of the finger. Pandactylitis develops as a result of untimely or incorrectly treated other forms of panaritium. With pandactylitis, the finger is swollen along its entire length, cyanotic, there is no movement, and there is purulent discharge from the wounds. Radiographs of the hand reveal destruction of the phalanx along the entire length or two adjacent phalanges. Treatment: surgical, consists of resection or disarticulation of the finger.

Phlegmons of the hand – purulent inflammation of the tissues of the hand. Varieties: phlegmon thenar – inflammation of the eminence of the thumb; phlegmon hypothenar – inflammation of the eminence of the little finger; phlegmon of the back of the hand; supra- and subgaleal phlegmon of the palmar surface of the hand. The causes of phlegmon of the hand are: phlegmon thenar - tendon felon of the 1st finger, phlegmon hypothenar - tendon felon of the 5th finger, deep subaponeurotic phlegmon - infected calluses. In addition, phlegmon of the hand develops with infected and bitten wounds of the hand, foreign bodies, ineffectively treated with any form of panaritium.

Clinic: back and palmar surface the hands are swollen, sharply painful, the fingers are half-bent, straightening them increases the pain. The presence of a purulent process is indicated by a high temperature of up to 38–39 degrees with chills.

Possible complications:

– Lymphangitis, lymphadenitis

– Phlegmon of the forearm (Pirogov-Paron space)

- Sepsis.

Treatment: surgically, phlegmons of the hands are opened with incisions taking into account the vessels, nerves and tendons of the hand, drained from counter-apertures. After surgery, immobilization of the hand and forearm, antibacterial and detoxification therapy are necessary.

Lecture 19. PURULENT DISEASES OF THE DEEP

CELLULAR SPACES

These include: deep phlegmon of the neck, purulent mediastinitis, purulent paranephritis, retroperitoneal phlegmon, purulent paraproctitis.

Deep phlegmon of the neck: Inflammation of the tissue located under the deep fascia of the neck. Infection in the deep tissue space of the neck most often comes from the oral cavity, nasopharynx, trachea, esophagus, and scalp. Deep phlegmon of the neck is caused by the progression of the inflammatory process in the teeth (caries), which can lead to osteomyelitis of the jaw, perimaxillary phlegmon, phlegmon of the floor of the mouth. Also, deep phlegmon of the neck is caused by a retropharyngeal abscess, suppuration of neck cysts, trauma cervical regions esophagus and trachea, purulent inflammation of the lymph nodes of the neck. Dangers of deep neck phlegmon:

1 – the possibility of spreading through numerous interfascial gaps and along the neurovascular bundles of the neck, with the development of purulent mediastinitis, sepsis, etc.

2 – erased local signs of inflammation in the initial stages, which leads to late diagnosis of neck phlegmon.

Clinic: at the beginning of the disease, patients note bursting pain in the neck and swelling, there is no hyperemia at the beginning, which makes it difficult to diagnose the process. The progression of the process leads to an increase in temperature, dense edema develops, which leads to compression of the trachea and esophagus. Severe intoxication develops: high temperature, tachycardia, leukocytosis. Often the inflammation is putrefactive or anaerobic in nature, and if not diagnosed in time, leads to mediastinitis and sepsis.

Treatment: conservative treatment only in initial stage(semi-alcohol compresses, anti-inflammatory treatment, sanitation primary focus). In the purulent stage, the phlegmon of the neck is opened along the anterior edge of the sternocleidomastoid muscle, active drainage is performed, and after surgery, broad-spectrum antibiotics, detoxification therapy, ultraviolet blood irradiation, and hyperbaric oxygenation are prescribed.

Purulent mediastinitis – purulent inflammation of the mediastinal tissue. The causes of mediastinitis are phlegmon of the neck, damage to the trachea and bronchi, complications during operations on the mediastinum, perforation of the esophagus (foreign body, during diagnostic and therapeutic endoscopy, “banquet syndrome”).

The disease is extremely severe, developing hyperthermia up to 39–40 degrees, chills, tachycardia up to 120–140 beats per minute, shortness of breath, chest pain. The pain intensifies when swallowing, and dysphagia is observed. Crepitation due to subcutaneous emphysema is possible.

Downstream, a fulminant form is isolated when patients die in the first 2 days. More often there is an acute form with a less violent clinical picture. The process can also have a subacute course, especially with massive antibiotic therapy.

For diagnostics: X-ray of the chest organs in 2 projections is required, which reveals the expansion of the mediastinal shadow, free air or fluid level in the mediastinum. A contrast study of the esophagus can reveal contrast leakage beyond the esophagus. With fibroesophagogastroscopy, a rupture of the esophagus can be determined. With the development of concomitant pleurisy, fluid is detected in the pleural cavity.

Treatment: emergency surgical intervention immediately after diagnosis. The operation consists of mediastinotomy - opening of the mediastinum from a cervical approach or laparotomy approach, or using a combination of both for active washing and sanitation of the mediastinum. In case of damage to the esophagus, the following are possible: 1) drainage of the rupture zone and gastrostomy; 2) extirpation of the esophagus with esophagostomy and gastrostomy; 3) extirpation of the esophagus with its simultaneous plastic surgery.

Mortality with mediastinitis is extremely high.

Paranephritis– purulent inflammation of the perinephric tissue. Most often, paranephritis is secondary in nature, developing as a result of the transition of infection with a kidney carbuncle, apostematous purulent pyelonephritis, kidney abscess, damage to perinephric tissue, urolithiasis with pyonephrosis, etc. Less commonly, paranephritis occurs with lymphogenous and hematogenous infection.

Clinic. The disease is characterized by an increase in temperature to 38–40 degrees with chills and lower back pain. The pain can radiate down to the thigh, intensifies when walking, a positive psoas symptom is pain and the inability to flex the straightened leg at the hip joint, so the leg takes a forced position - bent at the knee and hip joints and brought to the stomach. Swelling and pain in the lumbar region appears. Blood tests reveal leukocytosis, an increase in ESR, a shift of the leukocyte formula to the left, urine tests reveal proteinuria, and leukocytes are detected.

Diagnostics:

1.Clinic.

2. X-ray methods. Survey urography reveals smoothness or disappearance of the contour of the psoas muscle on the affected side. Excretory urography indicates the presence of occlusion of the urinary ducts.

3. Ultrasound examination - reveals signs of kidney carbuncle, pyelonephritis, infiltration of perinephric tissue.

4. CT scan(CT) - reveals perinephric infiltration.

5. In the absence of ultrasound and CT, diagnostic puncture of the perinephric tissue is possible.

Treatment: consists of a combination of surgical and conservative methods. If paranephritis is detected, a lumbotomy, opening of the perinephric tissue, and drainage are performed. After surgery, broad-spectrum antibiotics, infusion therapy, gravitational surgery, and blood and plasma transfusions are prescribed.

Paraproctitis – purulent inflammation of the perirectal tissue. More often, infection (colibacillary, enterococcal, anaerobic) enters the perirectal tissue during injuries of the perineum and rectum, with inflammation of the anal crypts, and also as a complication of a number of diseases of the rectum.

According to the localization of the purulent process, subcutaneous, submucosal, ischiorectal, retrorectal, and pelvic-rectal paraproctitis are distinguished.

According to the current, acute and chronic paraproctitis are distinguished.

Clinic: the disease begins with malaise, pain in the perineum, aggravated by defecation. The temperature rises to 38–40 degrees with chills. In superficial forms (subcutaneous paraproctitis), hyperemia and swelling of the skin of the perineum and buttocks appear. With deep paraproctitis there are no visible changes. A rectal digital examination reveals sharp pain, infiltration and bulging of the walls of the rectum. If treatment or diagnosis is not timely, the abscess can open outward into the perineum or rectum, with the formation of fistulas. From this time on, the transition of acute paraproctitis to chronic begins; fistulas can be incomplete external or internal, and complete, one end of which communicates with the rectum, the second end opens outward.

Treatment: In case of acute paraproctitis, surgical treatment is indicated - opening the abscess under the control of a finger inserted into the rectum. Care must be taken not to damage the external anal sphincter. For putrefactive and anaerobic paraproctitis, wide opening, necrectomy, and drainage are indicated.

After the operation, antibiotic therapy, hyperbaric oxygen therapy, detoxification therapy, and a slag-free gentle diet are prescribed. For chronic paraproctitis, fistula excision is performed.

Phlegmon of the retroperitoneum: most often develops with retroperitoneal appendicitis, with pancreatic necrosis, with ruptures of the retroperitoneal part of the duodenum, with osteomyelitis of the pelvic bones and vertebrae.

Clinic: the onset of retroperitoneal phlegmon overlaps the course of the underlying disease and is practically not detected. At the height of the disease, pain appears in the lumbar regions, patients are forced to sit with their legs brought to the stomach, a gradual increase in body temperature with chills, and the condition of patients worsens after a certain clear interval. When examining patients, pain is detected in the lumbar regions, abdominal pain, and intestinal paresis occurs.

Diagnostics:

1. Clinic.

2. Plain radiography of the abdominal organs - the blurring of the contours of the psoas muscle is revealed, most often on both sides, and there may be a horizontal fluid level.

3. Ultrasound and CT scan reveal signs of infiltration of retroperitoneal tissue, often with a cellular structure.

(Vulnera) Of all types of injuries in animals, wounds make up more than half of all mechanical damage. With large inflamed infected wounds, along with local changes in tissues, general disorders in the body also occur, and therefore in recent years such concepts as wound process and wound disease have been introduced. These terms mean the entire symptom complex of local and general violations organism observed in one or another animal species with wounds.

The biology of the wound process and wound treatment have been most fully studied in horses; the morphological, physicochemical and biological phenomena in the wound have been experimentally and clinically studied in them.

Phases of wound healing. During wound healing, three phases are observed, each of which is accompanied by certain morphological and physicochemical phenomena in the wound: the first phase - hydration, or self-cleaning; the second phase is dehydration, or filling the wound with granulations; the third phase is scarring and epidermization.

The biological pattern of phase flow and wound healing is observed during primary and secondary intention; Each phase, depending on the state of the healing wound (aseptic or infected), has its own morphological, biophysical, biochemical and clinical features, although during the healing of aseptic wounds the transition from one phase to another occurs gradually, without clearly defined boundaries. When healing gaping purulent wounds, the phase boundaries are more clearly defined.

The hydration phase usually begins from the moment bleeding stops and is characterized by hyperemia, exudation, leukocytosis, degenerative phenomena, as well as well-defined biophysical-colloid-chemical changes, namely: swelling of colloids and capillary walls, an increase in the amount of potassium in the wound and a decrease in the potassium content in it , increased concentration of hydrogen ions - acidosis, increased permeability of vascular capillaries and increased lymph flow, tissue swelling, changes in surface tension, tissue metabolism disorders, increased enzymatic processes.

I.G. Rufanov (1948), characterizing the first phase of the wound process, points out that the hydration phase is the phase of transition of jelly-like bodies into liquid ones (gel and sol), and therefore one of the conditions for the correct course of the wound process is tissue moisture. Therefore, everything that increases the phenomena of hydration and helps to increase the amount of water in tissues (exchange, exudation, rejection of necrotic elements) will contribute to faster and the right flow wound process.

Clinically, the first phase of wound healing is characterized by signs of acute inflammation, i.e. hyperemia, exudation, swelling of tissues due to their infiltration, increased local temperature, pain reaction.

According to I.V. Davydovsky, during the wound process it is necessary to distinguish three moments that constitute an integral part of any wound: traumatic swelling, inflammation and tissue regeneration. The author points out that the listed moments do not simply follow each other and can be precisely separated from one another in time, but are closely related to each other pathogenically and develop as a single holistic process that integrates these particular components in the form of edema, inflammation and regeneration.

The phase of dehydration, or regeneration, is characterized by reverse phenomena compared to the first phase. During this period, blood circulation is regulated, vasoconstriction occurs, exudation and emigration decrease or completely stop, regenerative processes develop, and acute inflammatory phenomena gradually decrease or completely disappear. In addition, the calcium content in the wound tissue increases, the concentration of hydrogen and potassium ions, the permeability of vascular walls and osmotic pressure decreases, tissue metabolism is restored, and the tissues become denser. In the area of ​​tissue damage, a regenerative process develops, as a result of which the wound is evenly covered with granulation, filling the wound defect. The newly formed granulation tissue is a reliable protective wound barrier that protects the wound from secondary infection, and acts as a biological filter that dilutes and neutralizes toxins released in the wound by microbes.

Clinically, the second phase of wound healing is characterized by the disappearance of acute inflammation, the cessation of exudate, a decrease in tissue swelling, and the absence of a pronounced pain reaction to irritation.

The scarring and epidermization phase is characterized by complex transformations of connective tissue mesenchymal elements into scar tissue followed by epithelization.

Usually, scarring of a wound is preceded by its epidermization, sometimes both of these processes occur simultaneously, or epidermization clearly prevails over scarring.

If epidermization predominates during wound healing, then the accompanying process of granulation maturation develops along a plane. Planar scarring does not cause a strong contraction of the granulating wound and its size decreases mainly due to the rapid increase in the width of the rim of the skin epithelium, i.e. due to epidermization. This type of healing is typical for superficial wounds, burns, bedsores and ends with the formation of a flat scar, tightly fused to the underlying tissues.

Therefore, in the third phase it is possible following paths healing: 1) the wound heals with concentric scarring if its size decreases and the width of the epithelial rim remains without visible changes; 2) if wound healing by concentric scarring has stopped, and the width of the epithelial rim is constantly increasing, this means that the scarring granulation wound is entering the healing phase by epidermization; 3) the wound heals by epidermization if there is no retraction of the wound, and its size decreases as the width of the epithelial rim increases; 4) if wound healing by concentric scarring has slowed down, and the width of the epithelial rim remains unchanged, this means that there has been some disruption in the process of maturation of granulation, epidermization or scar resorption in the border zone of the epithelial rim.

Types of wound healing. Wound healing, as I.G. Rufanov points out, is a process of regeneration, which is an expression of the body’s biological reaction to the received irritation. This reaction is manifested by a number of local morphological and biophysicochemical changes in the wound and changes throughout the body. However, not all tissues have the same regenerative ability, and therefore not all wounds heal equally quickly and firmly. The degree of wound regeneration is closely related to tissue differentiation and the reactive capabilities of both the tissue at the site of injury and the organism as a whole.

Depending on the nature of the tissues, the degree of their damage, microbial contamination of the wound and some other reasons, three types of wound healing are distinguished: 1) by primary intention; 2) by secondary intention and 3) under the scab.

Wound healing by primary intention (per primam intentionen) is the most perfect. With primary intention, a relatively rapid (6-8 days) fusion of the wound edges occurs without the formation of visible intermediate tissue and post-wound scars, with mild symptoms of serous aseptic inflammation. Such wound healing is possible: with complete contact of healthy, viable wound edges; in the absence of microbial contamination, foreign bodies, necrotic tissues and pockets in the wound. Usually, postoperative wounds, as well as random contaminated wounds with uneven bruised edges, heal by primary intention, but only after timely good surgical and antiseptic treatment, i.e. after bringing the wound into an aseptic state and applying a blind suture to the wound.

Wound healing by secondary intention (per secundum intentionen) is observed in infected, festering wounds, with uneven, separated edges, as well as wounds in which there are foreign bodies, necrotic tissue or accumulation of purulent exudate.

In the process of wound healing, three phases are distinguished by secondary intention: 1) degenerative, or hydration phase, characterized by acute inflammation tissue around the wound, rejection of injured tissue, exudation and gradual cleansing of the wound; 2) regenerative, or dehydration phase, characterized by the attenuation of inflammatory phenomena in the wound, wound cleaning, tissue compaction and uniform filling of the wound with healthy granulations; 3) the phase of scarring and epidermization of the wound. This type of wound healing is very common in horses where the wound heals with concentric scarring.

The healing time of granulating wounds varies, depending on the type and age of the animal, its fatness, location, shape and size of the wound, as well as treatment methods. Typically, such wounds heal within a period of 2-4 weeks to 1.5-2 months.

The duration of wound healing is significantly influenced by how severe its suppuration is. According to I.V. Davydovsky, wound suppuration represents the initial phase of its secondary cleansing from everything dead and foreign. It is closely connected with secondary tension and is a necessary link in regeneration. Consequently, without a suppurative process there cannot be secondary intention. If the initial cleansing does not follow, then after the wound suppurates, the construction of granulation tissue begins. Secondary wound cleansing is a purulent-regenerative process that ends with complete dissolution or rejection of the dead substrate and removal of the latter from the wound canal. So, secondary intention as a manifestation of regeneration includes most of the period of suppuration, the entire period of secondary wound cleansing and the final phase of wound healing, i.e., its scarring and epithelization.

Healing of wounds under the scab is a type of primary and secondary intention. Such healing is observed with granulating superficial wounds. The scab formed on the surface of the wound consists of dried exudate, lymph, fibrin, and formed elements of shed blood. The formation of a scab is based on the process of dehydration, in which colloids lose a large amount of water and become compacted, turning into an impermeable layer. In this regard, the scab creates favorable conditions for growth connective tissue, epithelium and it must be spared until the wound is completely healed (A. N. Golikov).

In the absence of microbial contamination of the wound, its healing under the scab can occur without suppuration.

Treatment of wounds. Rational treatment of wounds (wound disease) in animals is carried out using pathogenetic, etiopathogenetic and stimulating therapy. One of therapeutic measures, the use of which is mandatory, is surgical treatment of wounds. It usually comes down to mechanical cleaning and disinfection of the skin around the wound, examination of the wound, dissection of wound pockets, removal of foreign bodies from the wound, partial or complete excision and drainage of the wound.

I. G. Rufanov pointed out that when choosing a particular treatment method, each wound must be approached individually, taking into account the stage of the wound process.

The same treatment method and type of dressing cannot be equally suitable for the first and second periods of the wound. If in the first period of the wound's course good results are obtained by a wet-osmotic, sometimes hypertonic, suction dressing, then in the second period it is better to use a slightly irritating, moisture-reducing, drying dressing, and sometimes even artificial drying of the wound. At the same time, it should be taken into account local reaction(liquid, thick pus, dry wound) and the general condition of the patient.

Such therapeutic methods as different types of physiotherapy, vaccine-proteinohemotherapy, diet, and perhaps bacteriophage and lysate therapy, act basically in the same way, that is, in an enhancing, activating, irritating and switching manner, but the use of these same therapeutic factors without taking into account the stage of the wound process , the state of local and general excitability of the body (hyper- and hyposensitization), dose, interval can give a wide variety of results: brilliant, satisfactory or negative.

The degree of the body's reaction and its nature (norrmergic, hyperergic, hypergic, allergic) are also factors that often determine the choice of treatment method for a purulent wound. If you do not take these factors into account, I. G. Rufanov points out, you can get a negative result.

When choosing a wound treatment method, one must also take into account the bacteriological factor, the specific properties of various purulent bacteria, their ability to infect capillaries or bloodstream granulations (streptococci), increase exudation (staphylococci), give plaque (diplococci, Lefler's bacilli, etc.), and sometimes cause a reticuloendothelial reaction systems, produce enzymes that play a huge role in inflammation, give varying degrees necrosis, etc.

Therefore, when treating purulent wounds, it is necessary to use such methods of therapy that could create a certain optimum and minimum pH in the wound for the development of various bacteria and for the redox potential. By increasing or lowering the pH of the wound and the redox potential with local or general measures of influence on the wound, it is possible to bring the environment closer to the optimum or minimum conditions for the development of wound flora.

One of the factors that determines the correct approach to a wound is the body’s barrier apparatus: lymphatic, vascular, nervous and reticuloendothelial systems. Knowing the degree of intensity of the inflammatory focus, damage to the nearest and distant regional lymph nodes, vascular and nervous systems, it is easy to determine the activity of the surgeon (early incision); taking into account the degree of membrane permeability, osmotic properties of the wound and wound current allows you to choose the right dressing (with a hypertonic, colloidal solution or just dry).

Depending on the stage of the wound process, one or another treatment method is selected.

Treatment of aseptic wounds. Aseptic wounds include all postoperative wounds that are treated under aseptic conditions. After vascular hemostasis, sutures and a sterile bandage are applied to the wound, which, if the course of the wound is favorable, is changed once every 2-3 days. The sutures are removed on the 7-8th day. WITH for preventive purposes Before applying a suture, it is recommended to powder the wound with streptocide powder or irrigate it with a 5% solution of white streptocide in 70% alcohol, or lubricate it with an alcohol solution of iodine 1: 1000, 1: 3000.

Treatment of infected wounds. This category of wounds includes freshly inflicted accidental wounds infected with staphylococci, streptococci or other types of microbes. Treatment of such wounds begins with mechanical cleaning, after which physical, chemical and biological agents, depending on the duration of the injury, the nature and size of the wound and the degree of its contamination. To remove foreign bodies and non-vital tissues from the wound canal, surgical treatment of the wound is performed, after which the following are used for preventive and therapeutic purposes: penicillin-novocaine or autgemo-penicillin-novocaine blockade, intravenous novocaine solution, antibiotics (biomycin, terramycin, gramicidin, etc.) , 5% solution of protein-pyrolysin, streptocide in powder or streptocide, soluble in the form of a 5% solution in 70% alcohol, 5% reversible emulsion of streptocide in 30% fortified fish oil, alcohol solution of iodine 1:1000, Vincent powder (1 part dry bleach and 5-9 parts boric acid), Sapezhko liquid (crystalline iodine 2.5; potassium iodide 10.0; ethyl alcohol 30%