Treatment of a purulent wound in the hydration phase. Which of the indicated 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 remnants of necrotic tissue in a purulent wound. Bandage with which of the medicinal substances 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 drainage for a purulent wound.

1) tubular drains

2) rubber graduates

3) gauze swabs

4) rubber-gauze swabs

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

1) Vishnevsky ointment

2) proteolytic enzymes

3) washing with antiseptics

4) dressings with hypertonic solution

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

1) percussion

2) sounding

3) study of blood leukocytosis

4) fistulography

009. Wound discharge emits a sugary-sweet smell, bluish spots on the bandage. Name the most probable microflora in the wound.

1) staphylococcus

2) E. coli

3) Pseudomonas aeruginosa

4) streptococcus

010. Which of the following is not characteristic of the inflammation phase in wound healing?

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 applied after excision of the edges of the granulating wound?

1) provisional seam

2) early secondary seam

3) late secondary seam

4) primary delayed suture

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

1) provisional seam

2) early secondary seam

3) late secondary seam

4) primary delayed suture

013. In the phase of inflammation, the wound is cleared of (choose the wrong one)?

1) from infection

2) from foreign bodies

3) from excessive granulations

4) from necrotic tissues

014. A primary purulent wound is 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 PST

015. The wound in the regeneration phase has dimensions of 20x20cm. Choose from the offered medicinal products most featured

1) antibiotic therapy

2) skin graft

3) ointment bandages

4) stimulation therapy

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

1) wide dissection of the wound

2) dissection of fascial cases

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 develops

2) alkalosis

3) neutral environment

4) everything is correct depending on the condition of the patient

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 the wound, the instrument without effort penetrates into the subcutaneous “pocket” 10 cm deep, from which pus is released in a significant amount. Choose from the following therapeutic effects the most indicated

1) introduction into the "pocket" of antibiotics

2) additional incision (contra-opening)

3) physiotherapy

4) introduction into the "pocket" of a tampon with an antiseptic

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

1) cardiac therapy

2) transfusion of erythrocyte mass

3) vitamin therapy

4) antibiotic therapy

021. In the process of tissue regeneration during the healing of 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 tissues in the wound

2) massive seeding of tissues with microorganisms

3) the presence of foreign bodies in the wound

4) maintaining good blood circulation in the wound area

023. Everything is characteristic of the inflammation phase, except

1) exudation of plasma and lymph

2) exit and migration of leukocytes to the wound area

3) mast cell degranulation

4) migration of fibroblasts to the wound area

024. Suppuration of the wound, as a rule, is caused by

1) streptococcus

2) staphylococcus

3) gonococcus

4) Pseudomonas aeruginosa

025. A secondary purulent wound is 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 PST

4) statements 2 and 3 are true

026. In the treatment of a purulent wound in the regeneration phase, it is indicated

1) application 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:

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 a 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) in which microorganisms have entered

3) after the operation, if in the course of its implementation the lumen of a hollow organ was opened

4) 1 and 2 statements are true

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

1) antibiotic therapy

2) chipping the inflammation focus with an antibiotic

4) urgent blood test

031. Active surgical treatment of purulent wounds consists in its:

1) rational surgical treatment

2) the use of tubular drains

3) surgical treatment, drainage, suturing with vacuum aspiration

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

032. Treatment of purulent wounds in the traditional open way is characterized by:

1) favorable course of the wound process

2) fast recovery time

3) the addition of a secondary infection

4) statements 1 and 2 are true

033. Types of wound healing

1) secondary tension

2) Primary Tension

3) healing under the scab

4) all of the above

034. One of the indications for prescribing general antibiotic therapy in the treatment of pimple 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 correct

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

1) anti-inflammatory therapy

2) adaptation of the edges of the wound, stimulation of the growth of granulations

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

4) correct 1) and 3)

036. When healing a wound, secondary intention is expedient 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 the 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) invasiveness of the operation

4) all of the above

039. For local treatment of a wound infected with a bacillus of blue-green pus, it is advisable to use all of the listed drugs, with the exception of

1) polymyxin solution

2) boric acid

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

4) dioxidine

040. Active immunization with staph 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" granulation and marginal epithelization

2) copious purulent discharge

3) severe swelling of the edges of the wound

4) sluggish granulation

9. Sample answers to test tasks

Shock, infection, violation 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 body of the victim and his neuropsychic state. So, with fear, unexpected injury, etc., the strength of pain is greater; 3) the nature of the wounding weapon and the speed of inflicting injury. The sharper the weapon, the fewer cells and nerve elements are destroyed, and, consequently, the pain is less.

The nature and number of vessels destroyed during injury determine the strength of bleeding. The most intense happens with the destruction of large arterial trunks. The gaping of the wound is determined by its size, depth and violation of the elastic fibers of the skin. Wounds with complete dissection of the muscles lead to a large divergence of the edges of the wound. Located across the direction of the elastic fibers of the skin (Langer's lines) usually differ in greater gaping than wounds running parallel to them.

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

The surgical wound is applied during the operation under strict asepsis, but from the air, from the patient's skin, a small amount of microbes can get into it, so the wound is conditionally sterile. Treatment is reduced to the restoration of anatomical relationships by stitching tissues and applying a bandage.

Occasional fresh wounds are always infected, and there is always the 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 microbes may be introduced, and those already present in the wound move to deeper areas. In first aid, the skin around the wound is cleaned of contamination with tampons moistened with ether or gasoline, and widely smeared with 5% tincture of iodine. After that, 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 consists in removing infected tissues, 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 performed in severe general condition (shock, acute anemia etc.), the term is shifted until the patient feels better; with purulent infection in the wound.

In cases where the imposition of a primary suture is contraindicated (the possibility of infection), a delayed suture is resorted to. 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 sewn up. On large wounds not sutured with 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 the fastest cleansing of the wound. The following must be provided.

1. Rest of the affected organ (immobilization, occasional dressings).

2. The use of antiseptic substances both locally in the wound, and inside or intramuscularly.

3. Detoxification of the body.

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

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

6. Careful attitude to the tissues of the wound, careful dressings, as the injury leads to a breakthrough of microbes into internal environment body, the absorption of toxins, which is manifested by a sharp increase in temperature, chills, deterioration of health.

7. In the presence of purulent-necrotic tissues, drugs are indicated that can lyze (destroy) non-viable tissues. As such agents, proteolytic enzymes of the animal and bacterial origin applied topically in the form of solutions or powder (in the presence of abundant purulent discharge). Enzyme preparations due to their necrolytic and anti-inflammatory action, they significantly reduce the phase of wound hydration. 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 imposition 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, bandages with hypertonic, antiseptic solutions should not be used, as they damage the granulations, as a result of which wound healing is delayed.

For centuries, the art of bandaging has been shaped into a special science - desmurgy. It is important to apply a bandage conveniently and correctly not only in first aid to the victim, but also in treatment, as this contributes to the 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 made of elastic mesh "retelas" was designed. It is made from elastic and cotton thread and is produced in the form of a hosiery tape in seven sizes (from 0 to 6), which allows you to quickly apply a bandage to almost any part of the body.

In the treatment of patients with a purulent process, it is important to determine the nature of the violations of the general condition and to carry out measures that increase the reactivity of the body with an insufficient, sluggish reaction and lower it with an excessively violent reaction. At the same time, care must be taken to preserve and restore the function of the affected organ. The terms of immobilization and rest should not be delayed, replacing them in the dehydration phase with dosed ones, with gradually expanding volumes of exercise therapy and physiotherapy procedures.

Examination of the patient;

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

Treatment of 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 supporting documents.

The patient is instructed on the rules for applying an elastic bandage: An 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 the previous round by 1/3.

Treatment program

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

If conducted diagnostic measures indicate the patency of deep veins, then the patient is shown an operation to remove a large saphenous vein lower limb.

Before the operation, it is necessary to achieve maximum cleansing of the ulcer from necrotic tissues and reduce the discharge from the wound, i.e. “transfer the process from the stage of hydration to the stage of dehydration”. This is achieved by daily dressings or by applying a “boot” of Unna paste or plaster. A plaster boot is applied, capturing the foot, ankle joint and two thirds of the leg. The limb remains in plaster for 2 weeks. After removing the plaster, the ulcer either completely epithelizes, 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 bandage creates peace of the wound.

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

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

Management of the postoperative period:

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

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

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

4. On the 8th day, the stitches are removed.

Task #2

A woman who had been suffering from varicose veins in the region of both legs for many years applied for FAP. 2 days ago I felt unusual pain in the upper third of the anterior-inner surface of the left leg along the varicose vein, aggravated by physical activity. A woman works as a weaver - all the time on her feet. The general condition is satisfactory, the temperature is 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 leg is slight. The patient fell ill with tonsillitis two weeks ago.

Tasks

1. Formulate and justify the presumptive diagnosis.

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

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

4.Create a treatment program for outpatient and inpatient treatment.

Sample response

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

Factors contributing to the development of thrombophlebitis

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

Complications of thrombophlebitis

A dangerous complication of superficial thrombophlebitis in the region 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 fibrinolytic drugs such as streptokinase, trypsin, chymotrypsin and active anticoagulants, tk. continuous 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, suprastin are used. A good anti-inflammatory effect is given by reo-pyrine, butadione. When the inflammation subsides, physiotherapy is recommended.

Task #3

A FAP paramedic visited a 53-year-old patient at home, complaining of severe pain in the left lower leg of a bursting nature, swelling of the foot and lower leg, convulsive contractions calf muscles, temperature increase up to 38.5°. Sick for the second day. On examination, the skin of the left foot and lower leg is hyperemic, tense, shiny. The circumference of the left leg is 5 cm larger than the right leg. Palpation reveals pain along the vascular bundle, especially in the popliteal fossa.

Tasks

1. Formulate and justify the presumptive diagnosis.

3. Make an algorithm for providing emergency care with the rationale for each stage.

Sample response

Diagnosis: Acute deep thrombophlebitis of the left leg.

The diagnosis was made on the basis of clinical data: fever up 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 by 5 cm compared to the healthy one, palpation pain along the vascular bundle.

Algorithm for emergency care:

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

2. Antispasmodics (papaverine, platifillin).

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

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

5. Limbs give an elevated position on the pillows.

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

7. Transportation of the patient by ambulance to the surgical department in the supine position with a raised diseased limb laid on the Beler splint

Task #4

A 30-year-old man applied to the FAP. Smoked for 20 years. Complaints about intermittent claudication - (after 100 meters he is forced to stop due to pain in the calf muscles). He considers himself ill for half a year, 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 finger. The patient's shins have a marble color, the distal parts of the feet are purple-cyanotic. Nails are dry and brittle. There is no pulse in the arteries of the foot, on popliteal arteries weakened.

001. According to infection, wounds are distinguished:

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 at gunshot wound?

1) pressure on the tissues of the projectile;

2) pulsation of cells in the wound area;

3) wave-like movements of the channel walls;

4) change in osmotic pressure;

5) the mass of the projectile.

003. What determines the degree of gaping of the wound?

1) depth of damage;

2) damage to the 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 show their activity?

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

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 zones of damage are distinguished, except for:

1) zones of the wound channel;

2) molecular shaking zones;

3) areas of hemorrhage;

4) zones of primary necrosis;

5) parabiosis zones.

008. Shrapnel wounds are characterized by everything except:

1) the complexity of anatomical damage;

2) the presence of foreign bodies;

3) high degree of infection;

4) mandatory presence of inlet and outlet openings;

5) uneven skin lesions.

009. Which wound is more likely to develop infection?

1) cut;

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 bruising along the edge of the wound;

2) different depth of damage;

3) the presence of crushed tissues;

4) violations of the integrity of the nerve trunks;

5) less pronounced bleeding.

011. To accelerate healing in the treatment of a wound in the dehydration phase, the following are necessary:

1) frequent dressings;

2) the use of enzymes;

3) application of ointment dressings;

4) bandaging with hypertonic solutions;

5) therapeutic exercises.

012. Under the primary surgical treatment of the wound should be understood:

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

2) opening pockets and streaks;

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 a bone. How to perform primary surgical treatment of the wound?

1) excise the periosteum;

2) scrape a bone with a sharp spoon;

3) take off upper layer periosteum;

4) trepanation of 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) assign UHF to the wound;

2) apply a bandage with hypertonic solution;

3) apply a bandage with Vishnevsky's ointment;

4) drain the wound;

5) excise the dead skin area.

015. Specify the main indication for the imposition 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. A primary delayed suture is applied to the wound at the following times:

1) 3-4th day;

2) 5-6th day;

3) 8-15th day;

4) immediately after the primary surgical treatment;

5) 20-30th day.

017. In what case can you impose primary seam on a 6x8 cm wound 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 are no necrotic tissues in the wound;

4) when using antibiotics;

5) the primary seam cannot be applied.

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

1) development of acidosis;

2) increase in the number of hydrogen ions;

3) increase in the amount of potassium ions;

4) increased vascular permeability;

5) development of alkalosis.

019. What is the difference between late primary debridement and secondary debridement?

1) technique of operation;

2) the timing of the operation;

3) the number of previous dressings;

4) lack of primary surgical treatment;

5) the use of drainage or the rejection of it.

020. During ultrasonic treatment of a wound, the following occurs:

1) acceleration of the process of rejection of necrotic tissues

2) sterilization of the wound surface

3) decrease in the degree of bacterial contamination of the wound surface

4) simultaneous removal of all necrotic tissues

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

Choose a combination of answers

Lecture 16. ACUTE PURULENT DISEASES OF SOFT TISSUES

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

Let's consider private forms of diseases.

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

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

Outcomes and possible complications:

1. In the stage of infiltration, 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 passes through the angular vein of the eye into the ophthalmic vein, and from there into the superficial sinus of the dura mater.

Treatment: in the stage of infiltration, the treatment is conservative, includes lubrication with alcohol, iodine tincture, prescribe heat (UHF, UVI), half-alcohol compresses and dressings with ichthyol ointment.

In the stage of abscessing - surgical treatment: opening of an abscess with removal of a purulent-necrotic rod, drainage for 1-3 days.

Furunculosis - inflammation of several hair follicles simultaneously or sequentially. It is often found in diabetes mellitus, vitamin deficiency, a decrease in the body's immune forces, and chronic sepsis.

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

Antibiotics, autohemotherapy, immunization of the body with staphylococcal toxoid, UVI blood are used in the treatment. In folk medicine, brewer's yeast is used.

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

The disease proceeds with severe general intoxication of the body, especially in debilitated patients.

Treatment: usually surgical, an abscess is opened with a cruciform incision with the removal of necrotic tissues - necrectomy. Subsequently, dressings are carried out with hypertonic solutions, water-soluble ointments. Physiotherapy lasers are used. When large defects are formed skin skin graft is performed.

Hydradenitis - acute purulent inflammation sweat glands. Most often localized in the armpits.

Clinic - the disease begins with the formation of a painful seal in the armpit, then skin hyperemia appears and an abscess forms.

Treatment - before abscessing, conservative treatment is possible: heat, UHF, chipping with a solution of antibiotics.

With abscess formation - surgical treatment:

1. opening and drainage, but the capsule of the sweat gland may remain, which often causes relapses of hydradenitis.

2. excision of an inflamed sweat gland with a capsule and surrounding tissue, which eliminates the likelihood of a recurrence of the disease.

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

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

Forms:

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

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

3. Phlegmonous - the 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. Sharp shape;

2. Recurrent form;

3. Migratory form.

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

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

With other forms erysipelas- surgical treatment: in the bullous form - opening of the blisters, in the phlegmonous form - a 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 cellular tissue, which does not tend to delimit.

Forms:

By localization:

1. Subcutaneous

2. Subfascial

3. Intermuscular

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

By the nature of the exudate:

1. Serous

2. Purulent

3. Putrid.

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

Treatment: only with the beginning form is conservative treatment possible.

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

Abscess (abscess)- limited accumulation of pus in soft tissues and various bodies, 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, dibazol, calcium chloride).

5. Postoperative.

By localization

1. Surface

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

Clinic: With superficial abscesses, all 5 signs of inflammation are local manifestations. With deep abscesses are manifested common signs: high fever, in the stage of infiltration - constant, with abscess formation - hectic, with chills, pouring sweat, increase in ESR the appearance of proteins in the urine.

Signs of abscess infiltrate:

1. Appearance of hectic temperature

2. Symptom of fluctuation (swelling)

Forms:

1. Acute - more pronounced clinic.

2. Chronic (more often in the lungs).

Treatment abscess surgery only:

1. Puncture method (including under ultrasound control)

2. Puncture-flow method

3. Open method - opening and drainage of the abscess

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

Complications:

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

2. Sepsis;

3. Amyloidosis of the kidneys.

Mastitis - acute inflammation of the breast. More often lactation (insufficient care of the mammary gland in lactating women, microtrauma, milk stasis).

Classification:

By localization:

1. Subareolar - in the peripapillary zone;

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.

Forms:

1. Sharp;

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

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

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

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

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

Lecture 17. PURULENT DISEASES OF SEROUS CAVITIES

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

Pleurisy - inflammation of the pleura. More often, pleurisy is secondary, as a result of the transition of inflammation in pneumonia, with lung abscess. Rarely occurs as an independent disease. Separately, reactive pleurisy is distinguished, which develops with subphrenic abscess, pancreatic necrosis, due to the transition of inflammation through the diaphragm.

The nature of the exudate distinguish:

1. Serous pleurisy

2. Hemorrhagic pleurisy

3. Fibrinous pleurisy

4. Dry pleurisy

5. Purulent pleurisy

6. Empyema of the pleura.

The prevalence of inflammation distinguish:

1. Basal pleurisy (inflammation of the sinuses)

2. Interlobar pleurisy

3. Encapsulated pleurisy

4. Diffuse pleurisy.

Along the inflammatory process allocate:

1. Acute pleurisy

2. Chronic pleurisy.

Clinic: Pleurisy is characterized by pain in the chest, aggravated by deep inspiration and coughing, fever, chills. Breathing becomes shallow and frequent, the affected side chest lags behind when breathing, auscultation reveals wheezing and weakening of breathing, percussion determines dullness in the sloping (lower) sections of the chest. On radiography, homogeneous darkening is noted, the sinuses are not differentiated, exudate is 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 7–8 intercostal spaces, along the upper edge of the rib (so as not to damage the intercostal nerve and blood vessels), along the axillary and scapular lines. After layering local anesthesia the pleural cavity is punctured, the exudate is evacuated, an antiseptic solution is injected into the pleural cavity.

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

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

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

Peritonitis- inflammation of the peritoneum.

Origin distinguish:

1. Secondary peritonitis:

- due to acute surgical disease;

- as a result of perforation damage to a hollow organ.

2. Postoperative peritonitis:

- due to the 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.

The nature of the exudate distinguish:

1. Serous peritonitis

2. Hemorrhagic peritonitis

3. Fibrinous peritonitis

4. Purulent peritonitis

5. Putrefactive peritonitis

6. Fecal peritonitis

7. Biliary peritonitis

8. Urinary peritonitis.

By the prevalence of the process distinguish:

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

- undelimited (has no restriction from the non-inflamed peritoneum);

- Delimited (infiltration 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. Generalized generalized peritonitis (inflammation of the entire peritoneum).

By stages of development allocate:

1. Reactive phase

2. Toxic phase

3. Terminal phase.

Clinic: signs of peritonitis are superimposed on the manifestations of the underlying disease (acute appendicitis, acute cholecystitis etc.). It is characterized by increasing pain in the abdomen, symptoms of intoxication, nausea and vomiting, bloating, hyperthermia. When examining a 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 join. Blood tests show leukocytosis, a shift leukocyte formula to the left, toxic granularity of neutrophils, the leukocyte index of intoxication increases, the ESR increases.

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

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

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

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

After the operation, infusion detoxification therapy, antibiotic therapy, stimulation of the motility of the gastrointestinal tract, stimulation of the body's defenses, and parenteral nutrition are carried out.

Pericarditis - inflammation of the pericardial sac. More often it develops as a result of septic processes, less often - initially.

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 violation of the activity of the heart, or heart failure, manifested by shortness of breath, cyanosis of the skin, palpitations, weakness, fatigue, swelling on lower limbs. The examination reveals tachycardia, auscultation reveals a weakening of the heart tones, pericardial friction noise, and percussion reveals an expansion of the boundaries of the heart. When X-ray of the chest organs in 2 projections, a spherical shape of the heart is noted.

Treatment: in the initial stages - conservative treatment. With the accumulation of exudate, a puncture of the pericardial cavity is performed. With fibrinous-purulent pericarditis, thoracotomy, pericardiotomy with exudate evacuation are performed. After a puncture or operation, antibacterial, detoxification, cardiogenic therapy is carried out.

Lecture 18

Panaritium - purulent inflammation of the tissues of the finger. This is one of the most common purulent diseases. Pathogens - more often staphylococci, enter the tissues with cuts, injections, splinters, and in girls - often after a manicure.

Classification:

1. By stages (downstream):

serous (edematous) stage - is reversible;

purulent stage - requires only surgical intervention.

2. By clinical form:

Cutaneous panaritium

Subcutaneous felon

Subungual panaritium

Periungual felon (paronychia)

Tendon panaritium

Articular panaritium

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

Treatment: In the first stage - treatment of wounds, alcohol compress. The indicator of the transition of the process 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. With the localization of the inflammatory focus on the terminal phalanx, a stick-shaped incision is made, in the region of the middle and proximal phalanx- side cuts.

Subungual felon - develops under the nail as a result of splinters. Pus accumulates under the nail, the nail exfoliates, bursting pains appear, the temperature rises, pressure on the nail is sharply painful.

Treatment: surgical. With limited abscesses, a wedge-shaped resection of the nail is performed with the removal of a splinter and pus. With a total detachment of the nail, it is removed.

Paronychia - inflammation of the nail fold develops as a result of infection of microtraumas, including after a manicure. There is swelling and hyperemia of the nail fold, with pressure there is a sharp soreness and the release of pus from under the edge of the nail fold.

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

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

Clinic: tendinous panaritium is characterized by severe pain along the entire finger, aggravated by an attempt to extend the fingers. The finger is swollen along the entire length, with the transition of edema 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 felon - purulent inflammation of the interphalangeal or metacarpophalangeal joints. Due to inflammation in the joint, the finger takes on a flask-like appearance, the finger is half-bent. When unbending, there is a sharp pain in the joint, the pain increases with axial load on the finger. With a long course of inflammation, the articular cartilage is destroyed, the process passes to the bone tissue.

Treatment: in the presence of 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 felon - purulent inflammation of the bones of the fingers, or osteomyelitis of the bones of the hand. It develops as a result of a long course of other forms of felons. To suspect the development of bone panaritium allows a long-term swelling of the tissues of the fingers, a long-term purulent discharge from the wounds of the fingers. The diagnosis is confirmed by radiography of the hand, when osteoporosis, destruction bone tissue, the formation of sequesters is possible.

Treatment: in the stage of osteoporosis, conservative treatment is possible - antibiotic therapy, taking into account the microflora and its sensitivity, laser therapy, sanitation of purulent streaks in soft tissues, X-ray therapy. In case of destruction and sequestration of bone tissue, surgical treatment is indicated - a 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 mistimed or incorrectly treated other forms of panaritium. With pandactylitis, the finger is swollen along the entire length, cyanotic, there are no movements, purulent discharge from the wound. On radiographs of the hand, destruction of the phalanx is revealed along the entire length or two adjacent phalanges. Treatment: surgical, consists in resection or disarticulation of the finger.

Phlegmon of the brush - purulent inflammation of the tissues of the hand. Varieties: phlegmon tenar - inflammation of the eminence of the thumb; phlegmon hypothenar - inflammation of the elevation 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: tenar phlegmon - tendinous panaritium of the 1st finger, phlegmon hypothenar - tendon panaritium 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 volar surface the hands are swollen, sharply painful, the fingers are half-bent, their extension increases the pain. The presence of a purulent process is evidenced by a high temperature of up to 38–39 degrees with chills.

Possible complications:

– Lymphangitis, lymphadenitis

- Phlegmon of the forearm (Pirogov-Paron spaces)

- Sepsis.

Treatment: operative, the phlegmon of the hands is opened with incisions, taking into account the vessels, nerves and tendons of the hand, drained from counter-openings. After the operation, immobilization of the hand and forearm, antibacterial and detoxification therapy are necessary.

Lecture 19

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 cellular space of the neck most often comes from the oral cavity, nasopharynx, trachea, esophagus, and scalp. Progression of the inflammatory process in the teeth (caries) leads to deep phlegmon of the neck, which can lead to osteomyelitis of the jaw, perimaxillary phlegmon, phlegmon of the floor of the mouth. Also, a deep phlegmon of the neck leads to a pharyngeal abscess, suppuration of neck cysts, injuries cervical regions esophagus and trachea, purulent inflammation of the lymph nodes of the neck. Dangers of deep phlegmon of the neck:

1 - the possibility of spreading through numerous interfascial fissures 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 arching pains 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, a dense edema develops, which leads to compression of the trachea and esophagus. Severe intoxication develops: high fever, tachycardia, leukocytosis. Often, inflammation is putrefactive or anaerobic in nature, with untimely diagnosis leads to mediastinitis, sepsis.

Treatment: conservative treatment only initial stage(half-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, after the operation broad-spectrum antibiotics, detoxification therapy, ultraviolet blood irradiation, hyperbaric oxygenation are prescribed.

Purulent mediastinitis - purulent inflammation of the tissue of the mediastinum. 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, with diagnostic and therapeutic endoscopy, "banquet syndrome").

The disease is extremely difficult, hyperthermia develops up to 39-40 degrees, chills, tachycardia up to 120-140 beats per minute, shortness of breath, chest pain. The pain is aggravated by swallowing, dysphagia is observed. Crepitation due to subcutaneous emphysema is possible.

Downstream, a lightning-fast form is isolated, when patients die in the first 2 days. More often there is an acute form with a less violent clinic. 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 necessary, where the expansion of the shadow of the mediastinum, free air or fluid level in the mediastinum are detected. A contrast study of the esophagus can reveal leakage of contrast outside the esophagus. When fibroesophagogastroskopiya can determine the rupture of the esophagus. With the development of concomitant pleurisy, fluid is detected in the pleural cavity.

Treatment: emergency surgical intervention immediately after diagnosis. The operation consists in mediastinotomy - opening the mediastinum from the cervical access or laparotomy access, or use their combination 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 in mediastinitis is extremely high.

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

Clinic. The disease is characterized by fever up to 38-40 degrees with chills, back pain. Pain can radiate down to the thigh, aggravate when walking, a positive psoas symptom is pain and the inability to flex the straightened leg in the hip joint, so the leg takes a forced position - bent at the knee and hip joints and brought to the stomach. There is swelling and pain in the lumbar region. In blood tests, leukocytosis, an increase in ESR, a shift of the leukoformula to the left are detected, in urine tests - proteinuria, leukocytes are detected.

Diagnostics:

1. Clinic.

2. X-ray methods. Plain urography reveals smoothness or disappearance of the contour of the psoas muscle on the side of the lesion. Excretory urography indicates the presence of occlusion of the urinary tract.

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

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

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

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

Paraproctitis - purulent inflammation of pararectal tissue. More often, an infection (colibacillary, enterococcal, anaerobic) enters the pararectal tissue with 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, pelvic-rectal paraproctitis are distinguished.

Along the course, acute, chronic paraproctitis is distinguished.

Clinic: the disease begins with malaise, pain in the perineum, aggravated by defecation. The temperature rises to 38-40 degrees with chills. With 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. With untimely treatment or diagnosis, the abscess can open outward into the perineum or rectum, with the formation of fistulas. From this time, the transition of acute paraproctitis to chronic begins, fistulas are incomplete external or internal, and complete, one end of which has a message with the rectum, the other end opens outward.

Treatment: in 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. With putrefactive and anaerobic paraproctitis, a wide opening, necrectomy, and drainage are indicated.

After the operation, antibiotic therapy, hyperbaric oxygen therapy, detoxification therapy, and a slag-free sparing diet are prescribed. In chronic paraproctitis - excision of fistulas is performed.

Phlegmon of the retroperitoneal space: most often develops with retroperitoneal appendicitis, with pancreatic necrosis, with ruptures of the retroperitoneal part of the duodenum 12, with osteomyelitis of the pelvic bones and vertebrae.

Clinic: the beginning of retroperitoneal phlegmon is superimposed on the course of the underlying disease and is practically not detected. At the height of the disease, pains appear in the lumbar regions, the forced position of patients with legs brought to the stomach, a gradual increase in body temperature with chills, a deterioration in the condition of patients after a certain light period. When examining patients, pains in the lumbar regions, abdominal pains are revealed, intestinal paresis joins.

Diagnostics:

1. Clinic.

2. Plain radiography of the abdominal cavity organs - the blurring of the contours of the lumbar muscle is detected more often on both sides, the presence of a horizontal fluid level is possible.

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

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

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

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

The biological regularity of the 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 sharply defined boundaries. When healing gaping purulent wounds, the boundaries of the phases are more clearly expressed.

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, colloidal and 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. , an increase in the concentration of hydrogen ions - acidosis, an increase in the permeability of vascular capillaries and an increase in lymph, tissue swelling, a change in surface tension, a disorder in tissue metabolism, and an increase in enzymatic processes.

I. G. Rufanov (1948), characterizing the first phase of the wound process, indicates that the hydration phase is the phase of the 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 contributes to an increase in the amount of water in the tissues (exchange, exudation, rejection of necrotic elements) will contribute to a faster and right course wound process.

Clinically, the first phase of wound healing is characterized by signs of acute inflammation, i.e., hyperemia, exudation, tissue edema due to their infiltration, an increase in local temperature, and a pain reaction.

According to I. V. Davydovsky, during the wound process it is necessary to distinguish three points that are an integral part of any injury: traumatic edema, inflammation and tissue regeneration. The author points out that the listed moments do not just follow each other and can be accurately separated from one another in time, but are closely interconnected 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, as it were, by the reverse phenomena in comparison with the first phase. During this period, blood circulation is regulated, vasoconstriction occurs, exudation and emigration decrease or completely stop, the development of regenerative processes, acute inflammatory phenomena gradually decrease or completely disappear. In addition, the calcium content in the wound tissues increases, the concentration of hydrogen ions and potassium ions decreases, the permeability of the vascular walls and osmotic pressure decrease, 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 liquefies and neutralizes toxins released in the wound by microbes.

Clinically, the second phase of wound healing is characterized by the disappearance of the phenomena of acute inflammation, the cessation of exudate release, a decrease in tissue edema, 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 epithelialization.

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

If epidermization predominates during wound healing, then the accompanying process of maturation of granulations develops along the plane. Planar scarring does not cause a strong contraction of the granulating wound and its size decreases mainly due to a 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 soldered to the underlying tissues.

Therefore, in the third phase, following paths healing: 1) the wound heals with concentric scarring, if its size decreases, and the width of the epithelial rim remains unchanged; 2) if the wound healing by concentric scarring has stopped, and the width of the epithelial rim is constantly increasing, then this means that the scarring granulation wound enters 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 the healing of the wound by concentric scarring has slowed down, and the width of the epithelial rim remains unchanged, then this means that there has been some kind of violation of the process of maturation of granulation, epidermization or resorption of the scar 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 biological reaction of the body to the irritation received. This reaction is manifested by a number of local morphological and biophysical-chemical changes in the wound and changes throughout the body. However, not all tissues have the same regenerative capacity, and therefore not all wounds heal equally quickly and firmly. The degree of wound regeneration is closely related to the differentiation of tissues and the reactive capabilities of both the tissue in the wound site and the organism as a whole.

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

Wound healing by primary intention (per primam intentionen) is the most perfect. With primary tension, a relatively fast (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 full contact of healthy, viable wound edges; in the absence of microbial contamination, foreign bodies, necrotic tissues and pockets in the wound. Usually, postoperative wounds heal by primary intention, as well as random contaminated wounds with uneven bruised edges, but only after timely good surgical and antiseptic treatment, that is, 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 disconnected edges, as well as wounds in which foreign bodies are located, there are necrotic tissues or an 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 tissues around the wound, rejection of injured tissues, exudation and gradual cleansing of the wound; 2) regenerative, or dehydration phase, characterized by attenuation of inflammation 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 when the wound heals with concentric scarring.

The terms of healing of granulating wounds are different, depending on the type and age of the animal, its fatness, localization, shape and size of the wound, as well as on the methods of treatment. Typically, such wounds heal within 2-4 weeks to 1.5-2 months.

The duration of wound healing is also significantly affected by how strongly its suppuration is expressed. According to I. V. Davydovsky, wound suppuration is the initial phase of its secondary cleansing from everything dead and foreign. It is closely related to secondary tension and is a necessary link in regeneration. Therefore, without a suppurative process, there can be no secondary intention. If the primary cleansing did not follow, then after the suppuration of the wound, the construction of granulation tissue begins. Secondary cleansing of the wound is a purulent-regenerative process, culminating in the complete dissolution or rejection of the dead substrate and the removal of the latter from the wound channel. So, secondary intention as a manifestation of regeneration includes most of the period of suppuration, the entire period of secondary cleansing of the wound and the final phase of wound healing, i.e. its scarring and epithelialization.

Wound healing under the scab is a kind 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 blood cells. The basis of the formation of the scab is the process of dehydration, in which the colloids lose a large amount of water and condense, turning into an impermeable layer. In this regard, the scab creates favorable conditions for the 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.

Wound treatment. Rational treatment of wounds (wound disease) in animals is carried out with the help of pathogenetic, etiopathogenetic and stimulating therapy. One of medical measures, the use of which is mandatory, is the 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 one or another method of treatment, it is necessary to approach each wound individually, taking into account the stage of the course of the wound process.

The same treatment method and type of dressing may not be equally suitable for the first and second stages of the wound. If in the first period of the course of the wound a moist-osmotic, sometimes hypertonic suction dressing gives good results, 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, account must be taken of local reaction(liquid, thick pus, dry wound) and the general condition of the patient.

Such therapeutic methods as different types of physiotherapy, vaccine protein hemotherapy, diet, and maybe bacteriophage and lysate therapy, act basically the same way, i.e. intensifying, activating, irritating and switching way, but the use of the 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 reaction of the body, its nature (normergic, hyperergic, hypergic, allergic) are also factors that often determine the choice of method for treating a purulent wound. If these factors are not taken into account, I. G. Rufanov points out, a negative result can be obtained.

When choosing a method of treating a wound, it is also necessary to take into account the bacteriological factor, the specific properties of various purulent bacteria, their ability to affect capillaries or blood granulations (streptococci), increase exudation (staphylococci), give raids (diplococci, Lefleur's bacilli, etc.), sometimes cause a reaction of reticuloendothelial systems, produce enzymes that play a huge role in inflammation, give varying degrees necrosis, etc.

Therefore, in the treatment of 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 redox potential. By increasing or lowering the pH of the wound and the redox potential by 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 the wound flora.

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

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

Treatment of aseptic wounds Aseptic wounds include all postoperative wounds that are treated under aseptic conditions. After hemostasis of the vessels, sutures and a sterile dressing are applied to the wound, which, if the course of the wound is favorable, is replaced 1 time in 2-3 days. The sutures are removed on the 7-8th day. WITH preventive purpose it is recommended that before suturing, powder the wound with streptocide powder or irrigate with a 5% solution of white streptocide in 70% alcohol, or lubricate 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 prescription of the wound, the nature and size of the wound and the degree of contamination. To remove foreign bodies and non-vital tissues from the wound canal, surgical treatment of the wound is performed, after which, for prophylactic and therapeutic purposes, the following are used: penicillin-novocaine or outhem-penicillin-novocaine blockade, novocaine solution intravenously, 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 streitocide on 30% fortified fish oil, alcohol solution of iodine 1:1000, Vincent powder (1 part dry bleach and 5-9 parts of boric acid), Sapezhko liquid (crystal iodine 2.5; potassium iodide 10.0; ethyl alcohol 30%