Optimized approach to surgical treatment of wound surfaces

• Main Authors: O. V. Ponomarenko, V. I. Pertsov
• Format: Article
• Language: English
• Published: Zaporozhye State Medical University 2016-12-01
• Series: Zaporožskij Medicinskij Žurnal
• Subjects: Wound; Ulcer; Plastic Surgery; Surgical Flaps
• Online Access: http://zmj.zsmu.edu.ua/article/view/85536/83164
• ISSN: 2306-4145; 2310-1210

Treatment of traumatic defects and chronic venous ulcers is one of the persistent problems of medical science. Objective. To improve outcomes of patients with wounds, traumatic, functional and aesthetic defects by developing a comprehensive program of surgery to restore form and functions of the body. Materials and methods. We have operated on 179 patients with wound defects of various etiology in the clinic. Depending on the cause of wound defect, the patients were divided into groups: trophic ulcers of vascular etiology – 75 patients, post-traumatic (mechanical) wound defects – 42 patients, postishemic wound defects (compartment syndrome) – 12 patients, neurotrophic ulcers – 15 patients, consequences of purulent – inflammatory diseases – 35 patients. We consider the ultrasound duplex scanning with color mapping as the primary diagnostic criterion in choosing patients’ treatment tactics. Results. In the patients’ group with trophic ulcers of vascular etiology the first stage of treatment was sanation of trophic defect with the mandatory appointment of specific antibacterial therapy, in 58 patients autodermoplasty with the split, perforated flap was performed, in 4 patients it was carried out with single-step alofibroblasts’ transplantation, 17 patients were performed transplantation of full layer skin grafts. In patients with wounds after injury cellulocutaneous and musculocutaneous flaps on the vascular pedicle, plasty with local tissues and split seed grafting autodermoplasty were used. In compartment syndrome secondary sutures were imposed and autodermoplasty with split seed grafting was performed. In neurotrophic ulcers of vertebral localization and in the geater tochanters’ area plasty with one or two V – like musculocutaneous rotation flaps, cellulocutaneous double lobe pedicle flap was used. In patients with consequences of purulent – inflammatory complications autodermoplasty with split seed grafting and rotation cellulocutaneous flaps on the axial blood supply were performed. Conclusion. The choice of surgical treatment in patients with wound defects of trunk and extremities is determined by anatomic functional and hemodynamic features of the damaged area and the results of surgical correction of wound surfaces depend on a technically perfect surgery and adequate antibacterial therapy.