METHOD FOR SURGICAL MANAGEMENT OF VAST PERINEAL WOUNDS FOLLOWING ANAEROBIC PARAPROCTITIS Russian patent published in 2015 - IPC A61B17/00 B82B1/00 

FIELD: medicine.

SUBSTANCE: preoperative patient preparation involves urinary catheterisation and rectal drainage. That is followed by radical surgical d-bridement of a purulonecrotic centre and wide opening of the involved site. The pus pockets are drained, and the necrotic tissues are excised to form a vast wound surface. The radical surgical d-bridement of the purulonecrotic centre leaves a sphincter muscle of anus and a serous-muscular layer of the rectal walls preserved. On the 3^rd-4^th postoperative day, after multiple necrectomies of the wound surface and intensive infusion, detoxification and antibacterial therapy, the vast wound surface is covered with a porous sponge and/or a gauze bandage as a wound filler. The sponge is made of a hydrophilic polyurethane base impregnated with activated carbon. The gauze bandage is impregnated with a colloidal solution of zerovalent metal silver Ag⁰ particles having a silver nanoparticle size from 2 to 25 nm. The patient is anaesthetised adequately and placed in a plastic air-tight transparent isolator chamber configured as cut down trousers with the vast wound surface covered with the wound filler. The 3-5 postoperative days involve 3-4 continuous vacuum drainage of inflammation products of the involved soft tissues through the porous sponge and/or gauze bandage coverage. The vacuum drainage does not require the dressings to be changed and uses a negative pressure of 85-130 mmHg. After each procedure of the vacuum drainage of the wound surface and every time the isolator chamber is opened, the wound is visually inspected, examined for bacterial contamination and explored. Necrectomy is performed if needed. After the inflammation is arrested completely and the wound surface is clean, whereas the wound surface is decreased considerably, a bacterial swab test is conducted. That is followed by the stages of skin repair of the wound defect with the use of local tissues. The vacuum drainage of the necrotic putrid inflammation products contaminating the soft tissues uses the porous sponge having 30 to 45 pores 700 to 1,500 mcm in size per 1 cm² of the surface area. In case the combined use of the porous sponge and gauze bandage covering the vast wound surface during the vacuum drainage of the inflammation products contaminating the soft tissues, the gauze bandage is first to cover the wound, and then it is the porous sponge that is placed. The vacuum drainage of the inflammation products contaminating the soft tissues is combined with rectal drainage implying the controlled faecal diversion and urine diversion through a urinary catheter into an external urine bag.

EFFECT: reduced hyperemia and wound edge oedema, providing accurate visualisation of tissue necrosis, reducing the time of formation of the clean wound with adequate granulation tissue, preventing anaerobic flora growth, reducing the time of pus pockets cleansing and healing in a combination with higher quality of patient's life.

4 cl, 6 ex