HEALING PROBLEMS WITH «LITTLE» WOUND. SURGERY STRATEGY

Abstract

Purpose of the study. An analysis of own experience in treating wounds which were found to need special treatment or ended in failure.

Methods. Results of treatment of 221 patients were analysed. Criteria of inclusion were wound/ necrosis/blow size not more than 5 cm in greatest measurement at arrival. The force of blow was not greater than the body weight. Of patients 149 have diabetes mellitus, on anticoagulant therapy were 53. All patients have been operated on, onetime 132, twice 53, three times 28, four times or more 8.

Results. Complicated healing was caused by prolongation of inflammation in 47 cases, spreading of necrosis in 35, arising of compartment syndrome 7.

The most important reasons of complications were

1) edema of patient’s limb, difficulties in; 2) acceptance of limbs compartment syndrome both of microbial and coagulopathy origin; 3) differentiation between routine and Clostridia genesis of inflammation, 4) estimating rightful duration of drainage staying and antibacterial therapy in compromised patient.

Conclusion. In cases of specific infection, coagulopathy, limb edema of different etiology and, in diabetic patients, renal insufficiency, low c-peptide level, and insulin resistance each of this obstacles lead to special complications, if neglected may result in limb amputation and, be even life threatening. Each of it need a peculiar treatment. Knowing of this specifics gives to surgeon some particular tool in treatment.