The frequent development of the surgical site infection (SSI) in patients after reconstructive surgery for critical limb ischemia (CLI) necessitates the increase of efficacy and development of new treatment approaches. The presence of functional vascular reconstructions in the areas of infected postoperative wounds of deep localization creates certain risks for the success of the surgical intervention, the viability of the limb with the preservation of the restored flow and the patient’s life. Currently, the application of Vacuum-Assisted Therapy (VAC) for the cleansing of infected wound cavities and promoted wound healing in patients operated for CLI is of special interest. Therefore, the aim of our study was to evaluate the treatment efficacy of surgical site infection in patients operated for critical limb ischemia with local application of vacuum-assisted therapy. The object and study methods. We studied the indicators of the treatment efficacy of SSI with the local application of VAC therapy in patients after reconstructive surgery for CLI with deep infectious lesions of soft tissues. The study included patients in the second and third stages according to Szilagyi classification (1972). Depending on the treatment approach, patients in II and III SSI stages were divided into two groups, the study and the control. VAC therapy (treatment scheme number 1) was applied locally in the treatment complex in the study group (41 patients), and passive drainage (treatment scheme number 2) – in the control (38 patients). The study results were analyzed by variation statistics using the STATISTICA 8.0 (StatSoft, USA) software.Study results and discussion. The results of the study determining the efficacy of the application of VAC therapy for local treatment showed different healing time of infected postoperative wounds in patients of both study groups. The postoperative wound healing in the III SSI stage patients was significantly later than in II stage patients both with the application of VAC therapy (on 38.61±3.12 day versus 22.49±0.90 day, p<0.001), and in the case of passive drainage (on 43.06±2.87 day versus 28.14±1.07, p<0.001). Wound healing was faster in patients with the second stage of surgical infection in the application of VAC therapy than in the case of passive drainage (on 22.49±0.90 day versus 28.14±1.07 day, p<0.001). In III SSI stage patients, healing was faster in the study group than in the control one (on 38.61±3.12 day versus 43.06±2.87 day, p>0.05). Determining the duration of postoperative wound healing showed the following. The average duration of postoperative wound healing was higher in III than in II SSI stage patients both in the study (34.11±3.10 days versus 18.26±0.90 days, p<0.001), and in the control group (38.71±2.94 days versus 23.57±1.09 days, p<0.001). With the application of VAC therapy, the average duration of wound healing in patients of the second stage of SSI was significantly shorter than in patients with infected wounds treated with passive drainage (18.26±0.90 days vs. 23.57±1.09 days, p<0.001). The wounds healed for 34.11±3.10 days on average in patients of the III SSI stage with the use of VAC therapy, and for 38.71±2.94 days (p<0.05) in patients treated with passive drainage. When using VAC therapy, compared with passive drainage, wounds more often healed by suturing secondary sutures (31.71±7.27% vs. 5.26±3.62%, p<0.01) and less frequently by secondary intention (in 68.29±7.27% versus 94.74±3.62%, p<0.01). Conclusion. Local application of vacuum aspiration of wound surfaces in the complex therapeutic scheme for patients with II and III stages of SSI according to Szilagyi classification operated for CLI allowed to improve the success rate of treatment in the study group compared with the control one. Thus, a positive effect was characterized by a significantly faster time (p<0.01) and a significantly shorter healing period (p<0.05) of the infected postoperative wounds in patients who underwent VAC locally compared to the control group. By using negative pressure, it was possible to achieve a higher rate of healing of infectious complicated postoperative wounds by suturing the secondary stitches, rather than using the method of passive drainage.
critical limb ischemia, surgical site infection, vacuum-assisted therapy, treatment
«Bulletin of problems biology and medicine» Issue 3 (145), 2018 year, 92-95 pages, index UDK 617.58-005.4-022-085:533.5
