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Purulent-septic wounds are a serious problem of modern surgery. The complication rate reaches 27.8% despite the development of antimicrobial therapy. The pathogenesis is based on an imbalance of pro-inflammatory anti-inflammatory cytokines. Excessive activation of SIRS leads to multiple organ failure, CARS causes immunosuppression and chronic infection.
The analysis of 12 clinical trials in 2015-2023 was carried out. The sample size is 1542 patients. The effectiveness of diagnostic methods was evaluated: ultrasound showed 92% accuracy, CT 95%, and MRI 98%. Radical surgical treatment provided sanitation in 87% of cases. In severe lesions, staged necrectomies (3-8 interventions) were required. The number of operations correlated with the lesion area (r=0.82, p<0.001).
Vacuum therapy reduced the time for wound cleansing by 35%, increased the granulation rate by 42%, and reduced the frequency of repeated operations by 28%. Flow-washing systems with chlorhexidine dioxidine ensured the elimination of microflora in 94% of cases. Microbiological analysis revealed the predominance of Staphylococcus spp. (34.5%), Streptococcus spp. (28.7%), Enterobacteriaceae (22.3%). Empirical therapy included third-generation cephalosporins metronidazole (64%) and carbapenems (28%).
Laser sanitation reduced the cleaning time by 25-30%. Hyperbaric oxygenation reduced the necrosis area by 35±12%, and reduced the incidence of complications by 28% to 9%. Cycloferon immunomodulatory therapy reduced the incidence of pneumonia by 20.6% to 3.7%, intra-abdominal abscesses by 20.6% to 3.7%, and prevented wound complications.
The results confirm the need for an integrated approach, including early diagnosis, radical surgical treatment, and adequate antimicrobial therapy. Of particular importance is the timely initiation of immunocorrection in the first 24 hours after surgery. Physiotherapeutic methods (laser, hyperbaric oxygenation) have shown high efficacy in anaerobic infection. The development of new combined methods for optimizing the duration of therapy is promising. The data obtained can serve as the basis for clinical recommendations. Further multicenter studies with an expanded sample of patients are required to confirm the effectiveness of the proposed treatment algorithms.
Additional studies should include an assessment of long-term treatment outcomes, an analysis of the cost-effectiveness of the methods used, and the development of prognostic criteria for the outcome of the disease. Special attention should be paid to the study of the effect of combination therapy on the quality of life of patients in the postoperative period.
Keywords:purulent-septic wounds, surgical treatment, antibacterial therapy, immunocorrection, vacuum therapy
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