Features of infected wounds treatment in children

Abstract

Objective: to study the treatment outcomes of infected wounds by investigation the viability of wound edges during the surgical treatment.
Materials and methods. We observed 40 children with infected wounds that were treated at the Pediatric Surgery Department of Zaporizhia Regional Children’s Clinical Hospital during the period 2013-2016. All children underwent the initial surgical debridement, which included the excision of devitalized tissues followed by suturing. In the main group, in addition to subjective (visual) methods, the objective ones for determining the vitalized wound tissues were used. Diagnosis of the tissue perfusion was carried out by the 1-centimeter-spaced in depth and at length study of the microcirculation around the perimeter of wound edges, using the laser doppler flowmetry.
Results and discussion. The initial debridement without excision of the estimated skin area of injuries with the reduced blood flow was performed in patients of the main group in 27.5% of cases, and in the control group – in 35% of cases. The initial debridement with the removal of devitalized areas was provided in 17.5% and 20% of cases respectively. The satisfactory wound healing was achieved significantly more often after the excision of assessed devitalized areas in the main group than in the control group (p<0.001). The development of necrotic edges during the postoperative period in children, who did not underwent the avivement, was observed in 2.5% of main group cases and in the 17.5% of control group cases (p<0.05). In the comparison group also noted the inviability of soft tissue areas in 7.5% of cases, where the partial resection of wound edges was performed. Those patients also experienced festering wounds, which required local therapy and wound drainage.
Conclusions. 1. The investigation of microcirculation parametres improves by 44.4% the outcomes of the surgical initial debridement of wounds. 2. The using of the laser doppler flowmetry in the determation of the microcirculatory bloodstream at the first day of admission to hospital allows to select the extent of surgical debridement and contributes to the reduction of hospital stay.