Clinical efficacy of complex multiple-factor approach to forearm phlegmon treatment

The objective of this paper is to improve treatment outcome in patients with mediastinal and retroperitoneal forearm phlegmon through a specially developed and implemented algorithm for postoperative management. The algorithm takes into account the postoperative phase of wound healing and clinical implementation of lymphotropic antibacterial therapy. Materials and Methods. The authors developed and implemented the algorithm for postoperative management, considering the phase of wound healing and clinical use of lymphotropic antibacterial therapy. 34 patients with forearm phlegmon were divided into two clinical groups and the comparative analysis of their treatment results was conducted. The index group included 20 patients who were subject to the differential algorithm for postoperative management depending on the phase of wound healing. They also underwent indirect lymphotropic antibacterial therapy. While treating the matched 14 controls the therapists didn't take into account the phase of wound healing and didn't conduct cytological control of wound healing. Moreover, the treatment process included traditional administration of antibiotics. Results. The study proved greater efficacy of endolymphatic administration of antibiotics, in comparison with traditional (intravenous and intramuscular) treatment modalities. It provides authority for further investigation of the suggested algorithm and its possible practical application. Conclusion. Lymphotropic administration of antibacterial drugs in patients with purulent diseases of forearm soft tissues accelerates the positive therapeutic effect and increases medication bioavailability. Wound healing status, inflammatory dynamic pattern and cytogram analysis improve treatment quality and results, objectively indicate the efficacy and optimal timing for drainage and debridement of wounds and also indicate the staging of post-operative local treatment. Besides, cytogram analysis contributes to the reparative process determination and management.