Treatment of patients with intermuscular phegmon of the upper limb on the background of tissue hypertension

Rationale: Treatment of patients with phlegmon of the upper extremity (shoulder and forearm) is a complex and urgent task of modern surgery. In most cases, the results of treatment do not satisfy surgeons and patients. Increased tissue pressure, compartment-syndrome of the upper extremity on the background of purulent-inflammatory processes remains without due attention, which increases the number of complications both in the early and remote post-operative periods. The purpose of the work: to improve the results of the treatment of patients with deep intermuscular phlegmons of the upper extremity (shoulder and forearm), by developing a treatment-diagnostic approach based on the determination of the relationship between tissue hypertension and pain syndrome. Materials and methods: An individual complex rating scale was developed. One of the key factors of the rating scale was an indicator of tissue pressure. In the process of calculating the degree of severity, the obtained indicators served as the basis for determining the treatment tactics of compartment syndrome, namely its medicinal therapy or surgical resolution (fasciotomy). In the study, 134 patients with deep intermuscular phlegmon of the shoulder and forearm were divided into two groups: the first group included 62 patients, whose treatment was carried out according to known technologies. They carried out the measurement of tissue pressure in the affected segments of the upper extremity in the control stages of the treatment (before the operation, after the operation, discharge). In the II group (72 patients) we used a developed diagnostic and treatment algorithm based on the severity of tissue hypertension and compartment syndrome. Results: When treating patients with phlegmon of the upper extremity at normal values of tissue pressure (8-10 mm rt. st.), early postoperative complications were significantly reduced (by 1.9 times) and the pain syndrome was completely stopped (according to the FPS-R scale) at 14 -y day. In the control group, the pain syndrome persisted 6 months after the operation, but it was associated with the formation of pain trigger zones. Conclusion: The proposed developed algorithm for the diagnosis and treatment of phlegmon of the shoulder and forearm, protected by patents of the Russian Federation for inventions №2755169, №2587972, №2695367, №2755388, allowed to improve the results of complex treatment and reduce the time of postoperative rehabilitation of patients.