Negative Pressure Wound Therapy with Chymotrypsin Instillation in The Treatment of Purulent-Necrotizing Soft Tissue Infections of The Trunk and Extremities

Introduction. Purulent-necrotic diseases of soft tissues (PNDST) remain a challenging problem in purulent surgery with a mortality rate of 25–50 %. The method of local negative pressure wound therapy with instillation (NPWT-i) is a modern standard for treating complex wounds. The use of chymotrypsin within the NPWT-i framework overcomes the shortcomings of traditional enzyme therapy due to controlled delivery and rapid evacuation of lysis products. Objective: To analyze the efficacy of the method of local negative pressure wound therapy with instillation of chymotrypsin compared to the use of physiological saline in patients with PNDST of the trunk and limbs. Materials and methods. The study included 27 patients with PNDST of the trunk and limbs. In group 1 (n=15), NPWT-i with chymotrypsin was applied; in group 2 (n=12) – NPWT-i with physiological saline. The groups were comparable in terms of baseline characteristics. Results. In group 1, significantly lower levels of leukocytosis and C-reactive protein (CRP) were noted on days 3 and 7 (p<0,05). According to digital planimetry data, by day 7 in group 1, the area of necrosis and fibrin was significantly smaller, and the area of granulation tissue was larger (p<0.05). Clinical outcomes in patients of group I were also better in terms of the number of secondary surgical debridements (3 [2;3] vs 4 [3;5], p=0,015) and the duration of hospitalization (21 [16;25] vs 31 [21;33] days, p=0,013). Conclusion. The use of the method of local negative pressure wound therapy with instillation (NPWT-i) of chymotrypsin solution is an effective tool in the comprehensive treatment of patients with purulent-necrotic diseases of soft tissues of the trunk and limbs.