Features of treatment of purulent-nflammatory wound complications after relapa-rotomies "on demand" in emergency abdominal surgery

In patients with emergency abdominal surgical pathology (EASP), purulent-inflammatory wound complications (PIWC) after emergency relaparotomy (ERLT) “on demand” develop in 30–65 % of cases. ERLT is performed in the first phase of wound healing (3-7 days), during this period of time, inflammatory processes are clearly expressed in the wound: the wound is oversaturated with inflammatory mediators (prostaglandins, inflammatory cytokines, chemokines) leading to vascular contraction and increased permeability of the vascular wall, local acidosis, increased catabolism, migration of leukocytes into the wound, and wound ischemia is increased due to the compressive effect of the sutures. These components of the first phase of wound healing, during relaparotomy by removing sutures, significantly increase the risk of infection and complicate the treatment tasks. The aim of this study is to improve the treatment outcomes of patients with EASP after ERLT by using improved methods of treating PIWC. Materials and methods: Clinical studies were conducted on 129 patients with various types of EASP who underwent ERLT, of which 87 were retrospective (comparison group) and 42 were prospective (main group). The results showed that in the main group, the use of improved methods of treating PIWC based on closed prolonged irrigation of wounds with antibiotics and antiseptics, with anaerobic flora, additional insufflation of the wound with oxygen, allow earlier elimination of anaerobic non-clostridial flora (ANF), replacement of mixtures of facultative anaerobic bacteria with a monoculture, and avoidance of nosocomial infection. Compared to the comparison group, the updated algorithm for treating suppurating wounds reduced the time of the possibility of applying secondary sutures by (6 ± 1) days, reduced the duration of hospitalization by (10 ± 2) days, and mortality by (4.5 ± 0.5) %. Conclusions. The proposed improved methods of closed treatment of PIWC after ERLT allow to avoid complications from the wound (phlegmon, eventration), statistically significantly reduce the duration of hospitalization and mortality.