THE USAGE OF CONTINUOUS EXUDATE ASPIRATION TECHNIQUE IN TREATMENT OF PYOINFLAMMATORY PROCESSES OF MAXILLOFACIAL AREA

Morozova M. N., Demianenko S. A., Boyarintsev S. V., Chervyakov I. S.

CONTENTS

Scentific article

The objective to decrease the complications frequency in postoperative period in treatment of purulent processes in the facial and neck area motives the surgeons to put into practice the optimal methods of drainage of purulent cavities. While passive drainage the exudate is evacuated by single or several drain tubes in dressing or in special tanks. But the tank may be used not only for collection the exudate but for aspiration too – the physical antiseptics technique – continuous exudates aspiration (CEA) or low-vacuum drainage. In maxillofacial surgery the usage of CEA is not justly little. This article shows the treatment results of 1060 patients who have been treated in the department of maxillofacial surgery in the hospital of Crimea State Medical University named after S. I. Georgievsky from 2002 till 2014 year. Objectives: to analyse the treatment results in patients with pyoinflammatory processes of maxillofacial area while using different drainage techniques. Target and study methods. The results of pyoinflammatory processes treatment of 2 groups of patients were analyzed: the basic group (624 patients) had taken the CEA technique and the control group (336 patients) had taken the classic one (drainage-washing). The patients were with the following pathology: abscesses and phlegmons of face and neck – 776 patients; chronic osteomyelitis of lower jaw – 284 patients. To provide the CEA the tube drainage was put into the cavity then the tank for collection and active aspiration of exudate was connected to distal end. To create a seal after the tapping abscesses and phlegmons the wound was covered with surgical membrane «IobanTM -2» (3M Company), after sequestrectomy the wound was closed in layers. The indicants characterizing the general state of patients and the dynamics of progression of purulent wound process were studied. Study results and its discussion. The terms of normalization of clinical showings in patients with pyoinflammatory processes under CEA in 2-3 points shorter than under standard drainage technique. It is important that not in one instance while using CEA there was no need to provide necrectomy in tissues of a wound because necrotic patches are freely separated from the walls by virtue of continuous flow of tissue fluid into a cavity. After removing vacuum drainage the purulent cavity becomes minimal (the effect of vacuum suture). After such the procedure during 24-hours the wound covers with hemorrhagic crust and heals like “tidy wound”. In all the patients treated with CEA at first 24 hours after the lancing the abscesses and phlegmons the level of exudate toxicity is higher than in patients with standard treatment. During the next 3 24-hours the period of time needed for immobilization of Paramecium becomes greatly longer. By the term of drainage removing (3-4 24-hours after operation) the speed of infusorias immobilization is approximate to the term of its immobilization in plasma of healthy human beings. In conventional treatment it is in 1,5 times higher. The amplification of exudate toxicity found in patients of the basic group proves that in the first 24-hours of CEA effect (probable in first hours) the toxic products are forcedly go out of a wound but don’t go into the systemic circulation. Progressively as a wound becomes clean the toxicity of removing stuff is greatly lowering and drawing closer to the showings of the healthy human beings’ plasma. The results of cytologic screening have shown that in first 24-hours after operation of lancing the abscesses and phlegmons using the classical technique of drainage in different angles of view there were remains of detritus, absolute cell areactivity and massive microflora located extracellulary. Using CEA during 24 hours the retain forms of neutrophil granulocytes shown phagocytic activity appeared. After the 3 24-hours of postoperative period with using CEA the number of retain forms of neutrophil granulocytes had been decreased; undifferentiated polyblasts, fibroblasts and lymphocytes emerged. The usage of CEA reduces the duration of wound process especially the duration of the stage of necrotic cleansing of a wound and maximally approximates the terms of healing of purulent wound to the terms of healing by first intention. Fast grow of activity of succinate dehydrogenase after the operation in patients with CEA proves two possible ways to effect to wound process: enhancement of microcirculation because of resistance to augmentation of edema along with continuous forced suction of tissue fluid which contains all needed for cleansing and healing matters from adjacent healthy tissues. Thus: usage of CEA allows to achieve fast detoxication of tissues located maximally closer to a wound, has an anti-edema action, promotes to delivery into a wound matters needed for its healing, enhances microcirculation. All these features along with effect of vacuum suture promote to healing in short terms and without additional expenses for medication.

treatment, exudates, pyoinflammatory processes of maxillofacial area, chronic osteomyelitis, vacuum drainage

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«Bulletin of problems biology and medicine» Issue 2 part 2 (108), 2014 year, 018-022 pages, index UDK 616. 314-089. 23+616-002. 36 + 616. 71-018. 46-002 + 616-089. 48