RESULTS OF TREATMENT OF PATIENTS WITH SEVERE FORMS OF ERYSIPELAS

Abstract. Introduction. Among patients with purulent-inflammatory diseases of the skin and soft tissues requiring surgical treatment, erysipelas occurs in 70% of cases. In addition, erysipelas causes severe complications in the form of necrotic cellulitis and fasciitis in 6-12% of cases; in cases of erysipelas localization in the lower extremities, the frequency of phlegmonous-necrotic forms reaches 55-83%. The presence of sepsis, the source of which is erysipelas, is fatal in 50% of cases. Thus, there is currently no trend towards a decrease in the incidence of erysipelas, the number of severe complicated forms is not decreasing, and there is a persistent increase in the recurrence of the disease. Objective. To analyze the results of treatment of patients with forms of erysipelas complicated by purulent-necrotic soft tissue damage and sepsis. Materials and methods. The paper presents the results of treatment of 457 patients with various forms of erysipelas. The erythematous form was found in 157 (34.4%) patients, the bullous form in 108 (23.7%) and the bullous-necrotic form in 90 (20.7%) patients; the phlegmonous form of erysipelas was found in 97 (22.2%) patients. In terms of localisation, erysipelas inflammation was most common in the lower extremities – 297 (65.3%), in the upper extremities – 77 (16.8%), on the face – 25 (5.5%) and on other parts of the body – 58 (12.7%) patients. Hospitalisation of patients is differentiated. The purulent surgery department treated 388 patients who were admitted in a moderate condition. The intensive care unit admitted 69 patients in a severe and extremely severe condition. Results. All patients, regardless of the form of erysipelas and its location, were prescribed basic therapy, including crystalloid solutions, antibacterial, desensitising and detoxification drugs. Local treatment of patients with various forms of erysipelas was carried out in a differentiated manner. The indication for surgical intervention was the presence of purulent-necrotic foci at the time of admission or their formation in the future. The scope of surgical interventions included surgical treatment of the purulent focus or amputation of the affected limb. Of the 37 patients with erysipelas complicated by sepsis in the first 5-7 days, 16 (43%) died in the intensive care unit; among the deceased, only 9 underwent surgery. In 7 patients, surgery was impossible due to decompensation of vital functions. The overall mortality rate with differentiated treatment tactics for patients with various forms of erysipelas was 6.3%. Conclusions. Patients with erysipelas should be hospitalised in a surgical ward on a differentiated basis, depending on the location of the focus and the form of its complication. Treatment in the hospital begins with general basic therapy, which includes antibacterial drugs, desensitising and detoxification agents. The treatment of patients with erysipelas is differentiated. Surgical interventions are performed when purulent complications arise. The extent of surgical intervention depends on the depth of tissue damage and its location. The course of the disease in patients with erysipelas is significantly influenced by the type of complication developed. Mortality increases rapidly in the presence of extensive purulent-necrotic processes and sepsis.