SURGICAL TREATMENT OF EXTENSIVE PURULENT-NECROTIC PHLEGMON OF THE FOREARM WITH STAGED MANAGEMENT OF THE WOUND PROCESS AND THE USE OF AUTODERMOPLASTY

The article presents a clinical case of successful treatment of extensive purulent-necrotic phlegmon of the forearm in a 37-year-old patient, which developed as a result of late seeking medical care after a traumatic injury. The characteristic features of the clinical picture on admission are described: an extensive wound measuring 12 × 2 cm with necrotic masses, pronounced perifocal inflammatory process, signs of systemic intoxication. A step-by-step treatment algorithm is described in detail, including emergency surgery (radical necrectomy with drainage), complex antibacterial and anti-inflammatory therapy, and the use of the NPWT system. Particular attention is paid to the reconstructive stage of treatment - autodermoplasty with a split skin flap 0.3 mm thick on the 12th day, when the criteria for wound readiness for plastic surgery were achieved: complete cleansing from necrotic masses, formation of mature granulations, normalization of laboratory parameters of inflammation. The details of the surgical technique are given, including the features of collection, preparation and fixation of the graft. Good immediate treatment results are noted - 95% graft engraftment by the 10th day after surgery. The work emphasizes the importance of a comprehensive approach to the treatment of such patients, including radical surgical treatment, modern methods of local treatment (NPWT) and timely performance of reconstructive interventions. The presented data confirm the effectiveness of the proposed algorithm for managing patients with extensive purulent-necrotic lesions of soft tissues of the extremities.