Perm Medical JournalPerm Medical Journal0136-14492687-1408Eco-Vector313710.17816/pmj30632-36Research ArticleCOMPLEX SURGICAL TREATMENT OF PATIENTS WITH PURULO-NECROTIC COMPLICATIONS OF REPLANTED EXTREMITIESTimerbulatovM V-IbragimovR K-GalimovT R-KazbulatovS S-KutuevZ Z-15122013306323612072016Copyright © 2013, Timerbulatov M.V., Ibragimov R.K., Galimov T.R., Kazbulatov S.S., Kutuev Z.Z.2013Aim. To raise the efficiency of treatment in patients with purulo-necrotic complications of replanted extremity segments. Materials and methods. The results of complex treatment of 65 patients with traumatic amputations of the hand and forearm and purulo-necrotic complications are presented in the paper. Treatment of patients of the main group (33 patients) in the postoperative period included, along with traditional, prolonged lymphotropic antibacterial therapy using 1% methylene blue combined with cephtriaxon. The results were estimated by means of standard clinicolaboratory investigations. Quantitative determination of microorganisms in 1 g of the tissue obtained from the wound with calculation of the number of colony-forming units (CFU) in 1 ml of the investigated material was carried out. Results. Clinical analysis of the main group of patients showed decrease in bacterial semination of the postoperative wound from 4,41±1,12×10 5 to 6,4±1,35×10 3 in 1 ml of the investigated material ( p 0,001) by the day 15, fall in initially existing purulo-necrotic complications to 18,2% versus 50% in the comparison group ( p 0,05) beginning from the day 30 and reduced average period of hospitalization from 40,1±3,16 to 33,5±2,76 days ( F =1,1, p =0,03). Conclusion. Lymphotropic therapy in complex treatment of patients with replanted extremities promotes decrease in purulo-necrotic complications by 31,8%, reduces the period of treatment by 16,5% and is an effective method for treatment of patients with purulo-necrotic complications of deep subfascial structures developed after replantation of extremities.Microsurgeryextremity replantationindirect antibacterial therapyadultshuman beingМикрохирургияреплантация конечностинепрямая эндолимфатическая антибактериальная терапиявзрослыечеловек[Белоусов А. Е., Ткаченко С. С. Микрохирургия в травматологии. Л.: Медицина 1988; 224.][Богомолов М. С., Седов В. М. Микрохирургические реплантации фрагментов кисти. СПб.: Санкт-Петербургское медицинское издательство «Элби-СПб» 2003; 236.][Датиашвили Р. О. Реплантация конечностей М.; Медицина 1991; 240.][Крылов В. С., Миланов Н. О., Боровиков А. М. Пятилетний опыт микрохирургической аутотрансплантации тканей. Проблемы микрохирургии. М. 1985; 9–11.][Крылов В. С., Степанов Г. А., Акчурин Р. С. Микрохирургия при реплантации конечностей и ее сегментов. Научный совет по травматологии и ортопедии: пленум академии мед. наук СССР. Пермь 1982: 93–94.][Курбанов У. А., Одинаев М., Карим-Заде Г. Послеоперационные сосудистые осложнения при реплантации пальцев кисти. Анналы пластической, реконструктивной и эстетической хирургии 1998; 3: 60–61.][Подгайский В. Н. Организационно-тактические аспекты микрохирургии реплантации конечностей и их сегментов: дис. … д-ра мед. наук. Минск 1997; 338.][Kaplan I., Ada S., Ozerkan F. Free flaps reconstruction in hand and orthopaedic surgery. 6th Congress of the International Federation of Societies for Surgery of the Hand (IFSSH). Helsinki 1995; 207–211.][Weaver F. A. Papanicolaou G. Difficult peripheral vascular injuries. Surg Clin. North. Amer. 1996; 76: 4–9.]