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At the choice of methods of treatment nagnoivsheysya wounds after appendectomy it is necessary to proceed from a phase of a wound process and the general condition of an organism. Various classifications of a wound process with division it on 2, 3 and even 4 phases are given in literature (S. S. Girgolav, 1933; V. I. Sazontov, 1951; M. F. Kamayev, 1962), however it is in practice convenient to use I. G. Rufanov's proposal to allocate a phase of hydration and dehydration.
The first action at treatment of a contaminated wound is creation of conditions of sufficient outflow of wound contents. For this purpose it is necessary to remove necessary quantity of seams, to widely disclose a wound, to empty flow and to track that there were no narrow courses and deep pockets. A mistake is removal of small quantity of seams in hope for the fastest wound repair. It leads to a delay of outflow of pus and rejection of necrotic fabrics, complicates use of medicamentous means, leads to prolongation of treatment due to further distribution of process on an extent.
Medical actions at suppuration of a wound can be divided into 3 following categories: local and general influence on activators of a wound fever, local impact on a wound process, stimulation of defense reactions of an organism in general (S. Rusanov, 1962).
Now the most powerful antimicrobic tool are antibiotics. They are widely applied in fight against the heavy extending wound fever. At the same time surely it is necessary to consider sensitivity of microflora to an antibiotic and individual portability his patient. Recently even more often it is possible to meet resistant to penicillin forms that demands use of other drugs of a broad spectrum of activity.
Along with it it is necessary to consider also character of microflora. Most often suppuration after appendectomy is caused by the colibacillus getting into a wound from an intestines gleam. It is established clinically, by a characteristic look and a smell purulent separated, and bacteriological. Depending on sensitivity of microflora and taking into account its character we consider more it expedient to appoint streptomycin or Kanamycinum. Sometimes very effective are combinations of antibiotics to sulfanamide drugs.
We are not supporters of wide use of antibiotics at any suppuration of a wound and we apply them only at a heavy current of a wound process from high is purulent - resorptive fever. Limit use of antibiotics and other surgeons (B. Ya. Kiselyov, 1968; Kunzen, 1956).
In literature there is no consensus about expediency of topical administration of antibiotics. Supporters of this method point not only to efficiency of penicillin and streptomycin as bacteriostatic means, but also lack of the braking impact on the course of regenerative processes (M. F. Kamayev, 1962). Fuss (1956) notes small efficiency of topical administration of antibiotics. The researchers applying antibiotics to local influence point to difficulties of accounting of sensitivity of microflora to various concentration of antibiotics at its constant dynamics, selection of doses, concentration and combinations of drug (G. I. Boguslavsky, 1965). We in the practice refused topical administration of antibiotics, including more effective other means of antibacterial influence and first of all chemotherapy.
Did not lose the value streptocides, and also antiseptic agents so far: from iodic tincture and peroxide of hydrogen to drugs of chlorine, manganese, silver etc.
In specific therapy of purulent complications of appendectomy the great value is got by immune serums, vaccines, anti-staphylococcal plasma, a bacteriophage (G. G. Caravans, S. L. Rachkevich, 1972; A.S. Synovets et al., 1972).
When using means of local impact on a wound repair strictly consider a phase of a wound process. In the I phase of a wound process, in addition to creation of conditions of optimum drainage of a wound and use of antibacterial agents, strengthening of a hyperemia and exudation in a wound is of great importance. Apply to this purpose hypertensive (5 — 10%) the solutions of chloride sodium for the first time offered in 1914 to Whaite. This method is eurysynusic and now. There were suggestions for improvement of this method later. M. P. Sokolovsky (1939) specifies that solutions of grape and beet sugar possess more expressed osmotic action, do not damage fabrics and work protivovospalitelno.
This phase of a wound process is characterized by rejection of necrotic fabrics that is typical for secondary healing of wounds (I. V. Davydovsky, 1952). In clinic often it is necessary to observe delay of this process. Existence in a wound of necrotic fabrics significantly complicates healing processes that demands surgical intervention — a necretomy. The necretomy which is widely applied at different types of contaminated wounds, especially at burns, bullet wounds etc. finds limited application at treatment of wounds after appendectomy. In such wound with great success apply proteolytic enzymes to acceleration of rejection of necrotic fabrics. Most often use crystal trypsin. This drug in concentration of 10 PIECES/ml possesses powerful proteolytic action on nekrotizirovanny fabrics, without damaging healthy and without detaining epithelization (V. D. Bratus, 1962, 1967; M. F. Kamayev, 1962; K. I. Veremeenko, 1971). Except crystal trypsin, are widespread in surgical practice and - chymotrypsin crystal and chemical opsin (amorphous chymotrypsin). Crystal trypsin and chymotrypsin, except topical administration, can be entered parenterally. It renders strong antiinflammatory and antiedematous effect (K. I. Veremeenko, 1971; Innerfield, 1954). Without possessing bacteriostatic and bactericidal action, enzymes of proteolysis are capable to strengthen action of antibiotics, obviously, due to improvement of their contact with a microbic cell (Reizer, 1951), reduce resistance of microflora to antibiotics (E. A. Govorovich), destroy the penicillinase developed by microflora in response to administration of penicillin (K. I. Veremeenko, 1971; Abderhalden, 1958).
Topical administration of enzymes allows to clear within several days a wound of necrotic and fibrinous imposings. A. V. Grigoryan, V. K. Gostishchev (1972) note that trypsin, chymotrypsin and chemical opsin are effective at fabric necroses, and ribonuclease and a deoxyribonuclease — in the presence of dense pus. It is not recommended to carry out enzymatic treatment at hemorrhagic diathesis and bent of a wound to bleedings.
From physiotherapeutic procedures in this phase of a wound process the good effect renders ultra-violet radiation of a wound in high erythema doses in combination with UVCh (A. M. Dobrova, 1970). These actions strengthen processes of hydration and development of granulyatsionny fabric.
In the II phase of a wound process there is dehydration and regeneration, the inflammatory phenomena, acidosis, porosity of vessels and exudation decrease, there is a development of granulyatsionny and cicatricial fabric. The purpose of medical actions during this period is stimulation of regenerator and reparative processes, creation of conditions of rest and protection of a granulyatsionny shaft against development of consecutive infection.
Purpose of this or that topical treatment considers degree of manifestation of the inflammatory phenomena, character wound separated, a condition of granulyatsionny fabric and epithelization. For this purpose use various ointment drugs protecting granulyatsionny fabric from damages, ultra-violet radiation by suberythema doses.