RU2254061C2 - Method for surgical treatment of furnier's disease due to sagittal access - Google Patents

Abstract

FIELD: medicine, purulent surgery.

SUBSTANCE: the present innovation deals with treating gangrene of penis and scrotum due to opening scrotal phlegmon by a single sagittal incision coming through suture and scrotal septum. One should radically dissect necrotized tissues.

EFFECT: more shortened terms of therapy.

5 dwg, 1 ex

Description

The invention relates to medicine, namely to purulent surgery.

More than 100 years of experience in the surgical treatment of fulminant gangrene of the external genitalia comes down to multiple strip sections of the scrotum, penis, and perineum with simultaneous excision of dead tissue (Berenstein BC 1937, Reznitsky MI 1976, Shubin BH 1959, Arbuzov V.N. , Urzhenin A.V. 1980, Mukhin I.V., Leshchenko V.M., Chumak G.O. 1983, Denmukhamedov S.R., Emelyanov I.I. 1958, Izmailov G.A., Morozov V.G. ., Mavzyutov L.Kh. 1986 and others).

Multiple strip incisions are not considered the best surgical tactics for Fournier’s disease, as they have several disadvantages: they violate the poor blood supply to the scrotum, increase the boundaries of necrosis, which makes it difficult in the postoperative period of scrotum plasty with local tissues, and does not provide adequate wound aeration and visual monitoring the course of the wound process, exclude the possibility of complete removal of pathologically altered tissue sites.

The purpose of the invention is to develop the optimal method of surgical intervention for Fournier disease, which helps to reduce treatment time, reduce the number of complications. (V.Yu. Kim, S.E. Karashurov, E. S. Karashurov. Fournier's disease: pathogenesis, clinical features, treatment. International Medical Journal. - 1998. - N11 - 12 - p. 997-998).

Based on available literature sources, the authors propose an emergency opening of the scrotum phlegmon with wide (strip) incisions with tissue drainage and washing them up to 4-6 times a day with potassium permanganate and hydrogen peroxide solutions. Necrotic tissue is excised during the first intervention, as well as repeated interventions after the first operation. Often, as a result of necrosis of the scrotum, the testicles are exposed. There are ways to temporarily move them under the skin of the inguinal areas.

Multiple strip incisions are not considered the best surgical tactics for Fournier’s disease, as they have several disadvantages: they violate the poor blood supply to the scrotum, increase the boundaries of necrosis, which makes it difficult in the postoperative period of scrotum plasty with local tissues, and does not provide adequate wound aeration and visual monitoring the course of the wound process, exclude the possibility of complete removal of pathologically altered tissue sites.

Our experience is based on the treatment of 22 patients with Fournier's disease.

Given these shortcomings, we have proposed and implemented in clinical practice a different approach to surgical intervention in Fournier's disease.

Under epidural anesthesia or endotracheal anesthesia, a phagmon is opened through a sagittal incision through the suture and septum of the scrotum, radical surgical treatment of the purulent wound is performed, which consists in excising all non-viable tissues, including all testicle membranes, to the albumen.

In the case of a purulent necrotic process spreading to the penis in the perianal, gluteal region and thigh, the incision can be continued to these areas. During the operation, the wounds were treated with antiseptic solutions: 3% hydrogen peroxide solution, 0.02% chlorhexidine solution, etc. The operation was completed by plugging the wounds with gauze napkins, abundantly moistened with a solution of 3% hydrogen peroxide.

This method is illustrated in figures 1-5 where

figure 1 - phlegmon of the scrotum and penis, figure 2 - opening the phlegmon of the scrotum with a sagittal section through the seam and septum, continuously continuing the section, the purulent nerves of the penis, perianal region and left buttock are opened, the operation is completed by loose plugging of the wound with tissues moistened with a 3% solution hydrogen peroxide, temporary reducing sutures to the wound, FIG. 3 - postoperative wound in the cleansing phase, FIG. 4 - postoperative wound in front of the scrotum with local tissues, FIG. 5 - scrotum plastic with local tissues, secondary sutures in the wound Serian region, left buttock and penis.

An example of a specific implementation of the method:

Patient Valiev N.V., 57 years old, diagnosis: A common form of Fournier disease. Diabetes mellitus type 2, moderate.

He entered the surgical infection department on the 13th day from the onset of the disease on July 24, 02. After a preliminary short-term intensive preoperative preparation for 4-6 hours, the patient underwent surgery under epidural anesthesia: Autopsy of the scrotum with sagittal section through the suture and scrotal septum, radical necrectomy .

Continuously continuing the incision up and down, the purulent streaks of the penis, perianal region and left buttock were opened. The wounds were treated with antiseptic solutions and loosely swabbed with gauze napkins, abundantly moistened with a solution of 3% hydrogen peroxide. The operation was performed on 05.08.02 g: the application of secondary sutures on the wounds of the perianal region, the left buttock and penis, the scrotum plastic with local tissues. The patient was discharged 08/17/02 g with recovery.

Re-examined after a month. No complaints, sexual function preserved. Performs previous work.

Thus, the proposed method eliminates the disadvantages that multiple strip incisions have, reduces the time for cleansing wounds, allows the scrotum to be plastic with local tissues, reduces the percentage of complications and lethality, the operation is performed without technical difficulties.

Claims (1)

A method of surgical treatment of Fournier’s disease, including opening a scrotum phlegmon, characterized in that the scrotum phlegmon is opened with a single sagittal incision through the scrotum suture and the scrotum septum with a radical excision of necrotic tissue.

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