MODERN PRINCIPLES OF TREATING PURULENT DISEASES
Prevention and treatment of purulent inflammations is one of the most important problems in clinical surgery. Many renowned scientists devoted their research to this issue; the topic is discussed at different conferences, including conventions of Russian surgeons and international congresses. Purulent and inflammatory diseases are characterized by high morbidity, the disease severity and frequent unfavorable outcomes.
Any wound that occurred outside the operating theatre should be considered bacteria-contaminated. There can be primary contamination that occurs at the moment of wound infliction and secondary contamination that is associated with violated aseptic techniques during dressing and surgeries or with distribution of hospital-acquired infections.
The presence of microbes in the wound does not always result in the infectious process. The latter develops when the balance between microbes inhabiting the wound and defenses of the macroorganism are impaired. During the infectious process in the wound, microbes may spread inside viable tissues as well as into lymphatic and blood vessels.
Wound infection does not always cause development of the purulent process. It is determined by three factors:
1) the nature and degree of tissue damage;
2) the presence of blood, foreign bodies and devitalized tissues in the wound;
3) the presence of the pathogenic microbes in the concentration of 105 bacteria per 1 g of tissue.
This is the so-called critical level of bacterial load. Increase in this concentration may result in development of infection in healthy undamaged tissues. However, this "critical" level may be low as well. Thus, in the presence of blood, foreign bodies and ligatures, 104 microbes per 1 g of tissue will be enough for infection to develop. In ischemia caused by ligature tying (ligature-induced ischemia), 103 microbes per 1 g of tissue is sufficient.