TREATMENT OF PHLEGMONS OF THE MAXILLOFACIAL AREA BY AUXILIARY DRAINAGE WITH CONSTANT REDUCED NEGATIVE PRESSURE
Authors: Malanchuk V.A. , Sidoryako A.V. , Kulbashna Ya.A. 
Published: January 2020

Relevance. In the treatment of purulent wounds of the maxillofacial area, aspiration of the exudate is often ineffective due to the aspirational-obstructive effect. Therefore, the search for ways to improve wound drainage is relevant in the treatment of patients with phlegmons of all deep spaces of the maxillofacial area, including the fiber of the cervical neurovascular bundle.

Objective: To increase the efficiency of drainage of the phlegmons of the maxillofacial area and neck with the help of drainage with constant negative pressure.

Materials and methods. In the maxillofacial department of the City hospital of emergency and urgent medical care in Zaporizhzhia, 100 people aged 20-80 years were treated with phlegmons of the maxillofacial area. In one group (45 people), treatment was performed according to the traditional method. In group 2 (55 people), traditional treatment was supplemented by drainage of purulent wound with sustained reduced pressure at the exudation stage. To do this, in group 2 we used a device which shape was similar to the shape of a purulent cavity. It was made individually according to the imprint of the patient's purulent wound cavity, which reduced the likelihood of pressure sores in the wound. At installation of drainage the immersion limiter was covered with a sealing oily substance on a fat basis. The device was made of medical plastic with a through sponginess, the size of the frame was smaller than the capacity of the purulent wound cavity by 10-30%. The sizes of the openings of the frame wall were 0.1-0.5 mm. Mathematical calculations of the efficiency of exudate aspiration were conducted. The number of openings of the drainage body with the walls of the wound was 200 in one square centimeter, at an effective speed of 0.2 m/sec and an evacuation volume of 150 ml/min. This allowed to eliminate the aspirational-obstructive effect.

Results. The duration of hospitalization of the 2 group patients was shortened in comparison with patients of the 1 group. Improvement of the clinical picture and stabilization of the general condition in 53 (96.4%) patients of the 2 group were observed at 3 day after surgery, and the same indicators in 43 (95.6%) patients of the 1 group were observed at 4-5 day. In addition, it was decrese of the pain intensity at 4-5 day. In 48 (87.3%) patients of the 2 group, purulent exudation was stopped at 2-3 day, granulations appeared at 3-4 day, and the complete clearance and marginal closure of the wound were observed at 6-8 day. In 4 patients of the 1 and 2groups, the healing time of the postoperative wound was longer: termination of purulent discharge was observed up to 6-7 days, appearance of granulations - up to 7-8 days, complete clearance and marginal closure of the wound - up to 10-12 days. Also, in the 2 group,  there were fewer complications, pressure sores in the wound from tubular drainage and less spread of the inflammatory process in adjacent tissues of space.

Conclusions. Drainage of purulent wounds with constant reduced negative pressure increases the efficiency of exudate evacuation; reducing the number of complications; acceleration of the onset of the second phase of the inflammatory process.