A multidisciplinary approach to the treatment of patients with the combined form of hand phlegmon (a clinical observation)

   The present clinical observation describes a case of a patient with the combined form of hand phlegmon who received a complex three-stage therapy in the hospital for 22 days: 5 days in the department of purulent surgery where she was operated twice and received antibacterial and anti-inflammatory therapy. The next stage of wound treatment was in the day hospital for 14 days. After, the patient was re-hospitalized to the department of hand trauma where she stayed for 3 days. There, plastic closure of the wound defect was made with a posterior interosseous forearm flap. Terms of treatment depended on the wound process. We reduced the length of stay in the 24-hour hospital, but maintained our control of the patient in a day hospital. Thus, such an algorithm allowed us not only to reduce economic costs for the treatment, but also to form a significantly much comfortable psychological situation for the patient. Such an approach creates in patients an idea that their treatment is an integral and complex multi-stage process which assumes the importance of balanced assessment of long-term outcomes just at the early stages of wound treatment.

1. Alekseev M. S. Surgical treatment of deep forms of panaritium and phlegmon of the hand = Alekseev M. S. Khirurgicheskoye lecheniye glubokikh form panaritsiya i flegmon kisti : avtoref. dis. … dokt. med. nauk. M., 2003. 46 s. (In Russ.)

2. Chepurnaya Yu. L., Melkonyan G. G., Gulmuradova N. T., Sorokin A. A. Development of complex treatment of purulent-inflammatory diseases of the hand using laser radiation = Chepurnaya Yu. L., Melkonyan G. G., Gul’muradova N. T., Sorokin A. A. Razvitiye kompleksnogo lecheniya gnoyno-vospalitel’nykh zabolevaniy kisti pri ispol’zovanii lazernogo izlucheniya. Lazernaya meditsina. 2021; (1): 22–28. (In Russ.)

3. Lyubsky A. S., Alekseev M. S., Lyubsky A. A., Brovkin A. E. Errors and complications in providing medical care to patients with purulent-inflammatory diseases of the fingers and hand = Lyubskiy A. S., Alekseev M. S., Lyubskiy A. A., Brovkin A. E. Oshibki i oslozhneniya pri okazanii meditsinskoy pomoshchi bol’nym s gnoyno-vospalitel’nymi zabolevaniyami pal’tsev i kisti. Lechashchiy vrach. 2000. (In Russ.)

4. Kraynyukov P. E., Matveev S. A. Surgery of purulent diseases of the hand : a guide for doctors = Kraynyukov P. E., Matveyev S. A. Khirurgiya gnoynykh zabolevaniy kisti : rukovodstvo dlya vrachey. M.: Planeta, 2016. 272 s. (In Russ.)

5. Tonkin M. A., Stern H. The posterior interosseous artery free flap. J Hand Surg Br. 1989; 14 (2): 215–217.

6. Balakrishnan G., Kumar B. S., Hussain S. A. Reverse-flow posterior interosseous artery flap revisited. Plast Reconstr Surg. 2003; 111 (7): 2364–2369.

7. Kim K. S. Distally based dorsal forearm fasciosubcutaneous flap. Plast Reconstr Surg. 2004; 114 (2): 389–396.

8. Hsu C., Chang J. The posterior interosseous artery flap revisited. Operat Techn Plast Reconstr Surg. 2003; 9 (4): 173–180.

9. Costa H., Gracia M. L., Vranchx J., et al. The posterior interosseous flap : a review of 81 clinical cases and 100 anatomical dissections- assessment of its indications in reconstruction of hand defects. Br J Plast Surg. 2001; 54 (1): 28–33.