Substantiation of tactics of chronic wound bed preparation at various stages of the infectious process on the basis of the analysis of the results of microbiological, clinical and morphological parameters

Abstract

The chronic wounds (CW) bed preparation requires an integrated approach using wound assessment, microbiological and histological analysis, which will avoid skin graft failure.The aim was to evaluate the possibility of using microbiological and morphological parameters of CW assessment to substantiate the choice of tactics of wound bed preparation to skin grafting (SG).Morphological and microbiological indicators of CW (n = 229) at various stages of the infectious process were analyzed. To prepare CW to SG, the following treatment methods were used: dressings, vacuum therapy (VT), mechanical debridement (MD), and ultrasound debridement (UD).The criteria that determine the possibility of CW preparation “under a bandage” in combination with MD are: the absence of inflammation signs and the normal state of granulations (red-pink color, firm and moist), a negative result of wound swabs, the histological result of Si 1/Si 2 and Sp 1/Sp 2. For CW performed with pathologically altered granulations colonized by potential pathogens and having Sp 3, Si 2/Si 3 criteria, the use of 2 UD procedures is indicated (1st in combination with MD, 2nd before SG), between which VT is applied. Critically colonized wounds showing the signs of Sp 3 in combination with Si 1 or Si 2, from which microorganisms are isolated in an amount of ≤105 CFU/ml and are characterized by persistent properties, are an indication for VT, which is performed between two UD procedures. Clinical infection signs, the presence of bright red friable and bulge granulations in the wound, morphological signs of Si 3/Si 2 and Sp 1/Sp 2 are indications for the use of 2 UD procedures in combination with systemic antibiotic therapy based on wound swab culture results.Microbiological and morphological parameters characterize the CW state at various stages of the infectious process (colonization, critical colonization, infection) and are recommended as criteria for choosing tactics for wound bed prepara tion to SG.