Periarterial sympathectomy in patients with systemic scleroderma, Raynaud’s syndrome and purulent complications

Introduction. In the aspect of surgical treatment of purulent complications of soft tissues of the extremities in systemic connective tissue diseases accompanied by Raynaud’s syndrome with purulent complications, the issue of tissue trophic restoration is relevant.

Aim. To evaluate the effectiveness of periarterial sympathectomy on the regeneration process of chronic infected wounds in patients with systemic sclerosis.

Materials and methods. A prospective, open, non-randomized study in the purulent surgery department of the Republican Clinical Hospital involved 30 patients with hand phlegmon of various localizations on the background of systemic scleroderma with lesions of the hands and forearms. On the 7^th day after opening the abscess, local treatment and visual cleansing of the wound with the formation of young granulation tissue in the edges and bottom of the wound, and removal of drains, the patients were divided into 2 groups. The main group (n = 15) included patients who underwent periarterial sympathectomy at the level of the brachial artery with daily local treatment. The control group (n = 15) included patients who received only topical treatment (iodopyron or levomycetin ointment). All patients were women receiving prednisone in a maintenance dosage of 25.5 ± 9.5 mg orally.

Results. The rate of maturation of granulation tissue and the rate of epithelialization were statistically significantly higher in the main group (p < 0.05). By the 11^th day after sympathectomy, all patients in the main group showed healing of infected wounds by secondary tension, which in the control group was observed only in 13.3% of cases. When assessing the microbial landscape of wounds at the time of discharge from the hospital, the absence of pathogenic flora in the main group is noted, which distinguishes it from the control group.

Conclusions. Periarterial sympathectomy performed at the stage of epithelialization of infected wounds with hand phlegmon in patients with systemic scleroderma with Raynaud’s syndrome leads to an acceleration of their regeneration processes and a decrease in bacterial contamination.

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