An integrated approach using bacteriophages in the treatment of chronic ischemic hand wounds in a patient with severe concomitant pathology

The treatment of chronic wounds in conditions of immunosuppression and the presence of severe concomitant pathology, even in patients of working age, is a complex and not fully solved task of modern surgery. Objective . The aim of the study was to evaluate the clinical effectiveness of systemic and local phage therapy in the complex treatment of chronic purulent lesions of the hand in a patient with severe concomitant pathology. Materials and methods . The clinical case of a 51-year-old patient with type 1 diabetes mellitus, chronic renal failure (condition after kidney transplantation), severe diabetic retinopathy of both eyes and obliterating atherosclerosis of the arteries of the upper and lower extremities is presented. Due to necrotic lesion of the distal phalanx of the third finger of the left hand, amputation was performed at the level of the distal part of the main phalanx of the third finger of the left hand with local tissue plastic under conduction anesthesia. Postoperative treatment included systemic and local phage therapy, prescribed based on the results of a phagogram ("Piophage", Microgen, Russia, 20 ml 2 times per day), as well as symptomatic treatment without ussing chemical antibiotics and antiseptics. Research results . The postoperative period was uneventful: there were no signs of suppuration or ischemia, the pain syndrome regressed, and the wound healed with primary tension. The patient's condition remained stable against the background of immunosuppressive therapy. A follow-up examination after 14 days and 12 months confirmed a favorable outcome. Conclusion . Systemic and topical application of bacteriophages as part of complex therapy in a patient with chronic ischemia and severe comorbid pathology made it possible to prevent the development of infectious and inflammatory complications and ensure successful healing of the postoperative wound. The results obtained confirm the prospects of phage therapy as a safe and pathogenetically sound method of treating patients with chronic wounds of various etiologies.