Purulent surgery=Гнойная хирургия

ГНОЙНАЯ ХИРУРГИЯ
PURULENT SURGERY
УЧЕБНО-МЕТОДИЧЕСКОЕ ПОСОБИЕ
Рекомендовано 
Учебно-методическим объединением 
по высшему медицинскому, 
фармацевтическому образованию
в качестве учебно-методического пособия
для студентов учреждений высшего образования,
обучающихся по специальности 
«Лечебное дело»
 
Москва 
Гомель
 
ИНФРА-М 
ГомГМУ
2027
МИНИСТЕРСТВО ЗДРАВООХРАНЕНИЯ РЕСПУБЛИКИ БЕЛАРУСЬ
УЧРЕЖДЕНИЕ ОБРАЗОВАНИЯ
«ГОМЕЛЬСКИЙ ГОСУДАРСТВЕННЫЙ МЕДИЦИНСКИЙ УНИВЕРСИТЕТ»
Кафедра хирургических болезней № 2
И.А. СЛАВНИКОВ
ВАКАР АНДЖУМ
МОХАННАД АБД АЛИ

УДК 617-002.3-089(075.8)=111
ББК 54.561.2я73=432.1
 
С47
Славников И.А.
С47  
Гнойная хирургия = Purulent surgery : учебно-методическое пособие / И.А. Славников, Вакар Анджум, Моханнад Абд Али. — Москва : 
ИНФРА-М ; Гомель : ГомГМУ, 2027. — 242 с.
ISBN 978-5-16-022394-0 (ИНФРА-М, print)
ISBN 978-5-16-115108-2 (ИНФРА-М, online)
ISBN 978-985-588-493-5 (ГомГМУ)
В учебно-методическом пособии отражены вводные вопросы дисциплины, касающиеся терминологии, классификации, принципов диагностики и лечения. Материал изложен в соответствии с современными научными представлениями на основе данных отечественной и зарубежной 
литературы.
Соответствует учебной программе учреждения высшего образования 
по учебной дисциплине «Общая хирургия» для студентов 2–3 курсов специальности «Лечебное дело», обучающихся на английском языке.
УДК 617-002.3-089(075.8)=111
ББК 54.561.2я73=432.1
Р е ц е н з е н т ы:
кафедра общей хирургии учреждения образования «Белорусский государственный медицинский университет»;
Величко А.В., кандидат медицинских наук, доцент, заведующий хирургическим отделением (трансплантации, реконструктивной и эндокринной хирургии) государственного учреждения «Республиканский научнопрактический центр радиационной медицины и экологии человека»
ISBN 978-5-16-022394-0 (ИНФРА-М, print)
ISBN 978-5-16-115108-2 (ИНФРА-М, online)
ISBN 978-985-588-493-5 (ГомГМУ)
© Гомельский государственный 
медицинский университет, 
2026

CONTENTS
List of abbreviations...............................................................................4
Class 1. Purulent surgical infection. Endogenous intoxication .............6
Class 2. Purulent diseases of skin and subcutaneous tissue ................19
Class 3. Purulent diseases of the fingers and hand ..............................39
Class 4. Purulent diseases of bones, joints and synovial bursae .........63
Class 5. Purulent diseases of the glandular organs, lymphatic system,
blood vessels ............................................................................................105
Class 6. Purulent diseases of serous membranes ..............................123
Class 7. Anaerobic and putrefactive infection ...................................146
Class 8. Specific surgical infections ..................................................166
Class 9. Sepsis ...................................................................................197
Questions for final control of students’ knowledge ...........................235
References ..........................................................................................238

LIST OF ABBREVIATIONS
ABA 
– arterial blood analysis
ACCP  
– American college of Chest Physicians
ALT 
– alanine aminotransferase
ARDS 
– acute respiratory distress sindrome
AST 
– aspartate aminotransferase
ATP 
– adenosine trifophate
ATS 
– anti-tetanus serum
BCC 
– blood circulating capacity
BP 
– blood pressure
CAE 
– controlled abacterial environment
CFS 
– cerebrospinal fluid
CMV 
– cytomegalovirus
CRP 
– C-reactive protein
CSOM 
– chrome suppurative otitis media
CT 
– computer tomography
DHL 
– diagnostic peritoneal lavage
DPT 
– difhteria pectussis tetanus (vaccine)
DVT 
– deep vein thrombosis
ECG 
– electrocardiogram
ENT organs – ear, nose, throat organs
ESR 
– erithrocyte sedimentation rate
GABA 
– gamma-amino-butyric acid
GBT 
– general blood test
GIT 
– gastrointetinal tract
HII 
– hemotological index of intoxication
HIV 
– human immunodeficiency virus
HTIG/ATG – human tetanus immunoglobulin/anti-tetanus immunolobulin
ICU 
– intensive care unit
IСD 
– international classification of diseases
IM 
– intramuscularly
IPPV 
– internittent positive pressure reyime
IU 
– international unit
IV 
– intravenously
LDH 
– lactate dehydrogenase
LII 
– leucocyte index of intoxication 

MOD 
– multiple organ dysfunction
MRT 
– magnetic resonance imaging
NAI 
– non-clostridial anaerobic infection
NK cells  
– natural killler cells
NMR 
– nuclear magnetic resonance
NSAIDs  
– nonsteroidal anti-inflamatory drugs
OT 
– operating theatre
PAS 
– para-aminosalicylic acid
PID 
– pelvic inflamatory disease
PMN 
– polymorphonuсlear leukocytes
PVC 
– polyvinylchloride
RTI 
– respiratory tract infection
SBP 
– spontaneus bacterial peritonitis
SIRS 
– systemic inflamatory response syndrome
SLE 
– systemic lupus erythematosus
SSI 
– serious surgical infection
STI 
– sexually transmitted infection
TNF 
– tumor necrosis factor
TPHA 
– treponema pallidum haemagglutination test
TPI 
– treponema pallidum immobilisation test
TPN 
– total parenteral nutricion
TPVP 
– total peripheral vascular resistance
UTI 
– urinary tract infection
UV 
– ultraviolet
VDRL test – veneral disease research laboratory test
WHO 
– World Health Organisation

CLASS 1
PURULENT SURGICAL INFECTION.  
ENDOGENOUS INTOXICATION
Educational goals
To study the etiology and pathogenesis of purulent-inflammatory 
diseases. Familiarize yourself with the clinical picture, methods of laboratory and instrumental diagnosis of purulent surgical infection. Learn to use 
the main options for conservative therapy and surgical treatment of purulent 
surgical diseases.
Behavioral goals
To develop the value-personal, spiritual potential of the student. To develop the qualities of a patriot and citizen, ready for active participation 
in the economic, industrial, socio-cultural and public life of the country. 
Helping the student realize the social significance of his future professional 
activity, learn to comply with academic and labor discipline, the norms of 
medical ethics and deontology.
Motivation for learning of the topic
The problem of pathogenesis and treatment of purulent surgical infection is one of the oldest sections of medicine and has a long history. Interest 
and constant attention to this old problem is explained primarily by the fact 
that the idea of purulent-inflammatory diseases is constantly changing along 
with the development of medicine, microbiology and technical sciences. 
Advances in the study of etiology, clinical forms, and methods of treatment 
of purulent surgical diseases are of theoretical and practical importance. 
Only having an accurate understanding of the function and mechanisms of 
interaction between bacteria and immunocompetent cells of the macroorganism, the degree of participation in the development of purulent-inflammatory processes, can it be possible to develop rational, highly effective 
methods for the prevention and treatment of purulent surgical diseases.
Requirements for the initial level of knowledge
The study of topic is carried out on the basis of the knowledge and skills 
acquired by the student in the sections of previously studied academic disciplines.

As a result of studying this class, the student must know:
1. Types of pathogens of purulent surgical infection.
2. Factors that determine the immunobiological state of the patient’s body.
3. Classification of purulent surgical infection.
4. Clinical signs of the inflammatory reaction.
5. Features of diagnosis of patients with purulent surgical infection.
6. Laboratory and instrumental research methods used in patients with 
purulent-inflammatory diseases.
7. Basic principles of conservative and surgical treatment of patients 
with purulent surgical infection.
8. Sources and ways of spreading hospital infections.
As a result of studying this class, the student should be able to:
1. Correctly interpret the complaints of a patient with a purulent surgical infection.
2. Consistently collect anamnesis of the disease and life in patients with 
purulent-inflammatory diseases.
3. Perform an objective examination of patients with purulent surgical 
infection.
4. Determine local signs of inflammation in the lesion.  
5. Correctly choose the method of treatment (conservative, surgical) for 
patients with purulent surgical infection.
Control questions from related disciplines:
1. Normal anatomy: the structure of the musculoskeletal system, internal organs and body cavities.
2. Normal physiology: physiological characteristics of the abdominal 
and thoracic cavities.
3. Pathological anatomy: inflammation.
4. Pathological physiology: infectious-toxic shock.
5. Topographic anatomy and surgery: topography of the skull, neck, 
chest, abdomen, projection of vessels and nerves of limbs on the skin.
6. Histology, cytology, embryology: histomorphology of the bronchi, 
lungs, hollow and parenchymal organs of the abdominal cavity, pleura and 
peritoneum.
7. Biological chemistry: biochemical indicators in normal and in pathological conditions.
8. Microbiology and immunology: types and properties of microorganisms; types of immunity.

9. Pharmacology: classification of antibiotics, local anesthetics, vasopressors, anticoagulants, anticonvulsants.
10. History of medicine: surgeons who made a significant contribution 
to the development of purulent surgery.
11. Radiation diagnostics: X-ray signs of purulent-inflammatory diseases of the skull, chest, abdomen and osteoarticular system.
12. Propaedeutics: methods of examining the patient.
13. General surgery: principles of asepsis and antisepsis; desmurgy; 
therapeutic immobilization; transfusion of blood and blood substitutes.
Control questions for practical class:
1. Surgical infection. Pathogens. The main factors determining the development and course of infection.
2. Classification of surgical infection.
3. Acute purulent anaerobic surgical infection. Etiology. Pathogenesis.
4. Clinical manifestations (general and local reactions).
5. Principles of treatment of acute hypertension. Conservative treatment.
6. Surgical treatment of acute hypertension.
7. Prevention of infection during operations. Hospital infection.
8. Endogenous intoxication. Pathogenesis, treatment.
Material equipment for class:
1. Medical equipment: samples of tourniquets, suture and dressing material, instruments and medications used to treat patients with purulent surgical infection.
2. X-rays with the possibility of demonstration on a negatoscope.
3. Photo albums, video material on lesson topics with the possibility of 
demonstration on a computer monitor.
General guidelines for conducting class:
1. Introduction. Organizational aspects. Checking the presence of students 
in class and the appearance of students. Introductory speech by the teacher. 
Answers to students’ questions that arose while preparing for the lesson.
2. Control of the initial level of knowledge. The teacher checks the initial level of knowledge of students by conducting test control.
3. Theoretical part of the lesson. Analysis of theoretical material. Testing students’ knowledge on the topic of the lesson through oral questioning. 
Listening to reports, abstracts, presentations, information messages from 
students on the topic of the lesson.

4. Practical part of the lesson. Supervision of patients in the wards, 
dressing room.
5. Monitoring the mastery of the topic. Solving situational problems orally.
6. Final part of the lesson. Summing up the current lesson. Issuance of 
final grades by the teacher. Familiarizing students with the grades received 
and, if necessary, explaining the criteria for assigning a particular grade. Explanation of tasks for the next lesson.
7. Guided independent work of students. Recommendations from the 
teacher for completing a section of an essay, message or multimedia presentation on a selected topic.
8. A break during the lesson for students to perform sanitary and hygienic measures and eat food.
Definition of the term
Infection is an invasion and reproduction of microorganisms in a macroorganism with the subsequent development of their complex interaction 
from the carriage of a pathogen to a severe disease [11].
Inflammation is the leading reaction of the body in acute purulent infection, a sign of a well-organized and expediently organized adaptability of 
the body.
Alteration – tissue damage, is the initial phase of inflammation, which 
determines the kinetics of the inflammatory response.
Exudation is the phase that quickly follows alteration and the release of 
mediators.
Cell proliferation is the final phase of inflammation aimed at restoring 
damaged tissues.
Abscess – focal purulent inflammation with the formation of a cavity 
filled with pus [11].
Phlegmon is a diffuse purulent inflammation in which purulent exudate spreads diffusely between tissue elements, penetrating, exfoliating and 
lysing tissues [11].
Historical aspects
The term infectio (latin. infectio – contamination) was first introduced 
in 1841 by Hufeland. Infection in surgery determines the essence of many 
diseases and postoperative complications. Until the 1860, surgeons were not 
able to perform surgeries because of the sever surgical site infection. The 
term “hospitalism” was first described by the English surgeon Erichsen and 
now days we call it nosocomial infection. Erichsen gave 13 recommenda

tions to prevent this infection – to day most of them are still valid. The first 
person to perform surgery by using his “antiseptic method” was Joseph Lister. His method lead to develop the modern “aseptic surgery”.
Relevance of the problem
A surgical infection is always a major problem in surgical practice. 
In about 2–4% of all hospitalized patient undergoing surgical interventions, 
surgical infections occur. Despite that most infections can be treated with 
antibiotics; still surgical infection remains a major cause of death after surgery. Epithelial surfaces act as mechanical barrier and phagocytes, antibodies; complements, macrophages, leukocytes, opsonins, etc. act as protective 
mechanisms. Asepsis (prevention of entry of microorganisms) and antisepsis (killing of the bacteria in the skin or tissues) has made a difference in 
surgical practice.
ICD-10 сoding
In the International Classification of Diseases, Tenth Revision (ICD-10), 
most cases of surgical site infections belong to nosological forms from 
L00 – L08, T79 – T88.
Classification of surgical infection
Currently, the following criteria are used for classifying surgical infection [11]:
I. According to the clinical course, there are:
1. Acute surgical infection:
● purulent;
● putrid;
● anaerobic;
● specific (tetanus, anthrax, etc.).
2. Chronic surgical infection:
● non-specific;
● specific (tuberculosis, syphilis, etc.).
II. By etiology:
● staphylococcus infection;
● streptococcus infection;
● pneumococcal infection;
● colibacillary infection;
● gonococcal infection;
● anaerobic non-spore-forming infection;