Ihor Stoianovskyi
@new.meduniv.lviv.ua
Surgery Department #1
Danylo Halytsky Lviv National Medical University
RESEARCH, TEACHING, or OTHER INTERESTS
Surgery
Scopus Publications
Scopus Publications
, I.V. Stoianovskyi, S.D. Khimich, , O.M. Chemerys, and
Group of Companies Med Expert, LLC
The aim of this study was to investigate the effectiveness of digital infrared thermography in the early diagnosis and detection of areas of impaired perfusion and tissue necrosis in patients with necrotizing fasciitis. Materials and methods. This scientific work is based on observations of 10 patients with suspicion of necrotizing fasciitis during 2022-2023. The patients underwent thermography using a digital infrared thermal imaging camera to obtain heat maps and thermograms, which were then analyzed for abnormal thermal patterns. The results of the thermography were compared with other signs of necrotizing fasciitis to assess the accuracy of the method. Results. The study found that in patients with necrotizing fasciitis, there were three concentric zones with different surface temperatures around the main locus of infection. The central zone (N) had a lower temperature, the intermediate zone (F) had an increased temperature, and the outer zone (S) had a temperature close to normal for that area of the body. The results of statistical analysis indicated that there was no significant difference in temperature between the outer and intermediate zones. However, there were significant differences between the outer and central zones, as well as between the intermediate and central zones. The researchers found that the 5.720.23С temperature difference between the central zone (N) with reduced thermal emission and the intermediate zone (F) with increased thermal emission, is a sign of the late stage of necrotizing fasciitis. However, at the early stage of development of necrotizing fasciitis, the "N" zone is absent, although a pronounced "F" zone is observed, which is surrounded by the "S" zone with a temperature difference of approximately 1.920.28С. Conclusions. Distinct thermal patterns observed in patients with necrotizing fasciitis provide an opportunity to improve diagnostic accuracy and assist in timely surgical intervention. Continuing the study and improvement of medical thermography can make it possible to include it in standard clinical practice in the future to improve the diagnostic and treatment process of necrotizing fasciitis. The research was carried out in accordance with the principles of the Declaration of Helsinki. The research protocol was approved by the Local Ethics Committee of the institutions indicated in the work. The informed consent of patients was obtained for participation in the study. No conflict of interests was declared by the authors.
, T.I. Farmaha, O.V. Lukavetskyi, , O.M. Chemerys, , I.V. Stoianovskyi, and
Group of Companies Med Expert, LLC
The treatment of burn injuries is complicated by the proper diagnosis of areas requiring immediate necrectomy (deep burn) and those that can heal on their own (superficial burn). Non-contact thermography using the FLIR One device may be a reliable, non-invasive, and cost-effective method for assessing the depth of thermal injury. Aim - to study the temperature of healthy skin, deep and superficial burns using the FLIR One non-contact thermograph, the temperature difference between them, and the diagnostic value of the method for assessing burn depth. Materials and methods. The study involved 22 patients with limb burns. Thermometry of the affected areas was performed using the FLIR One thermograph within the first 48 hours after injury, before and during wound sanitation, with images analyzed using the FLIR One application. Results. The temperature of healthy skin was 34.7°C (34.4-35.1°C), the temperature of superficial burns was 35.8°C (35.5-36.2°C), and the temperature of deep burns was 32.4°C (32.0-32.8°C). The difference between healthy skin and deep burns was 2.3°C (2.2-2.4°C), and between superficial and deep burns was 3.4°C (3.0-3.8°C). A temperature of 33.7°C with non-contact thermography indicated a deep burn with 95% sensitivity and specificity. A decrease in the temperature of the affected skin by more than 2.0°C compared to healthy skin (2.2-2.4°C) or superficial burns (3.0-3.8°C) also indicated deep thermal damage. Conclusions. Thermography using FLIR One is a reliable and accessible method for analyzing the depth of burn wounds. The temperature of healthy skin during thermography is 34.7°C (34.4; 35.1)°C and is lower than the temperature of superficial burns (35.8°C (35.5; 36.2)°C) but higher than the temperature of deep burns (32.4°C (32.0; 32.8)°C). A temperature of 33.7°C with high sensitivity and specificity indicates a deep burn. The study showed that a temperature decrease of more than 2.0°C compared to healthy skin or superficial burns indicates deep thermal damage. The research was carried out in accordance with the principles of the Declaration of Helsinki. Informed consent of the child and child's parents was obtained for the research. The authors declare no conflict of interest.
Ihor V. Stoianovskyi, Sergii D. Khimich, and Orest M. Chemerys
ALUNA
The aim: To detect the ultrasonographic signs of necrotizing fasciitis (NF) suitable for its early diagnosis. Materials and methods: Eigty two patients with soft tissue infection, including 14 with necrotizing faciitis, were examined by ultrasonography at the admission. Ultrasonografic features were compared to intraoperative findings by the same surgeon. Results: The thickening of subcutaneous tissue had high sensitivity (100%), but low specificity (5.8%). The hypoechoic and hyperechoic zones had the shape of “cobblestone” with sensitivity – 78.5%, specificity – 33.8%. Higher specificity (69.1%) had sign of “cobblestone separation” on two layers. The presence of fluid above the fascia (sensitivity – 71.4%; specificity – 69.1%), thickening of the fascia (sensitivity – 85.7%; specificity – 58.8%), indistinctness of the fascia edges (sensitivity – 85.7%; specificity – 66.1%) and loss of fascial homogeneity (sensitivity – 71.4%, specificity – 66.1%) were noted in early stages of NF. Advanced cases of NF were accompanied by the dissection of thick¬ened fascia with a strip of fluid (sensitivity – 57.1%, specificity – 92.6%) and accumulation of a fluid under the fascia (sensitivity – 28.5%, specificity – 95.5%). The muscles thickening (sensitivity – 28.5%; specificity – 67.6%), skin thickening (sensitivity – 57.1%; specificity – 58.8%), and loss of the skin’s lower edge clarity (sensitivity – 57.1%; specificity – 63.2%) don’t have diagnostic value without other signs of NF. Conclusions: Point-of-care ultrasonography allows visualization of soft tissue changes that may be hidden in the initial stages of necrotizing fasciitis and should be recommended for implementation as mandatory method of examination in patients with suspected surgical soft tissue infection.
S.D. Khimich, , I.V. Stoianovskyi, O.M. Chemerys, , and
Group of Companies Med Expert, LLC
Purpose - to analyze the typical defects of the formulation of the diagnosis of necrotizing fasciitis (NF), to verify the lexically correct term NF, to develop proposals for the correct coding of NF according to ICD-10-AM. Materials and methods. The medical records of 150 patients who during 1999-2021 were treated in two hospitals of Lviv City (Ukraine) for necrotizing fasciitis was analyzed. Compared diagnoses when referred to the hospital, preliminary and final clinical diagnoses, preoperative and postoperative diagnoses, recorded their statistical codes for ICD-10. An analysis of Ukrainian and Russian-language surgical publications available in Ukraine for the period from 1985 to 2021 on the keywords «surgical soft tissue infection», «necrotizing fasciitis», «soft tissue necrosis». Results. In 142 (95.0%) of the 150 patients operated on for NF, the diagnosis was not correctly formulated during referral. Most often NF was directed and in the initial stages was treated under the guise of other diagnoses: «phlegmon», «erysipelas», «thrombophlebitis», «gangrene», «perianal abscess». NF was suspected by the surgeon prior to the first surgery only in 53 (35.33%) patients. In other cases, it was diagnosed intraoperatively or during repeated interventions. Codes corresponding to other forms of surgical infection were often used for statistical coding of NF. We also worked on lexical variants of the term «necrotizing fasciitis» in Ukrainian language. Conclusions. It was worked out the most correct terminologically Ukrainian equivalent of the diagnosis «necrotizing fasciitis». For statistical coding of NF, it should be designated as the main active disease by code M72.6. The use of a unified term and statistical coding will allow in the future to form a single within the state diagnostic-related group for fair reimbursement of funds to health care providers for treated cases of NF. The research was carried out in accordance with the principles of the Helsinki declaration. The study protocol was approved by the Local ethics committee of all participating institutions. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors. Key words: necrotizing fasciitis, terminology, international classification of diseases.