Application of Phagotherapy in the Treatment of Burn Patients (Review).

Treatment of patients with a burn injury is a complex process involving multicomponent multidirectional intensive therapy of the majority of organs and systems damaged by thermal effects on the skin, alternating with repeated surgical interventions aimed at removing nonviable tissues with subsequent plastic closure of wound defects. After the recovery from the burn shock, local infectious complications are considered to be the leading problem that decelerates the process of recovery and is the main cause of lethal outcomes. Since the skin integrity is broken, microorganisms penetrate readily into the internal environment of the human organism resulting in a septic state with multiple organ failure. A widespread and often uncontrollable use of antibacterial drugs in medical practice has led to the emergence of multiple drug resistance (MDR) in microorganisms. Introduction of drugs made on the basis of bacteriophages into practice is presently becoming increasingly important. This is confirmed by the growing interest in this field of pharmacology, the development of special programs aimed at studying the processes of phage and bacterial cell interaction. This review presents the main types of bacteria pertaining to MDR pathogens, principles of their classification, and the risk factors for infecting patients. The mechanisms of the selective action of phage particles on a bacterial cell and the possibility of using phage therapy in the treatment of burn injury (experimental and clinical data) based on the analysis of foreign literature are demonstrated as well as new positive properties of phages related to the changes in the macroorganism immune status caused by the interaction with bacteriophage particles.

Viability of Bacteriophages in the Complex Hydrogel Wound Dressings in vitro.

Using bacteriophages to overcome the increasing resistance of microorganisms to antibiotics is a novel research venue of clinical importance. Among other challenges, this technique is expected to create and maintain an adequate local concentration of bacteriophages at the site of application. In addition, the possibility of combining the phage preparation with antioxidants and anesthetics may provide new options for stimulating the reparative process. The aim of the study was to assess the viability and lytic activity of bacteriophages incorporated into a hydrogel-based wound dressing that contains polyvinyl alcohol, phosphate buffer, with optional additions of succinic acid and lidocaine. Materials and Methods: A technique for incorporating bacteriophages into the complex hydrogel wound dressing ex tempore has been proposed. The bacteriolytic activity of phages inside the hydrogel was determined using standard microbiological techniques. Specifically, we used nutrient media with lawn cultures of Staphylococcus aureus added with the following antibacterial combinations: bacteriophages + succinic acid, bacteriophages + lidocaine, and bacteriophages + succinic acid + lidocaine. The lytic activity of bacteriophages was assessed within 1 to 7 days after the formation of the hydrogel. Results: In all samples containing bacteriophages, the presence of viable and lytically active phages was noted within 1 to 7 days, as evidenced by the "negative colonies" on the culture lawns. On days 1 to 3, no secondary growth was recorded in the phage-containing samples. In hydrogel samples containing phages, succinic acid, and lidocaine, secondary bacterial colonies were detected starting from day 4 indicating some reduction in the lytic activity. Conclusion: The results suggest that bacteriophages immobilized in the hydrogel maintain their viability and lytic activity, and this activity persists when the phages are combined with succinic acid and lidocaine.

[The value of optical coherence tomography and morphometry in evaluating the peripancreatic adipose tissue in infected pancreatic necrosis]. / Znachenie opticheskoi kogerentnoi tomografii i morfometrii dlia otsenki sostoianiia parapankreaticheskoi zhirovoi kletchatki pri infitsirovannom pankreonekroze.

OBJECTIVE: To investigate the morphometric and optical coherence tomography (OCT) characteristics of the microstructure of retroperitoneal peripancreatic adipose tissue during passive drainage and active perfusion-aspiration drainage for infected pancreatic necrosis. MATERIAL AND METHODS: The authors analyzed 74 samples of peripancreatic adipose tissue obtained from 37 patients with passive (Group 1) and active perfusion-aspiration drainage (Group 2) of a focus of peripancreatitis. The tissues were examined with OCT, then fixed in a formalin solution and underwent histological examination, including morphometric one. RESULTS: The examined groups showed qualitative and quantitative differences in the tissue microstructure. In Group 1 samples, the proportion (median (upper quartile; lower quartile)) of interlobular connective tissue was 5.6 (3.9; 6.1)%; and that of adipocytes was 44.6 (41.2; 51.6)%. Necrotic tissue occupied 46.2 (35.6; 56.1)% of the area of specimens. The OCT images of necrotic tissue displayed a preponderance of unstructured regions with a high signal level while the parenchymal areas showed a cellular structured pattern. In Group 2 samples, the proportion of interlobular connective tissue was 16.2 (11.4; 19.7)%, and that of adipocytes was 68.5 (59.7; 71.2)%. At the same time, Group 2 exhibited necrosis - 14.4 (11.5; 19.2%) that was 3.2 times less than in Group 1. The OCT images of Group 2 samples showed a preponderance of cellular structured regions characteristic of the parenchyma, with pronounced stromal elements, which corresponded to the histological pattern. CONCLUSION: Active perfusion-aspiration drainage of peripancreatic adipose tissue versus passive drainage is associated with a smaller proportion of necrotic tissue (14.4% versus 46.2%; p≤0.05) and a larger proportion of a stromal vascular component (16.2% vs. 5.6%; p≤0.05). OCT could qualitatively distinguish viable fat tissue parenchyma from necrotic areas, without specially preparing the samples, which was confirmed by histomorphometric results.

[Survival of patients with primary and secondary amputations for critical lower limb ischaemia]. / Vyzhivaemost' pri vypolnenii pervichnykh i vtorichnykh amputatsii u bol'nykh s kriticheskoi ishemiei nizhnikh konechnostei.

The authors analysed therapeutic outcomes in a total of 171 patients presenting with critical lower limb ischaemia and subjected to amputation at various levels. In so doing, eighty-eight (Group One) patients sustained primary amputation and the remaining eighty-three (Group Two) patients endured secondary amputation after an initially undertaken attempt at revascularization. It was determined that performing primary amputation statistically significantly shortened the lifespan in the postoperative period as compared with secondary amputation performed. There was no clear-cut interrelationship between the presence of accompanying pathology and the lifespan in the post-amputation period. 18 months after discharge from hospital the mortality rate in Group One patients amounted to 52% and in Group Two patients to 29% (p<0.05).

[Intraabdominal pressure control by hernia repair].

Methods of indirect abdominal pressure measurement by hernia repair are studied experimentally and in clinic. The study resulted in the creation of the complex of preoperative patient preparation with the use of pneumobandage. The extent of safe intraabdominal pressure gradient after hernia closure is defined. A pressure pad for the autodermal transplant preparation and a new device with dynamometer for adaptation and reposition of wound edges are constructed and introduced into practice.

[Hardware controlled laparostomy in staged treatment of peritonitis with abdominal compression syndrome].

Clinical results of treatment were analyzed in 97 with patients generalized peritonitis. Application of staging hardware controlled laparostomy (HCL) allowed to halve the frequency of wound complication in comparison with semienclosed treatment mode. High clinical efficacy of control and correction of biophysical parameters of abdominal cavity was revealed: lethality from generalized peritonitis decreases in 2.4 times (from 39.3% to 14.3%) as a result of HCL application with monitoring and correction of intra-abdominal pressure in comparison with uncontrolled traditional treatment modes. Construction of the apparatus used for controlled laparostomy allows to open and close abdominal cavity under control of intra-abdominal pressure and tighting force of paravulnar tissues.

[Extrawound programmed vulnosynthesis in the treatment of festering wounds].

The treatment of 200 patients with granulating wound of soft tissues was analyzed. A conventional method of treatment was used in 90 patients. In the study group (110 patients) different types of adaptive-reposition devices and the method of extrawound programmed vulnosynthesis were used. This method demonstrated technical advantages compared with standard methods of treatment of festering wounds that permitted to improve the results of complex treatment.

[New trends in surgical technologies of soft tissue wound management].

The authors performed an animal model study of postoperative wound complications using 72 white Wistar rats and 36 mongrel dogs with aseptic cut wounds, granulating wounds, and relaparotomic wounds. In the control group the wounds were closed by a conventional method; in the main group a machine stitch was performed. Wound closure in the main group was performed after approximation of wound edges with specially constructed devices. Morphological and microbiological analysis showed that the key role in development of complications is played by morphofunctional wound substrate, which comprises the degree of paravulnar tissue traumatization with suture when a conventional method is used, and paravulnar tissue ischemia in case of microbial dissemination. The authors conclude that machine stitch is preferable.

[Experimental-clinical grounds for the treatment of granulating soft tissue wounds by the wound edge approximating stapler].

Factors of risk of the appearance of wound complications were studied in experiment on a model of granulating wounds in 18 mongrel dogs. A traditional method (control group) and an apparatus method (main group) were used for suturing the wounds. In the main group of animals suturing the wounds was performed after bringing together the wound edges by specially designed devices. Morphological and microbiological investigations have shown that the leading role in the appearance of complications belongs to the morphological substrate of the wound with the main component including the degree of traumatizing the paravulnerable tissue with a suture thread when connecting the wound edges by a traditional method, ischemia of the paravulnerable tissues under conditions of microbial dissemination. The introduction of the developed method of closing the soft tissue granulating wounds into clinical practice resulted in a statistically significant reduction of pyo-inflammatory complications in the main group of patients. A conclusion is made on a more favorable course of the wound process when using the apparatus method of closing the wounds.

[Wound-adapter in the treatment of purulent wounds]. / Primenenie ranoadaptera dlia lecheniia gnoinykh ran.

The method of closure of soft tissues purulent wounds with wound-adapter of original construction has been developed and used in clinical practice. This method provides complete reposition and adaptation of wound margins without suture eruption. Good results (primary closure) were achieved in 85.8% cases in the study group, and in 49.7% cases in the control group, satisfactory results (secondary closure partly) - in 14.2 and 50.3% cases, respectively. Hospital stay was reduced from 27.6 +/- 1.5 to 22.4 +/- 0.7 bed-days (p < 0,05).

[Surgical treatment of a carbuncle]. / Khirurgicheskoe lechenie karbunkula.

The results of the treatment of 250 patients with a carbuncle of various location were analyzed retrospectively. A differential approach to choice of surgical method with consideration of the degree, phase and localization of inflammation is preferable. Early and radical surgery, antimicrobic drugs, infusion therapy make base of up-to-date and adequate treatment. In the phase of infiltration deep incision often stops the disease or promotes a decrease of the necrotic zone. In suppurations linear incisions were made only on the face for cosmetic reasons. In other areas a few large connected T-, [symbol: see text]-, [symbol: see text]- or cross-formed incisions were preferable. In 30 cases I-formed incision with two rectangular flaps was used.

[Prophylaxis and treatment of eventration after relaparotomy]. / Profilaktika i lechenie éventratsii posle relaparotomii.

A method of prophylaxis and treatment of eventrations after relaparotomy using apparatus of transtissue fixation was fested clinically. The apparatus was used in 24 patients with acute abdominal surgical disease subjected to relaparotomy. The apparatus of transtissue fixation permits to shorten time of operation, to make easier the work of surgeon and assistants, to minimize damage to sutured inflamed tissues. Lethality was 16.7%. There were no eventrations.

[The use of adaptive-repositioning apparatus for the closing of granulating soft-tissue wounds]. / Primenenie adaptatsionno-repozitsionnykh apparatov dlia zakrytiia granuliruiushchikh ran miagkikh tkanei.

The authors propose a new method of closing granulating wounds by attaching its edges with the help of an adaptation-reposition apparatus. This method was used in treatment of 53 patients with granulating wounds of different localization. Good results were noted in 88.7% and satisfactory ones in 11.3%. The method was shown to be highly efficient as compared with the control group.