IMPROVEMENT OF TREATMENT OF COMPLICATED FORMS OF DIABETIC FOOT SYNDROME.

Considering an increasing the incidence of diabetes mellitus, the aim of the study was to improve the results of treatment of patients with diabetic foot syndrome due to the proposed complex VAC-associated therapy. The use of this method within 5 days of treatment was increased the local blood flow of the wounds from 26-31 to 49-53 mm Hg (p<0.01), while in the comparison group the blood flow was at the level of 32-37 mm Hg. The granulation tissue in the wound developed on average by 4.76±0.82 days, which is significantly faster than in the control group - 9.88±1.13 (p<0.05). Wound contamination of the main group was 7.9±0.26 Lg CFU/g tissue for treatment, on the 5th day - 2.8±0.23 Lg CFU/g tissue, and the regenerative-inflammatory type of cytograms prevailed in smears-prints. On the 10th day - there was no pathological microflora in the wound, marginal epithelialization appeared, a cytogram of the regenerative type. At the same time, in the comparison group, the contamination before treatment was 7.7±0.19 Lg CFU/g (p<0.05), and on the 5th and 10th days the indicators were significantly higher - 6.1±0.18 Lg CFU/g (p<0.01) and 3.2±0.17 Lg CFU/g (p<0.01), respectively, and the cytograms still remained of the inflammatory type. Due to the improvement of microcirculation, rapid cleaning of the wound and a decrease in local signs of inflammation, stimulation of the growth of granulation tissue, microbial decontamination and a significant reduction in the time for cleaning and healing the wound, the proposed method of combined VAC-therapy can significantly reduce the time required to prepare the wound for its healing. The proposed complex method of VAC-therapy significantly improves the healing processes of wounds and shortens the treatment time for complications of diabetes mellitus.

[ENDOTHELIAL DYSFUNCTION AND MICROSCIRCULATION FEATURES IN PATIENTS WITH HIGH RISK OF DEVELOPMENT OF REPERFUSION SYNDROME IN CONDITIONS OF RECONSTRUCTION ARTERIAL OPERATIONS].

Aim - to study the state of the microcirculatory bed and the endothelial system in patients at risk of developing reperfusion syndrome and suggest methods for their correction. The work included 29 patients with obliterating diseases of the abdominal aorta and lower limb arteries with a high risk of developing reperfusion complications. Two groups of patients were identified. Group I - 8 patients, preoperative preparation include the generally accepted approaches. Group II - 21 patients whose preoperative preparation included, in addition to preparations for improving rheological blood conditions, prolonged epidural anesthesia, intravenous injection of hydroxyethylstarches, korvetin and alprostadil. In patients of both groups, a study was made of the state of the level of endothelial dysfunction, changes in capillary blood flow and arterio-venular blood shunting. Revascularization of the lower limbs in patients with a high risk of developing reperfusion complications leads to a deepening of endothelial dysfunction. The latter is characterized by a 2.3-fold increase (p<0.001) in the early postoperative period of circulating endothelial cells in the blood, by 2.5 times (p <0.001) endothelin-1, while a 1.3-fold decrease (p<0,05) P-selectin and in 1,7 times (p<0,05) E-selectin. The depth of the lesion of the endothelial system is indicated by a decrease of 29.9 % (p<0.001) in the level of NO. Deepening of endothelial dysfunction after reconstructive-reconstructive surgery is reflected in violations of the function of the microcirculatory bed. It is characterized by a 1.9-fold decrease (p<0.001) of skin perfusion, 2.0 times (p<0.001) in the erythrocyte concentration index and a 14% decrease (p<0.05) in capillary blood flow. This is facilitated by an increase of 14% (p<0.05) in skin perfusion pressure and an increase of 16% (p<0.05) in the resistance index of the microcirculatory bed, which leads to a decrease in tissue oxygenation to a level 3.38±0.14 mm.hg.

[MODIFIED SYSTEM OF THROMBOPROPHYLAXIS IN PATIENTS WITH SURGICAL PROFILE].

The aim of the study was to reduce the incidence of postoperative thrombosis in the veins of the inferior vena cava basin under planned surgical interventions by using a modified thromboprophylaxis method. Two groups of patients were studied in a total of 698 patients who underwent a risk assessment of postoperative venous thromboembolism (PVTE) using the J. Caprini scale (2012). According to the patients indicated in determining the degree of risk of HTHP development according to the J. Caprini scale, the level of surgical stress was simultaneously determined. The level of the latter was established by the content of glucose and cortisol in the blood in the preoperative period, during the traumatic stage of surgical intervention and in the early postoperative period. Introduction to the J. Caprini system of the degree of surgical stress objectifies the system for determining the risk of postoperative venous thrombosis. Inclusion of UFH (the prevailing influence on factor II) in the system of thromboprophylaxis of LMWH (predominant influence on Xa factor) with planned surgical interventions made it possible to reduce the incidence of postoperative thrombosis of the veins in the NIP basin by 1.8 (p<0.001) times.

[ОPTIMIZATION OF SURGICAL TREATMENT OF HEMORRHOIDAL DISEASE STAGES III-IV].

The treatment results in patients, suffering chronic hemorrhoidal disease stages III- IV, in accordance to the elaborated method of hemorrhoidectomy, using radio-wave scalpel «Surgitron TM¼ with further welding of vascular pedicle, applying high-frequency electrocoagulator ЕК-301М1, are presented. In the patients, оperated on in accordance to the method proposed, the intraoperative complications rate and the blood loss severity were essentially lesser than in a comparison group. Owing an adequate level of surgical skills, the operative treatment method elaborated guarantees the reduction of early and late postoperative morbidity, rapid coming back to routine way of living postoperatively.

[EXPEDIENCY OF THE INTRATISSUE ELECTROPHORESIS APPLICATION IN PREOPERATIVE PREPARATION OF PATIENTS, SUFFERING CHRONIC ANAL FISSURE].

The experience of preoperative application of the intratissue electrophoresis with the dioxysol solution was analyzed for the patients, suffering chronic anal fissure. In the patients, beginning from the first day, there was proved the reduction of the pain syndrome severity, hemodynamic disorders, an acute inflammatory reactions in the anal fissure tissue, the young granulations growth in the edge of the wound and resection. Application of the method proposed have promoted the inflammatory process severity reduction, the reparative processes in anal fissure stimulation, the operation wound epithelization acceleration, the anal sphincter muscle spasmelimination, which constitutes the main pathogenetic mechanism of the disease.

[MORPHOGENESIS OF THE ANODERM STRUCTURAL CHANGES IN PATIENTS WITH CHRONIC ANAL FISSURES].

The objective of the study is to find peculiarities of the anoderm structural changes of morphogenesis in patients with chronic anal fissures (CAF) for further substantiation of therapeutic methods. The material of the study was the tissues of dissected anal complex (bottom and margins of ulcer, hypertrophic anal papilla, sentinel pile) from 33 patients. Histological examination found the defect of the stratified squamous epithelium. The epidermis of the marginal area of the wound, hypertrophic with signs of parakeratosis and acanthosis, hanged over the bottom. The surface of the bottom and margins of the wound in 31 cases (94%) was with thickening of rough fibrous masses. The bottom of ulcer in 29 (88%) cases is presented by sclerosed connective tissue. An increased amount of collagen fibers was found forming fuchsinophil is bundles. In 24 (73%) cases the scar on the fuchsine bottom of fissure was 3,4 mm (0,3±0,02) in deep. There are separate complexes of newly formed blood vessels with prevailing localization in the lateral walls of the wound. The blood vessels were with main by fibrosis in deep areas of the wound. Moderate interstitial edema and focal interstitial inflammatory infiltration mostly of lymphocytes and fibroblasts were detected; the amount of macrophages was not substantial. Considering cicatrical rebuilding of the anoderm of ulcer bottom caused, first of all, by hypoxia leading to activation of collagen-producing function of fibroblastes and absence of the signs of epithelization, patients with CAF should be treated surgically dissecting the bottom and margins of fissure in the complex with hypertrophic anal papilla and sentinel pile.