[Complex surgical treatment of recurrent post-injection abscess in a patient with systemic autoimmune disease]. / Kompleksnoe khirurgicheskoe lechenie retsidiviruyushchego postin"ektsionnogo abstsessa na fone sistemnogo autoimmunnogo zabolevaniya.

The authors present complex surgical treatment of a patient with rheumatoid arthritis and persistent wound in the right gluteal region after previous surgical treatment of post-injection abscess. According to these data, active surgical treatment of wounds and purulent-necrotic lesions of any etiology and localization, augmented by modern agents for local and systemic therapy (including phage therapy) provide favorable functional and cosmetic results even in patients with systemic autoimmune diseases receiving glucocorticosteroids. It is important to assess the wound process considering not only clinical data, but also objective information of qualitative and quantitative microbiological and cytological examinations.

[Morphological justification of the effectiveness of ultrasonic cavitation with 0.2]. / Morfologicheskoe obosnovanie éffektivnosti primeneniia ul'trazvukovoi kavitatsii s 0,2 % rastvorom lavasepta pri lechenii gnoino-nekroticheskikh oslozhnenii sindroma diabeticheskoi stopy.

AIM: Structural and functional analysis of cells from purulent-necrotic wounds in patients with diabetic foot syndrome undergoing ultrasonic treatment with 0.2% Lavasept solution. MATERIAL AND METHODS: It is presented morphological/ultrastructural analysis of wound specimens in 90 (DFS) patients aged 27-80 years with diabetic foot syndrome and purulent-necrotic complications who were hospitalized in the department of wounds and wound infections of the Vishnevsky Institute of Surgery in 2013-2016. Main group consisted of 75 patients, control group - 15 patients. Mean age was 58.4±8.2 years. All patients had diabetes mellitus type II for previous 13±4.5 years. Severity of foot tissue damage was assessed according to Wagner classification (F. Wagner, 1981). 46 (51.1%) patients had Wagner III-IV, 44 (48.9%) patients - Wagner II. Complex treatment included radical surgical management of purulent lesion, surgical revascularization for critical limb ischemia and foot reconstruction at the final stage. Additional measures were complete unloading of the foot, correction of carbohydrate metabolism and concomitant diseases. Topical treatment between surgical stages included dressing with 1.0% betadine solution (once a day). Ultrasonic cavitation was additionally applied in the main group. Electron microscopic examination of specimens was used before treatment, after 3-5 and 7-10 days in order to assess effectiveness of ultrasound cavitation for purulent-necrotic complications of DFS. RESULTS: Ultrasound cavitation with 0.2% Lavasept solution effectively cleans wounds from microbial and cellular detritus, destroys cellular membranes of biofilm-forming microorganisms, prevents their redo development and reinfection of the wound. Effective management of the wounds accelerates reparative processes that allows to perform foot reconstruction early.

[Actual cost of complex surgical treatment of patients with neuroischemic form of diabetic foot syndrome].

The results of calculation the average cost of complex surgical treatment of 52 patients with neuroischemic form of diabetic foot syndrome (Wagner 3, 4) are presented in the article. Calculation was performed in the program "Computer-aided system for calculation of patient's treatment cost" developed in A.V. Vishnevsky Institute of Surgery. This program permits you to analyze such components as hospital-stay duration, cost of surgery, pre- and postoperative management, pharmacotherapy, laboratory and instrumental research methods. Actual cost necessary to prevent high lower extremity amputations in patients with neuroischemic form of diabetic foot syndrome is 458 387.8 rubles per person that 10.02 times higher than amount allocated from the state budget.

Strategy of surgical management of peripheral neuropathy form of diabetic foot syndrome in ghana.

Introduction. Foot disorders such as ulceration, infection, and gangrene which are often due to diabetes mellitus are some major causes of morbidity and high amputation. Aim. This study aims to use a group of methods for the management of diabetic foot ulcers (DFU) in order to salvage the lower limb so as to reduce the rate of high amputations of the lower extremity. Materials and Methods. A group of different advanced methods for the management of DFU such as sharp debridement of ulcers, application of vacuum therapy, and other forms of reconstructive plastic surgical procedures were used. Data collection was done at 3 different hospitals where the treatments were given. Results. Fifty-four patients with type 2 diabetes mellitus were enrolled in the current study: females n = 37 (68.51%) and males n = 17 (31.49%) with different stages of PEDIS classification. They underwent different methods of surgical management: debridement, vacuum therapy (some constructed from locally used materials), and skin grafting giving good and fast results. Only 4 had below knee amputations. Conclusion. Using advanced surgical wound management including reconstructive plastic surgical procedures, it was possible to reduce the rate of high amputations of the lower limb.

[Peculiarities of surgical care in case of open injuries of limbs in emergency situations in peacetime].

It was done the comparative analysis of treatment results of casualties with open injuries of limbs in emergency situations in peacetime. It was determined that traditional approach of field surgery is unacceptable for this group of casualties. It is connected with limitations of evacuation and high frequency of complications. The developed modified surgical protocol permits not only to provide specialized care to casualties with soft tissue trauma and open fracture of limbs but also to reduce frequency of deep suppuration in 1.9 times. Also it allows to decrease number of dressings for one patient and period of the wound defect preparation to reconstructive plastic surgeries in 2.6 and 1.5 times respectively.

[Pyo-necrotic injuries in case of the neuro-ischemic form of diabetic foot syndrome].

It was analyzed the results of examination and treatment of 217 patients with neuro-ischemic form of the diabetic foot syndrome. Diabetic macroangiopathy with critical limb ischemia (TASC II) was diagnosed in all patients. Tissue foot damage of grade 3 (Wagner) was observed in 100 (46.1%) patients, grade 4 - in 117 (53.9%) patients. The developed strategy of surgical treatment includes the revascularization of an affected limb, surgical management of a pyo-necrotic focus and the plastic reconstruction of the foot after rapid relief of ischemia symptoms. An application of such treatment strategy led to preserve a foot or a stump of the foot in 205 (94.5%) patients.

[Specialized surgical care for children (victims of the earthquake) with open injuries].

The article presents the authors' experience of providing specialized surgical care for 197 children who had been affected by the earthquake in Pakistan (2005), Indonesia (2006 and 2009) and Haiti (2010). All victims had open injuries of soft tissues and bones. The article recites the strategy and principles of work organization of the mobile team of specialists from the Research Institute of Clinical and Research Institute of Urgent Pediatric Surgery and Traumatology in disaster areas. It includes the creation of a center for specialized surgical care for children, consultative work in all regional hospitals to where victims are initially evacuated, transportation and concentration of children with the most severe injuries in a specialized center. The basic principles of interaction with the central and local public health authorities and medical staff of hospitals were developed. The main characteristics of such injuries and their complications were defined as well. Mistakes made by the local and international surgical teams at the stages of primary and specialized surgical care were described. The effectiveness of the applied strategy of active surgical treatment of open injuries of soft tissue and bones complicated by surgical infection has been analyzed.

[Features of angenesis against the background of negative pressure wound therapy in patients with neuropathic and neuroischemic forms of diabetic foot ulcers].

The authors analyzed clinical (size, tissue oxygenation), histological (light microscopy) and immunohistochemical (CD68, MMP-9, TIMP-1) features of reparative processes of soft tissue of lower extremities in patients with diabetes mellitus against the background of vacuum therapy in comparison with standard local treatment. Patients (31 cases) with diabetic foot ulcers were followed-up after surgical d-bridement and before plastic closure of the wound. During perioperative period 13 patients obtained the negative pressure wound therapy (NPWT of 90-120 mmHg) and 18 patients had the standard care. Given results supported higher efficacy of NPWT as compared with standard local care. The therapy caused rapid reduction of wound and its depth, increased local microcirculation and reduced inflammation. These data were confirmed by the histological and immunohistochemical studies. The high efficacy of the method of local treatment could significantly reduce the time of wound preparation for the next step of surgical treatment.

[Single-step endovascular revascularization of the kidney, lower limb and endovascular reconstruction of abdominal aortic aneurysm in a patient with type 2 diabetic mellitus].

Presented in the article is a clinical example of surgical treatment of a patient with a severe course of type 2 diabetes mellitus, multiple lesions of coronary arteries, lower-limb arteries with the development of lower-limb ischaemia, bilateral lesions of renal arteries and chronic renal insufficiency, the presence of an aneurysm of the infrarenal portion of the aorta. The unique nature of the case report consists in joint work of endocrinologists, cardiologists, specialists in purulent surgery and reoentgenovascular surgeons, also in carrying out simultaneous endovascular reconstructive operation on various vascular basins: stenting of the right renal artery, balloon angioplasty and stenting of the left leg arteries and endovascular prosthetic repair of the abdominal aortic aneurysm. The comprehensive treatment of the patient resulted in safe performance of the endovascular intervention, saving the supporting function of the limb, improvement of glycemic control, decreasing the risk of sudden death on the background of abdominal aortic aneurysm rupture, decreased rate of progression of renal insufficiency, better control of symptoms of angina pectoris and cardiac failure. Also the article reflects importance of rendering medical care for patients with multifocal atherosclerosis and diabetes mellitus, also showing the necessity of creating multi-modality medical centres and working out of algorithms for treatment of this patient cohort.

[Medical care provision to the victim children of Haiti].

Treatment and diagnostic measures, including anesthesia during catastrophes and natural disasters are a world known problem. The paper presents the experience of anesthetic care provision during specialized surgical care to the victim children of the earthquake in Haiti. The materials of analysis were 529 anesthesias conducted to 72 children, who were in the treatment for crush syndrome, skeletal and concomitant injury. The peculiarities of anesthesia during the treatment of wound process depending on the stage of surgery are brought into view. During the preparatory phase the optimal type of anesthesia is inhalation and intravenous anesthesia, whereas for the defect closure (main stage) all types of anesthesia, including balanced endotracheal and combined anesthesia were used.

[The basic principles of treating patients with chronic osteomyelitis of the long bones]. / Osnovnye printsipy lecheniia bol'nykh s khronicheskim osteomielitom dlinnykh kostei.

Experiences with surgical treatment of 269 patients with chronic osteomyelitis of long bones based on the principles of active surgical treatment of purulent wounds were summarized. Certain aspects of surgical treatment of patients with chronic osteomyelitis were revised and supplemented. Different variants of surgical treatment of the osteomyelitis focus were shown depending on the volume and character of the injury and the methods of plastic substitution of defects of the bones and soft tissues. Main principles of antibacterial therapy for chronic osteomyelitis are described.

[Surgical treatment of long bones' chronic osteomyelitis]. / Khirurgicheskoe lechenie khronicheskogo osteomielita dlinnykh kostei.

The experience in surgical treatment of 269 patients with long bone chronic osteomyelitis based on the principles of active surgical policy for purulent wounds is summarized. Some aspects of osteomyelitis surgical treatment are reconsidered and complemented. Variants of osteomyelitic focus surgical debridement dependent on severity the lesion as well as methods of plastic replacement of bones' and soft tissues' defects are demonstrated.

[Plastic and reconstructive operations in purulent surgery and traumatology]. / Plasticheskie i rekonstruktivnye operatsii v gnoinoi khirurgii i travmatologii.

The authors propose a complex surgical treatment of extensive purulent wounds and tissue defects based on radical debridement of the pyonecrotic focus, primary and early reconstructive operations. New views on operation "debridement of a purulent wound" were formulated: it is considered as an initial element of the reconstructive surgery. 597 patients with extensive purulent wounds and tissue defects underwent plastic and reconstructive operations with good and satisfactory results in 96.6% of the cases.

[Etiopathogenetic principles fo surgical treatment for purulent wounds]. / Etiopatogeneticheskie printsipy khirurgicheskogo lecheniia gnoinykh ran.

Application of gas-liquid chromatography methods and mass-spectrometry enabled the authors to develop objective criteria, which provided prompt acceptance of quantity information about the stage ams severity of the wound process, its influence on the organism and prognosis of expectant complications (taking into account aerobic or anaerobic components of microflora) and early correction of surgical policy.

[Early reconstructive-restorative operations in vast traumatic injuries of shin complicated by purulent infection]. / Rannie rekonstruktivno-vosstanovitel'nye operatsii pri obshirnykh travmaticheskikh porazheniiakh goleni, oslozhnennykh gnoinoi infektsiei.

The experience in treatment of 278 patients with extensive traumatic injuries of the shin complicated by purulent infection is represented. Multistage treatment typical for such category of patients in which reconstructive-restorative stage is performed late after elimination of inflammatory process is not optimal. Owing to the complex of treatment measures based on the principles of active surgical treatment of festering wounds primary operations were a success in 24.6% of patients. In 75.4% of patients early dermoplastic and osteoplastic operations were carried out to 1 month after primary surgical treatment. Good and favourable results obtained in 98.6% of patients demonstrate effectiveness of the above policy of treatment.

[Staged tissue expansion in the surgery of suppurative wounds]. / Dozirovannoe tkanevoe rastiazhenie v gnoinoi khirurgii.

To close extensive infected wounds and to replace long bone defects, along with other methods a method of graded tissue strain (GTS) has been developed and introduced into practice (246 patients). The method differs from all others in that it requires no transfer of elaborate flaps while replacing soft tissue defects; and no graft or foreign body is introduced externally into the wound in replacing long bone defect. Soft tissue defect is gradually replaced by wound-adjacent intrinsic tissues, the wound is closed by related skin and bone defect is filled by an osseous regenerate which is formed during graded transposition of the osteotomized fragment. At the same time good blood supply and tissue innervation retain, which contributes to their resistance to purulent infection. The analysis of the findings has led to the conclusion that GTS is an indispensible contribution to the development of plastic purulent surgery allowing the anatomic and functional integrity of the diseased segment to be restored.

[Computed tomography in the comprehensive radiologic diagnosis of chronic osteomyelitis of the lower extremities and pelvis]. / Rol kompíuternoi tomografii v kompleksnoi luchevoi diagnostike pri lechenii khronicheskogo osteomielita nizhnei konechnosti i taza.

The role of computed tomography in multimodality radiation diagnosis was assessed in the treatment of chronic osteomyelitis of the lower extremity and pelvis in 218 patients (128 with posttraumatic osteomyelitis, 46 with hematogenic osteomyelitis of long bones, and 19 with chronic pelvic osteomyelitis) aged 16-78 years. Computed tomography was used to specify the symptomatology of chronic osteomyelitis, to define indications for radical surgical treatment. The soft tissues of the shin were studied in patients with chronic osteomyelitis versus lymphedema in 103 patients, post-thrombophlebitic syndrome in 17, acute wound infection in 9. The symptomatology of osseous regenerate in distraction osteosynthesis was studied (120 computed tomograms). It has been indicated that computed tomography is effective in studying the chronic osteomyelitis-inflicted extremity and pelvis in the pre- and postoperative periods.

[Treatment of extensive post-traumatic osteomyelitis of the long bones]. / Lechenie obshirnogo posttravmaticheskogo osteomielita dlinnykh kostei.

The principles of active surgical treatment of extensive posttraumatic osteomyelitis of the long bones made it possible to restore the anatomical and functional intactness of the affected extremities in 92 patients within a short time. All the patients were admitted from other medical institutions because the previous treatment was inefective. The developed therapeutic method consisted of the following main components: surgical debridement of the purulent focus with removal of all nonviable tissues; adequate immobilization of the bone fragments with apparatuses of external fixation; early restorative plastic operations; general intensive measures. The large wound surfaces were closed and the defects in the tissues were repaired by various plastic operations. Free dermatoplasty was performed in 38 patients, plastics with local tissues in 39, dosed soft tissue stretching in 19, plastics with a full-thickness graft on a nutrient supplying pedicle in 19, free plastics with a complex of soft tissues by means of microsurgical techniques in 6 patients, and different variants of compression-distraction osteosynthesis for repair of the bone defects were applied in all 92 patients. The results were satisfactory and good in 98.9% of cases. In 2 cases, which were not included in the group of discussed patients, amputation of the extremity was conducted immediately after admission because gangrene had developed.