[FEATURES OF SURGICAL TREATMENT OF MINERS, WHO ARE VICTIMS OF METHANE-COAL MIXTURE EXPLOSION].

The article studied an influence of operative treatment on miners in the stage of burn shock, complicated by multi- and combined trauma and how these treatment options have changed the lethality and burn complications rates. All data based on an analysis of retrospective research. A primary surgical treatment of burn wounds was performed using simultaneous grafting by temporary biological cover for superficial burns during the burn shock stage in the main group of patients. For miners of comparison group this strategy hasn't been applied and they were operated after ending of burn shock. The rate of development of burn sepsis decreased in 3,2 times (p=0,0001), the frequency of pneumonia reduced in 2,91 times (p=0,0001) and toxic encephalopathy - in 1,7 times (p=0,004) in the main group in relation to the comparison group. The authors made a conclusion, that significant reduction of the rate of the most dangerous complications of burns allowed decrease of lethality in patients of main group in 2,6 times in relation to the comparison group. There wasn't carried out the primary surgical treatment of burns with covering of postoperative wound surfaces by temporary biological material during burn shock stage in comparison group.

[Effects of thermal injury on the reactivity of the neuroendocrine system]. / Vplyv termichnoho ushkodzhennia na reactyvnist' neiroendokrynnoï systemy.

To study reactivity of hypothalamo-hypophyseal-adrenal system to stress in patients with thermal skin burns we determined the content of cortisol in blood, chemosensitivity of glucocorticoid receptors on thrombocytes and effects of dexamethasone infusions on these parameters. In patients with normal reactivity of the organism and increased initial level of cortisol its content was shown to be increased by 34.1% in 2-3 hours after infusion of dexamethasone, but it decreased in 5-6 hours and subsequently. In patients with low initial level of cortisol dexamethasone caused prolongation of the hormonal response (the level of cortisol increased by 57.9% in 2-3 hours; by 27.1% in 5-6 hours, and by 16.9% in 24 hours as compared to the initial level), which is a manifestation of its modifying effect on the reactivity of the system to stress. In these patients decrease in chemosensitivity of glucocorticoid receptors should be taken into consideration at analysis of the inflammatory reaction owing to modifying effects of steroid hormones on the cytokine production.

[Early surgical treatment of injured persons with subfascial electric burn of extremities in combination with preparation Betadine]. / Rannee khirurgicheskoe lechenie postsradavshikh s subfastsial'nym élektroozhogom konechnostei v komplekse s preparatom Betadin.

Basing on the clinical material analysis, on bacteriological investigation data, smear-"prints", the authors recommend application of 10% solution of Betadine for sanatation of the electric wounds with subfascial structures affection, what have permitted to accelerate the wound surface clearance, to reduce exudation, to activate the primary granulation tissue development to prepare the wound for its plastic closure. Application of Betadine in conditions of aseptic inflammation had promoted the secondary necrosis occurrence in the tissue ischemia after deep burn occurrence.

[Early surgical treatment of injured persons with very severe burns]. / Rannee khirurgicheskoe lechenie postradavshikh s naibolee tiazhelymi ozhogami.

The experience of treatment of patients with deep burns measuring 20% and more of the body surface was summarized. In the principal group 29 injured persons were operated on the 5-7th days after trauma, in the control one in 28 burned persons the skin transplantation was accomplished on granulating wounds. In the principal group lethality was 24.1%, in a control one--42.9%.

[The surgical treatment of deep burns in the course of the 1st week after the trauma]. / Khirurgicheskoe lechenie glubokikh ozhogov v techenie pervoi nedeli posle travmy.

Results of treatment of 252 patients with burns, to 138 of whom an early necrectomy in terms from several hours to 7 days was conducted, are adduced. Surgical concept of discrimination of the excised deep burn wounds of III and IV degrees according to the depth of affection, using the organ-preserving tactics in dependence of functional state and the cutaneous and fascial wound coverage safety, was proposed. The operative treatment tactics choice depending on indications and contraindications for securing of successful treatment of deep burns was discussed.

[Cryotherapy of postburn hypertrophic scars]. / Krioterapiia posleozhogovykh gipertroficheskikh rubtsov.

A technique for cryotherapy of the postburn hypertrophic scars, and a method for protection of the surrounding tissues from damaging effect of the low temperatures have been suggested. In 76.4% of patients, a good cosmetic result has been obtained.

[The accelerated training of skin-fascia flaps]. / Uskorennaia trenirovka kozhno-fastsial'nykh lpskutov.

The suggested method for training cutaneofascial flaps is based on the results of histological studies, it can be applied in the early postoperative period, and reduces the intervals between the stages of plastic surgery with flaps. Training is possible in any localization of the cutaneofascial flap.

[Early surgical treatment of deep burns]. / Rannee khirurgicheskoe lechenie glubokikh ozhogov.

Twenty four patients with deep burns were treated. Survival of free transplants was noted in excision of the necrotic tissues to fascia. An unsatisfactory result of plasty was noted in perifocal inflammation and leaving a necrotized crust along the periphery. In use of mesh transplants with an enlargement coefficient 1:2, the optimal survival was achieved.

[Free transfer of the latissimus dorsi flap to sites with decompensated regional blood flow in burn and vascular surgery]. / Svobodnaia peresadka loskuta shirochaishei myshtsy spiny v zony s dekompensirovannym regionarnym krovotokom v ozhogovoi i sosudistoi khirurgii.

In the experiment, a sluggish wound of an extremity against the background of chronic ischemia was modelled in white rats. Then, a scapular muscle was transferred onto a wound defect. Free transfer of the latissimus dorsi flap (LDF) aimed at closure of the extensive wound defect and revascularization of the tissue ischemia area was performed in 29 patients: for high-voltage electric burn (12 cases), frostbite (5), radiation ulcer (4) and obliterative diseases of the lower extremities (8). Complications--partial, or total necrosis of a flap--occurred in 11 patients. Risk of free LDF transfer is justified because of absence of the other methods for prevention of amputation of the extremities.

[Burns of the auricular conchae, their complications and treatment]. / Ozhogi ushnykh rakovin, ikh oslozhneniia i lechenie.

Clinical observations over 130 patients with burnt conchae of the auricle allowed the injuries to be subdivided into two groups: primary and secondary lesions. Primary lesions are associated with the direct effect of the thermal factor upon the concha of the auricle while secondary lesions are related to infectious complications of burns. The classification of thermal lesions presented here may help provide adequate and timely therapy. When treating burns of conchae of the auricle, it is important to prevent burn dissemination and suppuration of the wound.

[Diagnosis, classification and treatment of burns of the auricular conchae]. / Diagnostika, klassifikatsiia i lechenie ozhogov ushnykh rakovin.

On the basis of observation of 239 sufferers with burns of the ear auricles and analysis of clinical data, the authors have suggested a classification of such lesions. Primary lesions are associated with a direct influence of the thermal factor on the ear auricle tissues, and the secondary ones--with addition of infection. In treatment of the sufferers with burns of the ear auricles one should aim at prevention of the deepening of the burns and suppuration of a burn wound.