Local Infectious Complications Research Articles

Validation of the Global Leadership Initiative on Malnutrition Criteria for Predicting Adverse Outcomes in Acute Pancreatitis.

The Global Leadership Initiative on Malnutrition (GLIM) has proposed criteria for the diagnosis of malnutrition. No studies validated the GLIM criteria in acute pancreatitis (AP). The present study aimed to validate the predictive capacity of GLIM criteria for adverse outcomes in AP patients. Clinical data of 269 patients with AP were analyzed retrospectively. The Nutritional Risk Screening 2002 (NRS2002) was chosen as the screening tool. Multivariate logistic regression analyses evaluated the adverse clinical outcomes in malnourished patients. Overall, 160 patients (59.5%) were at nutritional risk and 38 (14.1%) were malnourished. Reduced muscle mass/ low bodymassindex + inflammation combinations contributed most to malnutrition overall and in each subgroup. The malnourished group had lower hemoglobin, neutrophils, albumin, total cholesterol, and triglycerides than the well-nourished group. The malnourished group had higher hospitalization costs (CNY, 11319.34 vs 9258.22, p <0.001) and more local complications (34.2% vs 14.7%, p =0.009) than the well-nourished group. There was an interaction between malnutrition and overweight/obesity on local complications (p for interaction = 0.023). Multivariate logistic regression showed malnutrition was significantly associated with local complications (OR 12.2, 95% CI: 2.51-59.37), infectious complications (OR 9.95, 95% CI: 1.25-79.44) and composite adverse outcome (OR 4.78, 95% CI: 1.05-21.73) in the overweight/obesity subgroup. There was no association between malnutrition and the rate of various adverse outcomes in the non-overweight/obesity subgroup. Additionally, we observed an association between malnutrition and composite adverse outcome (OR 6.75, 95% CI: 1.49-30.68) in patients <70 years only in females. Malnourished AP patients were more likely to have adverse outcomes than well-nourished patients. Malnutrition was associated with various adverse outcomes only in the overweight/obesity subgroups.

Features of the neutrophil granulocyte system in patients with common scalp defects

Objective. To identify the dynamics of changes in the structure of the neutrophil granulocyte system in patients with extensive scalp defects before and after their surgical closure. Materials and methods. A computer morphometric analysis of the quantitative and qualitative characteristics of neutrophilic granulocytes of patients with common scalp defects who were treated at the Department of Microvascular Plastic and Reconstructive Surgery of the Shalimov National Scientific Centre of Surgery and Transplantation from 2017 to 2023. The main group included 15 patients with widespread defects of the soft tissues of the scalp in the I – II stage of the wound process (10) and arteriovenous angiodysplasias in the III stage according to Schobinger (5). The control group consisted of 15 volunteers without pathology. The structure features (optical cytoplasmic density in units, which indicates the presence of bactericidal potential, and cell area in μm², which indicates the level of activation) of peripheral blood neutrophil granulocytes before and after surgical closure of the defect were studied. Results. Before the surgical intervention, a pronounced polymorphism was detected, which meant a functional failure of the neutrophil granulocyte system. After surgery and healing of the defect, excessive polymorphism of the neutrophil granulocyte system was not detected in patients. Conclusions. The assessment of the degree of cellular polymorphism of neutrophil granulocytes determines the diagnostic efficiency of the study and makes it possible to identify and predict the development of local inflammation and infectious complications in patients with scalp defects.

Relationship between Intraoperative Bile Culture Outcomes and Subsequent Postoperative Infectious Complications: A Retrospective Cohort Study.

The presence of positive bile culture during intraoperative procedures has been associated with elevated morbidity and mortality rates in hepatobiliopancreatic surgeries, contributing to increased healthcare expenditures. However, the precise impact of bactobilia on the development of postoperative complications remains uncertain due to existing disparities in the published literature. In this retrospective cohort study, we assessed 137 patients who underwent major hepatobiliopancreatic surgery to examine the relationship between intraoperative bile culture outcomes and subsequent postoperative infectious complications. Among patients with bactobilia, a significant 35.1% exhibited systemic or local infectious complications, whereas only 11.1% of those with negative culture results experienced any infectious complications (p = 0.002). Similarly, a notable difference was observed in the incidence of surgical site infections, with 24.3% in the bactobilia group compared to 7.9% in the negative culture group (p = 0.01). A total of 74 monomicrobial cultures with microbiological growth were isolated, predominantly featuring Gram-negative microorganisms, primarily Enterobacteriaceae in 49 cultures. Escherichia coli was identified in 37.8% of positive cultures, while Klebsiella pneumoniae was evident in 21.6%. Gram-positive microorganisms were present in 10 cultures, with Enterococcus emerging as the prevailing species. The logistic regression model identified a positive bile culture as an independent factor significantly associated with infection development (OR: 2.26; 95% confidence interval: 1.23-11; p = 0.02). Considering the limitations of the study, these findings underscore the critical importance of conducting bile cultures during the intraoperative phase to enable vigilant monitoring and prompt management of infectious complications.

Nutritional support in patients with acute pancreatitis. Review of published studies

Acute pancreatitis is a common disease that occurs in 5—10% of patients with urgent pathology of the abdominal cavity. The most prevalent metabolic disorders affecting this group of patients are hypermetabolism and hypercatabolism syndromes, which are accompanied by excessive consumption of carbohydrates, fats, and amino acids, increased oxygen intake, and carbon dioxide production.&#x0D; Objective — to analyse the current state of the problem of nutritional support for patients with acute pancreatitis.&#x0D; The degree of nutritional disorders in patients with acute pancreatitis varies depending on the etiological factors and severity of the disease, necessitating a differential approach to their correction. Patients with acute pancreatitis experience disruption of the intestinal microflora due to the antibiotic therapy, nutrient and fiber deficiency, and lack of microbial antagonism. This disruption leads to excessive growth of bacteria, particularly gram‑negative microflora. The effectiveness and safety of enteral tube feeding are determined by a complex of factors: the timing of recovery of peristalsis and the absorption function of the intestinal wall, the type of mixture, and the method of its administration. Restoration of intestinal absorption in patients with severe acute pancreatitis occurs on average 48 hours after the start of complex conservative therapy. The use of antiflatulents as part of a mixture for enteral nutrition allows to improve the laboratory indicators of blood serum and reduce the frequency of intestinal complications on the 7th day by 21.5% (χ2=4.88, 95% CI 2.3—39.5, p=0.03). Nasogastric nutritional support in patients with severe acute pancreatitis is safe and leads to a 25.8% reduction in the incidence of local infectious complications (χ2=4.59, 95% CI 2.43—45.53, p=0.03), length of hospital stay by 16 days (p=0.04), and deaths by 21.4% (χ2=4.13, 95% CI 0.81—39.68, p=0.04) in comparison with parenteral nutrition. Nutritional support should be started with nasogastric administration of a food mixture, and in case of complications (intolerance, aspiration, etc.), nasojejunal administration. Parenteral nutrition should be used if enteral nutrition is impossible or not tolerated.&#x0D;

Pathomorphogenesis of Thermal Injury in Animals

In the practice of a veterinarian, it is not often, but you have to deal with various injuries and wounds in animals. Burn wounds heal especially hard in animals. And death often occurs from intoxication or septicaemia Physiological processes in the body of animals take place at a certain body temperature, which is peculiar only to a certain type of animal. Changes in the thermal parameters of the body lead to pathological changes. And a stronger increase or decrease in body temperature parameters can lead to death. Thermal injuries in animals can be caused by the action of open fire, boiling water, chemicals, ionizing radiation, as well as by improper use of electric heaters or insufficiently grounded plates of electric scooters. A thermal wound is a pathological process with a violation of the integrity of the skin, which leads to a decrease in the basic functions of the body, severe injury and death. The degree of tissue damage depends on the type of active damaging factor, its strength and duration of exposure. [5] Local infectious complications are very common in thermal burns. The resulting infection slows down the healing of burn wounds and contributes to the formation of scars [6]. The contamination of wounds with bacteria begins immediately after the burn and consists of conditionally pathogenic bacteria of the environment or the animal’s own biome.

Метаболічні порушення, спричинені гострим панкреатитом, та їх корекція за допомогою ентерального харчування пацієнтів

The occurrence of hypermetabolism and hypercatabolism syndromes in patients with acute pancreatitis is associated with the release of pro-inflammatory cytokines, which leads to an increase in energy consumption and basic metabolism, which depend on both the severity of the course and the duration of the disease. The aim of our work was to investigate the state of the problem of nutritional support for patients with acute pancreatitis at the current stage. The degree of nutritional status disorders in patients with acute pancreatitis varies depending on the etiological factors and severity of the disease and requires a differentiated approach to their correction. With the development of hypermetabolic syndrome, energy consumption can increase by 77-158%. Nutritional support is an important component of acute pancreatitis therapy, the goal of which is to ensure adequate caloric intake, modulate the response to oxidative stress, and counteract catabolic effects during the course of the disease. Restoration of intestinal absorption in patients with severe acute pancreatitis occurs on average 48 h after the start of complex conservative therapy, which is the optimal time to start enteral nutrition. Nasogastric nutritional support in patients with severe acute pancreatitis is safe and leads to a 25.8% reduction in the incidence of local infectious complications, length of hospital stay by 16 days and deaths by 21.4% in comparison with parenteral nutrition. The use of antiflatulents as part of a mixture for enteral nutrition allows to improve the laboratory indicators of blood serum, to reduce the frequency of intestinal complications by 21.5%. Nutritional support should be started with nasogastric administration of food mixture, and in case of complications (intolerance, aspiration, etc.), nasojejunal administration. Parenteral nutrition should be used if enteral nutrition is impossible or not tolerated.

РЕТРОСПЕКТИВНЫЙ АНАЛИЗ ПРИЧИН РАЗВИТИЯ ИНФЕКЦИИ В ОБЛАСТИ ХИРУРГИЧЕСКОГО ВМЕШАТЕЛЬСТВА У ПАЦИЕНТОВ СТАРЧЕСКОГО ВОЗРАСТА ПОСЛЕ ЭНДОПРОТЕЗИРОВАНИЯ ТАЗОБЕДРЕННОГО СУСТАВА

Infectious complications of surgical site after hip replacement in elderly and senile patients is one of the most severe complications, occurring from 0.3% to 15.0% of cases. Periprosthetic joint infection (PJI) in patients of this age group with the background of severe concomitant pathology is not uncommon cause of disability and fatal outcomes. The article highlights significant risk factors of periprosthetic infection after modern endoprosthetics. A retrospective analysis of the treatment of 504 patients after primary arthroplasty for femoral neck fracture from 2017 to 2021 was performed. Thirty-eight patients (75%) suffered from local infectious complications in the form of PJI in the postoperative period. The main factors contributing to PJI include male gender, 84-88 years age group, more than 5 concomitant diseases, late hospitalization and surgical treatment (after more than 48 hours).

Вакуум-активна терапія у комплексному лікуванні постраждалих із вогнепальними пораненнями

VAC-therapy — сучасна новітня методика лікування ран, що значно поліпшує перебіг усіх стадій ранового процесу: зменшує локальний набряк, сприяє посиленню місцевого кровообігу, знижує рівень мікробного обсіменіння, призводить до відносно швидкого зменшення ранової порожнини, скорочуючи термін загоєння. Ціллю нашого дослідження було визначити клінічну ефективність використання VAC-therapy у лікуванні постраждалих із вогнепальними пораненнями. Для виконання нашого дослідження ми проаналізували лікування 74 постраждалих із вогнепальними пораненнями, що були отримані в результаті бойових дій, які лікувались у Військово-медичному клінічному центрі Центрального регіону в період 2015–2016 років. Проведене дослідження показало, що використання VAC-therapy є можливим у постраждалих із місцевими інфекційними ускладненнями вогнепальних поранень, значно покращує результати лікування ранового процесу у постраждалих із вогнепальними пораненнями, ускладненими гнійною інфекцією, що дозволяє рекомендувати VAC-therapy у клінічне використання.

Local infectious complications in cardiac surgery: etiology and the role of antimicrobial prophylaxis

To investigate the relationship between antimicrobial prophylaxis protocol, prevalence and etiology of local infectious complications after open cardiac surgery. A retrospective cohort observational study was performed between 2010 and 2019 at the Ural Institute of Cardiology. Antimicrobial prophylaxis was performed using the main (cefuroxime 1.5 g IV every 6 hours) and alternative protocols (vancomycin 15 mg/kg IV every 12 hours). The prevalence of local infectious complications throughout the entire follow-up period was 4.5±0.3% [95% CI 4.45-4.54]. There were 42 cases of deep infection (0.9±0.13%). Coagulase-negative staphylococci prevailed (15.9±2.5% of cases, 35 cultures). Resistant flora included coagulase-negative methicillin-resistant staphylococci (13 cultures, 37.1±8.2%) and representatives of Enterobacteriaceae family, producers of extended-spectrum beta-lactamase (8 cultures, 50.0±18.2%). Antimicrobial prophylaxis with vancomycin increases the risk of local infectious complications (OR 1.75, 95% CI 1.20, 2.55, p=0.001). Both protocols of antimicrobial prophylaxis demonstrated comparable efficacy against gram-positive and gram-negative microorganisms. Coagulase-negative staphylococci are the most common cause of local infectious complications in cardiac surgery. Modern antimicrobial prophylaxis regimens are relevant despite resistant flora.

Fast track recovery protocols for extended pelvic surgery

To compare the immediate results of extended pelvic surgery before and after introduction of standardized fast track surgery (FTS) protocol into routine clinical practice. The study included 111 patients with pelvic tumors who underwent extended pelvic surgery. The control group included 59 patients whose perioperative management implied traditional approaches (2018-2019), the main group - 52 patients with FTS protocol (2020-2021). Age, BMI and ECOG status were similar. In the main group, females (90.4% vs. 74.6%; p=0.046), patients with recurrent (46.2% vs. 22.0%; p=0.009) and complicated tumors (26.9% vs. 11.9%; p=0.054) prevailed. Obstructive resection without anastomosis was less common in the main group (28.8% vs. 47.5%; p=0.068). Surgery time was higher (319±125 min vs. 236±79 min, p<0.001) in the main group, but blood loss (238±154 ml vs. 282±150 ml, p=0.029) and incidence of blood transfusions (23.1% vs. 42.4%, p=0.043) were lower. Moreover, complications (36.6% vs. 54.3%; p=0.086), mild complications (Clavien-Dindo class I-II) (11.6% vs. 28.8%; p=0.034) and local infectious complications (19.2% vs. 42.4%; p=0.009) were less common in the main group. Two patients died in the control group due to sepsis following colonic anastomosis and bladder suture failure, respectively. Postoperative hospital-stay was similar (14±9.1 days vs. 14.4±9 days; p=0.89). FTS protocol is possible and safe in patients with locally advanced and recurrent malignant pelvic tumors. This approach reduces blood loss, the number of blood transfusions and risk of postoperative infections.

Extensor Mechanism-Sparing Technique for Management of Proximal Tibia Sarcoma Resection: A Case Series Study

The proximal tibia is one of the most challenging anatomic sites for resection of large bone tumors, due to the vicinity of the extensor mechanism. Here, we report outcomes of a novel radical resection technique which preserves the extensor apparatus. 8 patients were operated between 2001 and 2011 for large sarcomas with high-grade tibial localization. Six were giant cell tumor of bone histology (GCTB; defined as severe bone destruction and soft tissue extension) and two chrondrosarcoma at surgical grade G1, but with double localization in tibia and femur. Primary bone tumors and recurrences were treated with novel multiplanar resection technique avoiding removal of the tibial tuberosity and the patella tendon insertion, preserving extensor mechanism. In all cases, curettage and borage were not indicated due to extensive lesion size. Radical resection of the lower extremity (2 femurs and 8 tibias) yielded wide margins (R0) and patients were evaluated at 10 years of follow up. The average post operative Musculoskeletal Tumor Society (MSTS) score was 26.87 points (range: 23-29). All patients reached full passive and active extension and the maximum active flexion was 108.75° (range: 90°-120°). At the last follow-up (mean: 121.8 months), all patients and implants survived; no local infection, recurrence, metastasis, or relevant complications occurred. This surgical technique therefore appears to provide a safe treatment option when wide surgical margins are possible, and preserving the integrity of the extensor mechanism may improve the clinical outcome.

Результаты применения противоспаечного геля после моделирования контузионного повреждения спинного мозга у крыс

Objective was to investigate an effect of anti-adhesion hyaluronic-containing resorbable gel on the course of traumatic spinal cord disease caused by a simulated contusion spinal cord injury (SCI) in rats. Material and methods A moderate spinal cord injury was simulated at the Th9 level of 40 female Wistar rats that were randomly divided into 2 groups. Group I received hyaluronic-containing absorbable antiadhesion gel Antiadgezin® that was intraoperatively applied to the dura mater of experimental rats; Group II of control rats received no gel. The BBB locomotor rating scale was used to evaluate the extent of recovered pelvic limb function. The animals were sacrificed on days 5, 15, 30, 60 and 90. Paraffin and epoxy semi-thin 1 μm sections were used for morphological examination of the spinal cord using light microscopy. Results The gel used for contusion SCI in rats caused neither significant changes during postoperative period nor local infectious and inflammatory complications, and showed no negative impact on functional results. Morphological examination revealed pathomorphological changes that were identical for both groups and characteristic of contusion SCI showing softening, necrosis of the nervous tissue, tissue and cell detritus of gray and white matter, small cysts in the early stages of the experiment; progression of syringomyelia and formation of large cysts primarily seen in the gray matter and the onset of regenerative processes in the white matter at 60 and 90 days of the experiment. Conclusion The absence of a negative effect of the anti-adhesion hyaluronic-containing resorbable gel on the functional results, and morphological characteristics of the spinal cord offer the opportunity of the further experimental use as a carrier of substance composition initiating beneficial metabolic and neuroprotective action for transdural delivery in simulated SCI.

Role of early enteral feeding in mild and moderate acute pancreatitis

Background: Timing of enteral feeding in acute pancreatitis was always a matter of controversy. Increasing evidence suggests that early enteral feeding reduces systemic and local complications of pancreatitis and thereby hospital stay. Hence the study has been undertaken to determine the feasibility, advantages and disadvantages of early enteral feeding in mild and moderate acute pancreatitis. Methods: Patients admitted with symptoms and signs suggestive of mild and moderate acute pancreatitis who were started on early enteral feeding (within 48 hours of admission) were included in study. Blood investigation results are used to classify patients accordingly to mild and moderate acute pancreatitis based on Ransons’s score. Patients were followed up and categorized based on development of complications, length of hospital stay.Results: Majority of the patients who were started on early enteral feeding showed significant decrease in complications and hospital stay. Study also suggested that age is a significant risk in development of complications. Gender is not significant in the development of complications.Conclusions: There is significant decrease in rate of systemic complication, local infective and non-infective complications, length of hospital stay among acute pancreatitis patients who were started on early enteral feeding (within 48 hours).

PECULIARITIES OF THE WOUND PROCESS DEVELOPMENT IN PATIENTS WITH THERMAL INJURY WHEN USED SILVER PREPARATIONS IN BURN WOUNDS SURGICAL TREATMENT

Fundamental research in the field of burn wound development process highlights new pathogenetic mechanisms that underlie the improvement of medical practice, the main purpose of which is to create optimal conditions for early regeneration of the affected skin, as well as to eliminate the development of local and general complications. Irrational general and local treatment of wounds contribute to the slowing down of regenerative processes, thereby worsening the prognosis and consequences of thermal injury.&#x0D; It was found out that in patients of both study groups in the first period of the study the characteristics of the cellular composition of the wound impressions of the wound bottom of the area of thermal damage correspond to the degenerative type.&#x0D; In patients of the main group in the second term of the study in the area of thermal damage cells with high levels of functional and metabolic activity begin to appear, which increase antimicrobial resistance and reduce the risk of generalization of the infectious process which is the main source of burns.&#x0D; In patients of the main group, an increase in the activity of neutrophilic granulocytes in the induced test was found in the second term of the study, which, in our opinion, indicates the involvement of neutrophilic granulocytes with high functional and metabolic activity. Under conditions of significant activation of resident monocytes in response to injury in patients of the main group in the second and third term, the area of thermal damage migrates functionally effective monocytes. In patients of the main group the preservation of the activity of myeloperoxidase - the main enzyme of the oxygen-dependent phase of phagocytosis at the minimum subcompensated level, which leads to the preservation of the oxygen-dependent metabolic reaction of neutrophilic granulocytes in the subsequent study, Increases in the content of PAS-positive substances in neutrophilic granulocytes indicate the preservation of the functional reserve for activation and completion of the oxygen-independent phase of phagocytosis.&#x0D; The use of the developed treatment promotes the involvement of functionally active phagocytic cells in the burn wound, reduces the toxic load on monocytes and neutrophils, which helps to maintain their functional activity at the subcompensated level. These trends in patients of the main group reduce the risk of both local and general infectious complications of burn disease.&#x0D; It was found that the level of spontaneous functional activity in the HCT test is associated with the activity of resident monocytes. They form the primary barrier that protects the body from infection or harmful macromolecular complexes. Monocytes - "inflammatory", which constantly come from the free pool and their functional activity against microbial antigens is much higher than resident monocytes. An indicator of the activity of monocytes - "inflammatory" is an indicator of functional activity in the induced HCT test. The results of the study indicate that under conditions of significant activation of resident monocytes in response to injury in patients of the main group in the second and third terms of the area of thermal damage migrate functionally effective monocytes.

ПРИМЕНЕНИЕ НОВЫХ МЕТОДИК ПРИ ЛЕЧЕНИИ ПОСТРАДАВШИХ С ПЕРЕЛОМАМИ ДЛИННЫХ ТРУБЧАТЫХ КОСТЕЙ ПРИ ТЯЖЁЛОЙ СОЧЕТАННОЙ ТРАВМЕ

Severe combined injuries, and especially polytrauma, differ significantly from other types of injuries by high requirements for the organization of medical care at all its stages, miltidisciplinarity, high financial costs, poor short-term outcomes and long-term treatment results. Therefore, the search for new concepts, strategies and tactics for the treatment of victims is an urgent problem not only for surgeons, resuscitators and traumatologists, but also for healthcare in general. Fractures of long tubular bones accompanying severe combined injuries or polytrauma pose a lesser threat to the life of the victim than severe traumatic brain injuries or damage to internal organs, but they are the main cause of long-term treatment and disability. Such victims make up a significant group of patients-66.2%, therefore they represent a separate problem in traumatology and injury surgery. A modern solution to this problem, improving the results of treatment and the quality of life of victims after suffering a severe combined injury or polytrauma is possible on the basis of new approaches, as well as on the new ideology of osteosynthesis. In the present study, 392 minimally invasive osteosyntheses were performed in 274 patients with severe combined trauma and polytrauma. The indication was the need to fix fractures in order to create favorable conditions for rapid and lasting fusion, early functional treatment and rehabilitation of victims, and to achieve the highest possible level of quality of life after treatment. The possibility and duration of osteosynthesis were determined by the severity of the condition of the victims, assessed by objective methods: a simple clinical scale of VPH-SG or, much less often, specialized resuscitation scales of VPH-SS, SAPS or MODS. The surgical intervention was possible when the severity of the victim's condition reached the highest level of compensation: 16-30 points on the VPH-SG scale. The immediate outcomes of treatment of 274 patients with severe combined trauma and polytrauma after performing a full and final volume of surgery were good. There were no fatal outcomes. The frequency of mild local infectious complications in the field of surgical intervention was 4.0%. The average duration of inpatient treatment was 23.8±2.3 days: with closed intramedullary osteosynthesis - 19.8±0.3 days, with bone osteosynthesis - 24.2±1.2 days, with non - focal osteosynthesis-27.3±1.9 days. The long-term and anatomical and functional results of treatment were analyzed in 158 patients. There were no unsatisfactory long-term results of treatment. Good long-term results were achieved in 81.0%, satisfactory – in 19.0% of the victims. Thus, the results of the analysis of the immediate outcomes and long-term results of treatment of fractures of long tubular bones using the technology of minimally invasive osteosynthesis in patients with severe combined trauma and polytrauma demonstrated the high effectiveness of this surgical technology, on the one hand, and the direct dependence of the treatment outcomes on the severity of the injuries, the severity of the condition of the victims and the number of fractures in one victim, on the other hand.

Presacral epidermoid cyst in a pediatric patient

Epidermoid cysts are benign cysts of ectodermal origin that are most commonly found on the face, trunk, and neck but have been infrequently described in the presacral region. Presacral epidermoid cysts are most commonly seen in middle-aged women and to our knowledge, only two previous cases have been reported in the pediatric population. In this case report, we present the case of a pediatric patient who underwent a total mass excision with formal coccygectomy for a presacral epidermoid cyst. We describe the differential diagnosis for a presacral mass in a pediatric patient and the clinical, radiographic, and histologic work up involved in obtaining the correct diagnosis. Finally, we discuss the surgical treatment options to remove the mass and to decrease the risk of local recurrence, infection, and other serious complications.

New possibility of application of bacteriophages to prevent infectious complications in free skin grafting (bacteriophages in skin grafting)

Aim . To prevent infectious processes in the area of a recipient wound in free skin grafting with a split-graft. Materials and methods. A method was developed for immobilizing bacteriophages in the area of split thickness skin grafts through transferring a solution containing bacteriophages into a gel form. Microbiological and clinical studies of the effectiveness of the proposed method were performed. Results. The viability of bacteriophages in a gel dressing for up to 4 days was confirmed, as well as the reduced likelihood of local infectious complications in skin grafting. Conclusion . The gel composition containing bacteriophages allows quick response to changes in current hospital microflora and effectively counteract the dangers of nosocomial infection.

Relationship Between Intra-Operative Hyperthermia, Post-Operative Fever and Local Infectious Complications in Children Undergoing Cochlear Implant Surgery

Relationship Between Intra-Operative Hyperthermia, Post-Operative Fever and Local Infectious Complications in Children Undergoing Cochlear Implant Surgery

Complications of permanent vascular access for haemodialysis

Permanent vascular access is the basis of renal replacement therapy by the method of programmed haemodialysis, on whose stable functioning depends the life of patients with end-stage renal disease. At the present time, there is significant deficit of scientific and methodological Russian-language literature on this problem, with no Russian consensus documents concerned. This article is a review of the contemporary world literature dedicated to the problem of permanent vascular access, including currently in force European (2018) and North American (2019) guidelines for good clinical practice, also discussing the problems of strategy and tactics of creating a permanent vascular access, monitoring its dysfunction, pathophysiology of functioning of arteriovenous fistulas. Presented herein are unified approaches to diagnosis and treatment of thrombolytic and haemorrhagic complications associated with the access, as well as local infectious and non-infectious complications. Special attention is paid to indications for the operation and rational therapeutic decision-making.

Prophylaxis of surgical site infection

The article provides a literature review of the methods for the prevention of local infectious complications preoperative, intraoperative and postoperative. The analysis of the literature is devoted to the methods of prevention of postoperative purulent inflammatory wound complications. The review of scientific medical literature is based on the analysis of this problem. The article presents risk factors that contribute to the development of postoperative wound complications. Classification of surgical wounds was adopted to determine the risk of developing a surgical site infection (SSI), which distinguishes 4 classes: clean, conditionally clean, contaminated and dirty. The presented classification is based on the postoperative assessment of the wound bacterial contamination rate. The ClavienDindo classification of postoperative complications is the most relevant. This classification presents the tactics of the surgeon, depending on the class. The results of various studies indicate that antibiotic prophylaxis in the preoperative period reduces the development of local complications. The description of prevention methods focuses on intraoperative methods (devices for bringing together the edges of the wound, devices for treating wounds, surgical needles, suture material) and various types of antiseptics, which can reduce tissue damage during surgical interventions, reduce microbial contamination and the number of wound postoperative complications. Intraoperative instrumental methods allow less pronounced trauma to the wound during its processing and suturing. The postoperative method for diagnosing wound complications is an ultrasound method, which determines various formations in a postoperative wound.