Purulent Surgery Research Articles

PURULENT-NECROTIC COMPLICATIONS AFTER AMPUTATION OF THE LOWER EXTREMITIES: ISSUES OF TREATMENT AND PREVENTION

Transfemoral amputation of a limb performed by a patient with obliterating atherosclerosis with irreversible ischemia is a difficult, traumatic operation and is accompanied by high mortality. High mortality after amputation of a limb at the hip level is associated with the severity of the general condition of patients and complications of the postoperative period. As our studies have shown, the most common complication after limb amputation is an infection of the femoral stump wound, its development is directly related to metabolic disorders in patients, a decrease in the immune status, ischemia of the stump tissues and foci of secondary infection. The clinical picture of infection of the femoral stump wound is variable. It depends, first, on the patient's general condition, the process's spread, the trophism of the stump tissues, and the nature of the microflora. Improving the treatment results of patients who have undergone limb amputation is possible by performing all the necessary preventive measures regarding ischemia and stump infection in the prescribed volume and the development of infectious complications, as well as treatment by the requirements of modern purulent surgery.

Ten years’ experience of vacuum systems in treatment of complicated postoperative wounds of various etiologies

Objective: increase effectiveness of wounds treatment after various etiology by using VAC.Materials and methods: study included 128 patients with surgical infection. Specter of operations is presented: pilonidal cyst excision — 40 (31.2%), sternomediastinitis — 23 (18%), mesh hernioplasty — 16 (12.5%), laparotomy — 15 (11.7%), emergency laparotomy — 7 (5.5%), traumatology paraimplant complications — 7 (5.5%), abdominoplasty — 7 (5.5%), postoperative esophageal fistulas — 6 (4.7%), decubital ulcers — 4 (3.1%), mammoplasty — 3 (2.3%).Results: duration of VAC-therapy averaged 22.1±0.26 days. Systemic inflammatory reaction noted in 43 (33.6%) patients. Granulation tissue on 8th day of treatment noted in 98 (76.6%) cases. Microscopically, on day 8 of treatment, inflammatory-regenerative cytograms were detected in 104 (81.3%) patients. Over the course of 16 days, wounds decreased by 62.1±2.5% in all observations. In 47 (36.7%) cases, secondary sutures were applied, in 30 (23.4%) — grafting. A month later, healing was noted in 106 (82.8%) patients. Complications (wound bleeding) were noted in 7 (5.5%) patients. Reoperations were performed in 11 (8.5%) patients. Period of complete healing was 29.3±0.4 days.Conclusions: vacuum therapy is an effective way to treat wounds in purulent surgery. Time of complete reparative regeneration of wound and period of expensive inpatient treatment are reduced.

Diversity of streptococcus species isolated in the departments of purulent surgery and coloproctology of a multidisciplinary hospital and their antibiotic resistance

Diversity of streptococcus species isolated in the departments of purulent surgery and coloproctology of a multidisciplinary hospital and their antibiotic resistance

Comprehensive Assessment of the Efficacy of Chitosan-Based Wound Dressings in Combination With Various Antiseptics

Comprehensive Assessment of the Efficacy of Chitosan-Based Wound Dressings in Combination With Various Antiseptics

A clinical case of surgical treatment of appendiceal stump abscess

In Ukraine, the share of patients with acute appendicitis is 89.1% of the total number of patients with acute surgical pathology. In modern surgical practice, early and late complications occupy the first place in the structure of acute surgical diseases of the abdominal organs, regardless of the age and gender of the patients, and the postoperative mortality is on average 0.15%. In the remote period after an appendectomy, despite the progress of modern surgery, a very rare complication known as inflammation of the stump of the appendix can occur. The patient, 25 years old, turned to the department of purulent surgery with complaints of a «small wound» at the site of the postoperative scar in the right inguinal area and minor purulent discharge from it. Four months ago, in July, he was operated on for acute phlegmonous appendicitis. On November 1, after physical exertion, the wound reappeared, and on November 3, the patient independently sought a consultation at the reception department of the Clinical City Hospital No3. He was examined by a surgeon and hospitalized. During the revision of the wound, a tumor‑like formation measuring 2.5x3.0x2.5 cm, as well as the parietal peritoneum, was revealed. Appendectomy was performed by the method of pouch ligation with drainage of the abdominal cavity through a separate contraperture with polyvinyl chloride drainage. After the operation, a diagnosis was established: abscess of the stump of the appendix, and external fistula of the anterior abdominal wall. The postoperative wound healed with primary tension, and the sutures were removed. The diagnosis of appendicitis may be mistakenly excluded from the clinical search due to the presence of a postoperative scar after appendectomy. A clear clinical picture of acute appendicitis or the opening of a fistula at the site of a postoperative scar in the right iliac region indicates the need for a computer tomography of the abdominal organs with contrast to establish an accurate diagnosis and choose the correct treatment tactics. The only treatment for inflammation of the appendiceal stump is a complete appendectomy with appendix removal either by open or laparoscopic surgery, which should be performed urgently to avoid further complications.

The Character of Purulent-Inflammatory Diseases of The Retroperitoneal Region

Conducted a retrospective data analysis of 439 patient records with purulent-inflammatory diseases of the retroperitoneal space, receiving inpatient treatment in the department of purulent surgery of the multidisciplinary clinic of the Tashkent Medical Academy from 2010 to 2022, in order to select the observation group.All patients, along with general clinical laboratory studies, underwent MSCT and ultrasound of the retroperitoneal region before the start of the treatment complex to determine the operational tactics of treatment. At the same time, a limited pathological focus (abscess) was detected in 28.7% of cases, signs of phlegmon were noted in 51.4% of cases, and combined types or postoperative fistulas were observed in 19.9% of cases.

The direction of increasing effectiveness of the treatment of periprosthetic joint infection

Introduction: in the world orthopaedic practice, attention is increasingly paid to surgical interventions that improve the patient’s quality of life. One of these interventions is joint arthroplasty. The most common reason for this operation is osteoarthritis. It is known that coxarthrosis and gonarthrosis have a a high incidence in the world and there is a dynamic increase in the amount data pathologies. However, behind all the advantages of joint arthroplasty here is most formidable complication – periprosthetic infection, which can be fatal for the patient. According to opinion of domestic and foreign experts, for a successful treatment of patients with this complication, intervention is needed by specialists of a narrow profile in combination with a multidisciplinary approach, however patient routing an unresolved problem to this day.The purpose of the work: to propose a model for routing patients with periprosthetic joint infection in Moscow.Results. As a result of the work carried out it was found that the main problem of routing patients with periprosthetic joint infection in Moscow is the stage and timing of the disease. Often the patient with lat periprosthetin infection is hospitalized in a hospital in a city that has a department of purulent surgery, but the specialists of the department have not the necessary equipment and skills to provide effective and qualified care as a result of which patient wastes time that could be spent more rationally.Conclusion. For more efficient routing of patients with periprosthetic joint infection in Moscow it is necessary to create specialized centres for the treatment of advanced perprosthetic infection. In cases of early periprosthetic infection the patient can undergo sanitizing surgical mixing in the conditions of the department of purulent surgery of any hospital in Moscow.

Features of the Occurrence and Development of Infectious Complications in Patients with Combat Injuries of the Musculoskeletal System (according to the Own Experience)

Background. One of the characteristics of a combat injury is the penetration of pathogenic microorganisms, pieces of dirty skin, clothes, dust, etc. into the depth of the wound. The combination of significant defects of bones and soft tissues, vessels and nerves of the affected segment of the limb (musculoskeletal system) causes a high percentage of unsatisfactory treatment results, as well as the development of infectious complications.
 Objective: to evaluate the nature of combat wounds in patients who had infectious complications in the musculoskeletal system during the war in Ukraine since 2014; to determine the features of the occurrence and development of such infectious complications.
 Materials and Methods. An analysis of case reports of patients with combat wounds with infectious complications (osteomyelitis, septic arthritis, surgical site infection (SSI), purulent- necrotic infection of soft tissues and wounds) who were treated at the Department of Bone- Purulent Surgery of the State Institution “Institute of Traumatology and Orthopedics of the National Academy of Medical Sciences of Ukraine” for the period from 2014 to mid-2022 was carried out.
 Results and Conclusions. Infectious complications in combat wounds mostly arise primarily as a result of the wound itself, taking into account the severity, extent of damage to structures and tissues, the type of weapon used to inflict the injury, and a wide spectrum of microorganisms, among which Staphylococcus aureus plays a leading role. In the control group, infectious complications occurred more often than SSI with further progression.

Plasma medicine: Prospects and experience of application of low-temperature argon plasma in medical rehabilitation

Plasma medicine is a dynamically developing field of science based on the physical and chemical properties of air-plasma flows.
 Low-temperature plasma is a partially ionized gas with a temperature of about 40C, the synergistic interaction of its active substances is a successful method of sterilization, decontamination of wound surfaces, treatment of surgical and burn wounds. Due to the combined action, over the past decades, low-temperature plasma has proven itself in purulent surgery, dermatology, and dentistry, but in addition, it has opened up great prospects in oncology. Possessing the effects of inhibiting inflammatory processes, stimulating regeneration processes, improving microcirculation and tissue metabolism, plasma flows are also used in medical rehabilitation.
 The review considers the possibilities of using low-temperature plasma in various fields of medicine, as well as the effect of plasma flows on basic cellular processes and various forms of cell death. The experience of using low-temperature argon plasma in the complex rehabilitation of patients with malignant neoplasms is presented.
 Literature sources from Russian and foreign databases (Elibrary, PubMed) on the topic of low-temperature plasma application in medical practice were analyzed. The analysis showed that plasma medicine is a rapidly developing modern direction, opening up new opportunities in healthcare.
 Further studies of plasma streams are needed to unlock their full therapeutic potential and fully understand the mechanisms of action.

THE USE OF 5-AMINOLEVULINIC ACID GEL IN THE TREATMENT OF DIABETIC FOOT SYNDROME

Background. Diabetes mellitus affects almost all body systems, but the most dramatic complications occur in the lower extremities. Diabetic foot syndrome takes the leading position in the list of complications of diabetes mellitus, leading to early disability and mortality.
 At present, a new technology - photodynamic therapy is being intensively developed worldwide. This technique can be used in many different fields of medicine, including purulent surgery.
 This study aimed to investigate the possibility of using 5-aminolevulinic acid as an photosensitizer in photodynamic therapy in the complex treatment of chronic wounds in patients with ischemic and mixed forms of diabetic foot syndrome.
 Materials and Methods. In 2021, 10 patients with type 2 diabetes mellitus and ischemic and mixed forms of diabetic foot syndrome of both sexes, aged 52 to 75 years, were observed. As a preparation for photodynamic therapy, daily dressings with hydrogel were applied (3-5 days). During this period, limb revascularization was performed, the aim of which was to restore the blood flow to the foot, preferably through the anterior or posterior tibial artery. After the restoration of the main blood flow, photodynamic therapy was performed: after sanitation of the wound surface with physiological NaCl solution, Levuderm gel (6% gel phosphate of 5-aminolaevulinic acid) was applied and covered with occlusive dressing for 2 hours, after which the gel remains were removed and irradiation with Korobov photonic matrices "Barva Flex" with 660 nm wave length was carried out. Energy applied to the wound averaged 30-40 J/cm2. The light power density was between 0.1-1.0 W/cm2, and the exposure time varied according to the wound area.
 Results. After photodynamic therapy on days 2-3, perifocal oedema decreased. By days 5-7, the quality of granulation and the degree of wound epithelialization significantly improved. The wound healing rate on days5-7 of treatment was 1,58±0,44, and on days 10-12 - 4,72±0,63 (p <0,01). The evaluation of the wound healing rate showed good and satisfactory results: By day 32, the wound in the study group was completely epithelialized in the majority of patients (88.9%).
 Conclusions. The method we have developed for treating chronic wounds using photodynamic therapy is pathogenetically feasible and highly effective compared to conventional therapies. Combined light exposure using photosensitizer stimulates the formation of reactive oxygen species, increasing the effect of phagocytic cells, which is manifested in the activation of neutrophil chemotaxis, adhesion, and endocytosis. photodynamic therapy using aminolaevulinic acid as a photosensitizer, enhances molecular mechanisms of intercellular interaction at all stages of primary immunity activation.

CYTOLOGICAL CHARACTERISTICS OF EXPERIMENTAL PURULENT NON-HEALING WOUNDS IN THE TREATMENT OF SILVER NANOPARTICLES

Summary. The purpose of the work is to conduct a cytological examination of swabs-imprints of experimental purulent wounds that have not healed for a long time, when treated with silver nanoparticles in comparison with 0.05 % Chlorhexidine solution.
 Research materials and methods. The study of the features of the cytological picture of skin regeneration was carried out on 60 white non-linear laboratory rats.
 Research results. The obtained results of the cytological examination of purulent wounds that did not heal for a long time indicate faster wound healing processes in the group using nanostructured silver compared to the control group: there was a faster decrease in the number of leukocytes in the field of view and the percentage of their destruction, faster activation of monocyte-macrophage cells series, the appearance of fibroblasts and epithelial cells and, as a result, a faster change in the types of cytograms from necrotic to regenerative.
 Conclusions. It was established that the presented method of using nanostructured silver contributes to a better elimination of microbial insemination, leads to a significant decrease in the number of neutrophil leukocytes and leukocytes in the stage of destruction, an increase in the percentage of phagocytic leukocytes, fibrocytes, fibroblasts, endotheliocytes and epithelial cells, which indicates a better antibacterial and anti-inflammatory effect and indicates much faster processes of cleaning and regeneration of purulent wounds. The use of silver nanoparticles has significant advantages compared to traditional treatment with a 0.05 % solution of Chlorhexidine and is promising for use in the practice of purulent surgery.

Analysis of the Outcomes of a New Method for Plastic Surgery for Postoperative Wound Of Sacrococcygeal Region after Excision of the Pilonidal Cyst: Randomized Trial.

Background. Despite a variety of existing methods of surgical treatment for sacrococcygeal pilonidal cyst, a universal technique has not been developed yet, due to the large number of postoperative complications and recurrences.Objectives. To improve the treatment outcomes of patients with pilonidal cysts through developing and implementing a new method for closure of the postoperative wound defect of the sacrococcygeal region.Methods. We conducted a randomized trial, involving 60 patients with sacrococcygeal pilonidal cyst. The control and main groups consisted of 30 people each. The study was carried out in the Purulent Surgery Unit of the Regional Clinical Hospital No. 1 — Research Institute, Krasnodar. The inclusion of patients in the trial was organized within 2019–2022 period. The duration of each patient’s follow-up period was equal to the hospitalization duration. The control group underwent the surgical treatment in the Moszkowicz (Moshkovich) modifi cation. The main group was treated by means of our own developed method. Postoperative wound complications were assessed according to Clavien—Dindo classifi cation. Statistical data processing was performed using Microsoft Excel 2013 with the add-ins Analysis package and AtteStat for statistical data.Results. The control and main groups included 30 participants each. The gender, age and body mass index (BMI) were not defi ned as statistically signifi cant. When analyzing the primary data, the treatment median time accounted for 10.5 (9.0; 13.8) days in the control group and 7.0 (7.0; 8.0) days in the main group, a signifi cant difference according to the Mann—Whitney test (p < 0.001). The number of postoperative complications (suture failure, wound abscess, necrosis of skin fl aps) in the control group was 16 cases, and in the main group — 1 case (signifi cance of differences under the chi-squared test p < 0.001). The number of recurrences in the control group comprised 7 cases, while in the main group there was 1 case (signifi cance of differences under the chi-squared test p = 0.023).Conclusion. The application of surgical treatment for pilonidal cysts in the authors’ modifi cation made it possible to reduce the time of hospitalization, the number of such postoperative complications as suture failure, wound abscess and necrosis of skin fl aps. The number of recurrences has also decreased significantly.

The scientific heritage of Professor V.I. Luk’yanenko, Colonel of medical service is an important page of the national maxillofacial surgery and stomatology (To the 100th anniversary of his birth)

BACKGROUND: A great contribution to the development of the maxillofacial surgery and stomatology in the second half of XX century was made by a prominent Russian maxillofacial surgeon, participant of the Great Patriotic War 19411945, Doctor of Medicine, professor, colonel of medical service Vladimir Isidorovich Lukyanenko.
 The study aimed to present the contribution of Professor V.I. Lukyanenko to the theory and practice of maxillofacial surgery and dentistry.
 Russian literature in the field of dentistry and maxillofacial surgery that mentions the merits of Professor Lukyanenko and his monographs, textbooks, and scientific articles served as the material for the article.
 Professor Lukianenko contributed significantly to the development of many scientific problems of dentistry and maxillofacial surgery. He was an innovator in traumatology of maxillofacial region, purulent maxillofacial surgery, periodontology, and therapeutic dentistry. Many of his editions, developments, and suggestions are still used in his daily educational and pedagogical work and are the reference books for dentists and maxillofacial surgeons of military medical and medical institutions of the country.
 The scientific heritage of Prof. V.I. Lukyanenko is a valuable contribution to the development of the maxillofacial traumatology, purulent surgery, and sections of stomatology. He has done much in the field for the improvement of surgical methods of treatment of facial bone fractures, osteomyelitis of the jaws, maxillary phlegmon, and periodontitis and diagnosis and treatment of pulpitis.

Valentin Feliksovich VOINO-YASENETSKY - Archbishop, professor-surgeon. To the 145th of birthday

Valentin Feliksovich VOINO-YASENETSKY - Archbishop, professor-surgeon. To the 145th of birthday

Comparative analysis of monolateral and bilateral spinal anesthesia

AIM: This study aimed to improve the treatment results of patients with diabetic foot syndrome by substantiating the optimal type of spinal anesthesia during foot surgery.
 MATERIALS AND METHODS: Sixty-four patients undergoing purulent surgery were examined and group as follows: Group 1 patients operated on under monolateral (unilateral) spinal anesthesia and Group 2 patients operated on under conditions of bilateral (traditional) spinal anesthesia.
 RESEARCH METHODS: Assessment of the level and intensity of pain and the level of catecholamines in urine was conducted in the first postoperative day. Cardiovascular system indicators and the temperature of the skin of the leg during anesthesia were monitored, and the Doppler scanning of peripheral circulation in the foot was performed.
 RESULTS: Pain sensitivity during lower limb movement was 20% less pronounced in group 1 than in group 2. A 4.4% decrease in heart rate, a 4.7% decrease in saturation level recorded 20 minutes after the onset of anesthesia, and a 9.8% decrease in mean arterial pressure were observed in group 2. In both groups, systolic blood pressure in the toe increased by 18% after anesthesia, and the temperature of the skin on the lateral surface of the leg increased by 3%. Adrenaline concentration in the daily portion of urine in group 2 was 34.4% higher than that in group 1 in the next postoperative day.
 CONCLUSIONS: The general condition of patients during anesthesia was more stable in group 1 than in group 2. After anesthesia, improved peripheral hemodynamics in the operated limb was noted. Compared with traditional spinal anesthesia, monolateral spinal anesthesia has a positive effect on the stress response of the patients body to surgical intervention.

STUDY OF PHYSICAL AND MECHANICAL PROPERTIES OF POLYMER-IMPREGNATED COMPOSITION IN CLINICAL PURULENT OSTEOLOGY

Bone cement, or PMMA (polymethyl methacrylate) is often used in purulent surgery. Scientific literature contains very contradictory data on the physical and mechanical properties of polymer-impregnated compositions, in particular, on the temperature of the PMMA polymerization process and the ways to reduce it, such as introduction of antimicrobial drugs for prevention and treatment of infectious complications in patients after injuries and musculoskeletal surgery.
 The aim of the study is to conduct an in vitro experiment and to evaluate the temperature of the exothermic polymerization reaction of bone cement (PMMA) and possible ways to reduce it.
 Materials and Methods. The authors conducted 8 series of experiments in vitro. In each series, a disk (45–50 mm in diameter, 5–7 mm thick) was made by hand after mixing the components of the polymer composition. The temperature of the ongoing exothermic reaction was measured on the disk surface using a non-contact infrared thermometer ADA TemPro 300 in a continuous scanning mode.
 Results. The temperature of the exothermic polymerization reaction of PMMA Synicem 1-based bone cement was 92.8±1.6 °C (min 91.2 °C, max 94.9 °C), and Palacos®MV+G-based bone cement 92.7±1.2 °С (min 91.1 °C, max 93.8 °C). Reducing the monomer amount by 50 % (polymer / monomer ratio was equal to 4:1) and simultaneously introducing “Sextaphage” (10 ml) led to a sharp temperature decrease of the exothermic reaction by more than 30 °C.
 Conclusions. One of the ways to reduce the temperature of the exothermic reaction in vitro is to change the ratio of polymer powder and liquid monomer, reducing the amount of monomer introduced into the polymer composition.

Why was the surgeon V.F. Voyno-Yasenetsky canonized?

Surely everyone has heard of Saint Luke the Blessed Surgeon, whose name is given to many scientific and medical institutions, medical universities and colleges, treatment and diagnostic centers. The Institute of Pediatric and Adult Neurology and Epilepsy in Moscow, the Diagnostic and Treatment Center in Kamensk-Shakhtinsky, and the International Educational Center for Medical Institutions bear his name. Do you know that the famous surgeon Valentin Feliksovich Voyno-Yasenetsky and Saint Luke the Blessed Surgeon are one and the same person, and that he lived and worked not in ancient times, but under the Soviet Union? An outstanding scientist, PhD in Medicine, professor, laureate of the Stalin Prize V.F. Voyno-Yasenetsky made a huge contribution to the development of surgery, including purulent surgery. He wrote about 60 scientific papers, and many of the works were accompanied by his own drawings. He was awarded the Stalin Prize of the first degree for Essays on Purulent Surgery and Late Resections for Gunshot Wounds of the Joints. These monographs were a necessary and timely scientific and practical guide in all base and field hospitals during the Great Patriotic War. In this work, the anatomical and topographic principle of the study of suppurative processes, first put forward by N.I. Pirogov, was consistently highlighted. Over the years, the monograph has not lost its relevance; it remains of interest to neurosurgeons, ophthalmologists, dentists, urologists, and doctors of other specialties. The author of these books was PhD in Medicine, a scientist, surgeon, teacher and artist, who took holy orders in the most terrible years of persecution of the church, in 1921. For the courageous confession of Orthodoxy, he was repeatedly arrested. He spent many years in prisons and camps, but he always remembered the high calling of a doctor. While healing the body, he also healed spiritual wounds, and he never betrayed any of his callings.

The importance of ultrasound in the diagnosis of pleura complications of acute destructive pneumonia in children

Background. The problem of timely diagnosis of complications of acute destructive pneumonia accompanied by pyofibrothorax remains relevant. The study was aimed to investigate the features of ultrasound diagnosis (ultrasound) of the condition of the visceral and parietal pleural lamina in acute destructive pneumonia in children at different stages of the disease. Materials and methods. In the departments of purulent surgery and pulmonology of the Regional Children’s Hospital of Dnipro for the period of 5 years, there were observed about 475 children aged from 1 to 17 years with pneumonia, purulent-destructive changes in the lungs and pleura. For analysis and further study, we choose a group of 50 patients of different age groups, who underwent ultrasound in real time without prior preparation of patients. The condition of the parietal and visceral pleural lamina at the different stages of diagnosis and treatment was studied. Results. A group of patients aged from 4 to 10 years was performed an ultrasound of the pleural cavities in real time without prior preparation on the paraspinal, scapular, axillary, midclavicular, and thoracic lines when admitted to the hospital and on the first day of treatment. Ultrasound was used to determine the structure and volume of free fluid as well as the condition of the parietal and visceral pleural lamina, their thickness, and other features. The use of ultrasound allowed diagnosing the early manifestations of pyofibrothorax and determining the condition of the parietal and visceral pleural lamina in the children with destructive pneumonia. Conclusion. Further improvement of the algorithm of ultrasound diagnosis of acute destructive pneumonia in children with pyofibrothorax will reduce radiation exposure to a child’s body, increase the efficiency of the development and improvement of treatment methods at the stages of pyofibrotorax, reduce the duration of inpatient treatment.

Laser hair removal in the complex treatment of pilonidal cyst in children

Introduction. A pilonidal cyst (PC) in children is a common congenital pathology that manifests in the puberty period.Purpose. To improve outcomes of pilonidal cyst care in children.Materials and methods. The researchers analyzed results of surgical treatment of 156 children with PC who were hospitalized to the department of emergency and purulent surgery in Filatov Children’s City Clinical Hospital (Moscow) and in the surgical department of Republican Children’s Clinical Hospital (Izhevsk) in 2018–2020. All patients were divided into groups depending on the type of preoperative preparation.Results. Cases of 156 children with PC were assessed: 121 boys (77.56%, p 0.05) and 35 girls (22.44%). Patients’ age ranged from 13 to 18. There were two groups. In Group 1 (n = 89, 57.05%), patients had dry shaving as a preoperative preparation; in Group 2 (n = 67, 42.95%), patients’ hair in the sacrococcygeal region was removed with laser technique.Conclusion. A combined technique of surgical treatment of pilonidal cysts in the coccyx in children improves outcomes, , reduces the number of complications and relapses as well as promotes early social rehabilitation and good cosmetic results.

Unilateral spinal anesthesia and the sciatic nerve block in foot surgery

Purpose of the study. To evaluate the effectiveness of unilateral spinal anesthesia as a method of pain relief during foot surgery. Analyze the effectiveness of unilateral spinal anesthesia versus sciatic nerve block. To develop an algorithm for performing unilateral spinal anesthesia during foot surgery.
 Materials and methods. We examined 64 patients who were treated in the department of purulent surgery of the 3rd city hospital in Zaporozhye with a diagnosis of diabetic foot syndrome in the period from 2017 to 2019.
 Research methods. Assessment of the level of pain intensity using the standard visual analogue scale and the concentration of glucose in the blood serum. Monitoring of the parameters of the cardiovascular system, the temperature of the skin of the lower leg during anesthesia, Doppler scanning of the peripheral circulation in the foot.
 Results. 4 hours after performing anesthesia, the intensity of pain during movement of the lower limb, according to the visual analogue scale in the group with unilateral spinal anesthesia was 2,3 times less than in the group with sciatic nerve block (p < 0,05). After 10 hours – in the sciatic nerve block group there was a 9,4% increase in comparison with the unilateral spinal anesthesia group (p < 0,05). Compared with the unilateral spinal anesthesia group, in the sciatic nerve block group 20 minutes after anesthesia, the heart rate decreased by 7,2% (p < 0,05). After unilateral spinal anesthesia, the level of systolic blood pressure on 1 toe of the foot increased by 18,3% 20 minutes after anesthesia, and 20 minutes after sciatic nerve block – by 13,7% (p < 0,05). In patients with the unilateral spinal anesthesia group, the temperature on the operated lower limb after anesthesia increased by 3,8%, in the sciatic nerve block group – by 2,8% (p < 0,05).
 Conclusions. Regional anesthesia is the main method of choice for foot surgery compared to general anesthesia. sciatic nerve block does not in all cases lead to 100% surgical anesthesia and requires additional medical analgosedation. For foot surgery, unilateral spinal anesthesia is preferred.