Wound Suppuration Research Articles

ADVANTAGES OF LAPAROSCOPIC SURGERY IN CALCULOUS CHOLECYSTITIS

Purpose: The aim of the study is the comparative analysis of the operating time, blood loss during surgery, postoperative discomfort, and pain, hospital stay, cost-effectiveness, and patient satisfaction in patients undergoing laparoscopic cholecystectomy and conventional cholecystectomy in UMHATEM "N.I.Pirogov". Material and Methods: For a one-year period (from 01.01.2018 to 01.01.2019) 512 patients with calculous cholecystitis were operated on the Department of General, Visceral, and Emergency surgery on UMHATEM "Pirogov". In 487 of these cases, laparoscopic cholecystectomy was performed (group I), the remaining 25 cases were treated with conventional cholecystectomy (group II). Women with laparoscopic cholecystectomy (group I) were 392 (75.82%), men 95 (24.18%). From the open surgery cohort (group II), women were 19 (75.41%), men 6 (24.59%). The age in this retrospective analysis varied from 18 to 83 years (average 52.7 years). Results: From group I (lap. cholecystectomy), women were 392 (80.49%), men 95 (19.51%). In group II (open cholecystectomy), women were 19 (76%), men 6 (24%). Age in this retrospective analysis ranged from 18 to 83 years (average 52.7 years) for both groups. There was no significant difference between demographic variables in the two groups. The operating time varied between 23 and 165 min (average 39.4 min) for group I and 35 to 104min (average 44.6min) for group II respectively. The hospital stay was recorded from 48 hours to 7 days (2.7 days on average) for group I and 3 to 9 days (average 4.5 days) for group II respectively. Surgical morbidity included 12 patients (operative wound suppuration, ileus, postoperative hernia, jaundice), 7 from group I (1.44%) and 5 from group II (20%), which was considered a significant difference. Conclusion: Laparoscopic cholecystectomy is an easy intervention, reduced time-consuming procedure, with shortened complication rates compared to open cholecystectomy. It completely debates an advantage of a decreased hospital stay and early return to work compared to open surgery.

ORNIDAZOL-BASED APPLICATION SORBENT WITH NANO SILICA AND ITS ANTIMICROBIAL ACTIVITY.

The aim: To investigate the effect of application sorbent based on ornidazole with nanosilicon in experiment and clinic. Materials and methods: In order to study the effectiveness of the Ornidasil application sorbent for the treatment of purulent wounds, we conducted an experimental study in rats. Also, we studied the effectiveness of the Ornidasil in the clinic for the treatment of patients with diabetic foot syndrome and to prevent the suppuration of postoperative wounds in patients with purulent peritonitis in toxic and terminal stages. Results: The formation of active substance complexes with hydroxylated matrices is due to hydrogen bonds between the oxygen atom of the silanol group of the silica surface and the hydrogen atom of the alcohol group of the ornidazole molecule. This promotes the gradual release of ornidazole from the surface of such a matrix into the wound exudate. Thus, on day 13, 9 experimental rats of group I healed completely, 11 rats had a small wound surface, complete healing occurred on day 15. We also investigated the effectiveness Ornidasil in the clinic. In the comparison group, postoperative wound suppuration occurred in 6 patients (31.6%), and in the main group - in 3 patients (12.5%). Conclusions: A study of the effectiveness Ornidasil in the complex treatment of Diabetic foot syndrome showed that in the experimental groups, wound healing occurred 1.6 -1.9 times faster. The use of polyurethane wound protector in combination with Ornidasil reduced the suppuration of postoperative wounds in patients of the main group by 2.5 times relative to patients in the comparison group.

Antimicrobial polymer-siRNA polyplexes as a dual-mode platform for the treatment of wound biofilm infections.

Treatment of wound biofilm infections faces challenges from both pathogens and uncontrolled host immune response. Treating both issues through a single vector would provide enhanced wound healing. Here, we report the use of a potent cationic antimicrobial polymer to generate siRNA polyplexes for dual-mode treatment of wound biofilms in vivo. These polyplexes act both as an antibiofilm agent and a delivery vehicle for siRNA for the knockdown of biofilm-associated pro-inflammatory MMP9 in host macrophages. The resulting polyplexes were effective in vitro, eradicating MRSA biofilms and efficiently delivering siRNA to macrophages in vitro with concomitant knockdown of MMP9. These polyplexes were likewise effective in an in vivo murine wound biofilm model, significantly reducing bacterial load in the wound (∼99% bacterial clearance) and reducing MMP9 expression by 80% (qRT-PCR). This combination therapeutic strategy dramatically reduced wound purulence and significantly expedited wound healing. Taken together, these polyplexes provide an effective and translatable strategy for managing biofilm-infected wounds.

Chin augmentation with custom-made implants for microgenia treatment: a two-year follow-up

Objective — to determine the feasibility and effectiveness of using custom‑made and 3D‑printed mandibular implants in patients with microgenia, and to investigate their quality of life and satisfaction with aesthetic results during a two‑year follow‑up.
 Materials and methods. 21 patients participated in the study, with 14 (66.7 %) women and 7 (33.3 %) men. The average age of patients was 23.4 ± 2.3 years. All patients had signs of microgenia. In our study, a CT scan of the skull without contrast enhancement served as the primary diagnostic tool. Polyetheretherketonen (PEEK) was the material of choice for the implants.
 Results. Among the early postoperative complications were alterations to the sensation of the skin overlying the lower lip, which was restored within 1 — 2 months, and bruising, which had a tendency to spread to the neck. None of the patients had impaired motor innervation of the lower lip. Hematoma and wound suppuration were not detected either. One or two years after surgery, none of the patients had any delayed complications, including implant displacement, bone resorption in the lower jaw, decreased motor activity of the facial muscles, or altered sensation affecting the lower lip. Aesthetic results were assessed after the one‑year follow‑up. In a sample of 21 patients, the aesthetic outcome was excellent in 18 (85.7 %) patients and good in 3 (14.3 %) patients. No patients had bad aesthetic outcomes.
 Conclusions. The absence of delayed complications and the low risk of early complications, which in 71.4 % of patients only present as a temporary alteration to the sensation affecting the lower lip, indicate the safety of the suggested method. In all patients after mentoplasty with custom‑made implants, the physical and mental components of health improved statistically (with all values p < 0.05). Excellent aesthetic outcomes were observed in almost all patients (85.7 %) after mentoplasty with custom‑made implants.

Cofactorial herniotransformation peculiarities of midline abdomen

Relevance. Recently, much attention has been paid to the study of the role of various risk factors in the pathogenesis of herniation along the midline of the abdomen. The question of their interrelation with another equally important predictor of herniogenesis - connective tissue insufficiency remains understudied. The aim of the present study is to investigate the severity of connective tissue dysplasia and peculiarities of its interaction with other risk factors in different variants of midline abdominal herniotransformation. Materials and Methods. The examined group included 150 (89.2%) patients with postoperative median hernias of various sizes and 18 (10.8%) patients with primary hernias of the white line of the abdomen. In 12 (8%) cases, relapses of postoperative hernial protrusions were noted. In 12 (10.5 %) cases, relapses of postoperative hernial protrusions were noted. The surveyed group included 109 (64.8 %) women and 59 (35.2 %) men. Risk factors for median herniogenesis were evaluated in the opposite sense relative to the severity of connective tissue pathology. Results and Discussion. We evaluated the risk factors of median herniogenesis in the opposite value and direction with regard to the severity of connective tissue pathology in the observation groups. It was found out that the leading role in herniotransformation of the medial abdominal line belongs to the suppuration of postoperative medial wounds, relaparotomy and heavy physical load with the role efficiency of 66.6 %, 56.2 % and 54.5 % respectively. The lowest level of connective tissue dysplasia was observed in the groups where the risk factors of median herniogenesis were the age of patients, the presence of relaparotomy in the history and heavy physical activity. Only in the observation group, where pregnancy and childbirth in the anamnesis were the predictors, the patients with white line hernias had less severe connective tissue insufficiency by 27,9 % in comparison with the patients with postoperative median hernias. In patients with recurrent midline hernias in all risk factors, the severity of connective tissue dysplasia always reached the maximum score. Conclusion. At any predictor of hernia formation or their combined effect, the severity of connective tissue dysplasia always remained severe, which confirms one of the leading roles of connective tissue pathology in the formation of medial abdominal hernias.

Application of the Developed Mechanical Methods for the Treatment of Patients with Wound Complications of Postoperative Ventral Hernias Prosthetic Repair

Introduction. Until now, the treatment of postoperative ventral hernias and their complications remains a difficult task of abdominal surgery. Patients with extensive wound defects of the abdominal wall complicated by a purulent-inflammatory process of soft tissues are of particular difficulty for treatment; an attempt to stitch these tissues together in the II phase of the wound process using conventional options results in unnecessary trauma and makes it much more difficult, and sometimes impossible, to accurately match homogeneous layers.The aim of the study was to demonstrate the potential of successful use of the developed adaptive instruments for mechanical treatment of the wound surface and closure of a large defect in the soft tissues of the anterior abdominal wall, formed during suppuration of the surgical wound and rejection of the endoprosthesis after prosthetic repair of the hernia ring.Results. Two clinical cases of successful use of the developed adaptive instruments for mechanical treatment of the wound surface and hardware decompression suturing of wounds in the treatment of deep wound infection in postoperative ventral hernias prosthetic repair were presented. Healing of wound defects after wound suppuration and implant rejection was achieved in both cases.Conclusion. The data obtained demonstrated the safety and clinical efficacy of a staged surgical treatment with mechanical debridement of the wound, followed by vacuum therapy and the implementation of a hardware decompression technique for closing the wound defect; this creating optimal conditions for wound healing according to the type of primary intention.

Features of Drainage of the Implant Placement Area in Patients with Incisional Ventral Hernias

Introduction. There are different and sometimes conflicting points of view regarding the drainage of the implant placement area in patients with postoperative ventral hernias. This is due to the variability of drainage methods and the commitment of surgeons to one or another technique. In addition, the results of surgical treatment and features of the postoperative period differ in these patients. Current contradictions in the drainage techniques and management of patients with seromas after hernioplasty for PVH determine the relevance of this issue and the need to obtain additional data on benefits and drawbacks of one method or another.The aim of the study was to analyse clinical outcomes of patients with postoperative ventral hernias depending on the drainage technique of the implant placement area.Methods. The study included 392 patients diagnosed with postoperative ventral hernia, who were treated in GBUZ "Samara Regional Clinical Hospital named after V.D. Seredavin" in 2017-2020. Patients clinical outcomes were compared and analysed. Group I included 110 patients with passive drain of the surgical wound, group II included 282 patients with active drain. The groups were assessed based on major parameters of the drainage impact on the surgical treatment outcomes. Non-parametric values were compared by calculating the chi-square (2), parametric - by calculating the Student's t-score. Results. In group I, the average duration of hospitalization was 22,564,45 bed-days. The average terms of drainage were 2,020,69 days. Clinically significant seroma was diagnosed in 35 (32%) patients. The average number of US-guided puncture-drainage interventions was 1,870,89 procedures. Suppuration of the surgical wound was diagnosed in 16 (14,5%) patients. The postoperative mortality rate in the group was 3,6%, 4 patients died. In group II, the average duration of hospitalization was 13,572,92 bed-days. The average terms of drainage were 6,332,12 days. Clinically significant seroma was diagnosed in 42 (14,9%) patients. The average number of US-guided puncture-drainage interventions was 0,650,39 procedures. Suppuration of the surgical wound was diagnosed in 21 (7,4%) patients. The postoperative mortality rate was 2,1%, 6 patients died.Conclusion. Active drain of the implant placement area in patients with postoperative ventral hernias statistically significantly reduces the duration of patients stay in hospital (Student t-score = 11,51 p0,01), frequency of clinically diagnosed seromas (2 = 14,36, p0,01), frequency of suppuration of postoperative wounds (2 = 4,665, p0,05). When choosing the drainage option for the implant placement area, preference of choice should be given to active penetrating open drain or active penetrating closed drain.

MODERN PRINCIPLES FOR LOCAL MANAGEMENT OF PURULENT WOUNDS

At present, surgical infection is one of the most thorny, difficult and urgent issues in clinical practice and is a great social and ecological importance globally. Growing number of suppurative and necrotizing lesions, postoperative suppurative complications, cases of generalized infection and various toxic and allergic reactions are among the challenges the surgeons have to encounter in daily practice. Patients with suppurative inflammatory lesions, which occurrence rate is reaching out 35 – 40% of soft tissue inflammatory cases, constitute a considerable share of all surgical patients. And sometimes the treatment outcomes of such conditions are unsatisfactory. Under the body immune response, the number of postoperative suppurative complications is demonstrates a tendency toward the growth. The clinical course of such suppurative processes is usually acute and often causes systemic infection, sepsis, and even lethal outcomes. In the total number of the lethal cases in surgical inpatient departments, the number of acute surgical infection ranges from 40 to 60%. Moreover, there has been an increase in a number of chronic cases resulted from acute ones that require more time and expenses to manage them. Long hospital staying, insufficient treatment efficacy of existing techniques, considerable economic losses for rehabilitation evidence the range of questions unsolved. The literary review has shown that early detection and proper management of purulent foci is among the leading factors of successful management of surgical wounds. Despite the active implementation of new approaches and techniques for the treatment of purulent wounds, so called "under the bandage" wound management is of considerable clinical importance, therefore the right selection of wound dressing materials, different by their chemical nature, dressings techniques, medications is one of the most promising ways on local treatment of suppurative wounds that can significantly increase the effectiveness of the treatment outcomes.

Efficacy of Human Adipose Derived Mesenchymal Stem Cells in Promoting Skin Wound Healing.

Background The aim of this pilot clinical study is to evaluate the efficacy of human adipose derived mesenchymal stem cells (HAMSCs) treatment for the wound healing with patients. Methods This study was a clinical trial to investigate the efficacy of human adipose derived mesenchymal stem cells treatment for the wound healing with patients. 346 patients with skin wounds attending the central hospital of Yue Yang were enrolled in the study, setting in the period from January 2016 to January 2021. Patients were randomly allocated into two groups: experimental group received treatment with human adipose derived mesenchymal stem cells for each 10 cm2 of wound and control group received conventional dressing with normal saline for each 10 cm2 of wound. Results No adverse events were recorded during the period of treatment. The granulation tissue coverage rate and thickness of granulation tissue after 10 days of treatment in experimental group were significantly improved compared with control group. Furthermore, the occurrence of bleeding of wound and suppurative wounds between two groups had significant difference (P < 0.05). Conclusion The data in this pilot study indicated that human adipose derived mesenchymal stem cells may be a safe and effective alternative therapy for wound healing. Moreover, larger, placebo-controlled, perspective studies are necessity to evaluate the efficacy and safety of human adipose derived mesenchymal stem cells treatment for wound healing patients.

Experimental Simulation of Compression Anastomosis in Double-Barreled Enterostomy Using a Titanium Nickelide Memory Shape Device

Introduction. Enterostomy remains a relevant option of staged treatment of small intestine diseases in children. T-anastomosis with stoma (Bishop-Koop) and double-barreled enterostomy with compression anastomosis (Mikulicz) are among the most widely accepted ones. Disadvantages of compression anastomosis can be eliminated by using a NiTi-clip with shape memory. The aim of the study was to perform an experimental study to detect effectiveness and advantages of NiTi-clip application in formation of a compression anastomosis in a double-barreled enterostomy compared with manual T-anastomosis. Methods. The study included 24 rabbits of the "Serebristyi" breed, aged 2.5-3 months, weighed 2790-3100 g; they were divided into two equal groups. Autopsy was performed in 10, 14, 21 days with pneumopression and histological examination. Differences were considered statistically significant at p-value 0.05. Results. The duration of the Mikulicz operation (group A) was significantly shorter than that of Bishop-Koop`s (group B) (p = 0.000). Significant differences in weight were found in 14. 21 days, with a predominance in group A (p = 0.029). Complications included wound suppuration, eventration, peritonitis, evagination, dermatitis, and anastomotic leakage. In 10 days, compression anastomosis had a lower anastamotic pressure, but in 21 days, it was more stabile than in manual anastomosis (p = 0.019). In 14 days, inflammatory changes in the mucosa with fibrosis in the muscle layers and lesions were detected in the area of ​​manual anastomosis, they were accompanied by inflammation around sutures. In 21 days, fibrotic changes spread in all layers. Proliferation prevailed over inflammation in the area of ​​the compression anastomosis. Conclusions. Double-barreled stoma formation with NiTi-clip application took less time than T-anastomosis. Animals with a double-barreled stoma and compression anastomosis had a larger weight gain. Compression anastomosis with NiTi-clip in the stoma was stabile than manual anastomosis. With compression anastomosis, layer-by-layer regeneration from serous to mucous membrane occurs, healing occurred faster, with a predominance of proliferation processes, the risk of stenosis decreased. The use of NiTi-clip in the surgical treatment of children with double-barreled enterostomy can be recommended for practical use.

Hip joint implanting

The paper provides some experience with hip joint endoprosthesis with Poldi and Beznoska implants, Czechia, used in 210 patients (235 operations). Total and cervicocapital endoprostheses were implanted in 193 and 42 cases, respectively. The indications for total and unipolar joint replacement were severe Stage III coxarthrosis, aseptic necrosis of the head of the femur, pseudoarthrosis of its neck, subcapital fractures with severe limb dysfunctions and persistent pains. Positive results (complete recovery of joint movements and limb load) were noted in 93% of patients in the follow-up periods of 6 months to 18 years. The complications were seen as follows: wound suppuration in 4 patients, aseptic instability in 4 (they all were reoperated), relaxation of a total implant and partial protrusion of the head of a unipolar implant in 6 patients.

Surgical treatment of pilonidal disease with the use of «closed» techniques

The OBJECTIVE was to evaluate long-term results of the use of «closed» techniques of surgical treatment of pilonidal disease.METHODS AND MATERIALS. The study included 147 patients who underwent excision of the pilonidal sinuses according to Karydakis – 28 and excision of the pilonidal sinuses with mobilization of the gluteal fascia – 89, laser obliteration using Filac Fistula Probe – 30 patients. To assess the long-term results, a questionnaire survey of patients, a face-to-face examination and ultrasound of the soft tissues of the postoperative scar area, statistical data processing were carried out.RESULTS. By primary intention, wounds healed in 91.4 % of patients. Complications were observed in 10 (8.5 %) patients: postoperative wound seromas – 8, wound hematoma – 1, postoperative wound suppuration – 1. After mobilization of the gluteal fascia, recurrence of the disease was established in 4 (4.4 %) patients, after obliteration with the use of laser energy and Filac Fistula Probe – in 4 (13.3 %) patients. No relapse was diagnosed after Karydakis procedure.CONCLUSIONS. Operations using «closed» techniques are effective methods of surgical treatment of pilonidal disease. At the same time, there is a low percentage of complications, relapses of the disease and a short period of rehabilitation.

Primary Closure or Delayed Primary Closure? Assessment of Optimum Management of Surgical Wounds for Perforated Appendicitis

BACKGROUND: Open appendectomy is the treatment of choice for perforated appendicitis. Perforated appendicitis is associated with a 15–20% risk of developing post-operative wound infection, which the later associated with increased morbidity as increasing post-operative pain, longer hospital stay, suppurative wounds, patient dissatisfaction and increase cost of treatment. Some literatures revealed inconsistent results related to the incidence of surgical site infection (SSI) between delayed primary closures (DPC) and primary closure (PC) in open appendectomy for perforated appendicitis. AIM: The objective of the study is to define the best practice of wound management in patients operated on for perforated appendicitis. PATIENTS AND METHODS: One hundred and twenty patients having perforated appendicitis underwent open appendectomy enrolled in the study. The patients were randomly grouped according to the method of managing the surgical incisions into two groups; patients with their incisions closed primarily (PC) and those with their incisions left open to be frequently dressed for 5 days with Betadine-soaked gauze packing till it become clean then closed (DPC). An infected wound was assigned as such if purulent discharge yielded from the incision site. Results to be addressed were the incidence of SSI and the hospitalization length. RESULTS: Out of the total 120 patients, 19.17 % developed SSI following closure of the incision. Patients managed by PC revealed higher rate of SSI than DPC group (32.8% vs. 5.1%, p &lt; 0.001) and longer hospitalization (8.3 vs. 6.4 days, with a p &lt; 5%). CONCLUSION: DPC is preferred policy over PC when managing an open appendicectomy wounds for perforated appendicitis, as the former is associated with low incidence of wound infection and shorter hospitalization.

Peculiarities of treatment of patients with gunshot fractures of the leg in Yemen

Retrospective analysis of treatment of 232 wounded with gunshot crus fractures was presented. All patients were treated at Jemen Central Hospital ALTAWRA (Sana) from 1966 to 2000. Out of all patients 94% had missile wounds and 6%) comminuted wounds. All wounded were admitted to Hospital during 24 hours after injury. Peculiarities of wound treatment were the following: injured limb after application of author's stabilizing reposition device if necessary was washed by soap-saline solution. Primary debridement was more active compared to classic one and included removal of small osseous fragments and resection of large osseous fragment ends. In 66%) of wounded no complications were observed during postoperative period and healing by first intention was noted. In 8,4%) of patients healing by granulation occurred. In 15% of cases wound suppuration was limited by soft tissues. Osteomyelitis was diagnosed in 8,6% of patients. In 2% of cases crus gangrene followed by vascular thrombosis was developed.

Modern Principles of Medical Rehabilitation of Patients with Median Defects of the Abdominal Wall

Aim: To analyze rehabilitation and improvement of the quality of life of patients with median abdominal wall defects (MAWD) by increasing the efficiency of alloplasty by determining the general principles of planning and performing surgical interventions. Materials and methods: We carried out an analysis of the treatment results of 346 patients with MAWD, who underwent surgery in the 1st Poltava City Hospital for the period 2005-2019. There were 269 women (77.8%), men – 77 (22.2%). 282 (81.5%) patients underwent reconstructive surgeries, 59 (17.1%) – reconstructive and corrective alloplasty techniques, and 5 (1.4%) – corrective ones. Patients underwent surgery: onlay – in 3 patients (0.9%), sublay – in 289 (83.5%), sublay-inlay – in 38 (11.0%), inlay – in 4 (1.2%), Ramirez modification – in 10 (2.9%), open IPOM – in 2 (0.6%). Results: Local complications were in 25 (7.2%) cases: seroma in 12 (3.5%) patients, infiltrate in 5 (1.5%), necrosis of the edges in 4 (1.2%), hematoma – in 3 (0.9%), wound suppuration – in 1 (0.3%). In the remote period, 14 (4.1%) were registered: recurrence – 7 (2.0%); long-term deep seroma- 3 (0.9%); ligature fistulas with phlegmon – 2 (0.6%); abscess formation – 1 (0.3%), hernial sac infiltration – 1 (0.3%). Conclusions: The results of MAWD alloplasty depend on the correct solution of the planning problem and the choice of the most rational treatment tactics. Adequate abdominoplasty leads to an improvement in the quality of life of patients, medical and social rehabilitation.

ХИРУРГИЧЕСКОЕ ЛЕЧЕНИЕ ПАХОВОЙ ГРЫЖИ В СОЧЕТАНИИ С КРИПТОРХИЗМОМ

Objective: To evaluate outcomes of single-stage surgery performed for inguinal hernia combined with cryptorchidism. Methods: Between 2005 and 2020, 22 patients aged 3 to 28 years underwent surgery for inguinal hernias combined with cryptorchidism. All surgeries were performed using instrumentation, affording surgical precision through enhanced visualisation and magnification. The combination of the hernia with cryptorchidism was noted in 12 (54.5%) and 8 (36.4%) patients on the right and left sides, respectively. In addition, bilateral localisation of hernia and cryptorchidism was observed in 2 (9.1%) patients. In addition to clinical investigation, ultrasonography (US), Doppler ultrasonography (DU) and, to a limited extent, computed tomography (CT) were used preoperatively and in the long-term postoperative period. Dynamical changes in the threedimensional testicular measurements, testicular volumes and the time-averaged maximum velocity (TAMAX, cm/s) in the testicular arteries were evaluated. Results: In the immediate postoperative period, seroma formation and suppuration of wounds were not noted. However, in 3 (13.6%) cases, transient swelling of the scrotum was observed. According to ultrasound data, 6 months after single-stage operations, there was a statistically significant increase in all parameters of the operated testicle compared to the initial values, including three-dimensional testicular measurements and volume (p&lt;0.05) in all age groups. In addition, 6 months after the operation, the sizes of surgically brought down and healthy testicles in all age groups became equal, except for the thickness of the testis in children aged 3-5 years. At the same time, according to DU data, there was also a statistically significant increase in TAMAX in the testicular artery on the side of the lesion (p&lt;0.001). Conclusion: The use of instrumentation, affording surgical precision through enhanced visualisation and magnification when performing surgery for inguinal hernia and cryptorchidism, is the gold standard treatment. Because it prevents iatrogenic damage to critical anatomical structures, allows maximum mobilisation of the vascular pedicle of the retained testicle and contributes to the safe bringing down of the latter without much tension. The selection of an appropriate hernial orifice reconstruction method, along with the recurrence prevention, also helps to avoid compression of the elements of the spermatic cord and thus improve the fertile function. Keywords: Inguinal hernia, cryptorchidism, a combination of inguinal hernia and cryptorchidism.

Local management of purulent wounds with wound dressings

Purulent-inflammatory lesions of skin and soft tissues account for 30-35% of causes of admission to surgical hospitals. In outpatient system, this value reaches 35-60%. Moreover, suppuration of wounds after elective surgery occurs in 2-5% of cases. Adequately selected drugs for local wound therapy can achieve localization of purulent process and avoid spread of infection. This review summarizes data on development, experimental and clinical testing of wound dressings over the past 10 years, presents classification options and analyzes their advantages and disadvantages. The authors emphasize higher efficacy of hydrophilic coatings, and coatings based on chitosan, collagen, methylcellulose and its derivatives are preferred. It is advisable to introduce a component with antimicrobial, anesthetic and hemostatic activity stimulating tissue regeneration into the matrix of wound dressing. The priority is introduction of antiseptic substances causing fewer side effects compared to antibiotics. Further research and development of new wound dressings is a priority in surgery considering changing landscape and development of resistance of microorganisms.

Доклиническая оценка лечения на модели хронического остеомиелита у кроликов

Introduction. Chronic osteomyelitis is one of the problems in orthopedic surgery. Recently, in the treatment of chronic osteomyelitis, biodegradable materials are increasingly used as a local antibiotic carrier. In our study, we used bone allograft, which prepared by Marburg system. The purpose of the study was to evaluate preclinical changes of use the antibiotic-impregnated bone allograft on osteomyelitis model in rabbit. Materials and methods. Osteomyelitis was caused in rabbits by the human strain Staphylococcus aureus, which is introduced into bone defects created in the distal femur. Three groups were selected depending on the filling: group 1 - antibiotic impregnated biodegradable material “PerOssal”, group 2 –whole bone allograft soaked in antibiotic, group 3 - perforated bone allograft soaked in antibiotic. We used a clinical examination for the evaluating decreasing of chronic osteomyelitis process.Results. The body temperature of all experimental animals was measured with a non-contact thermometer during the entire observation period, which was 42 days. The average temperature in rabbits in groups before surgery was 36.90 in-group 1; in-group 2 - 36.40; in-group 3 - 36.20. On the first day after the operation, in groups 1 and 3, there was no significant difference with the initial body temperature in rabbits before the operation, while in-group 2, the body temperature on the first day after the operation was 39.00. In the early postoperative period, the maximum increase in body temperature is observed on the 3rd day in-group 1 up to 39.20 and in-group 3 38.20. In-group 2, the maximum rise in temperature was on the 2nd day after surgery up to 38.60. The average weight in operated rabbits before surgery was 2983.3 g in-group 1; in-group 2 - 3206.7 gr; in-group 3 - 2300.0 gr. In the 1st group in the postoperative period in the 1st group there is a deficit on the early postoperative day amounted to 1.3 g in dynamics decreased up to 5 days and then there was a stable increase in weight, which in general by the 42nd day was 783, 4 grams. In-group 2, on the first day, there was a maximum body weight deficit of up to 92.3 g, with a subsequent increase, and in general, for the entire observation period, the increase was 200 g. In-group 3, on the first postoperative day, the body weight deficit was 13.9 grams. In the dynamics, there was a slight instability in weight, for example, on day 5, body weight was 3284.6 g, with a decrease on day 6 to 3169.2 g. Visually assessing the wound in-group 1, wound suppuration, divergence or instability of the sutures were not noted. In-group 3, on the 28th day after the operation, there was a slight infiltration of soft tissues in the area after the surgical wound. In the 2nd group on the 14th day there was a slight infiltration of soft tissues in the area after the surgical wound, and on the 28th and 42nd days there was suppuration of the postoperative wound.Conclusion. Thus, in this study we showed, that perforated bone allograft is an available biomaterial can be used in bone regenerative surgery.Key words: Preclinical evaluation algorithm, chronic osteomyelitis, rabbits model, preclinical study

Evaluation of Glycologic Point-of-Care Infection Test Kit for Diabetic Foot Ulcers in Relation to Bacterial Presence: A Prospective Cohort Study.

Point-of-care testing for infection might help podiatric physicians optimize management of diabetic foot ulcers (DFUs). Glycologic's proprietary GLYWD product has been developed to detect changes in a patient's immunologic/inflammatory response related to wound infection. We evaluated how bacterial presence in DFUs relates to GLYWD test outcome. This was a single-organization, prospective, controlled cohort study of clinical opinion versus GLYWD test result for DFU infection status and the appraisal of bacterial presence in the wounds and semiquantitative microbiology swab at weeks 0, 3, 6, 12, and 18. Spearman correlation, backward elimination linear regression, and principal components analysis were applied to determine which variables, including degree of bacterial load, are associated with a positive clinical opinion or GLYWD result for DFU infection. Forty-eight patients were enrolled, and 142 complete wound appraisals were conducted; a consensus outcome between clinical opinion and GLYWD result was achieved in most (n = 122, 86%). Clinical opinion significantly correlated with a higher bacterial load (Spearman rho = 0.38; P < .01), whereas GLYWD did not (rho = -0.010; P = .91). This observation was corroborated with logistic regression analysis, in which a previous observation of both clinical opinion and GLYWD associating with wound purulence and erythema was also confirmed. Podiatric physicians are guided by hallmark signs of DFU infection, such as erythema and purulence; furthermore, we found that clinical opinion of infection correlates with increased bacterial load. GLYWD test results match clinical opinion in most cases, although the results obtained with this point-of-care method suggest that the degree of bacterial presence might not necessarily mean a higher chance of inducing an immunologic/inflammatory host response to said bacteria.

Treatment of victims with mine-explosive injuries

To study the incidence and structure of combat gunshot surgical trauma received during the 2nd Karabakh War and to analyze the results of treatment of these victims. We analyzed surgical treatment of 60 victims with combat gunshot surgical trauma received during the 2nd Karabakh war. In 25 (41.7%) victims, injury occurred as a result of mine-explosive trauma. These victims were divided into 3 groups depending on mechanism of mine-explosive injury. The 1st group included 7 (28%) patients who received mine-explosive injury due to indirect (propelling) effect of blast wave. The 2nd group included 14 (56%) victims in whom mine-explosive injury was caused by non-contact (distant) impact of mine fragments. The 3rd group consisted of 4 (16%) patients whose mine-explosive injuries were caused by direct impact of explosion factors on various anatomical areas. Patients were also ranked into 3 groups depending on the nature and severity of mine-explosive injury: wounded with isolated injuries (n=16, 64%), wounded with concomitant injuries (n=2.8%), wounded with combined and multiple injuries (n=7, 28%). Most patients underwent organ-sparing procedures. Resections were performed only in 4 cases (splenectomy - 3, nephrectomy - 1). Postoperative complications developed in 23 (38.3%) wounded (suppuration of postoperative wounds - 13, post-traumatic pleuritis - 5, clotted hemothorax - 2, subphrenic abscess - 1, phlegmon of perineum and perianal region - 2). Mortality rate was 1.7%. Timely sorting and evacuation of victims, early qualified surgical care and correct postoperative management with monitoring of vital functions can improve the results of treatment of victims with mine-explosive trauma. Autologous skin grafting for extensive defects and closure of colostomy with restoration of colon continuity were essential in rehabilitation of these patients.