Vol 6, No 2 (2013)

The purpose of the study To improve the results of the treatment of patients with purulent wounds through the development and introduction of a differentiated approach to the selection of skin plastic and reconstructive surgeries into clinical practice. Materials and methods The results of the treatment of 312 patients with purulent wounds of various etiologies were analyzed. The age of the patients ranged from 15 to 82 years. The wounds with the area of no more than 100 cm2 were observed in 152 (48,7%) patients, 100-200 cm2 - in 109 (34,9%), more than 200 cm2 - in 51 (16,3%) patients. The large size of the wound defect served as an indication for performing skin grafting. Results and their discussion We noted that if the area of the wounds was less than 100 cm2 , skin flaps were used (115 (75,7%) patients). For the area of the wounds between 100 and 200 cm2 , the use of split flaps prevailed (75 (68,8%) patients). For the wounds of more than 200 cm2 , plastic by split flaps was most commonly performed as the only possible form of the wound closure (24 (47,1%) patients) or in combination with plastic by local tissues (15 (29.4%) patients). Conclusion Full-thickness skin grafting can be used for the closure of the wounds that are located in the bearing areas as well as cosmetically and functionally important zones as well as during the recovery phase of the treatment of pressure ulcers, neurotrophic ulcers and deep frostbites. A differentiated approach to the selection of skin plastic and reconstructive operations allowed to achieve 91,4% short-term and 80% long-term positive results in the treatment of patients with surgical infection.

The purpose of the study Through the development of complex of diagnostic and treatment, events organization, aimed at the prevention of the development of abdominal adhesions, improve the results of treatment of patients after surgery for a mechanical abdominal trauma, complicated haemoperitoneum. Material and methods For clinical study was performed 83 patients with open and closed mechanical trauma of the abdomen, complicated by haemoperitoneum. In dynamic screening was used self constructed diagnostic magnoimmunsorbs-test system based on the antigen commissural complex. Definition of indicators of hemostasis was carried out using by method of NGOs «RENAM». Results and their discussion Modified by author the test system on the basis of magnoimmunsorbs and immobilised adhesive antigen allows with the high per-formance to predict the development of intraabdominal adhesions, to control of results by antiadhesion therapy. Develop a pathogenetically justified complex of therapeutic measures, directed on elimination of hypoxia in the tissues, activity normalization of the fibrinolitic blood system, the appointment of the antiadhesion drug, the gradual application of physical therapy. This complex allow to bettering the treatment results , to decrease adhesion development in postoperative period from 65% to 12,1% i.m. in 5,4 times. Conclusion In patients operated due to abdominal trauma, hemoperitoneum was founded statistic improved condition of medium hipocoagulation, decreased activity of fibrinoliticic blood system. In identification of the dynamic changes in amount of positive reactions Ag+At in different titres of blood serum can be determined the therapy starting date and estimated its effectiveness.

Relevance In the structure of urgent surgical pathology the acute pancreatitis is a hold one of leading positions. The purpose of the study is reported in experimental of the pathogenetics mechanisms a advances acute pancreatitis in consequences on surgical aggression; on bases of the receive informations prepare of new approach in decreases (prevention) of the negative manifestations of surgical traumae. Material and methods The study is based on materials of experimental studies. The acute pancreatitis is a simulated by the method of V.M. Buyanov et al. (1989). The adult mongrel dogs performed a median laparotomy, punctured gallbladder, bile were taken with followed by ligation of the puncture site. Bile then injected into the parenchyma of the vertical parts of the pancreas of 0,6 ml in 5 points. In two day after simulation performed a relaparotomy. It the control periods of the investigation (the first, third and fifth day after relaparotomiae) animals collected the blood, biopsy of the pancreas. Results and their discussion The exposed that of the effect of surgical aggression a leading to bigger intensifies in the pancreas cells of a processes of lipid peroxidations, activation of phospholipasae A2 and oppression systems of antioxidant protections, that one is important of mechanisms in the pathogenesis on breaking lipid metabolisms and development a membranodestruction phenomenons in organ bring of progresses a diseases, right until destruction forms. Conclusion Established of experimental that antioxidant of etoksidol showing a fast (already the first day after relaparotomiae) and a significant influences on the processes of lipid peroxidations of the pancreas cells, reducing the level of primary and secondary products of lipid peroxidations. The important moment it ability is to reduce the activity of phospholipasae A2 and increase its own antioxidant enzyme potential of a tissue structures of organ damages. This bring pronounced of a membranoprotectors action of the preparation that essential decrease action no only «natural» trigger mechanisms of pathology, but and negative influence of surgical aggression.

Relevance One of the features of traumatic epidemic peace time is an increase in the frequency of injuries of the organs of the abdominal cavity. Abdominal trauma occupy one of the per-out places in the structure of injuries of various systems of the body, and their frequency is 12-40,5%. In Western European countries in peace-time the specific weight of abdominal injury reaches 1.5-4.4% of all injuries. In different regions of our country the abdominal trauma falls from 1.5 to 36.5% from the number of injuries peace time, but their frequency and severity, in spite of the tendency to decrease, remain high. Injuries of parenchymatous organs are one of the most severe types of surgical pathology, both in peacetime and in wartime. The condition of the injured is determined by the multiplicity damage of parenchymatous organs, as well as the volume and intensity of blood loss. One of actual problems of surgery at the present time is to stop the bleeding in the event of damage of the liver, spleen. The purpose of the study To explore, experiment and make a comparative assessment of cryotherapy and some local applicator means of hemostasis in wounds of the liver and spleen. Materials and methods The paper presents experimental data showing changes in the tissue of liver and spleen under low temperature (-195,75°С) when modeling the wounds of various depth and length of the given organs. Simultaneously, in the control group the use of some of the adhesive hemostatic agents in cases of liver and spleen injury on a equatable number of experimental animals was evaluated. In all of the cases a histological study of areas of cryoapplication and adhesion of local hemostasiс agents was conducted. Results and their discussion It was proven that it takes significantly less time for hemostasis with the help of cryoapplication in comparison with hemostatic sponges. In addition to that, cryogenic method has antiadhesive activity and to a lesser extent causes inflammatory changes in the tissues as well as it allows for the formation of connective tissue in the place of the stoppage of bleeding significantly faster. Conclusions Local cryohemostasis can be used in cases of parenchymatous hemorrhage for an ultimate or temporary hemostasis. Proven lesser degree of severity of inflammatory changes when using cryohemostasis and showed a significant decrease in inflammatory reaction after cryohemostasis in the early stages of the experiment, which is not observed when using hemostatic sponge.

Relevance Hemangiomas - the most common in early childhood benign vascular tumors. Treatment of vascular tumors and challenge still remains the subject of discussion of many experts, as evidenced, as a waiver of any medical or surgical intervention on the involution c hope, and offers a large number of different treatments. The purpose of the study Improvement of treatment of hemangiomas in children by local cryoablation according to the ultrasound picture of education. Materials and methods Experimental. For the identification of a mechanism for cryotherapy hemangioma, we conducted an experiment on the model of vascular tumor crest of live chickens. For the experiment using ridges 20 live chickens at the age of 150-200 days. The experimental scheme was as follows. Scallops on the first group of chickens was performed cryotherapy (liquid nitrogen) on an area of 1.5 cm 2 exposure of 30 seconds. As a control group of birds, the scallops are not affected. After the experimental exposure was carried out daily visual monitoring of birds and morphological changes scallop chickens. Crest biopsy was performed at 1, 4, 8 and 14 of the study. Clinical section. For 2008-2009. hospitalization GOOSE "DRKB number 1" asked 487 children, who revealed 540 hemangiomas. After clinical evaluation in 214 children (43.94%) performed ultrasound of hemangiomas, conducted 232 surveys. In 435 patients treated with cryotherapy hemangiomas started due to the fact that the patient was exposed to a preliminary diagnosis of capillary hemangioma. Results and their discussion In the experiment, after cryoablation on the first day of the integrity of the scallop is not broken, the cells clear. By 4 days is a violation of the integrity and structure of the surface layer of the vascular and the surrounding connective tissue layer, the structure of which is bubbly. Marked migration of fibroblasts and macrophages, the formation of fibrous tissue. To a lesser extent affected fibro-fatty layer and place in a large caliber vessels there. On the 8th day of the ongoing destruction of frostbite tissue rejection of the surface layer. Observed a tenfold increase in the number of fibroblasts, the large size of the cytoplasm with clear boundaries. Appear around the cells of connective tissue fibers yellow. By 14 days of elastic fibers are replaced by collagen. Collagen fibers to orient the intercellular substance. There is a destruction of fibroblasts to form in their place of continuous acellular collagen strands, followed by the formation of thin fibrous strands of vascular and connective tissue layers and their subsequent epithelization. Found that the method of cryoablation not guarantee 100% recovery in the treatment of hemangiomas. Recovery occurred in only 66.21% of patients who underwent cryoablation. Results kriolecheniya hemangiomas depends on the severity of the subcutaneous component of the presence or absence of feeding vessels. In 33.79% cryotherapy was ineffective in some cases been successful only in the skin, subcutaneous component continued to grow. When the skin with subcutaneous hemangiomas feeding vessels after krioaplikatsii recovery does not occur, after 2-3 weeks there is a renewed exophytic growth. When the skin with subcutaneous hemangiomas component and subcutaneous feeding vessels after cryoablation observed the opposite effect - the rapid growth of hemangiomas, recovery occurred after surgical or combined treatment. Conclusion Lack of subcutaneous vascular pattern accented or branched component in patients with a preliminary diagnosis of capillary hemangioma on ultrasound mode DRC found only in 44% of cases. When cavernous hemangioma and mixed by ultrasound mode DRC branched components in a mixture of 56% is observed, branching venous component of character - in 36% of the components of blood and branching character - 8%. The results of cryosurgical treatment of hemangiomas depends on the severity of the subcutaneous component of the presence or absence of feeding vessels: with capillary hemangiomas of the skin without subcutaneous component and lack of vascular pattern accented with DRC recovery occurs after one session cryoablation in 79% of cases and after 2 sessions - in 21% of cases. When the skin with subcutaneous hemangiomas component, capillary or cavernous vascular pattern accent and no feeding vessels, as detected by the DRC after cryoablation was successful on the skin, subcutaneous component continued to grow, although not extensively, recovery occurred after surgery, or combined treatment. When the skin with subcutaneous hemangiomas feeding vessels revealed by the DRC, even in the absence of other changes in the subcutaneous tissue after cryosurgical treatment recovery does not occur, after 2-3 weeks there is a renewed exophytic growth and recovery - after surgery or combined treatment. When the skin with subcutaneous hemangiomas and subcutaneous component supply vessel revealed by the DRC after cryoablation opposite effect was observed, the rapid growth of hemangiomas, the recovery - after surgery or combined treatment.

The purpose of the study There is development of method of estimate possible outcome of the acute pancreatitis with primary injury head and isthmus of pancreas. Materials and methods 60 patients which had hard courses acute pancreatitis, aged of patients was between 19 and 80 years were studded. The patients with localization of inflammation in head and isthmus of pancreas were included in clinical group. Reactive response of neutrophil (RRN) was calculated on the ground of blood analysis. Indices of bilirubin in blood and diastase in urine are taken into account. Presence according to abdominal cavity organ CT – angiography’s dates significant signs of hard course acute pancreatitis are taken into account too. Results and their discussion The original method “Method of estimate possible outcome of the acute pancreatitis with primary injury head and isthmus of pancreas” was developed for estimate possible outcome of the acute pancreatitis with primary injury head and isthmus of pancreas. If we have each sign, decided quantities of points are given, and possible outcome of the pathologic process was judged by depending on total score. Sensitivity is 90,4%, specificity - 95,7%, accuracy - 87,1%, positive predictive value (PPV) - 86,3%, negative predictive value (NPV) - 97,1% Conclusion As a result, the introduced method make it possible to early identify of hard courses acute pancreatitis and prognoses unfavorable outcome of diseases.

The purpose of the study Effect of the suspensions of copper and zinc nanoparticles on regeneration of an experimental conditionally aseptic wound when applied locally. Materials and methods The research object was60 laboratory white rats; copper, zinc nanoparticles generated with the help of plasma technology as suspensions in isotonic sodium chloride solution. Modeling of a full-layer conditionally aseptic wound was carried out in the interscapular region with an area of 400 mm². In the work experimental, planimetric, microbiological and statistical research methods were used. Results and their discussion The change of the area of the conditionally aseptic wound in experimental animals, conditionally aseptic wound healing rate (in mm²/day), diurnal reduction of the area of experimental wounds (in %) in dynamics are analysed. In animals of the experimental group taken the treatment by the suspension of copper nanoparticles a fast healing of the wound surface was observed. During the whole period of the research the healing of the wound surface of the animals of the experimental group was more active than in case of the comparison group because of the absence of the reinfection, that is connected to the evident antibacterial action of copper nanoparticles. Under the influence of the suspension of zinc nanoparticles stimulation of wound regeneration, earlier complete healing was observed as well, but some animals had wound infection resulted in expansion of the wound surface. It confirms the evident regenerative action of zinc nanoparticles in case of an absence or low-grade antiseptic effect. Conclusion The analysis of healing rate of conditionally aseptic wounds, diurnal reduction of the area of experimental wounds in dynamics confirms the effect of copper and zinc nanoparticles as a suspension on soft tissue wound regeneration.

The purpose of the study To analyze the results of the treatment of patients with acute destructive pancreatitis and determine the most effective methods of various drainage operations to decrease the number of complications and mortality rates as well as improve treatment outcomes. Materials and methods The results of the treatment of 1433 patients, among whom 136 (9,5%) had various forms of acute destructive pancreatitis, were analyzed. The basic complex conservative therapy during the study period was consistent and included antisecretory, infusion, antiulcer, antibacterial, corrective therapy, extracorporeal detoxification methods. At admission, the general condition of 49 patients (36,3%) was viewed as moderate, of 46 patients (34,2%) – as serious and of 33 patients (24,5%) – as extremely difficult. Results and their discussion In case of primary destruction of the pancreatic tissue and parapancreatic cellulose of less than 30%, conservative therapy, extracorporeal detoxification methods along with minimally invasive surgery proved to be effective in 91,1% of the cases. In 8,9% of the cases, additional minimally invasive "closed" drainages of the local suppurative complications were required. The prolonged epidural analgesia was applied to all patients during the complex treatment, regardless of the number of destructive changes and severe course of the disease, starting from the first days. The general stages of surgical intervention for patients with severe acute destructive pancreatitis during the early development of both aseptic as well as early and late unlimited postnecrotic septic complications were developed. Conclusion A differentiated approach to the surgical treatment strategy of the patients with destructive pancreatitis, depending on the amount of the initial lesion of the pancreas, allowed to reduce the average number of suppurative complications by 4 times per patient (from 9,8 to 2,2%) and decrease the mortality rates by 3 times from suppurative complications.

Relevance The number of ischemic stroke (IS) has been increasing every year. Large investigations world wide have proved the effectiveness of carotid endarterectomy (CEA) in IS prevention for patients with significant atherosclerotic carotid artery (CA) lesions. Many authors got superior results after closing arteriotomy site with patch during CEA. This article is a continuation of early published in this journal “Short-term outcomes of carotid endarterectomies using different types of patch materials” (Vol.IV, №1 2011). The purpose of the study To analyze the long-term results of using different patches at CEA, to determine the indications for the use of a plastic material. Materials and methods In presented investigation long-term outcomes of carotid reconstructions with patch angioplasty have been analyzed. Patches were made of polytetrafluoroethylene (PTFE) and great saphenous vein (GSV) fragment from the hip. We formed two groups – the first group consists of 110 patients, they underwent 113 CEA with PTFE patch plasty. The second one combined 82 patients (83 CEA, autologous vein patch). Statistically groups were similar by concomitant diseases. The analyzed period of longterm outcomes was for the first group 38 months, for the second – 43 months. Results and their discussion The main cause of death in both groups was cardiac infarction (9,7% vs 8,4%, P>0,05). Lethality from IS at operation site was statistically comparable: 2.7% after CEA with PTFE patch angioplasty and 1,2% if autologous vein patch has been used, P>0,05. Consequences of non-lethal IS in the ipsilateral hemisphere were found after 3,5% and 1,2% cases accordingly, P>0,05. Hemodynamically significant CA restenosis (>60%) was registered after 1,2% CEA with saphenous vein patch; 8,9% patients with PTFE patch had this complication (3,5% – CA occlusion), P<0,05. Conclusion CEA’s with patch angioplasty demonstrate durable outcomes in long-term period. The results didn’t find any statistically significant difference in frequency of ipsilateral lethal and non-lethal strokes. Risk of hemodynamic significant carotid artery restenosis was higher in patients with PTFE patch angioplasty rather than using autologous vein patch.

Relevance One of topical issues of modern obstetrics is diagnostics and treatment of women with an injury of the perineum during childbirth. Damage of soft tissues of the birth channel is seen at each 3-5 women in labor, thus the frequency of ruptures of a perineum can reach 15% of cases. For the purpose of restoration of anatomic and functional integrity of a perineum during childbirth various techniques of an episiorraphy are applied. Unfortunately, results of using each of them are not always favorable and are accompanied by inconsistency of muscles of a pelvic bottom and leads to development of serious gynecologic pathology – genital prolapse. The purpose of the study The purpose of the research work was development of the method for surgical restoration of the perineum, allowing to reduce the frequency of failures after an episiotomy or a spontaneous rupture of a perineum during childbirth. Materials and methods In research work 236 women was included, who had injury of perineum during delivery. 106 women were carried out by a traditional technique and entered into the control group. The main group was made by 130 women who are treated with offered technique for restoration of perineum. Results and their discussion Complaints of patients of the main group for pain in a perineum met by 1,3 times less than in control group. More favorable healing of a perineum wound in women of the main group allowed to reduce the need for anesthetics and antiinflammatory therapy, and also application of courses of physiotreatment. In the main group, unlike control, cases of a hematoma of a vagina and inconsistency of suture on a perineum weren't revealed. In the remote terms dyspareunia at women of the main group was met twice less than in the control.

Reconstruction of the shape of the nose is one of the oldest plastic surgery. Near the medial frontal flaps are preferred by local flaps for reconstruction of large defects cover most of the nose because of the supratrochlear artery, which provides the main blood supply to the median axis of the frontal flap. The article presents a clinical case of the reconstruction of the defect all layers nose and left nostril by a two-stage plastic near the medial frontal flap. At the same nostril formed using ear cartilage and mucous membrane of the nasal septum. On examination at 1 month after the second stage, the patient was completely pleased with the aesthetic result. This clinical observation proves efficiency naso-frontal flap reconstructions at the tip of the nose in a short-stay surgical hospital patients.

The main problems of modern surgery are in the field of emergency abdominal pathology. Relevant issues are the treatment of patients with acute surgical abdominal disease, including acute small intestine obstruction, complicated by peritonitis and acute liver failure. Deaths in acute small intestine obstruction is 10,7-64,7%, while the complication of peritonitis mortality reaches 47- 100%. Mortality in patients with peritonitis, complicated by acute liver failure reaches 73% with no tendency to decrease even in the core of modern hospitals. In peritonitis disturbed barrier function of the liver with «breakthrough» of infectious and toxic agents into the systemic circulation and the development of multiple organ dysfunction syndrome and toxic-septic shock. It is obvious that without a deep knowledge of the morphofunctional changes in the body of endotoxemia and after its removal, there can not be a qualitative improvement in the pathogenetic therapy of patients with acute liver failure complicating during peritonitis. We need experimental-morphological study - an experimental model of acute small intestine obstruction are needed, which would investigate morfofuntsionalnye conversion in the liver in the dynamics of the disease, to determine the staging of these changes and, consequently, on the basis of the data to justify the preventive and therapeutic tactics in the preoperative and early postoperative period