Vacuum Therapy in Complex Treatment of Purulent-Necrotic Diseases of Soft Tissues: Clinical Cases

Background. Radical surgeries for phlegmons, abscesses, necrotizing infection are often followed by extensive wounds which require an individual approach to their rapid closure by means of plastic surgery methods. In such a case, the optimal wound therapy is primary healing with the use of vacuum therapy.Cases description. The study involved three clinical trials of patients with acute purulent-necrotic diseases of soft tissues of various localizations, volumes and grades, for which vacuum therapy was used as a part of complex therapy. Surgical interventions are proved to be urgently performed in acute purulent-necrotic diseases. Early reconstructive skin and bone plastic surgery aimed at closing post-operative wound defects is also very important.Conclusion. In the demonstrated clinical cases, the purulent process was stopped and wound therapy was performed by means of primary healing, which undoubtedly ensures medical and social rehabilitation of such patients. Notably, vacuum drainage is not an independent method, but an important component in the complex active surgical treatment of purulent wounds

Application of chitosan-based wound dressings in local treatment of parenchymal organ wounds: a preclinical experimental study

Background. Injuries of various origins with damage to parenchymal organs remain one of the urgent issues of emergency surgery, despite all the achievements of medical science of the first quarter of the XXI century. One way to improve the quality of treatment for patients with this pathology consists in developing new wound dressings or modifying the properties of existing ones. Hemostatic efficacy is claimed to be one of the main requirements for such dressings.Objective. To perform a comparative analysis of the efficacy of the developed biodegradable wound dressings based on chitosan in the treatment of experimental wounds of parenchymal organs.Methods. The study involved laboratory animals (male rabbits weighing 2900 ± 150 g) to form experimental wounds of parenchymatous organs. The methodology involved wounding the liver via internal method, with the creation of a tissue defect of a given volume, or forming a linear incised wound with fixed parameters followed by application of a developed wound dressing. In the control group of animals, a collagen hemostatic sponge was used as a wound dressing. The animals used in the experiment were kept in accordance with GOST 33044-2014 “Principles of good laboratory practice”. The experiment involved studying the properties of two samples of wound dressings developed on the basis of modified Chitosan Soft (Ch-S) and Chitosan Hard (Ch-H) chitosan, having different properties due to their different structural parameters. The applied ultrasound control of the experimental wound area, with visualization of the samples of the investigated material in the process of biodegradation, enabled the features of the wound process to be studied in more detail. Statistical processing of the study results was carried out by methods of variational statistics, including the calculation of mean values (M), standard errors of mean values (± m). The criterion of the level of statistical significance considered a value of p <0.05. Histomorphological examination of samples was carried out using classical methods.Results. An experimental study conducted on laboratory animals in the treatment of liver wounds, followed by a comprehensive assessment of the results obtained, revealed high efficacy in the developed wound dressings in comparison with the control. The following parameters predicted in the development of wound dressing samples were confirmed: stable hemostatic and scaffold functions, biodegradability, adhesiveness and stimulating effect on bioreparative processes in the wound area. In addition, the ultrasound control algorithm in vivo was adapted in animals to assess the dynamics of the wound process and biodegradation of the studied wound dressings in wounds of parenchymal organs in the experiment, previously used in studying the dynamics of the wound process in soft tissues.Conclusion. The developed samples of chitosan-based wound dressings proved their efficacy in an experimental model of the wound process in parenchymal organs. The applied ultrasonic method for monitoring the biodegradation of the studied wound dressing, as well as the dynamics of the wound process in the liver tissue, revealed the correspondence between the visualized image and the histomorphological picture of the studied tissues, the structure and properties of the wound dressing

The effect of zinc complex of N-isopropenylimidazole on the morphological characteristics of gum tissues in experimental endodontic-periodontal lesions in rats Authors

Introduction: Combined inflammatory and destructive processes affecting the dental pulp and tissues of the periodontal complex are among the most problem diseases of the dental system. Current therapy with use of available pharmacological agents does not always allow achieving the expected positive result. In addition, often the lack of information about morphological processes in the tissues of the dental system, in particular the gums, with endodontic-periodontal lesion (EPL) limits the ability of dentists to carry out targeted pharmacotherapy with both traditional and, in particular, new medications. The aim of the study was to evaluate the morphological characteristics of gum tissues in a therapeutic context of N-isopropenylimidazole zinc complex derivative in experimental endodontic-periodontal lesion in rats. Materials and Methods: A simulation of EPL in rats was performed in two ways: simultaneous induction of acute periodontitis and parodontitis by pulp extraction and natural infection of the pulp cavity, as well as by ligation of the necks of lower incisors. The research protocols included 5 groups of animals: 1st – intact group (control-1); 2nd – animals with simulated EPL (control-2); 3rd – animals with simulated EPL and treated with Metrogyl Denta® gel (M-D); 4th – animals with simulated EPL and treated with N–isopropenylimidazole zinc complex derivative gel under the laboratory code Pilim-1; and 5th – animals with simulated EPL and treated with the combination of M-D + Pilim-1. The gum of the lower incisors was taken for morphological studies. Slides were stained with hematoxylin and eosin. Computer morphometry was performed using the ImageJ software. Results and Discussion: The substances M-D, Pilim-1 and, especially, the combination of M-D+Pilim-1 (against the background of chlorhexidine bigluconate used as oral rinse) for 14 days in rats with simulated EPL cause a significant improvement of the morphological structure of the gum with minimal residual dystrophy and sclerosis. The combination M-D + Pilim-1 led to a 1.3-time increase in epithelial thickness, and a 1.5-time decrease in acanthosis depth in comparison with M-D, while the number of capillaries and their diameter had no significant differences. Compared with Pilim-1, the epithelial thickness increased 1.5 times, and the acanthosis depth and the number of capillaries decreased 1.6 and 1.4 times, respectively, whereas the diameter of the capillaries did not change significantly. The pronounced protective effect of the combination M-D + Pilim-1 on the morphological structure of the gingival mucosa of rats with simulated EPL may be associated with antimicrobial, anti-inflammatory, regenerating, angioprotective and antioxidant properties of both M-D and Pilim-1 separately, and, possibly to a greater extent, of the combination M-D + Pilim-1. Conclusion: The substances M-D, Pilim-1 and, especially, the combination M-D + Pilim-1 (against the background of chlorhexidine bigluconate used as oral rinse) for 14 days in rats with simulated EPL have a protective effect on the epithelial structure and the connective tissue of the proper mucous plate, manifested in active normalization of pathological changes and significant restoration of their organotypic structure

RESULTS OF MODERN METHODS OF RESTORATION OF BLOOD FLOW AT A CRITICAL ISCHEMIA IN PATIENTS WITH ATHEROSCLEROTIC LESIONS OF THE LEG ARTERIES

One of the most main problems of medicine in 21th century is critical limb ischemia (CLI). From 500 to 1000 patients to 1 million of population have it, according many researches’ results. In our research we have made the analysis of two groups patients which had popliteal or calf arteries’ diseases. The first group was treated by balloon angioplasty, the second one was treated by therapeutical angiogenesis. The information, that were received during two years was analyzed. In the first group number of thrombosis was larger and a thrombosis was revealed in early stages. However, the amount of bad results was decreased and the term of patency was increased after a second operation. In the second group thrombosis of the stenotic artery of the tibia had place in later stages, what resulted in repeated therapeutic angiogenesis that was needed for evolving of microcirculation

Remote results of reconstructive operations at femoral-popliteal-tibial segments at the various ca-pacities of the distal bed

This article is devoted to the study of remote results of reconstructive operations with atherosclerotic affection of femoral-popliteal-tibial segment. This original technique used intraoperatively to evaluate the volume of the distal bed. It is found, that in postoperative period the graft patency depends on index of the distal bed

Microsurgical reconstrution of the femoral vein valve as a treatment for recurrent varicose veins (case from practice)

In this article offered a case of surgical treatment of recurrent varicose veins. The operation described in detail. We present short-term and long-term results. In this report clearly reflects the efficiency of the correction valve of femoral vein for recurrent varicose veins

PROGRESS IN SURGICAL TREATMENT OF CHRONIC LOWER LIMB ISCHEMIA

Aim. The study was conducted to expand the variety of ways for surgical treatment of chronic ischemia of lower limbs complicated by the involvement of the femoropopliteal and pedidial arterial segment. Materials and methods. The experience of surgical interventions in 43 male patients aged 52-75 suffering from chronic ischemia of lower limbs complicated by the atherosclerotic involvement of the femoropopliteal and pedidial segment has been summarized. According to the classification by A.V. Pokrovskiy, ischemia of the 3rd stage has been determined in 24 patients (55,8%), while ischemia of the 4th stage complicated by necrosis of the toes (critical ischemia) has been determined in other 19 patients (44,2%). All examined patients have undergone the reconstructive interventions using the prepared lateral subcutaneous vein of the upper extremity as a shunt.Results. During the first day after the operation, the regression of pain syndrome as well as the warming of the lower extremity was indicated in 93% of patients. In 8-12 days after the reconstructive operation, the patients have undergone the 15 necrectomy or toe amputation. In the nearest postoperative period (less than 6 months) no thrombotic complications in the reconstructed segment have been determined. Within the observation period from 6 months to 5 years the bypass patency has been preserved in 71% of patients; ischemia of the 2nd B type has been revealed in all patients with the preserved bypass patency by the clinical examination.Conclusion. Despite the “forced” character of usage of the prepared V. cephalica due to the absence of “traditional” venous shunts as well as the labor intensity of the method, it allows to expand the variety of ways for surgical treatment of patients suffering from chronic ischemia of lower limbs of the 3rd-4th stages complicated by occlusive involvements of the femoropopliteal and pedidial segment

The optimal method of surgical treatment of patients with floating thrombosis of the iliac-femoral venous segment

The scientific work presents analysis of an examination of 78 patients with floating thrombosis in the iliac-femoral venous segment. Аll patients depending on the method of surgical treatment were divided into three groups. First group consists of patients who had had thrombectomy of iliac-femoral venous segment with the plication superficial femoral vein (SFV). Patients from second group has had thrombectomy and ligation of the SFV. Third group consist of patients who had had thrombectomy with resection of the (SFV).In all patients of group I in the remote period the symptoms of chronic venous disease (CVD) were manifested by mild edema and did not exceed grade 3. While in group II at 5% (2) of patients diagnosed grade 4 CVD as trophic disorders of the skin shin, and the terms of recanalization of the thrombosed veins in 38.5% (15) patients have come at a later date in comparison with I group. The worst results were marked in group III. There were more pronounced than in I and II groups the swelling of the limbs and trophic disturbances. Recanalization in the majority of patients of this group 71,4% (10) occurred in the later stages (6-10 months)

Results of surgical treatment of recurrence of varicose veins, manifested expansion of perforating veins

The paper presents an analysis of a examination of 87 patients with relapse of varicose veins after surgery, manifested in the form of an extension of perforating veins. These patients after the examination were re-operated on us. Depending on the method used to treat the patients were divided into 3 groups. In group I, the elimination of reflux of superficial femoral vein combined with ligation of perforating veins. In group II perforating veins ligation was performed without eliminating reflux. In the III group included patients femoral vein-off valve, which also carried the ligation of perforating veins. Repeated relapse in group I was observed in 9.1% (2), the second was observed in 66.7% (10) of patients in the third group recurrence showed at 37% (11) patients

TACTICS OF THE SURGEON IN URGENT COMPLICATIONS OF COLON CANCER

Aim. The aim of the work is to develop the tactics for the treatment of complicated colon cancer (tumor perforation, tumor bleeding, acute obturation obstruction).Materials and methods. The clinical development included 324 patients with urgent complications of colon cancer. 269 patients were operated urgently and immediately, 56 operations were deferred. The diagnosis was based on anamnesis, clinical, laboratory and special research methods (ultrasound, CT, EGD, colonoscopy, histological examination). Results. Postoperative mortality in urgent complications of colon cancer was 3.5%.Conclusion. The rationale for the choice of method and volume of surgery, depending on the location and nature of complications of colon cancer, is provided