Аутотрансплантация лоскутов при лечении периимплантной инфекции после накостного остеосинтеза (анализ клинических наблюдений)

Unfortunately, suppuration of a postoperative wound remains the most frequent complication of surgical intervention. If suppuration is located superficially, within the subcutaneous fat, it can be successfully managed with minimal functional losses. The clinical course is significantly complicated if the focus of infection is located under the skin, in the thickness of the muscles, in the fracture zone. In the case of suppuration in the area of osteosynthesis, the complication may become critical.Such a complication is a serious condition that requires multi-stage complex and sometimes multidisciplinary treatment.The conditions for a successful outcome in this pathology are the minimum period from the moment of suppuration, active surgical tactics, stability of the implant, and good vascularization of the surrounding soft tissues.Active surgical tactics involves the opening and sanitation of purulent foci, leaks, recesses. Staged necrectomies are inevitable companions of surgical treatment and can cause the formation of defects in the skin, subcutaneous tissue, and muscles.The resulting soft tissue defect leads to exposure of the bone and plate. Removal of the metal fixator becomes inevitable.Only the closure of the defect with a complex of tissues based on free vascularized composite grafts can radically solve the problem.The article presents two clinical observations of deep wound infection after bone osteosynthesis, where autotransplantation of a vascularized flap was used. The use of this technique made it possible to achieve suppression of infection, wound healing by primary intention, to create conditions for consolidation of the fracture, restoration of function and preservation of the limb as a whole.Нагноение послеоперационной раны остается, к сожалению, наиболее частым осложнением хирургического вмешательства. Если нагноение локализуется поверхностно, в пределах подкожно-жировой клетчатки, с ним удается достаточно успешно бороться с минимальными функциональными потерями. Клиническое течение значительно осложняется, если очаг инфекции располагается под кожей, в толще мышц, в зоне перелома. В случае нагноения в области накостного остеосинтеза осложнение может стать критическим.Такое осложнение — это тяжелое состояние, требующее многоэтапного комплексного, а порой мультидисциплинарного лечения.Условиями успешного исхода при данной патологии являются минимальный срок с момента нагноения, активная хирургическая тактика, стабильность имплантата, хорошая васкуляризация окружающих мягких тканей.Активная хирургическая тактика подразумевает вскрытие и санацию гнойных очагов, затеков, карманов. Этапные некрэктомии являются неизбежными спутниками хирургического лечения и могут стать причиной формирования дефектов кожи, подкожной клетчатки, мышц.Образовавшийся дефект мягких тканей приводит к обнажению кости и пластины. Удаление металлофиксатора становится неизбежным.Лишь закрытие дефекта комплексом тканей на основе свободных васкуляризированных составных трансплантатов способно кардинальным образом решить возникшую проблему.В статье представлены два клинических наблюдения глубокой раневой инфекции после накостного остеосинтеза, при которых была применена аутотрансплантация васкуляризированного лоскута. Использование данной методики позволило добиться подавления инфекции, заживления раны первичным натяжением, создать условия для консолидации перелома, восстановления функции и сохранения конечности в целом

Intraperitoneal drain placement and outcomes after elective colorectal surgery: international matched, prospective, cohort study

Despite current guidelines, intraperitoneal drain placement after elective colorectal surgery remains widespread. Drains were not associated with earlier detection of intraperitoneal collections, but were associated with prolonged hospital stay and increased risk of surgical-site infections.Background Many surgeons routinely place intraperitoneal drains after elective colorectal surgery. However, enhanced recovery after surgery guidelines recommend against their routine use owing to a lack of clear clinical benefit. This study aimed to describe international variation in intraperitoneal drain placement and the safety of this practice. Methods COMPASS (COMPlicAted intra-abdominal collectionS after colorectal Surgery) was a prospective, international, cohort study which enrolled consecutive adults undergoing elective colorectal surgery (February to March 2020). The primary outcome was the rate of intraperitoneal drain placement. Secondary outcomes included: rate and time to diagnosis of postoperative intraperitoneal collections; rate of surgical site infections (SSIs); time to discharge; and 30-day major postoperative complications (Clavien-Dindo grade at least III). After propensity score matching, multivariable logistic regression and Cox proportional hazards regression were used to estimate the independent association of the secondary outcomes with drain placement. Results Overall, 1805 patients from 22 countries were included (798 women, 44.2 per cent; median age 67.0 years). The drain insertion rate was 51.9 per cent (937 patients). After matching, drains were not associated with reduced rates (odds ratio (OR) 1.33, 95 per cent c.i. 0.79 to 2.23; P = 0.287) or earlier detection (hazard ratio (HR) 0.87, 0.33 to 2.31; P = 0.780) of collections. Although not associated with worse major postoperative complications (OR 1.09, 0.68 to 1.75; P = 0.709), drains were associated with delayed hospital discharge (HR 0.58, 0.52 to 0.66; P < 0.001) and an increased risk of SSIs (OR 2.47, 1.50 to 4.05; P < 0.001). Conclusion Intraperitoneal drain placement after elective colorectal surgery is not associated with earlier detection of postoperative collections, but prolongs hospital stay and increases SSI risk

METHOTREXATE — «GOLD STANDARD» OF JUVENILE RHEUMATOID ARTHRITIS TREATMENT

The article presents the literature review of recent publications on efficacy and safety of methotrexate in treatment of juvenile rheumatoid arthritis. Administration of methotrexate 15 mg/m2 of body surface weekly results in significant decrease of inflammatory activity of rheumatoid process and in several cases in induction of clinical and laboratory remission of the disease. Maximal effect can be achieved via subcutaneous or intramuscular injection

Synthesis of fe/ni bimetallic nanoparticles and application to the catalytic removal of nitrates from water

This work investigated the effectiveness of zerovalent iron and Fe/Ni bimetallic nanoparticles in the treatment of water polluted by a high concentration of nitrates. Nanoparticle synthesis was carried out by a sodium borohydride reduction method in the presence of sodium oleate as a surfactant. The particles were characterized by XRD and SEM. Batch experiments were conducted on water samples contaminated by 300 mg L−1 of nitrate. The parameters investigated were the Fe/Ni dosage (0.05, 0.1, 0.2, 0.3, and 0.4 g L−1) and the reaction pH (unbuffered; buffered at pH = 3; initial pH = 3, 5, and 10). The results showed that almost complete nitrate removal (>99.8%) was always achieved after 15 min at a concentration of bimetallic nanoparticles higher than 0.2 g L−1 . The optimization of bimetallic nanoparticle dosage was carried out at a fixed pH. Kinetic study tests were then performed at different temperatures to assess the effect of temperature on the nitrate removal rate. By fixing the pH at acidic values and with an operating temperature of 303 K, nitrates were completely removed after 1 min of treatment

BIOLOGIC THERAPY IN PEDIATRIC RHEUMATOLOGY

The article presents data on unique worldwide experience of biologic agents use in pediatric rheumatology. 433 children with different types of juvenile arthritis (JA) were treated with biologic drugs in Rheumatological Department of Scientific Center of Children’s Health, Russian Academy of Medical Sciences from November 2002 to September 2010: 270 patients received infliximab, 74 — adalimumab, 55 — rituximab, 34 — tocilizumab. Results of a study showed that differentiated biological therapy unlike classic immunosuppressive agents (methotrexate, cyclosporine, leflunomide, etc.) results in clinical and laboratory remission in 70% patients with JA and decrease of disease’s activity in 20% of children in one year. Treatment with genetically engineered biologic drugs increase quality of life of children with JA and their families, provides normal growth and development of patients, and changes a prognosis of this previously incurable autoimmune disease.<br /