Novosti
Khirurgii

DOI: https://dx.doi.org/10.18484/2305-0047.2022.1.5   |  

R.N. CHORNOPYSHCHUK

THE USE OF PLATELET-RICH PLASMA IN THE TREATMENT OF BURNS IN THE EXPERIMENT

National Pirogov Memorial Medical University, Vinnytsya, Ukraine

Objective. To evaluate the effectiveness of platelet-rich plasma injections in the treatment of wounds in experimental animals with burns.
Materials and Methods. The experiment was carried out on 30 sexually mature male Wistar rats, which, after simulation of infected burn wound with boiling water and excision of necrotic tissue to pinpoint bleeding, hemostasis, on the second day, were divided into the main and control groups, depending on the chosen strategy of subsequent treatment. Wound defect of the animals in the control group (15 rats) was treated and bandages soaked in 0.02% decamethoxin solution were applied. Platelet-rich plasma was additionally injected into the wound area of the animals in the main group (15 rats) on the 1^st, 3^rd, 5^th day after necrectomy. The remaining plasma was applied to the wound surface followed by closure with a polyvinyl chloride film and gauze bandage. Wound dressings were performed daily. The study involved a histological examination of the wound site and surrounding tissues the collection of which was carried out on the 1^st, 3^rd, 7^th, 14^th day after the removal of necrotic tissues.
Results. In animals of the main group, the treatment of which involved the use of platelet-rich plasma, on the 3rd day after necrectomy in the wound area a decrease in the depth of injury that extended only of to subcutaneous tissue, a decrease in the activity of the inflammatory reaction in the tissues, followed by the proliferation of new epidermis and almost complete healing of wound defect up to 14 days were determined. For comparison, pathological changes in the tissues of the injured area of the animals in the control group were more pronounced with signs of muscle injury. In addition, during the entire observation period in this group of animals, an intense inflammatory reaction with low proliferative activity persisted.
Conclusion. The effectiveness of platelet-rich plasma injections as an element of complex local treatment of burn wounds in rats has been experimentally confirmed.

Article in the .pdf format

DOI: https://dx.doi.org/10.18484/2305-0047.2022.1.12   |  

R.E. KALININ ¹, I.A. SUCHKOV ¹, N.D. MZHAVANADZE ¹, V.O. POVAROV ¹, E.A. KLIMENTOVA ¹, O.N. ZHURINA ¹, G.A. PUCHKOVA ²

PROGNOSTIC MARKERS OF RESTENOSIS IN PATIENTS WITH PERIPHERAL ARTERY DISEASE AFTER ENDOVASCULAR PROCEDURES

I.P. Pavlov Ryazan State Medical University, Ryazan, Russian Federation ¹,
Physician of Ultrasound Diagnostics, Ryazan Regional Clinical Cardiologic Dispensary ², Ryazan,
Russian Federation

Objective. To study the role of hemostatic parameters as potential markers of restenosis in patients with peripheral artery disease (PAD) after endovascular procedures.
Methods. An open prospective study involved 55 PAD patients aged 63 (57; 69) with the stage IIb-IV Fontaine chronic lower limb ischemia; 48 (87.3%) subjects were male; 18 (32.73%) patients had type 2 diabetes mellitus (T2D). Before angioplasty or stenting of the arteries of the lower extremities, the activity of protein C (PrC), the levels of soluble endothelial receptors for protein C (sEPCR), the activity of coagulation factors FVIII, FIX, FXI were determined in the peripheral blood. Within a year every three months Duplex ultrasound or angiography for follow-up examination have been performed to detect restenosis.
Results. Within one year restenosis was detected in 13 (23.6%) patients. Binary regression analysis revealed T2D, FVIII activity and sEPCR as prognostic markers of restenosis. sEPCR level lower than 46.8 ng/ml was associated with a 4.263 higher risk for restenosis after endovascular procedures (odds ratio 4.263, CI 95% 1.509-12.042); absolute risk 47±11% (CI 95% 25-69 %). The patients with T2D had a 2.6 higher risk for restenosis as compared to subjects without diabetes mellitus (odds ratio 2.6, CI 95% 1.031-6.599); absolute risk 41.18±12% (CI 95% 17.78-64.58%). The probability of developing restenosis was inversely related to the initial indicators of FVIII activity and the level of sEPCR: the lower the absolute values of FVIII and sEPCR, the higher the likelihood of developing restenosis in the postoperative period.
Conclusion. Patients with diabetes mellitus (type 2), reduced activity of coagulation factor FVIII and level of soluble endothelial protein C receptors are at particularly high risk for restenosis

Article in the .pdf format

DOI: https://dx.doi.org/10.18484/2305-0047.2022.1.20   |  

A.G. SKURATOV, A. N. LYZIKOV, V.M. MITSURA

ASSESSMENT OF PORTAL HYPERTENSION SEVERITY IN LIVER CIRROSIS

Gomel State Medical University, Gomel,
Republic of Belarus

Objective. Development of a non-invasive assessing diagnostic and severity grading accuracy of portal hypertension in cirrhosis of the liver.
Methods. To identify diagnostically significant indicators, a statistical analysis of the data of laboratory and instrumental diagnostics was carried out in 60 patients with liver cirrhosis. The following biochemical indicators were determined: general and biochemical blood tests, coagulogram, general urine analysis; the level of interleukin-6 (IL-6), matrix metalloproteinases 1 and 9 (MMP-1, MMP-9), tissue inhibitor of matrix metalloproteinase 1 (TIMP-1), hepatocyte growth factor (HGF); abdominal ultrasound examination, esophagogastroscopy. The index of the ratio of the number of blood platelets (N×10⁹ / L) to the transverse size (D) of the spleen in millimeters (PSR - Platelet count to Spleen diameter Ratio) was calculated: PSR = NTr / D spleen.
Results. The following indicators turned out to be diagnostically significant (predictive values based on ROC analysis are presented): blood levels of IL-6 (>19.9 pg/ml), MMP-1 (>8.06 ng/ml), cholesterol (≤4,5mmol/L), portal vein diameter (>13 mm), PSR (≤1.89). Diagnostic methods for cirrhosis and portal hypertension was developed, based on a point assessment of a set of laboratory and instrumental criteria (AUC = 0.931; p <0.001). The method can be used in a complex of medical services aimed at diagnosis of portal hypertension severity in patients with cirrhosis of the liver, as well as medical prevention of life-threatening complications of the disease.
Conclusion. The developed method makes it possible to identify patients with a «severe» form of portal hypertension, to recommend an unscheduled FEGDS with an endoscopic assessment of the risk of bleeding, and to carry out preventive and therapeutic procedures. If a low probability of a “severe” form of PH is identified, FEGDS should be refrained from if the patient has absolute or relative contraindications to the use of this diagnostic method.
The method can be used in a complex of medical services aimed at diagnosing the severity of portal hypertension against the background of liver cirrhosis.

Article in the .pdf format

DOI: https://dx.doi.org/10.18484/2305-0047.2022.1.28   |  

B.I. BELOKONEV, S.Y. PUSHKIN, Z.V. KOVALEVA, D.B. AVEZOVA, D.V. NOVIKOV

TREATMENT METHODS OF PATIENTS WITH POSTOPERATIVE VENTRAL HERNIAS AND CREATED INTESTINAL FISTULAS

Samara State Medical University, Samara, Russian Federation

Objective. To substantiate the methods of surgical treatment in patients with postoperative ventral hernias and created intestinal fistulas based on the comparison of the outcomes of one-stage and two-stage operations.
Methods. The analysis of patients (n=40) with postoperative ventral hernias and created intestinal fistulas imposed for therapeutic purposes or created as the treatment outcomes of uncreated fistulas has been performed. Jejunal fistulas were present in 7 patients (17.5%), ileal fistulas in 18 (45%), and colonic fistulas in 15 (37.5%) patients. The patients of group 1 (n=15, 37.5% ) underwent the two-stage operations. First, the fistula was closed with the access to the site of its location, and then after 3-6 months, the excision of hernia was performed. In patients of group 2 (n=25, 62.5%) fistula was simultaneously removed and hernia was excised. The «tension-free» techniques in hernia orifice repair in those groups was performed. The outcomes were evaluated by the number of local and general complications in the period from 10 days to 6 months.
Results. Wound complications after the first operation developed in 2 (13.3%) patients in the 1^st group. There were no complications after the second stage of hernioplasty. In group 2, wound complications developed in 3 (12%) patients. There was no anastomotic failure in the groups. In the long terms, good results were obtained in 15 patients in group 1 and in 25 patients in group 2. The use of anterior prosthetic «tension-free» techniques of plastic surgery by the combined methods in one-stage allows obtaining results comparable to two-stage operations.
Conclusion. In patients with hernias and intestinal fistulas, the method of treatment in one-stage or two-stages depends on the possibility of the gastrointestinal restoring patency from minimally invasive access in the site of the fistula location.

Article in the .pdf format

DOI: https://dx.doi.org/10.18484/2305-0047.2022.1.38   |  

R.I. DOVNAR ¹, A.YU. VASIL’KOV ², T.M. SAKALOVA ¹, I.E. BUTENKO ², S.M. SMOTRYN ¹, N.N. IASKEVICH ¹

ANTIBACTERIAL ACTION OF SILVER NANOPARTICLES

Grodno State Medical University ¹, Grodno,
The Republic of Belarus,
A.N.Nesmeyanov Institute of Organoelement Compounds of the Russian Academy of Sciences ², Moscow,
The Russian Federation

Objective. To determine the minimum inhibitory concentration of Ag nanoparticles in relation to clinical pathogenic strains of microorganisms.
Methods. The minimum inhibitory concentration of Ag nanoparticles, obtained by metal vapor synthesis was studied on six strains of pathogenic bacteria, including representatives of gram-positive and gram-negative groups. The microbiological analyzer Vitek 2 Compact was used to identify each strain and to determine the antibiogram. The metal nanoparticles used in the study were synthesized by the method of metalvapor synthesis. Ag nanoparticles were studied by transmission electron microscopy (TEM) and X-ray photoelectron spectroscopy (XPS) methods. Determination of the minimum inhibitory concentration was performed by the method of serial dilution using sterile 96-well plates with using the tests of positive and negative control. The concentration of microorganisms was controlled by the turbidity standard.
Results. All pathogenic strains of bacteria used in the study were characterized by pronounced polyantibiotic resistance, and the percentage of antibiotics against which the strain was resistant ranged from 12.5 to 93.3%. The minimum inhibitory concentration of silver nanoparticles ranged from 7.81 to 31.25 μg/ml, depending on the type of microorganism. Gram-positive microorganisms, in contrast to gram-negative ones, were characterized by lower values of the minimum inhibitory concentration. The data of transmission electron and X-ray photoelectron spectroscopy showed that the size of the studied nanoparticles is in the range of 2-15 nm.
Conclusion. Silver nanoparticles (2-15 nm in size) have antimicrobial action against clinically significant, polyantibiotic-resistant strains of microorganisms. The minimum inhibitory concentration of silver nanoparticles, depending on the strain of the microorganism, varies from 7.81 to 31.25 μg/ml. Silver nanoparticles have an inhibitory impact on microorganisms and to a greater extent inhibit the growth of gram-positive versus gram-negative. The obtained materials based on silver nanoparticles represent an effective alternative to the currently used antibacterial drugs.

Article in the .pdf format

DOI: https://dx.doi.org/10.18484/2305-0047.2022.1.46   |  

R.A. NAKONECHNYY, A.Y. NAKONECHNYI

OPTIMIZATION OF SURGICAL WOUND CARE AFTER URETHROPLASTY IN CHILDREN WITH HYPOSPADIA

Danylo Halytsky Lviv National Medical University, Lviv,
Ukraine

Objectives. To develop optimal postoperative wound care tactics for boys with hypospadias.
Methods. The patients (128) with hypospadias aged from 11 months to 7 years were examined. The main group A consisted of 83 (64.8%) patients in whom we used a special bandage. It includes layer by layer of soft polyamide net two-sided onlay coated with soft silicone and adhesive properties, abundantly treated with an antimicrobial ointment containing an osmotic agent, sterile absorbent wipes with non-woven material, a circularly applied elastic bandage and an adhesive plaster with porous non-woven material. The dressing usually held up to 5 days. Group B included 45 (35.2%) patients with hypospadias, in whom we used a conventional sterile circular gauze bandage with antimicrobial ointment. The gauze bandage changed daily. For all clinical symptoms the groups were comparable in age.
Postoperative wound healing had been monitored for 10 days after urethroplasty. The emphasis was made on such criteria as bleeding with hematoma formation, copious exudate excretion, penis skin hyperemia, «soft» and «dense» edema, drying crust (scab), skin sutures dehiscence, hypergranulation and necrosis.
Results. In group A, problems with the skin flap and postoperative wound were detected only in 17 (20.5%) boys on the second or third day after removal of the special bandage. In the postoperative period, 41 (91.1%) patients in group B had «painful» skin changes in the area of the postoperative wound, which appeared almost the next day after surgery.
Conclusion. The use of special bandage delays in time the contact of microbiota penis tissues compromised by surgery and the external environment, which, no doubt, improves the healing of skin grafts in the early postoperative period, and therefore reduces the number of urethroplasty complications.

Article in the .pdf format

DOI: https://dx.doi.org/10.18484/2305-0047.2022.1.61   |  

А.E. MURZICH ¹, О.А. SOKOLOVSKY ¹, О.L. EISMONT ¹, YA.I. ISAYKINA ²

SURGICAL TREATMENT OF FEMORAL HEAD NECROSIS WITH PRE-DIFFERENTIATED MESENCHYMAL STEM CELLS

Republican Scientific and Practical Centre for Traumatology and Orthopedics1, Minsk,
Belarusian Research Center for Pediatric Oncology and Hematology ², Borovliany, Minsk Region,
The Republic of Belarus

Objective. To study the results of pre-differentiated MSCs application in the treatment of femoral head necrosis in young patients.
Methods. The developed high-tech approach included: exfusion of 50-70 ml of patient’s bone marrow 4 weeks prior to implantation; osteogenic differentiation and obtaining a biomedical cell product; surgical decompression and introduction of pre-differentiated MSCs in fibrin gel; postoperative rehabilitation. Surgeries were performed in 25 patients at stages I and II according to the ARCO classification. The average age of patients is 34 [29; 45], men – 20 (80%), women – 5 (20%). The assessment scale is a visual analogue scale (VAS), Harris scale, radiography, MRI.
Results. Observation period was 41 [19; 59] month. Average Harris score before surgery was 76 [68.8; 79] points, after treatment – 90 [78.9; 92] points. In 15 (60%) cases an excellent results were obtained, in 5 (20%) – good, in 3 (12%) – satisfactory, in 2 (8%) – unsatisfactory (collapse progression). The level of pain syndrome was reduced from 40 [30; 50] to 10 [5; 25] points. There were no complications. Preservation of the femoral head sphericity and the width of the joint space, relief of bone marrow edema, reduction of the necrosis zone size and synovitis according to MRI data were found in 92% of cases.
Conclusion. The treatment method of femoral head necrosis with the use of pre-differentiated MSCs in the absence of infectious triggers in the lesion focus made it possible to preserve 95 % of cultured cells in the cell product composition and to introduce it minimally invasively, avoiding the need for bone graft collection. The introduction of the cellular technologies in practice made it possible to obtain positive treatment results in 92% of cases due to an improvement clinical condition by the Harris scale and reduce of pain syndrome compared to the initial state; it did not lead to infectious, allergic or other complications within the 41 [19; 59] month follow-up.

Article in the .pdf format

DOI: https://dx.doi.org/10.18484/2305-0047.2022.1.61   |  

V.Y. ZIAMKO ¹, V. K. OKULICH ¹, A.M. DZYADZKO ²

STRUCTURE OF MICROFLORA AND ANTIBIOTIC RESISTANCE TRENDS IN INTENSIVE CARE UNIT OF A MULTIDISCIPLINE INSTITUTION

Vitebsk State Medical University , Vitebsk^,
Minsk Scientific and Practical Center of Surgery, Transplantation and Hematology ², Minsk,
Republic of Belarus

Objective. To study dynamics of structure and antibiotic resistance of microflora in the intensive care unit depending on the amount of used antibiotics.
Methods. 41375 isolates were studied in the intensive care unit of a multidisciplinary hospital from 2015 to early 2021. Bacteriological examination of clinical samples on basis of Republican Scientific and Practical Center “Infection in Surgery” has been performed. The primary treatment of results with the analysis of sensitivity of microorganisms to antibiotics was carried out by means of International Computer Program (WHONET). Antibiotic sensitivity was determined by disk-diffusion method, suspended in Mueller-Hinton broth and semi-automatic analyzer ATB Expression (BioMerieux, France). The analysis of consumption of antibacterial drugs in the intensive care unit was carried out according to data of pharmacy which operates at the medical institution where the research itself was carried out.
Results. From 2015 to 2017 the analysis of microflora composition permitted to establish the prevalence of P. aeruginosa (22,74%), Acinetobacter spp. (22,25%) and K. pneumoniae (16,11%) which occurred 1,6 folds more often than other microorganisms while in general structure of multidisciplinary hospital S. aureus was most common (20,96% and 20,05%). Since 2018 carbapenem-resistant K. pneumonia has dominated (23,01%). Tigecycline and colistat were not effective against 4,3% and 5,7% of K. pneumoniae isolates in 2019, 10,2% and 13,7% of isolates in 2020, 37,3% and 39,6% – from January to May 2021 which was associated with a growth of tigecycline and colistat consumption.
Conclusion. Since 2018 prevalence of carbapenem-resistant K. pneumoniae has been observed in microflora of the intensive care unit which is associated with a growth of consumption of antibacterial drugs which caused appearance of K. pneumoniae isolates resistant to colistin and tigecycline.

Article in the .pdf format

DOI: https://dx.doi.org/10.18484/2305-0047.2022.1.74   |  

S.S. MASKIN, V.V. ALEKSANDROV, V.V. MATYUKHIN, L.A. IGOLKINA

BLUNT INJURY OF PANCREAS, GALL BLADDER AND EXTRAHEPATIC BILE DUCTS: TACTICS BASED ON THE PRINCIPLES OF EVIDENCE-BASED MEDICINE

Volgograd State Medical University of the Ministry o Health of the Russian Federation, Volgograd,
Russian Federation

Objective. Optimization of treatment and diagnostic tactics for blunt injury of the pancreas, gall bladder and extrahepatic bile ducts.
Methods. This current review was undertaken by Russian and foreign literature (2015-2020 yrs) search according to the following themes: pancreatic injury, traumatic pancreatitis, gall bladder injury, extrahepatic bile ducts injury, damage control surgery tactics, blunt abdominal trauma, therapeutic and diagnostic algorithm, conservative (non-operative) management, with subsequent exception from the request of experimental studies and cases of open trauma in the Internation scientific datebase PubMed, Cochrane Library, Scopus, Embase, ScienceDirect, Google Scholar Search, eLibrary. Multicenter studies, systematic reviews, meta-analyses, large case series, original articles, and randomized controlled trials were analyzed, indicating the levels of evidence and effectiveness of recommendations. An original algorithm for the diagnosis and management is proposed, the concept of damage control is described, and indications for diagnostic methods, conservative treatment, and types of surgical, endovascular, and minimally invasive interventions are specified depending on the severity of organ injury according to the classification of the American Association of the Surgery of Trauma (AAST) (table).
Results. The algorithm for the diagnosis and management for combined blunt trauma of the pancreas, gallbladder, and extrahepatic bile ducts is standardized, and indications for minimally invasive and open interventions in this category of patients are clarified.
Conclusion. Accurate knowledge of the algorithm for the diagnosis and management, indications for endovascular, minimally invasive techniques and open interventions, the choice of tactics based on the patient’s condition, the time of the injury, and possible complications can improve the results of treatment.

Article in the .pdf format

DOI: https://dx.doi.org/10.18484/2305-0047.2022.1.86   |  

E.K. AGHAYEV, Z.E. ISMAYILOVA, T.E. MAMEDOV

PREVENTION OF SUTURE INSUFFICIENCY IN INTESTINAL ANASTOMOSES

Azerbaijan Medical University, Baku,
Republic of Azerbaijan

The failure of intestinal anastomotic suture is one of the urgent and dangerous problems in abdominal surgery. This problem not only complicates the course of the early postoperative period and increases financial costs, but it is also the main cause of deaths, the rate of which remains quite high with generalized peritonitis. The problem of the intestinal anastomotic leakage in the postoperative period forces researchers to develop various methods of preoperative preparation of patients, ways to strengthen the line of stitched ends of the intestine, new protocols for managing patients in the postoperative period. Despite the use of atraumatic and minimally invasive techniques as well as various stapling devices, and biopolymers of various compositions, the morbidity rate for an anastomotic leak remains quite high. The literature analysis demonstrates a tendency of preservation high rates of the suture failure of intestinal anastomosis. The actuality of this problem is especially clearly observed in case of emergency and urgent resection of the intestine against the background of acute intestinal obstruction, cancer intoxication and generalized peritonitis. The risk of anastomotic failure is believed to be caused by the age and general condition of a patient, the nature of the underlying disease, the presence of concomitant chronic diseases, the type of surgical operation, as well as the method and localization of the anastomosis being created. Despite the fact that there are a lot of sources devoted to the analysis of the causes of this problem, there is no consensus on the significance of risk factors and the effectiveness of the preventive methods used. In a number of publications there are contradictory data concerning the effectiveness of some preventive methods. Therefore, the solution of this problem requires new fundamental researches.

Article in the .pdf format

DOI: https://dx.doi.org/10.18484/2305-0047.2022.1.95   |  

V.YU. RAYN

BILIARY FISTULA AFTER PANCREATICODUODENECTOMY

Khanty-Mansiysk State Medical Academy, Khanty-Mansiysk,
Russian Federation

Literature searches were carried out on the Pubmed information platform and in the elibrary and Cyberleninka libraries by keywords. Inclusion criteria are the following: availability of the full-text version of the original article, full compliance with the topic, publication period no more than 5 years. From 144 publications received, those completely duplicated and not meeting the inclusion criteria, were excluded. A total of 36 articles are included in the review. The epidemiology of biliary fistula after pancreatoduodenal resection, modern views on pathogenesis, classification, preventive measures and therapeutic and diagnostic tactics during its development are considered. In the postoperative period of pancreatoduodenal resection, biliary fistula is formed with a frequency of 1-24%. Non-modifiable risk factors include male gender, thin common bile duct, benign biliopancreatoduodenal pathology, and cancer with previous neoadjuvant therapy. Modifiable risk factors include obesity, hypoalbuminemia, obstructive jaundice, duration of hepaticojejunostomy, and prior endoscopic biliary drainage. Nowadays, effective and safe procedures are available in modern interventional radiology for the diagnosis and treatment of postoperative biliary fistula, which can be used as an alternative to endoscopic manipulations and revision interventions when the latter are associated with high risks of complications. Timely detection and treatment ensures the prevention of severe biliary fistula and repeated interventions and favorable prognosis, as well as saving medical and financial resources.

Article in the .pdf format

DOI: https://dx.doi.org/10.18484/2305-0047.2022.1.102   |  

K.V. LIPATOV ¹, A.G. ASATRYAN ², G.G. MELKONYAN ², V.A. KUZNETSOV ¹, I.V. GORBACHEVA ¹, M.V. YURCHENKO ²

NECROTISING FASCIITIS OF UPPER LIMB: CLINIC, DIAGNOSIS, TREATMENT

I.M. Sechenov First Moscow State Medical University of the Ministry of Health of Russia, Moscow,
4^th Moscow Clinical Hospital, Moscow, Russian Federation

Objective. To study the treatment results of patients with necrotizing fasciitis (NF) of the upper limb.
Methods. The authors’ observations of 9 patients with a rare and severe disease: necrotizing fasciitis (NF) of the upper limb have been analyzed. Minor skin lesions in the area of the hand became the entry gate for any infection. The median time prior hospitalization was 4,8±1,8 (M±σ) days. Immediately upon admission, the diagnosis of upper limb NF was established in 5 patients. This was followed by emergency radical surgery. The rest were also urgently operated on, but with a diagnosis of phlegmon of the hand and in insufficient volume. They were diagnosed with NF within the first day and a second operation was performed. In most cases the lesion included tissues of the hand, forearm, and arm. Primary surgery was supplemented by staged necrectomies, the number of which averaged 4,7±1,9 per patient. The complex of intensive treatment included broad-spectrum antibiotics, anticoagulants (enoxaparin 8,000 anti-Xa IU / day). Surgical closure of postnecrectomic wounds was performed using skin plastic operations: plastics with local tissues, autodermoplasty with a split graft.
Results. Most of the cases were classified as type II NF (Streptococcus pyogenes or Staphylococcus aureus). In one case, a very rare and extremely severe, NF caused by Pasteurella multocida was observed. No antibiotic-resistant strains were found. Emergency radical operation became the cornerstone of success. The need for staged necrectomy was determined by the formation of secondary necrosis in connection with severe microcirculation disorders. Extensive postnecrectomic wounds were closed after the inflammation subsided with the help of skin plastic operations. The average duration of inpatient treatment was 20,8±6,2 days. There were no lethal outcomes.
Conclusion. A complex approach to the treatment of necrotising fasciitis of upper limb allowed getting positive treatment results in all cases.

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DOI: https://dx.doi.org/10.18484/2305-0047.2022.1.112   |  

M.A. MEDVEDCHIKOV-ARDIIA ^{1, 2}, E.A. KORYMASOV ^{1, 2}, A.S. BENYAN ^{1, 2}

VERTICAL RECTUS ABDOMINIS MUSCLE FLAP FOR REPAIR OF THE ANTERIOR CHEST WALL DEFECT

Samara State Medical University, Samara,
Samara Regional Clinical Hospital Named after V.D. Seredavin, Samara,
Russian Federation

The case report of a patient with post-sternotomy mediastinitis is presented. A successful case of treatment of such a formidable complication after cardiac surgery was demonstrated. Success in the treatment of such patients depends on the complete cupping inflammatory process in the site of operation, as well as chest wall reconstruction. The positive clinical effect of vacuum-assisted dressings in the treatment of post-sternotomy mediastinitis is shown. The vertical rectus abdominis myocutaneous flap was used as a plastic material to cover a defect in the chest wall. The course of surgery and the result of treatment are described in details. To date, the surgical society has not developed a generally accepted tactic in the treatment of poststernotomy mediastinitis, both at the stage of arresting the infectious process, and in the process of reconstructive and restorative intervention. In practice, along with alloplastic materials, synthetic and metal implants are used. The autologous tissues include muscle flaps and the greater omentum. In thoracic surgery, the rectus abdominis can serve as an alternative to omentoplasty for extended chest wall defects.

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DOI: https://dx.doi.org/10.18484/2305-0047.2022.1.119   |  

V.YA. KHRYSCHCHANOVICH, N.YA. SKOBELEVA

PRINCIPLES OF ACUTE VARICOTHROMBOPHLEBITIS MANAGEMENT DURING PREGNANCY

Belarusian State Medical University, Minsk, Republic of Belarus

Thrombophlebitis of the subcutaneous veins of the lower extremities, also called superficial thrombophlebitis (ST), is a well-known and common disease often occurring in pregnant women with varicose veins (VV). As a rule, ST is considered as a disease with an uncomplicated and mild course, which is usually not life-threatening. However, in the case of appearance of concomitant deep vein thrombosis and/or pulmonary embolism, ST can cause severe complications. The article presents a clinical case of treatment of a pregnant woman (28 weeks of gestational age) with acute ascending varicothrombophlebitis in the system of the great saphenous vein (GSV). According to ultrasound data, the patient was found to have insufficiency of the sapheno-femoral junction and occlusive thrombosis of the lateral branches and the trunk of GSV, extending to the middle third of the left thigh. Taking into account the obstetric history, clinical and ultrasound picture of the disease, and the risk of perioperative complications, it was decided to prescribe prolonged anticoagulation with low-molecular-weight heparin (LMWH) and perform phlebocentesis of thrombosed GSV segments. The basic component of symptomatic treatment of ST was elastic compression. The chosen option for managing gestational varicotrombophlebitis allowed improving the patient’s overall health, as well as to quickly (within 2-3 days) arrest local inflammation and significantly reduce local edema and pain. The case presented highlights the possibility of successful and safe use of needle aspiration thrombectomy and anticoagulation with LMWH in pregnant women with ascending subcutaneous venous thrombosis.

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SUSHKOV SERGEY ALBERTOVICH

18 февраля 2022 года на 62-ом году жизни ушел из жизни заместитель главного редактора журнала «Новости хирургии», проректор по научно-исследовательской работе ВГМУ, кандидат медицинских наук, доцент, Сушков Сергей Альбертович.
Родился Сергей Альбертович 11 октября 1960 года в д. Плюссы Браславского района Витебской области.
В 1983 году с отличием окончил Витебский государственный медицинский институт по специальности «лечебное дело». После окончания института обучался в клинической ординатуре на кафедре общей хирургии. С 1984 по 1988 год работал секретарём комитета комсомола института. С 1988 по 1990 год обучался в очной аспирантуре на кафедре общей хирургии, на которой впоследствии, до 1997 года работал ассистентом. С 1997 по 2000 год работал заведующим хирургическим отделением клинической больницы на станции Витебск.
С 2000 по 2009 год являлся заведующим кафедрой общей хирургии ВГМУ. В период с 2002 по 2004 год работал деканом факультета подготовки иностранных граждан.
С 3 июня 2009 года работал в должности проректора по научно-исследовательской работе.
Сушков С.А. являлся руководителем Витебского областного научно-практического центра «Флебология». Ежегодно в центре выполняется более 400 операций по поводу варикозной болезни нижних конечностей. На базе центра защищены 2 кандидатские диссертации, ведётся постоянная работа по разработке новых и усовершенствованию имеющихся методов лечения варикозной болезни нижних конечностей: эндовазальная лазерная коагуляция, эндоскопическая диссекция перфорантных вен, шейф-терапия трофических язв, склерооблитерация подкожных вен, мини-флебэктомия, экстравазальная коррекция клапанов бедренной вены, внедрена эндовенозная лазерная коагуляция с применением радиального световода, радиочастотная аблация вен.
Под руководством Сушкова С.А. проходила разработка Национальных рекомендаций по лечению острой и хронической венозной недостаточности.
С 2000 года работал в редакции журнала «Новости хирургии», с 2005 года – заместителем главного редактора журнала.
В 2009 г журнал по его инициативе представлен в Российский индекс научного цитирования. В 2010 г. журнал «Новости хирургии» стал первым белорусским научным медицинским изданием, включенным в перечень ВАК Российской Федерации. При активном участии проректора журнал «Новости хирургии» вошел в реферативную базу SCOPUS.
С.А.Сушков награждён Почетными грамотами Совета Министров Республики Беларусь, Министерства здравоохранения Республики Беларусь, Витебского областного исполнительного комитета, грамотой Министерства образования Республики Беларусь, нагрудным знаком «Отличник здравоохранения Республики Беларусь».

Редколлегия журнала от имени медицинской общественности выражает искреннее соболезнование родным и близким в связи с постигшей их тяжелой утратой.

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