Novosti
Khirurgii
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Year 2022 Vol. 30 No 1

SCIENTIFIC PUBLICATIONS
EXPERIMENTAL SURGERY

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 1st, 3rd, 5th 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 1st, 3rd, 7th, 14th 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.

Keywords: burns, model, animals, inflammation, wound healing, reepithelialization, platelet-rich plasma
p. 5-11 of the original issue
References
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Address for correspondence:
21028, Ukraine,
Vinnytsya, Pirogov str., 56,
National Pirogov Memorial
Medical University,
tel. +380972128963,
e-mail: r.chornopyshchuk@gmail.com, Chornopyshchuk Roman N.
Information about the authors:
Chornopyshchuk Roman N., MD, Assistant of the Department of General Surgery, National Pirogov Memorial Medical University, Vinnytsya, Ukraine.
https://orcid.org/ 0000-0001-5422-7495

GENERAL & SPECIAL SURGERY

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 4711% (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 41.1812% (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

Keywords: hemostatic markers, restenosis, peripheral artery disease, endovascular interventions, diabetes mellitus
p. 12-19 of the original issue
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Address for correspondence:
390026, Russian Federation,
Ryazan, Vysokovoltnaya Str., 9,
I.P. Pavlov Ryazan State Medical University,
the Department of Cardiovascular,
X-ray Endovascular,
Operative Surgery and Radiation Diagnostics,
tel. +7 903 836 24 17,
e-mail: suchkov_med@mail.ru,
Suchkov Igor A.
Information about the authors:
Kalinin Roman E., MD, Professor, Head of the Department of Cardiovascular, X-ray Endovascular, Operative Surgery and Radiation Diagnostics, I.P. Pavlov Ryazan State Medical University, Ryazan, Russian Federation.
http://orcid.org/0000-0002-0817-9573
Suchkov Igor A., MD, Professor of the Department of Cardiovascular, X-ray Endovascular, Operative Surgery and Radiation Diagnostics, I.P. Pavlov Ryazan State Medical University, Ryazan, Russian Federation.
http://orcid.org/0000-0002-1292-5452
Mzhavanadze Nina D., PhD, Associate Professor of the Department of Cardiovascular, X-ray Endovascular, Operative Surgery and Radiation Diagnostics, I.P. Pavlov Ryazan State Medical University, Ryazan, Russian Federation.
http://orcid.org/0000-0001-5437-1112
Povarov Vladislav O., PhD, applicant of the Department of Cardiovascular, X-ray Endovascular, Operative Surgery and Radiation Diagnostics, I.P. Pavlov Ryazan State Medical University, Ryazan, Russian Federation.
https://orcid.org/0000-0001-8810-9518
Klimentova Emma A., PhD, applicant of the Department of Cardiovascular, X-ray Endovascular, Operative Surgery and Radiation Diagnostics, I.P. Pavlov Ryazan State Medical University, Ryazan, Russian Federation.
https://orcid.org/0000-0003-4855-9068
Zhurina Olga N., PhD, Researcher, Scientific and Clinical Center of Hematology, Oncology and Immunology, I.P. Pavlov Ryazan State Medical University, Ryazan, Russian Federation.
https://orcid.org/0000-0002-2159-582X
Puchkova Galina A., Physician of Ultrasound Diagnostics, Ryazan Regional Clinical Cardiologic Dispensary, Ryazan, Russian Federation.
https://orcid.org/0000-0002-6346-2064
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.

Keywords: liver cirrhosis, portal hypertension, gastroesophageal varices, diagnosis of the disease severity
p. 20-27 of the original issue
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Address for correspondence:
246050, Belarus, Gomel,
Lange st. 5,
Gomel State Medical University,
the Department of Surgery No1 with the Course
of Cardiovascular Surgery,
tel.: +375447957922,
e-mail: alexskuratov@mail.ru,
Skuratov Alexander G.
Information about the authors:
Skuratov Alexander G., PhD, Associate Professor of the Department of Surgery No.1 with the Course of Cardiovascular Surgery, Gomel State Medical University, Gomel, Republic of Belarus.
https://orcid.org/0000-0002-1994-1156
Lyzikov Anatoly N., MD, Professor of the Department of Surgery No1 with the Course of Cardiovascular Surgery, Gomel State Medical University, Gomel, Republic of Belarus.
https://orcid.org/0000-0002-4668-6007
Mitsura Viktor M., MD, Associate Professor of the Department of Infectious Diseases, Gomel State Medical University, Gomel, Republic of Belarus.
https://orcid.org/0000-0002-0449-5026
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 1st 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.

Keywords: ventral hernia, hernia repair, postoperative hernia, ventral hernia repair, intestinal fistula, complications
p. 28-37 of the original issue
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  6. Arnold MR, Kao AM, Otero J, Marx JE, Augenstein VA, Sing RF, Colavita PD, Kercher K, Heniford BT. Mesh fistula after ventral hernia repair: What is the optimal management? Surgery. 2020 Mar;167(3):590-97. doi: 10.1016/j.surg.2019.09.020
  7. Timerbulatov MV, Ibatullin AA, Gaynutdinov FM, Kulyapin AV, Aitova L.R, Kyzylbaeva AI, Abdeev A.A, Fatkhullin AS. Late stomal complications and their surgical correction. Kazan Med Zhyrn. 2012;93(4):602-605.doi: 10.17816/KMJ1552 (In Russ.)
  8. Slater NJ, Knaapen L, Bökkerink WJV, Biemans MJA, Buyne OR, Ulrich DJO, Bleichrodt RP, van Goor H. Large contaminated ventral hernia repair using component separation technique with synthetic mesh. Plast Reconstr Surg. 2015 Dec;136(6):796e-805e. doi: 10.1097/PRS.0000000000001793
  9. Latifi R. Practical approaches to definitive reconstruction of complex abdominal wall defects. World J Surg. 2016 Apr;40(4):836-48. doi: 10.1007/s00268-015-3294-z
Address for correspondence:
443099, Russian Federation,
Samara, Chapayevskaya Str., 89,
Samara State Medical University,
Department of Surgical Diseases No2,
tel. mobile: +7 927 606 19 83;
e-mail: belokonev63@yandex.ru,
Belokonev Vladimir I.
Information about the authors:
Belokonev Vladimir I., MD, Professor, Head of the Department of Surgical Diseases No2, Samara State Medical University, Samara, Russian Federation.
https://orcid.org/0000-0002-4625-6664
Pushkin Sergei Yu., MD,, Associate Professor, Professor of the Department of Surgical Diseases No2, Samara State Medical University, Samara, Russian Federation.
https://orcid.org/0000-0003-2206-6679
Kovaleva Zinaida V., PhD, Associate Professor of the Department of Surgical Diseases No2, Samara State Medical University, Samara, Russian Federation.
https://orcid.org/0000-0002-1810-7696
Avezova Diana B., Applicant of the Department of Surgical Diseases No2, Samara State Medical University, Samara, Russian Federation.
http://orcid.org/0000-0002-0813-8392
Novikov Denis V., Applicant of Surgical Diseases No2 Samara State Medical University, Samara, Russian Federation.
http://orcid.org/0000-0002-8194-4622
DOI: https://dx.doi.org/10.18484/2305-0047.2022.1.38   |  

R.I. DOVNAR 1, A.YU. VASILKOV 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.

Keywords: silver, metal nanoparticles, anti-bacterial agents, drug resistance, microbial sensitivity tests, nanotechnology, green chemistry technology
p. 38-45 of the original issue
References
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Address for correspondence:
230009, Belarus,
Grodno, Gorky Str., 80,
Grodno State Medical University,
the Department of Surgical Diseases No2,
tel. +375 297 868643,
e-mail: dr_ruslan@mail.ru,
Dovnar Ruslan I.
Information about the authors:
Dovnar Ruslan I., PhD, Associate Professor, Associate Professor of the Department of Surgical Diseases No2, Grodno State Medical University, Grodno, Republic of Belarus.
https://orcid.org/0000-0003-3462-1465
Vasilkov Alexander Yu., l PhD (Chem), Associate Professor, Leading Researcher of the Laboratory of Hybrid Metal-Containing Materials of A.N. Nesmeyanov Institute of Organoelement Compounds of the Russian Academy of Sciences, Moscow, Russian Federation.
https://orcid.org/0000-0001-8225-647X
Sakalova Tatsiana M., PhD, Associate Professor, Associate Professor of the Department of Microbiology, Virology and Immunology, Grodno State Medical University, Grodno, Republic of Belarus.
https://orcid.org/0000-0002-4075-4515
Butenko Ivan E., Senior Engineer of the Laboratory of Hybrid Metal-Containing Materials of A.N. Nesmeyanov Institute of Organoelement Compounds of the Russian Academy of Sciences, Moscow, Russian Federation.
https://orcid.org/0000-0002-1741-6155
Smotryn Siarhei M., MD, Professor, Professor of the Department of Surgical Diseases No2, Grodno State Medical University, Grodno, Republic of Belarus.
https://orcid.org/0000-0002-3944-1124
Iaskevich Nikolai N., MD, Professor, Professor of the Department of Surgical Diseases No1, Grodno State Medical University, Grodno, Republic of Belarus.
https://orcid.org/0000-0002-2954-0452

PEDIATRIC SURGERY

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.

Keywords: hypospadia, urethroplasty, postoperative wound, wound healing, bandage
p. 46-53 of the original issue
References
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Address for correspondence:
79059, Ukraine,
Lviv, Pylyp Orlyk Street, 4,
Danylo Halytsky Lviv National Medical University,
the Department of Pediatric Surgery,
tel.mob.: +38-067-254-33-71,
tel. work: +38-032-293-97-39;
e-mail: nrostyslav@gmail.com
Nakonechnyi Rostyslav A.
Information about the authors:
Nakonechnyy Rostyslav A., PhD, Assistant of the Department of Pediatric Surgery, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine.
https://orcid.org/0000-0003-0645-3361
Nakonechnyi Andrii Y., MD, Professor of the Department of Pediatric Surgery, Vice-Rector (Science), Danylo Halytsky Lviv National Medical University, Lviv, Ukraine.
https://orcid.org/0000-0003-1402-6642

TRAUMATOLOGY AND ORTHOPEDICS

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

.E. MURZICH 1, .. SOKOLOVSKY 1, .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 patients 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.

Keywords: femoral head, necrosis, mesenchymal stem cells, surgical decompression, fibrin gel
p. 61-73 of the original issue
References
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  13. Mao Q, Jin H, Liao F, Xiao L, Chen D, Tong P. The efficacy of targeted intraarterial delivery of concentrated autologous bone marrow containing mononuclear cells in the treatment of osteonecrosis of the femoral head: a five year follow-up study. Bone. 2013 Dec;57(2):509-16. doi: 10.1016/j.bone.2013.08.022
  14. Homma Y, Kaneko K, Hernigou P. Supercharging allografts with mesenchymal stem cells in the operating room during hip revision. Int Orthop. 2014 Oct;38(10):2033-44. doi: 10.1007/s00264-013-2221-x
  15. Tabatabaee RM, Saberi S, Parvizi J, Mortazavi SM, Farzan M. Combining concentrated autologous bone marrow stem cells injection with core decompression improves outcome for patients with early-stage osteonecrosis of the femoral head: a comparative study. J Arthroplasty. 2015 Sep;30(9 Suppl):11-15. doi: 10.1016/j.arth.2015.06.022
Address for correspondence:
220024, Republic of Belarus,
Minsk, Kizhevatov Str., 60/4,
Republican Scientific and Practical Centre
for Traumatology and Orthopedics
tel. +375 17 212 32 88.
e-mail: mae77@list.ru,
Murzich Alyaksandr E.
Information about the authors:
Murzich Alyaksandr E., PhD, Deputy Director for Science, Republican Scientific and Practical Centre for Traumatology and Orthopedics, Minsk, Republic of Belarus.
https://orcid.org/0000-0003-1625-7321
Sakalouski Aleh A., MD, Professor, Head of Children and Adolescents Trauma and Orthopedic Laboratory, Republican Scientific and Practical Centre for Traumatology and Orthopedics, Minsk, Republic of Belarus.
https://orcid.org/0000-0001-8749-3802
Eismont Oleg L., MD, Associate Professor, Head of the Joint Pathology and Sports Injury Laboratory, Republican Scientific and Practical Centre for Traumatology and Orthopedics, Minsk, Republic of Belarus.
https://orcid.org/0000-0002-1002-4132
IsaykinaYanina I., PhD (Biol), Head of the Laboratory of Cell Biotechnology and Cytotherapy, Belarusian Research Center for Pediatric Oncology and Hematology, Borovliany, Minsk Region, Republic of Belarus.

ANESTHESIOLOGY-REANIMATOLOGY

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.

Keywords: microbiota, lung microbiome, infection, antibiotics. intensive care unit, antibiotic resistance
p. 61-73 of the original issue
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Address for correspondence:
210009, Republic of Belarus,
Vitebsk, 27, Frunze Ave.,
Vitebsk State Medical University,
Department of Anesthesiology and Resuscitation,
tel. mobile: +375291460799,
e-mail: viktoryiazia@gmail.com,
Ziamko Viktoryia Y.
Information about the authors:
Ziamko Viktoryia Y., PhD, Associate Professor of the Department of Anesthesiology and Resuscitation, Vitebsk State Medical University, Vitebsk, Republic of Belarus.
https://orcid.org/0000-0002-6753-2074
Okulich Vitaly K., PhD, Associate Professor of the Department of Clinical Microbiology, Vitebsk State Medical University, Vitebsk, Republic of Belarus.
https://orcid.org/0000-0002-8226-6405
Dzyadzko Alexander M., MD, Head of the Department of Anesthesiology and Resuscitation, Minsk Scientific and Practical Center of Surgery, Transplantation and Hematology, Minsk, Republic of Belarus.
https://orcid.org/0000-0003-1965-1850

REVIEWS

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 patients condition, the time of the injury, and possible complications can improve the results of treatment.

Keywords: blunt abdominal trauma, pancreatic injury, pancreatic duct injury, gall bladder injury, extrahepatic bile ducts injury, multistage treatment tactics
p. 74-85 of the original issue
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Address for correspondence:
400131, Russian Federation,
Volgograd, Pavshikh Bortsov Sq., 1,
Volgograd State Medical University
of MOH Russia; the Hospital Surgery Department,
tel. 8-91-78-30-49-89,
e-mail: 79178304989@yandex.ru,
Aleksandrov Vasiliy V.
Information about the authors:
Maskin Sergey S., MD, Professor, Head the Hospital Surgery Department, Volgograd State Medical University of the Ministry o Health of the Russian Federation, Volgograd, Russian Federation.
https://orcid.org/0000-0002-5275-4213
Aleksandrov Vasiliy V., PhD, Associate Professor of the Hospital Surgery Department, Volgograd, State Medical University of the Ministry of Health of the Russian Federation, Volgograd, Russian Federation.
https://orcid.org/0000-0001-8364-8934
Matyukhin Viktor V., PhD, Associate Professor of the Hospital Surgery Department , Volgograd State Medical University of the Ministry of Health of the Russian Federation, Volgograd, Russian Federation.
https://orcid.org/0000-0002-8195-6172
Igolkina Lubov A., PhD, Assistant of the Hospital Surgery Department, Volgograd State Medical University of the Ministry of Health of the Russian Federation, Volgograd, Russian Federation.
https://orcid.org/0000-0003-1409-6165
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.

Keywords: intestinal anastomosis stitches failure, bowel resection, prevention of the anastomosis leakage, risk factors, reinforcement of anastomosis, biological impermeability of intestinal sutures, postoperative peritonitis
p. 86-94 of the original issue
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Address for correspondence:
AZ 1022, Republic of Azerbaijan
Baku, A. Kasumzade Str., 14,
Azerbaijan Medical University,
General Surgery Department,
tel.:+994 50 312 44 19,
e-mail: doc-elcin@yandex.ru,
Aghayev Elchin Kamil Ogly
Information about the authors:
Aghayev Elchin K., MD, Professor, Head of the General Surgery Department, Azerbaijan Medical University, Baku, Republic of Azerbaijan
https://orcid.org/0000-0003-0679-3008
Ismayilova Zulfiya E., PhD, Associate Professor of the General Surgery Department, Azerbaijan Medical University, Baku, Republic of Azerbaijan.
https://orcid.org/0000-0001-9462-9923
Mammadov Tapdig E., Senior Laboratory Assistant of the General Surgery Department, Azerbaijan Medical University, Baku, Republic of Azerbaijan.
https://orcid.org/0000-0001-6558-6821
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.

Keywords: pancreatico duodenectomy, hepaticojejunostomy leakage, biliodigestive anastomosis failure, postoperative biliary fistula
p. 95-101 of the original issue
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Address for correspondence:
628011, Russian Federation,
Khanty-Mansiysk, Mira Str., 40,
Khanty-Mansiysk State Medical Academy,
the hospital surgery department,
tel. mobile.: +7 982 194-67-41,
-mail: raynvu@okbhmao.ru,
Rayn Vasilisa Yuryevna
Information about the authors:
Rayn Vasilisa Yu., Senior Lecturer of the Hospital Surgery Department, PhD post-Graduate Student, Khanty-Mansiysk State Medical Academy, Russian Federation.
http://orcid.org/0000-0003-2406-0000

EXCHANGE OF EXPERIENCE

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,
4th 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 4,81,8 (Mσ) 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 4,71,9 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 20,86,2 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.

Keywords: upper limb necrotizing fasciitis, necrotizing soft tissue infection, Streptococcus pyogenes, Pasteurella multocida, surgical treatment
p. 102-111 of the original issue
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  4. Misiakos EP, Bagias G, Patapis P, Sotiropoulos D, Kanavidis P, Machairas A. Current concepts in the management of necrotizing fasciitis. Front Surg. 2014 Sep 29;1:36. doi: 10.3389/fsurg.2014.00036. eCollection 2014
  5. Hakkarainen TW, Kopari NM, Pham TN, Evans HL. Necrotizing soft tissue infections: review and current concepts in treatment, systems of care, and outcomes. Curr Probl Surg. 2014 Aug;51(8):344-62. doi: 10.1067/j.cpsurg.2014.06.001
  6. Choueka J, De Tolla JE. Necrotizing Infections of the Hand and Wrist: Diagnosis and Treatment Options. J Am Acad Orthop Surg. 2020 Jan 15;28(2):e55-e63. doi: 10.5435/JAAOS-D-17-00716
  7. Khamnuan P, Chongruksut W, Jearwattanakanok K, Patumanond J, Yodluangfun S, Tantraworasin A. Necrotizing fasciitis: risk factors of mortality. Risk Manag Healthc Policy. 2015 Feb 16;8:1-7. doi: 10.2147/RMHP.S77691. eCollection 2015
  8. Kheiran A, Palial V, Rollett R, Wildin CJ, Chatterji U, Singh HP. Cat bite: an injury not to underestimate. J Plast Surg Hand Surg. 2019 Dec;53(6):341-46. doi: 10.1080/2000656X.2019.1637750
  9. Milani-Nejad N, Tyler K, Grieco CA, Kaffenberger BH. Pasteurella multocida ecthyma complicated by necrotizing fasciitis. Dermatol Online J. 2017 Apr 15;23(4):13030/qt1h02t0tc
  10. Tessier JM, Sanders J, Sartelli M, Ulrych J, De Simone B, Grabowski J, Buckman S, Duane TM. Necrotizing Soft Tissue Infections: A Focused Review of Pathophysiology, Diagnosis, Operative Management, Antimicrobial Therapy, and Pediatrics. Surg Infect (Larchmt). 2020 Mar;21(2):81-93. doi: 10.1089/sur.2019.219
  11. Lancerotto L, Tocco I, Salmaso R, Vindigni V, Bassetto F. Necrotizing fasciitis: classification, diagnosis, and management. J Trauma Acute Care Surg. 2012 Mar;72(3):560-66. doi: 10.1097/TA.0b013e318232a6b3
  12. Jung N, Eckmann C. Essentials in the management of necrotizing soft-tissue infections. Infection. 2019 Aug;47(4):677-79. doi: 10.1007/s15010-019-01316-3
  13. Leiblein M, Marzi I, Sander AL, Barker JH, Ebert F, Frank J. Necrotizing fasciitis: treatment concepts and clinical results. Eur J Trauma Emerg Surg. 2018 Apr;44(2):279-90. doi: 10.1007/s00068-017-0792-8
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  15. El-Menyar A, Asim M, Mudali IN, Mekkodathil A, Latifi R, Al-Thani H. The laboratory risk indicator for necrotizing fasciitis (LRINEC) scoring: the diagnostic and potential prognostic role. Scand J Trauma Resusc Emerg Med. 2017 Mar 7;25(1):28. doi: 10.1186/s13049-017-0359-z
  16. Chaudhry AA, Baker KS, Gould ES, Gupta R. Necrotizing fasciitis and its mimics: what radiologists need to know. AJR Am J Roentgenol. 2015 Jan;204(1):128-39. doi: 10.2214/AJR.14.12676
  17. Melillo A, Addagatla K, Jarrett NJ. Necrotizing Soft Tissue Infections of the Upper Extremity. Hand Clin. 2020 Aug;36(3):339-44. doi: 10.1016/j.hcl.2020.03.007
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Address for correspondence:
119991, Russian Federation,
Moscow, Bolshaya Pirogovskaya Str., 2-4,
I.M. Sechenov First Moscow
State Medical University,
General Surgery Department ,
tel. mobile: +7 (916) 635-89-88,
e-mail: k_lipatov@mail.ru,
Lipatov KonstantinV.
Information about the authors:
Lipatov Konstantin V., MD, Professor of the General Surgery Department, I.M. Sechenov First Moscow State Medical University, Moscow of the Ministry of Health of Russia, Russian Federation.
http://orcid.org/0000-0002-9902-2650
Asatryan Artur G., PhD, Head of the Purulent Surgery Department, the 4th Moscow Clinical Hospital, Moscow, Russian Federation.
http://orcid.org/0000-0002-8409-2605
Melkonyan George G., MD, Professor, Chief Physician, the 4th Moscow Clinical Hospital, Moscow, Russian Federation.
http://orcid.org/0000-0001-7234-4185
Kuznetsov Vladimir A., Student, I.M. Sechenov First Moscow State Medical University of the Ministry of Health of Russia,, Moscow, Russian Federation.
http://orcid.org/0000-0001-8385-4113
Gorbacheva Irina V., PhD, Associate Professor of the General Surgery Department , I.M. Sechenov First Moscow State Medical University of the Ministry of Health of Russia, Moscow, Russian Federation.
http://orcid.org/0000-0002-1060-1163
Yurchenko Mark V., Surgeon, the Purulent Surgery Department, the 4th Moscow Clinical Hospital, Moscow, Russian Federation.
http://orcid.org/0000-0002-4059-7548

CASE REPORTS

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.

Keywords: sternal wound infection, osteomyelitis of the sternum, muscle flap, chest wall defect, chest wall reconstruction, sternum dehiscence, management of mediastinitis
p. 112-118 of the original issue
References
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  3. Momeni A, Kovach SJ. Important considerations in chest wall reconstruction. J Surg Oncol. 2016 Jun;113(8):913-22. doi: 10.1002/jso.24216
  4. Billington A, Dayicioglu D, Smith P, Kiluk J. Review of procedures for reconstruction of soft tissue chest wall defects following advanced breast malignancies. Cancer Control. 2019 Jan-Dec;26(1):1073274819827284. doi: 10.1177/1073274819827284
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  7. Tewarie L, Moza AK, Khattab MA, Autschbach R, Zayat R. Effective Combination of Different Surgical Strategies for Deep Sternal Wound Infection and Mediastinitis. Ann Thorac Cardiovasc Surg. 2019 Apr 20;25(2):102-10. doi: 10.5761/atcs.oa.18-00115
  8. Piwnica-Worms W, Azoury SC, Kozak G, Nathan S, Stranix JT, Colen D, Othman S, Vallabhajosyula P, Serletti J, Kovach S. Flap reconstruction for deep sternal wound infections: factors influencing morbidity and mortality. Ann Thorac Surg. 2020 May;109(5):1584-90. doi: 10.1016/j.athoracsur.2019.12.014
  9. Mitish VA, Usu-Vuiyu OYu, Paskhalova YuS, Ushakov AA., Zvyagin AA, Orudzheva S A, Zhestkov MS. Experience in surgically treating chronic postoperative osteomyelitis of the sternum and ribs after minimally invasive myocardial revascularization Rany i Ranevaia infektsiia. Zhurn im prof BM Kostiuchenka. 2015;2(2):46-55. doi: 10.17 650 / 2408-9613-2015-2-2-46-55 (In Russ.)
  10. van Wingerden JJ. Outcome following sternal reconstruction with the omental flap. J Reconstr Microsurg. 2018 Jun;34(5):e5. doi: 10.1055/s-0038-1668136
  11. Barbera F, Lorenzetti F, Marsili R, Lisa A, Guido G, Pantaloni M. The Impact of Preoperative Negative-Pressure Wound Therapy on Pectoralis Major Muscle Flap Reconstruction for Deep Sternal Wound Infections. Ann Plast Surg. 2019 Aug;83(2):195-200. doi: 10.1097/SAP.0000000000001799
  12. Lee SB, Lee JW, Kim HJ, Ko BS, Son BH, Eom JS, Lee TJ, Ahn SH. Long-term outcomes of patients with breast cancer after nipple-sparing mastectomy/skin-sparing mastectomy followed by immediate transverse rectus abdominis musculocutaneous flap reconstruction: Comparison with conventional mastectomy in a single center study. Medicine (Baltimore). 2018 May;97(18):e0680. doi: 10.1097/MD.0000000000010680
  13. Jeong W, Lee S, Kim J. Meta-analysis of flap perfusion and donor site complications for breast reconstruction using pedicled versus free TRAM and DIEP flaps. Breast. 2018 Apr;38:45-51. doi: 10.1016/j.breast.2017.12.003
  14. Johnstone MS. Vertical Rectus Abdominis Myocutaneous Versus Alternative Flaps for Perineal Repair After Abdominoperineal Excision of the Rectum in the Era of Laparoscopic Surgery. Ann Plast Surg. 2017 Jul;79(1):101-106. doi: 10.1097/SAP.0000000000001137
  15. Nichols DS, Satteson E, Harbor P, DeFranzo A, David L, Thompson JT 2nd. Factors associated with the use of vertical rectus abdominus myocutaneous flap reconstruction following abdominoperineal resection for anorectal cancer. J Surg Oncol. 2020 Oct;122(5):923-27. doi: 10.1002/jso.26086
  16. Netscher DT, Eladoumikdachi F, Goodman CM. Rectus abdominis muscle flaps used successfully for median sternotomy wounds after ipsilateral internal mammary artery ligation. Ann Plast Surg. 2001 Sep;47(3):223-28. doi: 10.1097/00000637-200109000-00001
Address for correspondence:
443079, Russian Federation,
Samara, Chapayevskaya Str., 89,
Samara State Medical University,
the Surgery Department of the Institute
of Professional Training,
tel.: +7 9053052755,
e-mail: doctormama163@yahoo.com,
Medvedchikov-Ardiia Mikhail A.
Information about the authors:
Medvedchikov-Ardiia Mikhail A., PhD, Thoracic Surgeon of the Surgical Thoracic Department, Samara Regional Clinical Hospital Named after V.D. Seredavin, Associate Professor of the Surgery Department of the Institute of Professional Training, Samara State Medical University, Samara, Russian Federation.
https://orcid.org/0000-0002-8884-1677
Korymasov Evgeny A., MD, Professor, Head of the Surgery Department of the Institute of Professional Training, Samara State Medical University, Samara, Russian Federation.
https://orcid.org/0000-0001-9732-5212
Benyan Armen S., MD, Associate Professor, Minister of Health Care of Samara Region, Thoracic Surgeon of the Surgical Thoracic Department, Samara Regional Clinical Hospital named after V.D. Seredavin, Professor of the Surgery Department of the Institute of Professional Training, Samara State Medical University, Samara, Russian Federation.
https://orcid.org/0000-0003-4371-7426
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 patients 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.

Keywords: varicose veins, pregnancy, superficial thrombophlebitis, diagnosis, treatment
p. 119-124 of the original issue
References
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Address for correspondence:
220116, Republic of Belarus,
Minsk, Dzerzhinsky Avenue, 83,
Belarusian State Medical University,
the Department of Surgical Diseases No2,
tel.: +375 17277-11-55,
e-mail: vladimirkh77@mail.ru,
Khryshchanovich Vladimir Y.
Information about the authors:
Khryshchanovich Vladimir Ya., MD, Professor the Department of Surgical Diseases No2, Belarusian State Medical University, Minsk, Republic of Belarus.
https://orcid.org/0000-0001-5353-205X
Skobeleva Natalia Ya., Obstetrician-Gynecologist, a Postgraduate Student of the Deparment of Obstetrics and Gynecology, Belarusian State Medical University, Minsk, Republic of Belarus.
https://orcid.org/0000-0003-2267-579X

OBITUARY

SUSHKOV SERGEY ALBERTOVICH

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