Healthcare technologies control in the frame of limited budget is an important aim for healthcare organizers and people who makes decisions. Methodological approaches formulation while choosing the method of assessment of social significance of medications in complications of type 2 diabetes – one of the unresolved problems of limited lists of life-saving medication, as well as the list of Population Drug Coverage for regions. Suggested methods of social cost of disease calculation and created clinical-economical simulators will allow people making decisions to have and adequate working tool. The main goal of clinical-economical simulator creation is a combination of clinical choice of specialists with economical expenses, which leads to technologies usage like diagnostics, treatment choice and case follow-up.

The article provides a review of the literature about the problem of etiology, pathogenesis, clinical implications, characters of Fournier’s gangrene diagnostics, and experience of patients’ complex treatment that was accumulated in clinic.

Materials and methods. It is shown the results of treatment of 11 patients with Fournier’s gangrene aged from 18 to 75 years in the period from 1995 to 2015.

Results: During the first 2 days from the incursion of disease 4 patients (36.4 %) were admitted for treatment, in the period from 2 to 4 days – 7 patients (63.6 %) were also admitted. 9 patients (81.8 %) were presented by the fulminant disease progression (rapid progression) of Fournier’s gangrene with toxic shock syndrome. The average severity index of Fournier’s gangrene (Fournier's gangrene severity index or FGSI) was 9.1 points (varied from 0 to 15). The average FGSI for survived patients was 8.6 points, and for died patient - 12.6 points. 11 patients had microorganisms, which were exported from the focus; the spectrum of detected causative pathogen is notable for polymorphism. Limited wound defects of the scrota of 2 patients (18 %) were healed by secondary intention. For 4 patients (36 %) with extensive defects of scrota tissues and versatile exposure of testicles and funiculus spermaticus after wound cleansing there were reconstructed the scrota with closure of disemboweled organs by mobilized local tissues. Among 5 patients with common variant of Fournier’s gangrene 3 patients had a scrota reconstruction combined with surgical correction and autodermoplasty of perineum and perianal defects, and 2 patients had reconstruction combined with secondary suturation of wound defects on the abdominal parietes, inguinal region and right femoris. 1 patient (9.1 %) died as in consequence of the extension of putrid and necrotic process on the abdominal parietes, femoris and perineum tissues, rapid progression of endotoxicosis and multi-organ failure.

Conclusion. Therefore, the own experience of Fournier’s gangrene treatment testify that this severe infectious process is accompanied by rapid destruction of perineum tissues with its extension beyond the anatomical region, severe intoxication with significant deficiency of homeostasis, the Systemic Inflammation Response Syndrome combined with organ damage, indicating the development of sepsis in the majority of patients (severe sepsis, and, even, septic shock). 

This article analyzes the successful experience of using xenon anesthesia in traumatizing bandages for burn patients. The developed methodology (approved by the legal and regulatory basis) and the equipment park, that is necessary for xenon inhaling, were approbated and introduced by the staff members based on CJSC “ATOM-MED CENTER” and Dollezhal R&D Institute of Power Engineering.

Materials and methods: The patients were divided into two groups: basic one and control one. The main group used masked anapnotherapy of the xenon-oxygen admixture. In the control group burn patients were applied daily bandages under intravenous anesthesia. Altogether there were 12 monoanesthesias with 70 % xenon in the department, and there were no narcotic or non-narcotic analgesics.

Before the beginning of inhalation the patients of the main group had denitrogenisation by two intakes of breath of pure oxygen through the earloop face mask. The duration of bandaging and inhalation was 33 ± 4.2 minutes in average. The given gas admixture consisted of xenon / oxygen in a proportion of 70:30; the flow rate varied from 3.5 to 5.5 liters per minute. The xenon flow was 6.5-10.5 liters per inhalation. All the respondents keep verbal contact with the surgeon during the treatment session. The patients of the control group had the total intravenous anesthesia by the standard method that is used in our clinic and involved intaking 0.4 mg of 0.005 % fentanyl liquid, 50 mg of 5 % ketamine liquid and 150 mg of 1 % propofol liquid.

Results: he information about changes of characteristics of central and peripheral hemodynamic indicators, achieved in the work, testifies that during xenon-oxygen anesthesia while traumatizing bandaging the greater stability of systolic blood pressure, diastolic blood pressure, mean airway pressure, heart rate and peripheral resistance were in the main group of patients compared to patients in the control group.

Conclusions: Anesthesia with the xenon-oxygen admixture is an effective method for surgical procedures for burn patients. This kind of analgesia allows reducing doses of psychotropic and sedating medications considerably, and that has a positive effect on the quality of treatment and reduces the risk of possible complications. The gained effect of analgesia prolongation up to 4 hours allowed refusing of narcotic analgesics using and non-steroidal anti-inflammatory drugs using among patients of the main group. 

The vascularized fibula osteocutaneous and fasciocutaneous free flap was transplanted to a surgical patient with a gunshot comminuted fracture, a defect of middle third of the diaphysis of right forearm with Ilizarov fixation on it and a defect of soft tissues on radial side of right forearm in a chronic wound process.

It was achieved perfect engraftment of the flap and relief of the wound process in the early postoperative period. The synostosis of the bone part of the flap with fragments of the radial bone happened in 5 months after the operation. 

The number of injured due to road traffic accidents (RTA) increases all-round the world. This type of injuries is often accompanied by open fracture of long bones, soft tissues defects with extended separation and crushing. Very often, the disease is complicated with surgical infections, posttraumatic osteomyelitis and sepsis. The below described situation demonstrates the results of successful complex surgical treatment of a patient with extensive injuries of soft tissues of lower limbs and open fractures of bones of knee joint.

18–19 may 2018 RPO “Surgical Society – Wounds and Wound Infections”, State Budgetary Healthcare Institution “Research Institute of Emergency pediatric surgery and traumatology” Moscow Health Department, Federal Government Budgetary Institution “A.V. Vishnevsky Institute of Surgery” Ministry of Health of Russian Federation, FSAEI “Peoples’ Friendship University of Russia” Ministry of Education and Science of Russian Federation, LLC “Russian Surgery Society”, International Fund of Assistance to Children suffered in Catastrophes and Wars plan to hold International scientific and practical conference “Vacuum therapy of children and adults’ wounds. Russian and international experience”