The article is dedicated to the 45th anniversary of its creation at the A. V. Vishnevsky Institute of Surgery (at present, A. V. Vishnevsky National Medical Research Center of Surgery) of the Department of Surgery for Purulent Wounds and Wound Infection (currently, the Department of Wounds and Wound Infections). The submission reflects the key moments of the department’s history, areas of work, biographies of managers and leading employees.

Object. To study the clinical efficacy of the Acerbin solution in topical administration and its effects on the morphological changes in tissues in the complex treatment of chronic wounds by various etiologies.

Materials and methods. The prospective clinical study consistently included 32 patients aged from 28 to 74 years (mean age 54.3 ± 3.6 years) with chronic wounds of various etiologies and localizations (did not heal against the background of local treatment within 30 days from the moment of formation). Patients were hospitalized in the Department of Wounds and Wound Infections of the A. V. Vishnevsky National Medical Research Center of Surgery in 2016–2018. 16 (50.0 %) patients were admitted with extensive nonhealing wounds on the background of chronic venous insufficiency (C6 according to the CEAP classification). In 7 (21.9 %) patients, chronic postoperative wounds of various localization were diagnosed and in 9 (28.1 %) – non-healing wounds after surgical treatment of the neuropathic form of diabetic foot syndrome (DFS) – Wagner II–IV. The protocol of local treatment in all patients was the same. After Acerbin solution applying, the wound surface was closed with a gauze cloth soaked in Levomekol ointment. Re-dressings were performed daily for the first 5–7 days, and then every other day. The average duration of treatment under dressings using a Acerbin solution did not exceed two weeks. All patients at the same time carried out qualitative and quantitative microbiological studies. For an objective assessment of the dynamics of the course of the wound process cytological and morphological studies were performed.

Results. In all cases, the initial clinical picture corresponded to a sluggish chronic process. Microbiological studies have shown a variety of pathogens of the infectious process. As a rule, associations of gram-positive and gram-negative microorganisms were detected. All isolated strains (Ps. Aeruginosa, E. coli, Acinetobacter sp., Kl. Pneumonia) were resistant to most broad-spectrum drugs, indicating their hospital affiliation. At 3–5 days of treatment in the cytograms changes in the cellular composition was revealed by increasing the number of polymorphonuclear neutrophils and a significant decrease in the number of polyblasts with their transition to active macrophages, a positive shift was observed during the wound process and an increase in the processes of biological wound cleansing. On days 7–10 of treatment the cytological picture indicated the activation of the regeneration process in the wound against the background of ongoing intensive biological cleansing. By 8–14 days of treatment, the wounds were completely cleared, which allowed to proceed to its final stage – to performance the reconstructive and plastic surgeries.

Conclusion. Using the Acerbin solution in the complex treatment of patients with non-healing wounds made it possible to avoid additional surgical debridment. Purification of wounds from necrotic tissues and fibrin occurred in a shorter time compared with traditional methods of treatment, which made it possible to perform the reconstructive stage of treatment of patients in a shorter time.

Objective: comparative analysis of the diabetes mellitus impact on the speed of lower extremities long-existing soft tissue defects healing in patients with chronic venous insufficiency.

Materials and methods. In a retrospective comparative study were included 52 patients without hemodynamically significant lesions of the arteries and with lower extremities veins pathology confirmed by ultrasound who had 95 ulcers (C6 class of CEAP) sized from 1 to 10 cm2.

Results. The average period of superficial ulcers healing until complete epithelialization of the wound surface in patients without diabetes mellitus was 1.1 months, and in the presence of diabetes mellitus it was 0.9 months. Average speed of the healing of such ulcers treated with application of hydrocolloid dressings in patients without diabetes mellitus was 4.7 cm2/month, and patients with diabetes mellitus – 2.6 cm2/month. The average period of healing the deep ulcers in patients without diabetes mellitus (2.6 months) and in patients with diabetes mellitus (2.4 month) also did not significantly differ. At the same time, the average speed of healing the deep ulcers treated with application of hydrocolloid dressings in patients without diabetes mellitus was 1.4 cm2/month, and in patients with diabetes mellitus – 1.3 cm2/month. In cases of treatment with implantation of collagen membranes these parameters were 1.8 and 1.2 cm2/month, respectively.

Conclusions. The speed of "venous" trophic ulcers healing in patients without diabetes mellitus was slightly higher than in patients with diabetes mellitus, but significant difference in the speed of wound healing between these two patient groups was observed only in cases when native collagen membranes were used for deep ulcers treatment of.

Objective: analysis of surgical care for drug-addicted patients with purulent-septic pathology on the example of the Vorkuta emergency hospital.
Materials and methods. In 2006–2018 in the Vorkuta emergency hospital, 285 drug-addicted patients between the ages of 23 and 52 were treated. Among them, parenteral hepatitis (B, C) was diagnosed in 257 cases, and in 83 cases – HIV. Patients were treated with postinjection abscesses and phlegmon of the extremities, purulent arthritis of various localizations, less commonly with phlebitis, ileofemoral thrombosis, arrosive bleeding, retroperitoneal phlegmon.
Results. Surgical treatment included surgical debridment of a purulent focus, management of wounds by an open method, closed flowaspiration lavage of cavities, and NPWT. In 91 cases (32.0 %), treatment remained incomplete due to the unauthorized departure of patients from the hospital, or due to a violation of the regime and rules of conduct in the hospital, which resulted in a forced discharge. The wounds were closed with either a primary suture over the through drainage, or secondary sutures, or various types of skin plastics. In the department of purulent surgery, 4 (1.4 %) patients died. The cause of death is the development of decompensated multiple organ failure.
Conclusions. The number of drug-addicts practically does not correlate with the population and is relatively constant. The quality of medical care directly affects mortality among drug-addicted patients with surgical infection. Drug-addicted patients who use opioid surrogates should be treated as septic when admitted to hospital.

Object. Create a patient’s model with a neuro-ischemic form of diabetic foot syndrome in the stage of purulo-necrotic changes and calculate the completed case of treatment according to the profile of surgery in order to change the payment system by compulsory medical insurance.
Materials and methods. On the basis of the FSBO “A. V. Vishnevsky National Medical Research Center of Surgery” Ministry of Health of Russia has carried out a preliminary calculation of the average cost the complex surgical treatment by patients with neuroischemic form of DFS in the stage of purulo-necrotic changes (Wagner II-IV). The formation of the clinic and statistic group (CSG) is based on a set of basic and additional classification criteria that determine the relative cost of patients treatment. The main criteria are: diagnosis (ICD code 10), applied medical technology (code in accordance with the Nomenclature of Medical Services, approved by order of the Ministry of Health and Social Development of the Russian Federation dated December 27, 2011 No. 1664n), as well as methodological recommendations for the CSG, approved by the Mandatory Medical Insurance Fund and the Ministry of Health for 2018. Additional classification criteria are: age category of the patient, concomitant diagnosis or complications of the disease, gender, duration of treatment. Expensive medications as additional classification criteria is possible to include if there are specific indications defined by clinical guidelines (treatment protocols). This rule applies only to drugs that are included in the List of vital and essential drugs for medical use. Differentiating signs in such subgroups can be services for the use of specific drugs. The level of costs is determined on the basis of the prevailing average level of purchase prices for these drugs in a constituent entity of the Russian Federation or in accordance with the registered maximum selling prices.
Results. The direct costs of treating a surgical patient with a neuroischemic form of DFS are 300,679 rubles 97 kop. and include: medical services for diagnosing the disease; medical services for treating and controlling a disease for a specified duration of treatment; medications; dressings and medical devices implanted into the human body. Overhead costs are 90,224 rubles 56 kop., and the preliminary total cost of a completed case of treatment is 390,904 rubles 47 kop.
Conclusion. Preliminary calculations clearly demonstrate the apparent lack of funding for the treatment of DFS. The existence of the needs of the clinical community for the formation of new or updated CSG based on the clinical recommendations of specialists (and not on the minimum services from medical and economic standards (MES)), using principles and methodological approaches for patient models, will help make it clear providing quality personalized care to patients.

The article presents the experience of successful patient treatment with a high external small bowel fistula using a combined approach: surgery and vacuum therapy.

Necrotizing cellulitis is an infection most often caused by mixed aerobic and anaerobic microflora or Clostridium perfringens, which affects the superficial and deep fascia and subcutaneous fat. Necrotic pyogenic infection (NPI) usually occurs as a result of infection of tissues with Streptococcae group A (for example, Streptococcus pyogenes) or by the association of aerobic and anaerobic bacteria (for example, Bacteroides species). Streptococci can reach the site of inflammation from distant foci of infection by hematogenous. This infectious disease most often affects the limbs and the perineum. NPI causes tissue ischemia as a result of extensive occlusion of small vessels in the subcutaneous fat. Vascular occlusion leads to heart attack and tissue necrosis, which increases the number of obligate anaerobes (for example, Bacteroides) and stimulates the anaerobic metabolism of facultative pathogens (for example, Escherichia coli). The chain of the listed pathophysiological reactions is the cause of the development of gangrene in patients with NPI.

The main method of treating NPI is surgical. Indications for surgical treatment are blistering, ecchymosis and fluctuations symptom. The initial incision should be extended until it becomes possible to separate the skin with subcutaneous fat from the fascia with a tool or finger. The most common mistake is non-radical surgical treatment. Repeated surgical treatments with removal of necrosis to the boundaries of healthy tissues should be repeated every 1–2 days – this procedure should become routine. Additionally prescribed intravenous infusions of antibiotics, usually include 2 or more drugs. The choice of antibiotic therapy should be based on the results of bacteriological research. Intensive detoxification requires the introduction of large volumes of fluid before and after surgery. After surgical treatment, extensive wound defects of soft tissues are formed, requiring elimination by reconstructive and plastic surgeries.

The article presents a clinical example of successful patient with a severe NPI treatment. Surgical treatment of the underlying disease and the replacement of an extensive wound defect using bioplastic material were performed.

26-28 of November 2018 RPO «Surgical Society – Wounds and Wound Infections», Société Française et Francophone des Plaies et Cicatrisations, «A.V. Vishnevsky National Medical Research Centre of Surgery» Ministry of Health of Russian Federation, «Research Institute of Emergency pediatric surgery and trauma» Moscow Health Department, «Peoples’ Friendship University of Russia» Ministry of Education and Science of Russian Federation, Russian Surgery Society and International Fund of Assistance to Children suffered in Catastrophes and Wars plan to hold Fourth International Scientific and Practice Congress «WOUNDS and WOUND INFECTIONS» with the Conference «Anesthesia and Intensive Care in Wound Infections».