Limb amputation is one of the oldest and most famous operation in surgery. Over the millennia, the tools for its implementation and the technique for its perfomance have been constantly improved. In part 1 of the article, using historical, chronological and dialectical methods, as well as the method of comparative content analysis a number of printed (Hippocrates, V-IV centuries B.C.; Celsus, I century; Abu-alQasim, XI century; A. Paré, XVI century, etc.), material (prostheses, surgical instruments) and visual (engraving, painting, etc.) sources, the circumstances and features of the emergence and development of instruments and techniques for limbs amputation from antiquity to the era were studied and recreated Renaissance. The main indication for amputation was the limb death (gangrene), as well as significant tissue trauma caused by cold or firearms (since the XIV century). The limb was truncated (or isolated) with a circular section along the demarcation line (in ancient times) or within healthy tissues (in the Middle Ages). The operation was carried out under a tourniquet applied above the level of amputation; healthy tissues were shifted proximally; sometimes a second tourniquet was applied - below the cut-off level. Anesthesia was achieved by operating in a state of painful shock, after bloodletting, or by applying a tight ligature (tourniquet). Bleeding was stopped with the surgeon's finger, cauterization or vessel cutting of, ligature of one vessel or the entire bleeding tissue (en masse), suturing of the bleeding vessel (A. Paré), as well as astringents and a bandage. The wound of the stump was left open or brought together with sutures. A major stage in the development of amputation was the work of A. Paré (XVI century), who improved instruments (in particular, clamps for stopping bleeding), the technique of the operation, and pain relief during its performance.
If in the Ancient World and in the early Middle Ages amputation was life-threatening, available only to a few of the most skilled doctors, was performed relatively rarely and was akin to art, then after its development in the XIII–XIV centuries. barbers began to perform it everywhere, routinely and gradually turned into a craft. Further development of indications for amputation, techniques for its implementation and the transformation of this operation from a craft into a science from the XVII century. until the middle of the twentieth century will be reflected in part 2 of this article.

Ischemic foot gangrene is one of the most common reasons of nontraumatic low limb amputations all over the world.
Objective: to analyze the clinical effectiveness of an individual treatment strategy application for patients with absolute indications for high limb amputation, aimed to reduce amputation level, the number of postoperative complications and mortality.
Materials and methods. This article presents the results of comparative clinical trial executing a lower-extremity amputation in 992 patients with ischemic gangrene. Applied in this study strategy of surgical treatment included usual below-knee, above-knee amputations and guillotine amputations in the lower third of the shin also the shin exarticulation without wound plastic. Guillotine amputations was used as an intermediate stage of treatment in cases where due to the severe general condition of patients to perform a classic myoplastic amputation with stump formation was impossible, since it is accompanied by a very high risk of postoperative complications and mortality.
Results. Using guillotine amputations and shin exarticulation as the first stage of complex surgical strategy aimed to rapid elimination of the purulent focus with minimal risks and the speedy stabilization of the patients general condition, emaciated and weakened by developing gangrene, led to reduce general lethality by 17.1 % and increased the quantity of below-knee amputations by 23.0 % compared with the comparison group.
Conclusion. Patients with ischemic gangrene require the development of an individual strategy for surgical treatment (taking into account the severity of the patients general condition, the prevalence of the purulent-necrotic process in the lower limb, the nature and degree of peripheral macroangiopathy), which can reliably and significantly reduce the number of amputations at the hip level (by 46.2%), as well as reduce mortality after high amputations of the lower extremities (by 17.1%) in an emergency city hospital. We consider it extremely important to reduce the number of primary amputations at the hip level!

Objective: analyze the effectiveness of the angiosomal oriented endovascular revascularization method in the complex treatment of diabetic foot syndrome (DFS).
Materials and methods. One of the most serious complications of diabetes mellitus is damage to the vessels of the lower extremities. In diabetic macroangiopathy, an extended lesion of medium-sized arteries occurs, which, coupled with an atherosclerotic lesion, often leads to the formation of arterial stenosis and occlusion. The leading method for correcting the patency of the great vessels today is endovascular balloon angioplasty. The study examined the feasibility of selective angiosomal revascularization of the lower extremities. The advantages of angiosomaly-oriented endovascular revascularization are a reduction in the duration of the intervention, a decrease in the volume of the injected contrast drug, and targeted restoration of blood flow in the arteries that feed the affected segment of the limb. The study included 49 patients with a neuroischemic form of DFS with hemodynamically significant stenosis and occlusion of the lower extremities arteries. Patients were divided into 2 groups. Patients of both groups underwent complex conservative treatment and performed operations on the lower extremities (from surgical debridement to below the knee amputation). Patients of the first group underwent angiosomaly oriented revascularization of the lower extremities. Patients from the second group underwent traditional endovascular revascularization.
Results. After angiosomaly oriented revascularization, a complete restoration of the initial diameter of the vessel was achieved in 80.0 % of cases, the absence of residual stenosis – in 82.5 %, the absence of intimal dissection – in 95.0 % of cases. It was possible to achieve laminar blood flow in 90.0 % of cases. A reduction in the revascularization procedure by an average of 30 minutes and a decrease in the consumption of contrasting pharmaceuticals by an average of 100.0 ml are shown.
Conclusion. When evaluating the results of complex treatment of patients after angiosomaly oriented revascularization, a decrease in the average hospital stay (11 and 13 days, respectively), a decrease in the average healing time of a wound defect by 1.25 times, a decrease in the average duration of ulcerative epithelization (9 and 13 days, respectively) and a decrease in the volume of surgical intervention and the number of high amputations during the year after angioplasty compared with patients who underwent endovascular revascularization according to the traditional method.

Objective: to investigate the structure of the new VitaVallis dressing and determine the mechanism of its wound healing effect.
Materials and methods. To study the structure of the VitaVallis dressing, transmission and scanning electron microscopy methods were used. The course of the wound process was studied in 60 male mice of the Balb / c line. The healing of a wound defect under the influence of dressings was studied on the model of a “skin flap”. Morphometric evaluation of histological preparations was carried out by computer-aided graphical analysis of samples. Statistical processing of the results was carried out using the parametric (Student's test) and non-parametric (Wilcoxon's test) methods. For analysis, the program Statistica 6.0 was used.
Results. The structure of the VitaVallis dressing is randomly spaced polymer fibers with a diameter of 1.0—5.0 microns, on the surface of which nanosheet structures of aluminum oxyhydroxide (AlOOH) are immobilized. In vivo experiments have shown that the use of VitaVallis dressing in the treatment of model wounds in mice promotes accelerated healing and leads to better epidermis organotypic differentiation and accelerates the maturation of granulation tissue. This effect is due to a combination of factors such as: reduction of inflammatory processes due to the removal and retention of wound exudate, including pathogenic microflora, stimulation of marginal epithelization, protection of the formed granulation tissue from drying out and acceleration of its maturation.
Conclusion. Analysis of the structure and mechanism of the wound-healing action of the dressing VitaVallis suggests the effectiveness of its use in the local treatment of wounds.

The article presents the results of a retrospective study of the intestinal lavage (IL) with saline enteral solution (SES) effectiveness for the treatment of dynamic intestinal obstruction in acute forms of pancreatitis and pancreonecrosis.
Objective: to study improve the results of patients treatment in intestinal paresis by various forms of acute pancreatitis, using IL lavage with the use of SES.
Materials and methods. The study included 81 patients: 56 (69.1 %) men and 25 (30.9 %) women, average age 59.3 ± 13.4 years, who were hospitalized in the clinic at different times from the onset of the disease: from 24 hours to 7 days. Patients were divided in two groups: 1^st group (46 people) included patients who started IL for the first 3 days after the onset of the disease; 2^nd group (35 people) consisted of patients who started IL after 3 days of the disease, 30 patients of 2^nd grouphad surgery before IL.
Results. Prokinetic effect of IL in gastrostasis and dynamic bowel obstruction improve the quality of conservative treatment (up to 78.3 % in 1^st group and 37.1 % in 2^nd group); avoid open surgical interventions (up to 6.5 % in 1st group, up to 37.1 % in 2^nd group), carry out decreasing invasive effects of drainage of limited focus (in 15.2 % of patients in 1^st group, 42.9 % in 2^nd group); eliminate the phenomen of gastrostasis within 3 days after IL in both groups. Reduction/elimination of the phenomen of dynamic intestinal obstruction after IL within 24 hours (up to 73.8 % in 1st group, up to 97.1 % in 2^nd group), allowed to start early enteral nutrition within 48 hours (in 73.9 % of patients of 1st group, up to 42.8 % patients of 2^nd group).
Conclusions. Early using of intestinal lavage in the complex therapy of acute forms of pancreatitis is safe and effective and reduces the number of purulent-septic complications, prevents the development of multiple organ failure, reduces the overall mortality, prepares the intestine for early enteral nutrition.

The article presents the chronology of the International Scientific and Practice Conference “High low limb amputations in children and adult” (May 20–21, 2019).