The article describes armed conflicts on the territory of Iraq and Afghanistan. Improvement of individual and collective protection equipment has reduced the number of cases of soft tissue wounds in the extremities. The main cause of mortality and wound complications is antibiotic-resistant microflora. Purulent complications lead to chronic treatment of the wound healing process and a long period of specialized treatment and rehabilitation, which entails difficulties in the socialization of wounded servicemen, as well as significant financial costs from the state. When providing medical care to wounded military personnel, it is negative pressure wound therapy. Phage therapy is a promising method for treating infectious complications.

The article provides a review of the literature on the assessment of the efficacy, safety and indications for the use of povidone iodine in modern clinical practice. The preservation of good sensitivity to the drug, despite its long-term use, as well as new opportunities associated with the effectiveness against biofilm forms of pathogens and viruses, in particular SARS-CoV-2, has been shown.

The results of the use in the experiment of composite hydrogel coatings of prolonged action based on polyvinyl alcohol are investigated.

Objective. The aim of the study is a comparative clinical assessment of the effectiveness of the developed composite hydrogel coatings of prolonged action in an experiment in laboratory rats.

Materials and research methods. After modeling alloxan diabetes mellitus and neuroischemic form of diabetic foot in laboratory white Wistar rats, the developed wound dressings were applied. A clinical analysis of their effectiveness was carried out and the optimal composition was determined. The animals were divided into three groups, 10 animals in each group, as follows: the first — control with self-healing of the wound, the second — with samples No. 1 (polyvinyl alcohol + chitosan + pectin + L-aspartic acid + gentamicin), the third — with samples No. 2 (polyvinyl alcohol + chitosan + pectin + L-aspartic acid + gentamicin + methyluracil). The first dressing change was carried out on the third day with the taking of histological material, then - every other day. When changing the dressing, such parameters as the nature and amount of wound discharge, the size of the ulcer, the presence of granulations and epithelialization were assessed. Dynamic assessment was performed on the 3rd, 7th, 14th and 21st days. The measurement of the area of the ulcer was carried out by transferring the contour of the ulcer to graph paper with manual counting.

Research results. The healing rate of ulcers in the experimental groups was higher than in the control group. When comparing second and third groups, a significant increase in speed was noted by the seventh day in third group (p < 0.05), which reduced the overall healing time of ulcers by 7 days.

Conclusion. The study showed that the healing time of ulcers in laboratory animals with the use of the developed wound dressings is significantly reduced in comparison with the control group. The proposed method of local treatment can be considered effective in the treatment of vascular etiology trophic ulcers against the background of diabetes mellitus.

Objective. To evaluate the efficacy of the use of a last generation hydrofiber dressing with silver, for the treatment of complex wounds that are difficult to heal.

Materials and research methods. A prospective observational case-follow-up study was carried out, which included patients with acute or chronic wounds that were difficult to heal, treated in the plastic surgery service of a public hospital in Bogota-Colombia, who underwent healing with hydrofiber dressings reinforced, with silver ions, benzethonium chloride and EDTA (Aquacel Agplus®, ConvaTec). The wound was monitored, evaluating infection control, exudate and biofilm, as well as the number of required dressings and the time required for the complete closure of the wound.

Research results. A total of 55 patients were included, with a median age of 44 years. In all cases, a follow-up was carried out until the definitive closure of the wound. At the end of the study, it was observed that, in 35 (63.6 %) patients, the wounds evolved to complete closure by second intention in an average of 59.3 days, requiring 12.5 dressings. 20 (36.4 %) patients had adequate wound bed preparation for definitive surgical coverage with grafts, flaps or dermal substitutes, in an average of 31.4 days, requiring 6.5 dressings on average.

33 (60.0 %) wounds were infected and adequate infection control was achieved on average with 5 dressings. A decrease in the direct and indirect signs of biofilm was achieved after 6 dressings.

Conclusion. The results show that the dressing studied is effective to control exudate, infection and biofilm, as well as to prepare the bed for a definitive surgical coverage.

The article presents the experience of treating wounded K., 29 years old, who, as a result of the suicide bombing of a homemade shell-free explosive device in a moving car of the St. Petersburg Metro 03.04.2017 received a severe mine-explosive combined wound to the head, chest and limbs with a fragmented blind skull. The trauma was accompanied by brain damage, a fracture of the cranial vault bones, lungs contusion, and fragmented fracture of the right tibia bones. The patient underwent sequential bifrontal decompressive craniotomy, external fixation of the right shin bones fractures, blocked intramedullary osteosynthesis of the latter, dura mater plasty, cranioplasty with a titanium plate after its computer modeling. The complex treatment allowed the patient to be discharged from the hospital after 4 months in a satisfactory condition.

The article presents a clinical case of a successful complex treatment anaerobic non-clostridial perineal infection in a 54-year-old patient with long-term diabetes mellitus. Particular attention is paid to the possibilities of local treatment using negative pressure wound therapy in the management of this patients category.

Extensive soft tissue defects can be complicated by systemic diseases (trophic ulcers in diabetes mellitus, chronic arterial insufficiency) or the result of trauma (domestic, military, operating, etc.). The current increase in the incidence of this pathology is due to the spread of cardiovascular diseases and diabetes mellitus. Closing an infected long-term non-healing wound, such as a tendon or bone, is one of the most difficult tasks of reconstructive surgery. For example, the use of classical methods of closing wound conditions is difficult to a degree due to the patient's polymorbid background. The clinical case presented in the article shows the possibility of closing deep shin wound with a complex relief by the transplantation of autologous adipose tissue, a patient with severe concomitant pathology.

On December 21-23, 2021 in Moscow, at Federal State Budgetary Institution "A. V. Vishnevsky National Medical Research Center of Surgery" of the Ministry of Health of Russia will host the 5th International Scientific and Practical Congress" Wounds and Wound Infections" with the conference "Problems of Anesthesia and Intensive Care of Wound Infections".