The article presents a review on the problem of diagnosis and treatment of atypical wounds. The authors highlight the importance of surgical vigilance in the absence of response to standard treatment for 4 weeks or more, the importance of tissue biopsy and multidisciplinary approach, if an atypical etiology and pathogenesis of long-term non-healing wounds are suspected.

The review presents information on various methods of surgical treatment of hidradenitis suppurativa depending on its stage, severity, inflammatory process extension, and disease duration. The author describes specific features of lesion opening, drainage, curettage, excision, deroofing as well as of CO2 and laser therapy, cryosurgery, physiotherapy, and electrosurgery. Particular attention is paid to the most effective surgical technique, namely: radical excision of inflammatory foci of hidradenitis. The emphasis is made at the management of comorbidities, at the adequate and thorough preoperative preparation using modern medications.

In the structure of acute surgical pathology, complicated infections of the skin and soft tissues retain their leading positions, accounting for up to 30–40% of all initial visits to the surgeon.

Objective: To evaluate the effectiveness (time of transition of wound healing process into reparative phase) and safety of polyethylene glycolbased ointment containing chloramphenicol (Levomekol®) in patients over 18 years of age with complicated infections of the skin and soft tissues.

Material and methods. The article presents outcomes of managing 30 patients with complicated infections of the skin and soft tissues, having various etiology and location. It was a non-interventional prospective clinical trial conducted at the department of wounds and wound infections of A.V. Vishnevsky National Medical Research Center of Surgery subordinate to the Ministry of Health of Russia (2023), as a part of joint research with Russian Peoples' Friendship University, subordinate to the Ministry of Education and Science of Russia. The trial was ordered by the pharmaceutical company Nizhpharm JSC (subject code: No. 032103-3-000).

Research results. By the study design, patients with diagnosed complicated infections of the skin and soft tissues of various etiology and location when purulent foci required surgical intervention were enrolled in the trial. Topical treatment at the postoperative period included daily wound dressings with polyethylene glycol-based ointment containing chloramphenicol (Levomekol®). By day 10 ± 1 of observation, edema and hyperemia disappeared in 25 (83.30 %) patients. Purulent discharge was absent in 27 (90.00 %) patients on day 3rd after surgery; and on day 7, no purulent discharge was registered in all 30 (100.00 %) patients. Granulation tissue formation was noted already on day 3 at the postoperative period, and by day 10 only 4 (13.33 %) patients had no granulation in their wounds. Microbial wound contamination also had a positive dynamics. By day 3 after surgical treatment of the purulent focus, in more than 90.00 % of patients there were no growth of pathogenic flora (except S. aureus). 20 (66.67 %) patients had no any S. aureus growth (i. e. culture test results were marked as “no growth”). By day 5, only 6 (20.00 %) patients had S. aureus growth equal to more than 105 CFU/g of tissue. In the rest of patients, there was either no growth or there was quantitative microbial contamination below 105 CFU/g tissue. By day 7–10 after surgical treatment, a marked quantitative growth was observed only in 4 (13.33 %) patients.

By day 10 ± 1 inflammatory, inflammatory-regenerative and regenerative types of cytograms prevailed, while purulent-inflammatory and destructive-inflammatory processes were seen only in wounds of 3 (10.0 %) patients. The identified dynamics, manifested by the objective criteria, indicated that the wound process had transformed into the regeneration phase.

Initially, 22 patients had no pain (73.3 %, VAS 0). In other 8 patients, pain was from 3 to 8 points. By day 7 in 4 (50.0 %) patients pain decreased by 50.0 %. No adverse events requiring discontinuation or changes of the topical treatment were registered.

Conclusion. A technique of active surgical treatment of wounds and purulent-necrotic lesions, developed at A.V. Vishnevsky National Medical Research Center of Surgery of the Ministry of Health of Russia (former Institute of Surgery named after. A. V. Vishnevsky), promotes eradication of purulent process and its transition into the regeneration stage. It also creates conditions for plastic surgery aimed to accelerate wound healing with primary intention even under surgical infection. An important component of the technique of active wound surgical treatment is topical therapy which is currently rapidly developing, especially being added with negative pressure, ultrasonic cavitation, laser technologies and others. At the same time, the classical bandaging in patients with purulent wounds has not lost its relevance. It is worth underlining that ointments based on polyethylene glycol, in particular, time-tested ointment Levomekol®, retain their high activity and effectiveness both for relieving infections and in preparing wounds for subsequent plastic surgery. With its continued effectiveness, the ointment still has a high safety profile due to which we keep on recommending it for treating complicated infections of the skin and soft tissues.

In the structure of acute surgical pathology, complicated infections of the skin and soft tissues retain their leading positions, accounting for up to 30–40% of all initial visits to the surgeon.

Management of deep pressure ulcers remains an actual problem in modern purulent surgery because there is neither decrease in the number of patients nor in the relapse percentage.

Objective: optimization of the treatment protocol for pressure ulcer management in patients with chronic critical state of cerebral origin.

Material and methods. 63 patients, aged 21–74, in chronic critical state and with decubital ulcers of varying depth and location were treated using high-frequency electrical stimulation. Lesion depth was equal to degree II–III by the classification of Agency for Health Care Policy and Research (1992). The stimulation technique and its technological support are described in details. Objective control included bacteriological and morphological tests and Bates-Jensen scale.

Research results. The data obtained from the studied group of patients (demographic and clinical parameters) were compared to the similar data of 34 patients from the comparison group who had standard therapy. High-frequency electrical stimulation promoted qualitative acceleration of reparative processes in chronic wounds, thus reducing the overall time of treatment and rehabilitation.

Conclusion. High-frequency electrical stimulation can be recommended as an additional physical action at chronic wound processes in patients in chronic critical condition.

Despite of the development of modern diagnostic and treatment technologies, lower limb amputation is performed every 30 seconds in patients with diabetic foot syndrome in the world. Elimination of infection and revascularization of the affected limb are still actual goals inpreserving the foot in diabetic foot syndrome. Studying specific features of the wound process, disease course as well as analyzing the effectiveness of modern diagnostic tools and surgical treatment contribute to the development and implementation of new measures to improve the quality of medical care in patients with complicated forms of diabetic foot syndrome.

Objective. To study specific features of the course of complicated forms of diabetic foot syndrome, to evaluate the effectiveness of diagnostic methods and surgical techniques in such patients.

Material and methods. The researchers have made a comparative analysis of the disease course, quality of its diagnostics and surgical treatment in 420 patients with complicated forms of diabetic foot syndrome, aged 16–85, who were treated at a second-level surgical hospital of the Kyrgyz Republic in January 2015 – December 2022. Study design is descriptive and retrospective. Operated patients with diabetic foot syndrome complicated by purulent-necrotic lesions were enrolled in the study.

Research results. Of all 420 patients, 57.6% were men and 42.4 % were women, in ratio 1.4 : 1.0. By the age parameter, elderly (n = 167, 42.4 %) and middle-aged (n = 155, 36.9 %) patients were more common; old (n = 45, 10.7 %) and young (n = 42, 10.0 %) were less common. The average length of hospital stay was 12.4 ± 1.6 days.

Patients with neuroischemic (n = 211, 50.2 %) and neuropathic (n = 157, 37.4%) forms predominated; less often were patients with ischemic forms (n = 52, 12.4 %). By the Wagner classification, patients with bone lesions (stage 3, 32.1 %) and skin lesions or ulcerations (stage 1, 28.1 %) were met most often too. Involvement of soft tissues till tendon or bone was relatively rare (stage 2, 10.2 %), while finger (stage 4) and feet (stage 5) gangrene was registered in 21.2 % and 8.3 % of cases, respectively.

Of surgical interventions, disarticulation of finger(s) (n = 127, 30.25 %) and surgical debridement of wounds and necrectomy (n = 123, 29.3 %) were made most often; less frequently: incision of purulent foci, necrectomy (n = 87, 20.7 %) and foot amputation (n = 23, 5.5 %). Among high amputations, transfemoral ones were 14 folds more common (13.3 %) than transtibial ones (1.0 %).

Good outcomes were registered in 173 (41.2 %) patients discharged with complete wound healing or with 70% wound healing, with eradicated pain and eliminated general/local inflammation processes as well as with normalized laboratory parameters. Satisfactory outcomes were in 163 (38.8 %) patients, in whom at discharge, there was incomplete wound healing (less than 70 %) despite normalized clinical and laboratory parameters and decreased pain. In 84 (20.0 %) patients, outcomes were evaluated as unsatisfactory; they had no local signs of wound cleansing or healing, but had progressing tissue ischemia, pain, clinical and laboratory indicators of inflammation. Postoperative mortality was 3.3 %.

Conclusion. High proportion of unsatisfactory outcomes (20.0 %) and high amputations (14.3 %) with predominance of transfemoral (13.3 %) over transtibial (1.0 %) types, mainly in patients with ischemic and neuroischemic forms, may be explained by the insufficient amount of medical equipment necessary for extremities revascularization. Such a situation requires better management of medical care in Kyrgyzstan for patients with diabetic foot syndrome so as to improve their quality of life.