The article summarizes theoretical ideas on purulent-septic conditions at the postoperative period. The proposed ecological model analyzes suppuration pathogenesis more widely, that is beyond only the surgical wound. Such an approach improves outcomes of antimicrobial therapy, as well as allows to develop preventive measures against surgical infections aimed to change the patient’s general resistance state.

   Objective: To find wound dressings which could incorporate solutions of bacteriophages and lactobacilli and could have potential to overcome
microorganism resistance to antibiotic therapy.

   Material and methods. Physicochemical and biological properties of 12 samples of wound coverings of different structures and properties which had been used for combustion wounds were analyzed. Wound dressings differed in their keystone structure (biopolymers of natural and artificial origin) and in biodegradability. The following properties of wound dressings were studied in vitro: absorption, biological inertness and duration of viability / lytic activity of staphylococcal bacteriophage and antagonistic activity of L. plantarum inoculum. In addition, own antibacterial activity of wound dressings against S. aureus culture was studied too.

   Research results. Among the studied wound dressings, the largest mass of liquid can be absorbed by the following wound dressings: Likosorb®, Fibrosorb®, Biatraum®, Hitokol-S®. All studied wound coverings are biologically inert towards the staphylococcal bacteriophage (they ensure the formation of zones of S. aureus lysis). Viability of L. plantarum inoculum was promoted by wound coverings OPSITE® Post-Op Visible, Fibrosorb®, Algipran®, Biatraum®. Wound coverings OPSITE® Post-Op Visible, Fibrosorb®, Likosorb® maintain the lytic activity of staphylococcal bacteriophage up to 7 days. L. plantarum viability for up to 2 days was registered in Fibrosorb® wound covering, up to 3 days – in OPSITE® Post-Op Visible. Wound coverings Chitokol-S®, Kollakhit® FA, Algipran® and Aquacel Ag® have their own antibacterial activity against S. aureus; when they were saturated with staphylococcal bacteriophage solution, their antibacterial activity increased.

   Conclusion. Wound coverings with sponge structure based on chitosan and polyurethane exhibit the greatest absorption level of inoculum solutions of L. plantarum and staphylococcal bacteriophage maintaining their viability / lytic activity.

   The present clinical observation describes a case of a patient with the combined form of hand phlegmon who received a complex three-stage therapy in the hospital for 22 days: 5 days in the department of purulent surgery where she was operated twice and received antibacterial and anti-inflammatory therapy. The next stage of wound treatment was in the day hospital for 14 days. After, the patient was re-hospitalized to the department of hand trauma where she stayed for 3 days. There, plastic closure of the wound defect was made with a posterior interosseous forearm flap. Terms of treatment depended on the wound process. We reduced the length of stay in the 24-hour hospital, but maintained our control of the patient in a day hospital. Thus, such an algorithm allowed us not only to reduce economic costs for the treatment, but also to form a significantly much comfortable psychological situation for the patient. Such an approach creates in patients an idea that their treatment is an integral and complex multi-stage process which assumes the importance of balanced assessment of long-term outcomes just at the early stages of wound treatment.

   Treatment of patients with total chronic hematogenous osteomyelitis still remains one of the important and difficult problems of purulent
surgery.

   Objective: To increase the effectiveness of surgical treatment of patients with chronic total osteomyelitis of long bones.

   Materials and methods of research. A retrospective analysis of outcomes after managing 38 patients with chronic total hematogenous osteomyelitis of long bones has been made. Patients were treated with original techniques of defect plastic surgery and physical antiseptic methods, such as CO₂-laser and low-frequency ultrasound.

   Research results. Of these, 24 patients with total osteodestructive changes underwent resection of the tibia and humerus, followed by their replacement with the fibula. In 14 patients with process location in the lower third of the tibia, grooved osteotomy was performed, followed by microsurgical plastic surgery of the defect with a fasciocutaneous flap on a vascular pedicle.

   Conclusion. The described surgical treatment of chronic osteomyelitis of long bones has high efficiency and minimal number of relapses at the early and late postoperative periods.