Valery A. Mitish, Honored Physician of the Russian Federation, Knight of the Order of N.I. Pirogov, Head of the Department of Wounds and Wound Infections at the A.V. Vishnevsky National Medical Research Center for Surgery of the Ministry of Health of the Russian Federation, Head of the Department of Disaster Medicine at P. Lumumba Peoples' Friendship University of Russia, founder and President of the Surgical Society – Wounds and Wound Infections, creator and editor-in-chief of the scientific periodical “Wounds and wound infections. Prof. B.M. Kostyuchenko Journal”, from 2015 to 2023. Director of the Scientific Research Institute of Emergency Pediatric Surgery and Traumatology of the Moscow Medical Center. One of the world's leading surgeons specializing in providing care to the wounded and injured, performing high-tech interventions using reconstructive and plastic surgery for mine-explosive and combat injuries, extensive wounds and soft tissue and bones defects in order to save the lives of children and adults, their maximum high-functional rehabilitation.

Background. Acute hematogenous osteomyelitis (AHO) is one of the most serious bones diseases associated with surgical infection. However, many issues of diagnosis and treatment of AHO in children remain unresolved to date, which confirms the importance and relevance of the pathology under study.

Objective. To determinate of the most significant diagnostic criteria, identification of the most common localization of the process and assessment of the effectiveness of complex treatment of hematogenous osteomyelitis in children.

Materials and methods. A retrospective analysis of the treatment results of 294 patients with AHO who were treated in a tertiary hospital in the Kyrgyz Republic in the period from 2015 to 2022 was carried out. By gender, 198 (66.3 %) were boys, 96 (33.7 %) were girls, the ratio was 2:1. The largest number were children under the age of 2 months – 88 (29.9 %), from 6 to 8 years – 51 (17.3 %), from 3 to 5 years – 49 (16.7 %). Children aged 9–15 years, from 1 year to 2 years, from 2 months to 1 year were less common – 14.6; 12.9 and 8.5 %, respectively. According to the clinical course, the generalized form of AHO was found in 59 (20.1 %), and in 235 (79.9 %) – the focal form.

Research results. In children under one year old, lesions of the meta-epiphyseal zone with involvement in the inflammatory process of joints prevailed, in children over 1 year old, lesions of the metadiaphyseal zone prevailed. Of these, 74.8 % of patients were hospitalized more than 2 weeks after the onset of the disease, which explains the predominant extramedullary lesions. All patients received comprehensive treatment, including surgical intervention according to indications,systemic antibacterial and symptomatic therapy. Fatal outcome was observed in 1 (0.3 %) case in a patient with a generalized form, and in 12 (4,0 %) cases – chronization of the process.

Conclusion. In the early diagnosis of AHO in the intramedullary phase, magnetic resonance imaging plays a special role in determining areas of pathological hydration, and computed tomography plays a special role in assessing cortical bone. Dynamic control of procalcitonin and C-reactive protein levels, along with the determination of the number of leukocytes and the absolute number of neutrophils, are markers of systemic infectious and inflammatory reactions that determine the outcome of treatment in patients with AHO.

Background. The issues of timely diagnosis and treatment of acute hematogenous osteomyelitis (AHO) confirm the importance and relevance of the problem under study, and therefore it is necessary to conduct in-depth research to determine antibiotic resistance in order to improve the quality of treatment for children with AHO.

The aim of the study to study the features of the structure of pathogens of AHO in children and their sensitivity to antibacterial drugs.

Materials and methods. The results of a microbiological study were studied in 128 children aged 5 days to 15 years who were being treated in a tertiary hospital in the Kyrgyz Republic with AHO in the period from 2015 to 2022.

Results and discussion. Microflora growth was observed in 76.6 % of cases: gram-positive microorganisms were detected in 79.7 %, gram-negative microorganisms in 16.2 %, and fungal infection in 4.1 %. Among the pathogens of AHO in children, microorganisms from the ESCAPE group were detected in 74.6 % of cases, of which Staphylococcus aureus – in 63.3 %, Klebsiella pneumoniae – in 4.1 %, Pseudomonas aeruginosa – in 4.1 %, Escherichia coli – in 3.1 %, which explains the frequent development of septic complications. Determination of the sensitivity of Staphylococcus aureus showed the presence of MRSA strains in 16.1 %. The maximum sensitivity of Staphylococcus aureus was detected to amikacin (100.0 %), vancomycin (90.0 %), moxifloxacin (90.0 %), meropenem (80.0 %) and linezolid (80.0 %). Staphylococcus aureus is less sensitive to gentamicin (75.0 %), levofloxacin (74.0 %), clindamycin (70.0 %), ciprofloxacin (66.0 %), erythromycin (65.0 %). Low sensitivity of staphylococcus aureus was detected to cephalosporins (cefazolin – 40.0 %, cefotaxime – 38.0 %, ceftazidime – 41.0 %, cefepime – 41.0 %) and penicillins (oxacillin – 35.0 %, ampicillin – 30.0 %).

Background. Treatment of pressure sores is one of the intractable tasks of purulent surgery in somatically severe patients with impaired blood circulation in areas subject to prolonged pressure, friction, or tissue shear. Surgical treatment methods depend on the location of the pressure sores and the general condition. At the same time, the percentage of forced disabling operations for bedsores complicated by the infectious process remains high, which also requires further study.

Objective: to substantiate the effectiveness of surgical treatment of pressure sores of various localization.

Materials and methods. The results of surgical treatment of 105 patients with bedsores of various localization aged from 16 to 76 years were studied. Of these, 11.4 % of patients had multiple lesions. About 39.0 % of patients were case had bedsores localized in the sacral region, 25.7 % – in the sciatic region, 14.3 % – in the area of the large trochanter, 3.8 % – in the area of the iliac crest, 2.9 % – in the scapular region, 1.9 % – in heel area, 1.0 % – in the occipital region.

Depending on the phase of the wound healing process, all patients were divided into 2 groups. The first group included 45 (42.9 %) patients with bedsores in the inflamation phase. All of them underwent radical and stage-by-stage surgical debridement of wounds with excision of necrotic tissues, adequate drainage during treatment. After cleansing the wound and the appearance of granulation tissues, 32 (71.1 %) patients were admitted to the second stage of defect closure surgery, the remaining 13 (28.9 %) patients had bedsores closed by secondary tention.

The second group included 60 (57.1 %) patients with bedsores in the second phase of the wound healing process and 32 (30.5 %) patients after the first stage of surgery.

Research results. During treatment, 18 (19.6%) patients underwent surgical treatment and rehabilitation of the wound, followed by secondary sutures or autodermoplasty with a full-layer skin grafts, and 7 patients underwent sciatic bone resection, after which complete healing of bedsores was noted. At the same time, 67 (72.8 %) patients underwent plastic surgery of bedsores with displaced rotational skin-fat flaps, skin-fascial and skin-fascial-muscular rotational flaps on the vascular pedicle.

Conclusion. Surgical treatment of patients with bedsores of various localization, taking into account the phase of the wound healing process, is the most effective and safe method.

Plastic surgery of bedsores of various localization in the II phase of the wound healing process with displaced rotational skin-fat flaps, skin-fascial and skin-fascial-muscular on the vascular pedicle in combination with active wound drainage are the most effective methods.

Diabetic foot syndrome with critical lower limb ischemia is a serious complication of diabetes mellitus and remains the leading cause of non-traumatic amputations. This article presents a clinical case of successful treatment of a patient with neuroischemic diabetic foot syndrome and multifocal atherosclerosis as an example of collaboration between a specialist in wound treatment and physicians at a vascular center.

It has been shown that only a multidisciplinary approach in the treatment of this pathology ensures the preservation of a supportive foot and reduces the risk of death from cardiac causes. Rehabilitation and follow-up of patients in the postoperative period in the diabetic foot's office helps to quickly heal wounds and reduce the risk of disease recurrence.