Objective: to study the specific features of the structural elements of the hard palate and skin in the healing of incised and sutured wounds at the stage of hemostasis and inflammation in pigs.

Materials and methods. Nine piglets weighing 35–40 kg were taken for an experiment. 2.5–3.0-cm rectilinear incisions (surgical wound models) were made in the back skin and hard palate. Three skin biopsy specimens and 3 hard palate mucosal biopsy specimens were taken for morphological examinations in each experimental series (control, 6 hours and 3 and 7 days postsurgery). The electron microscopic material was fixed by an in situ immersion method and then processed by the conventional procedure. Semi- and ultrafine sections were examined under a Latimet light microscope (Leica) and a JEM-1400 electron microscope (JEOL), respectively, at an accelerating voltage of 80–120 kW.

Results. A rapid decrement of inflammatory processes in the incised and sutured wounds in the early stages of healing results in delayed cleansing of damaged structures and fibrinoids from the wound surface compared to those in the heard palate mucosa. So formation of mature skin granulation tissue begins on day 7 rather on day 3.

Conclusion. The differences in the phases of hemostasis and inflammation affect the further phases of reparative regeneration (proliferation and scar formation), which may lead to a difference in the development of postoperative wound scar tissue. 

Background. Postoperative sternal and mediastinal complications are relatively rare and constitute about 0.3–6.9 %. However, taking into account a larger number of heart surgeries, the incidence of sternal osteomyelitis and mediastinitis is inevitably on the rise. It is the practice to identify 2 types of complications in relation to the depth of tissue damage: superficial sternal wound infection (suture sinuses, subcutaneous abscesses, sternal osteomyelitis with the formation of sequestra) and deep sternal infection with the development of mediastinitis. The treatment of patients with post-sternotomy complications is long-term and expensive.

Materials and methods. The results of treatment were studied in 95 patients with post-sternotomy infectious complications, including 46 (48.4 %) patients with superficial sternal infection and 49 (51.6 %) patients with deep sternal infection and development of mediastinitis. The role of vacuum therapy in treating infectious complications after sternotomy was assessed. The causes of poor treatment outcomes were analyzed.

Results and discussion. Step 1 is aimed at abolishing an infectious process and involves necrectomy, lancing a phlegmon, removal of metallic ligatures, excision of sinus tracts, resection of the osteomyelitically changed sternum and ribs. At this step, current technologies were used to treat purulent wounds, by regularly carrying out bacteriological tests. Vacuum therapy was performed in 41 (43.2 %) patients to abolish a purulent sternal process in guidance. The mean time to plasty was 12–28 days. All the patients received etiotropic antibacterial therapy. The optimal variant of Step 2 was omentoplasty and the use of a strand of the greater omentum in combination with mesh prosthesis. The necessary conditions for achieving a successful result in patients with deep sternal infection are to observe the continuity of treatment and to timely propose indicators by the second step, which is achieved by the treatment of patients at a specialized health care institution where a whole package of therapeutic measures can be implemented.

Conclusion. Attention should be concentrated on the treatment of patients with post-sternotomy infectious complications at a specialized department that deals with this problem and that can provide a comprehensive approach using up-to-date technologies both to manage purulent wounds and to accomplish the reconstructive and plastic stage. Vacuum therapy is the best way to prepare purulent sternal and mediastinal wounds for plastic surgery. The use of the greater omentum is not only a good procedure to treat anterior mediastinitis, but also a method to reinforce relatively satisfactorily the anterior chest wall. 

The authors present a review of published data on the problem of wound complications after abdominoperineal resection, and the data of their own randomized controlled study on 24 patients. In a group using local negative pressure method, the duration of antibiotic therapy was 5.0 ± 0.9 days, length of stay of 14.1 ± 2.8 days, infectious wound complications was not; in the comparison group, the duration of antibiotic treatment was 12.9 ± 1.6 days, length of stay of 28.4 ± 2.3 days and in 2 (16.7 %) cases wound complications were noted. 

of moist wounds in the treatment of patients with venous trophic ulcers.

Materials and methods. The results of treatment were analyzed in 67 patients aged 28 to 92 years (mean age 65.2 ± 7.2 years) who had 132 ulcers that had occurred in lower limb lymphatic and venous insufficiency.

Results. When salve dressings only were applied at all treatment stages, the healing rates for superficial ulcers were 0.78 cm² monthly and that for deep ones was 0.72 cm² monthly. When hydrocolloid dressings only were used in the granulations and epithelization phases, this indication was substantially higher (2.19 and 1.63 cm² monthly, respectively). When a native collagen membrane was implanted with simultaneous wound closure with hydrocolloid dressings, the mean healing rate for superficial ulcers was as large as 6.27 cm² monthly and that for deep ones was 1.79 cm² monthly, i.e. 2.5 times greater than that during traditional treatment. Overall, 2-week-to-8-month (mean, 2.4 months) treatment for trophic ulcers, by adhering to the principle of moist wound management, resulted in complete healing of 128 (97 %) of the 132 ulcers.

Conclusion. The application of the current dressings ensuring the management of moist wounds substantially accelerates wound defects resistant to traditional treatments. 

The specific features of problem wounds are long-term healing, resistance to traditional treatment, and limited efficacy of used medications. The efficacy of Acerbin® solution is due to the clinical effect of its each component on the individual components of a wound process (activated necrolysis, reduced wound exudation, stimulated development of granulation tissue and epitheliazation).

Objective: to clinically test Acerbin® spray and to determine its medical efficacy.

 Materials and methods. Acerbin® was clinically tested in 39 patients with problem wounds at different sites: excessive pressure ulcers of the sacrum, greater trochanter, and ischial tuberosity in the presence of spinal injury (n = 12 (30.8 %)), sluggish granulating purulent wounds after phlegmon lancing or amputations in the presence of a diabetic foot (n = 6 (15.4 %)), neuropathic diabetic ulcers of the foot and leg (n = 7 (17.9 %)), venous trophic ulcers (n = 10 (25.6 %)), extensive skin and fascial defects after necrotizing fasciitis of the hip and abdominal wall in the presence of diabetes mellitus (n = 4 (10.3 %)).

Results. Acerbin® was shown to exert a positive effect on a wound process in treating problem wounds: necrolysis acceleration and wound cleansing from pyonecrotic tissues up to 5.2 ± 0.6 days versus 16.7 ± 0.9 days in the comparison group (p < 0.05); emergence of active granulations after 6.3 ± 0.4 days versus 17.2 ± 1.1 days in the comparison group (p < 0.05); wounds healed by secondary intention in the majority of patients (n = 23 (58.9 %)); conditions were created for wound plastic closure in 12 (30.7 %) cases.

Conclusion. The investigation has verified the high efficacy of Acerbin® and the possibility of its wide application to wounds as a whole and expansion of indications for the therapy for problem wounds.

The paper describes a clinical case of visceral actinomycosis in a 19-year-old female patient. The complexity of preoperative and intraoperative diagnosis is the similarity of this form of actinomycosis and the neoplastic process and abscess of the abdominal cavity and small pelvis. The disease ran involving the abdominal wall, bladder, right fallopian tube, and parametrium. The diagnosis was based on the histological findings of specimens obtained during the first surgery. On day 18 after the first surgery, there was a need for relaparotomy. Postoperatively, the patient received combination therapy, long-term antibiotic therapy, and immunomodulators (actinolysate). The performed treatment provided a positive effect. 

The paper describes the experience of successful treatment for the patient with severe sacrococcygeal spine (bedsore) and diabetes. A comprehensive treatment of the patient including medical therapy, staged reconstructive plastic closure of the defect, rehabilitation. Thanks to the comprehensive treatment managed to achieve a positive treatment outcome.