Greeting from L.M. Roshal.

From edition.

2nd International Congress “Diabetes Mellitus and Surgical Infections” with cross-disciplinary conference “Innovational Technologies in Diagnosis and Treatment of Diabetic Foot Syndrome”.

Today, biopolymers and biomaterials are a broad and growing sphere of interest to both specialists from various fields of science and to society as a whole. The paper discusses the issues concerning the terminological interpretation of concepts, such as polymers, biodegradability, gels and hydrogels, hydrocolloids, films, sponges, and polymer matrices. It gives the results of the authors’ investigations of bandages as films and porous sponges containing the silver levels as given in the instruction (11 prototypes from different Russian and foreign manufacturers). Electron scanning microscopy revealed a varying content of the ground substance in the prototypes within the range from 0 (even no traces of silver were found) to 7.29 %. Thus, the effect of the test samples of bandages may not be always related to the active component that is positioned the ground components, and the therapeutic effect is achieved, for example, by the polymer base of this dressing agent. The main directions in further investigations of polymers for medical purposes are to elaborate technological approaches to producing biopolymers for the reduction of their cost and to make biomaterials with tailor-made properties. 

Objective: to clarify surgeons’ preferences for local drugs and additional treatments for wounds and wound infection.

Materials and methods. An anonymous survey was conducted in 232 surgical infection specialists.

Results. An analysis of questionnaires revealed surgeons’ preferences for the classification of wound process stages, for the choice of antiseptic solutions, and for that of agents for the local treatment of wound in each of its phases and for additional instrumental and drug therapies. The surgeons reported 46 different drugs for the treatment of wounds and wound infection. A significant percentage of the respondents practised chlorhexidine, dioxidine, iodine, Levomecol, Solcoseryl, and Actovegin ointments, wound physiotherapy, and vascular medications.

Conclusion. The survey has revealed a relative shortage of knowledge about current antiseptics and local combined drugs, the high level of prescription of ineffective local antimicrobial agents, the use of a number of drugs in the wound process phase when they exert no optimal effect, as well as the high frequency of prescribing instrumental and drug treatments for wounds. An attempt has been made to analyze the surgeons’ choice and to define ways to improve the treatment of wounds and wound infection. 

Introduction. The current concept of the metabolic and nutritional support of patients with peritonitis considers the early enteral administration of corrective solutions, special pharmaconutrients, and feeding formulas as a component of the pathogenetic treatment that contributes to recovery of the intestinal morphofunctional status, to resolution of intestinal failure (IF), to correction of metabolic disturbances, and to adequate provision of the body’s energy-plastic needs.

Objective: to improve treatment results in patients with peritonitis due to early enteral feeding of special formulas in order to resolve IF and to correction of nutritional and metabolic disorders.

Subjects and methods. A unicenter randomized study was conducted in 54 patients with generalized purulent peritonitis. In Group 1 (a comparison group; n = 25), enteral therapy for IF encompassed intestinal lavage, enterosorption, stepwise intraintestinal administration of glucose saline solution (3–4 days) and then the standard formula Nutrient Standard (1.0 kcal/ml) (5–6 days). In Group 2 (a study group; n = 29), the multi-elemental (oligopeptide) formula Nutrient Elemental was used in the first step and switched to the metabolic formula Nutrient Hepa in the second step, and then to the standard balanced nutrition formula Nutrient Standard. Hemodynamic parameters, oxygen budget, volemia, metabolism, immune system, gastrointestinal function, levels of enzymes, and hormonal status were studied.

Results. In Group 2 patients, the processes of absorption of glucose saline ingredients started to recover on days 2–3 and those of digestion of the semi-elemental formula Nutrient Elemental did on days 3–4. The early enteral feeding of the semi-elemental formula in combination with a formula with a high content of branched amino acids and the lowest level of aromatic amino acids, and the presence of serum proteins facilitated the resolution of IF within a shorter time period than in Group 1 patients and could also adequately meet the body’s energy and plastic needs.

Conclusion. Active small bowel decompression, intestinal lavage, enterosorption in combination with artificial therapeutic feeding that has been properly selected and performed in accordance with the given technology with the obligatory and early inclusion of a semi-elemental nutrition formula are shown to be powerful therapeutic factors that contribute to the resolution of IF and thus to the improvement of the results of peritonitis treatment. 

Surgery for the upper digestive tract is justly a high-risk one and is absolutely associated with the development of severe, life-threatening complications, particularly incompetent digestive anastomoses, which in turn lead to pyoseptic complications. After extensive surgical interventions into the esophagus and stomach, the mortality rates from anastomotic incompetence are as high as 60%. There is a steady decline in the number of complications due to the accumulation of experience and improvement of surgical techniques. Endoscopic techniques for the closure of perforation are priority since they result in lower mortality rates.

The paper describes the experience in treating 6 patients (after laparoscopic proximal gastric resection (n = 4), gastrectomy (n = 1), and longitudinal gastric resection (n = 1)), by using a vacuum aspiration system, in the period from March to December 2015. It shows a procedure for installing the vacuum aspiration system and its mechanism of action, gives the obtained results of this procedure, and analyzes the experience of world literature. 

Introduction. The paper describes the experience with acellular dermal matrices (ADM) used in patients with trophic ulcers (TU) and their comparative analysis with traditional autodermoplasty (ADP) on granulation.

Subjects and methods. The early (10–14-day) and late (over a year) results were analyzed in 8 TU patients aged 25–55 years who used ADM – Integra Dermal Regeneration Template (IDRT) (INTEGRA Life Sciences Corporation, USA). All the patients with TU met the following criteria: an area of 25 to 150 cm2; a proliferative phase of the wound process; a defect duration of more than 12 months (during medical treatment). The patients were divided into 2 groups: 1) 5 female patients used IDRT (a two-layer variant); 2) 3 patients (2 women and 1 man) had IDRTSL (a one-layer variant). A comparison group consisted of 5 patients (3 women and 2 men) who underwent ADP on granulation without ADM. The patients were assessed by age, sex, TU site, extent, and etiology, disease duration, previous treatment, and the presence of comorbidities.

Results. On days 10–14, the mean autodermal graft retention rate in Groups 1 and 2 was 72.0 and 66.7 %, respectively, whereas that in the comparison group was 75 %. The shortest length of hospital stay was observed in the comparison group. However, within a year, 4 (80 %) of the 5 patients in this group were unsatisfied with the results of treatment, which was associated with recurrent TU or the development of hypertrophic ulcer. No recurrences were noted in the study groups (Groups 1 and 2). All the 8 (100 %) patients confirmed that the proposed treatment option met their expectations and reported their better quality of life.

The paper considers examples of malignant tumor growth in the foci of chronic inflammation in patients with chronic osteomyelitis. It analyzes case histories and clinical features in malignization. Pathological examination of biopsy specimens from osteomyelitic ulcers and fistulas is shown to be of importance. 

Successful treatment of the lower limbs purulent necrotic injury regardless etiopathogenesis feasible by a multidisciplinary approach in a specialized or general hospital. This case demonstrates the successful implementation of a multidisciplinary approach in a general hospital using modern methods to the treatment of the lower limbs purulent necrotic injures in cases of the background phlegmasia cerulea dolens as the paraneoplastic syndrome. 

3rd International Congress “Wounds and wound infections” with the course “Anesthesia and intensive care in wound infections”.

Announcement of science events of the Regional Public Organization “Surgical Wounds and Wound Infections Society” in 2016–2017.