Greeting from L.M. Roshal

The article is dedicated to RAMS Academician M. I. Kuzin (1916–2009) and to his work as the head of the A. V. Vishnevsky Institute of Surgery of the AMS of the USSR (1976–1988). It is shown that M. I. Kuzin, becoming the head of the main surgical Research Institute of the country, not only developed many surgery areas, which were initiated by his predecessor – the academician of the AMS of the USSR – A. A. Vishnevsky and some exponents of his school (particularly, these are cardiac, thoracic and abdominal surgery), he extended some of areas (for example, peptic ulcer surgery, vast burns and wounds surgery), but also he laid the basis for new areas (liver surgery, endoscopic surgery, and so on). In general, 12-year-activity of M. I. Kuzin as the head of the A. V. Vishnevsky Institute of Surgery of the AMS of the USSR (and then he delegated his directorship to the academician of the AMS of the USSR V. D. Fedorov) was very profitable for progressive advance of collective, and this helped the Institute to become the “Collective of high culture” in 1979 and “The Exemplary Institution of Moscow” in 1981.

The article gives a general review of the recent literature on the problem of early diagnosis and effective treatment of sepsis caused by surgical infection. It is overviewed the role and importance of early detection of biological markers of systemic inflammation response syndrome and sepsis (C-reactive protein, interleukin-6, procalcitonin, presepsin, neutrophil CD64), the dynamics of their changes in the process of treatment, their sensitivity and specificity.

Objective: to study the dynamics of changes in the structure of osteomyelitis agents of the long bones and their sensitivity to germicide depending on the surgical treatment strategy.

Materials and methods. There were studied 1083 patterns of clinical material from 384 patients with different forms of the osteomyelitis of the long bones that were treated in a period from 2013 to 2015 in the Department of Wound and Wound Infections of A.V. Vishnevsky Institute of Surgery. The comparison group consisted of microbiological studies results of 115 similar patients who were on treatment for osteomyelitis in the same Department in 2010.

Results. The main osteomyelitis agents of the long bones both in the main and in the comparison group are representatives of the gram-positive coccal flora – S. aureus, S. epidermidis and in a less degree E. faecalis. Among gram-negative bacterium P. aeruginosa keeps the leading position. However, in the main group of patients it is noticed a significant reduction of leading pathogens resistance, and a detection of hospital re- and superinfection flora breakdown. Clinically, it is expressed by the fact that there were developed a surgical strategy of osteomyelitis of the long bones treatment of different etiology and localization in the Department of Wound and Wound Infections, which allow improving the results of treatment for such patients by reducing their length of stay in hospital and the possibility to avoid the infection of wounds by hospital strains of microorganisms.

Objective: to analyze the treatment results of green wounds among childhood inpatients and to determine the best treatment and prevention method of possible complications in order to improve the responses to treatment.

Materials and methods. There were analyzed the results of treatments of 653 children with green wounds aged 1 to 17, which were treated in the period from 2012 to 2016 in the Surgery and Traumatology departments of City Hospital No 9 (Sochi).

Results. Surgical treatable was performed in an expedited manner on presentation to hospital in the following sequence: a) initial surgical d-bridement; b) if there were fractures – apposition and fusion of bone fragments; c) suture of great vessels, nerves and tendons; d) layer-bylayer adesmosis with using reconstructive surgery elements. During the initial surgical d-bridement they also used modern methods of treatment: vacuum treatment of the wound with detersion by antiseptic solution for 42 (6.4 %) patients; supersonic cavitation for 18 (2.6 %), active and passive drainage and antibiotic therapy based on the microorganisms’ vulnerability for 154 (23.6 %), and other methods. Different types of reconstructive and plastic surgery were applied. In making an assessment of treatment results the wound healing by first intention was achieved for 588 (90.0 %) patients in a period from 1 month to 1 year. There were noted: suppuration – for 25 (3.8 %) patients, suture line disruption – for 11 (1.7 %), local necrosis of wound edges – for 17 (2.6 %), acrocontracture – for 7 (1.1 %), the formation of cicatricial keloid – for 5 (0.8 %).

Conclusions. Early initial surgical d-bridement for children and complex of surgical modern methods of wounds treatment are the most important ways to prevent and reduce the level of infection in the wound. Using of external fixation devices for children with vast wounds provides the  most favorable conditions for the wounds healing and allows using different types of skin grafting. During the initial d-bridement for children it is needed to keep rational conservatism, to use atraumatic surgical techniques and minimally invasive methods, to take care about tissues, and it is also necessary to consider great opportunities of reparative processes of child’s organism in comparison with adults and perspective of further growth of the child.

Objective: to present a comparative analysis of wound healing process and to evaluate the clinical effectiveness of using a local flap and a full-thickness skin graft in reconstructive surgery of head and neck skin tumors.

Materials and methods. There were analyzed the results of 524 patients’ treatments in the Yaroslavl Regional Clinical Oncological Hospital over the period from 2000 to 2013. For 478 patients skin tumors excisions were performed by the reconstruction with a local flap, and for 46 patients – with a full-thickness skin graft. While making an assessment of wound healing it was considered the dynamics of clinical symptomatology, clinical laboratory measurements, the results of local thermometry, of bacteriological and morphological studies, as well as the results of wound-tensiometry studies. As a comparison of averages, they used Student’s t-test, Mann–Whitney test, χ2 test and Fisher’s exact test with statistically significant results at p < 0,05.

Results. Comprehensive assessment of wound healing after skin tumors excisions of the head and neck with the elimination of the formed defect by using a local flap or a full-thickness skin graft showed that there was a vibrant local inflammatory reaction in both groups of patients up to 5–7 days after the operation. It was determined not only clinically, but also by objective criteria which characterized the wound healing process. Moreover, the hallmark of plastic reconstruction by skin graft was moderate intensity of local inflammation with the background of perceivable trophic abnormalities. Ultimately, the defined characteristics of wound healing process were as-sociated with a high incidence of complicated wound healing, up to 52.2 % using the skin graft and 33.1 % – the local flap. There were prevailed graft trophism problems in the complications structure in the form of partial or complete necrosis, which were particularly characterized for wound closing by free graft. From oncology position indicated wound risks were accompanied sufficiently high 5-year survival rate (81.8 and 93.9 %, respectively). Generally, choosing reconstructive surgery tactics to close the skin defect of the head and neck and considering a smaller percentage of complications it is preferred to use a local flap, in comparison with a free skin graft.

Objective: to study the impact of the concentration of cytokine HIF-1α in the donor area on the processes of reparative regeneration in free autodermografting by split-thickness skin graft for patients with disorders of the microvasculature and to improve results of autodermografting by local stimulation of HIF-1α to prepare skin graft to hypoxia conditions.

Materials and methods. The hypothesis of the influence of the local circulatory hypoxia on the concentration of HIF-1α was checked in the experiment with 18 white outbred male rats weighing 250–300 g. The microcirculation level was controlled by laser doppler flowmetry method. The indications to appraise the correctness of the hypothesis were analytical data of Enzyme Multiplied Immunoassay. This method of treatment was used in the clinic, where 18 patients with diabetic foot infections syndrome needed dermatoplastic surgery, and compared with the results of treatment of 22 patients with free autodermografting performed by traditional way.

Results. It is identified the significant difference in concentration of cytokine HIF-1α in the donor skin area in preparation it for hypoxia conditions by proposed method. The experimental data are confirmed in the clinic. After the free autodermografting based on developed technique in the main group the viability of grafter was preserved on Me (Q1; Q3) 84 (78; 93) % of its area. In the control group graft acceptance is registered on Me (Q1; Q3) 72 (65; 79) % of grafter area (p = 0.012).

Pleural empyema orpyothorax is an accumulation of infected fluid or purulencein the pleural cavity. Etiological factors of thedisease genesis are pneumonia, tuberculosis, trauma consequences and intraabdominalprocesses. The most common cause of this disease is pneumonia complicated by parapneumonic effusion. Pleural empyema has 3 stages of development, which gave the basis for classification of this pathology. The first phase is exudative pleuritis associated withaccumulation of purulent exudate in the pleural cavity. For the treatment of this phase it is usually enough to realize antimicrobial therapyand drainage of the pleural cavity. The next phase of the process is fibrinous-purulent, which characterized by the encystation of fluid in the pleural cavity with the formation of multiple cavities due to the accumulation of fibrinous inclusions.At this stage of empyema development optimal treatment is to use video-assisted thoracoscopy of the pleural cavity, which allows fixing the drainage tubes under the visual control. Finally, the last phase is fibrous, which characterized by the formation of the fibrous capsule at the visceral and parietal pleuras. At this stage it is necessary to use a thoracotomy with making decortications and pleurectomy. In May 2015 there was performed pleurectomy without opening the cavity for 1 patient with parapneumonic pleural empyema in the Department of Thoracic Surgery of Voronezh Regional Clinical Hospital No 1.

Recommendations for endocrinologists, surgeons, traumatologists, orthopedists, podiatrists, developed by the International Working Group on the Diabetic Foot (IWGDF) and set out in “Manual and documents of IWGDF 2015 for prevention and treatment of diabetic foot diseases: the achievement of argumentative consensus”.

On May 15–16, 2017 RPO "Surgical Society – Wounds and Wound Infections", A.V. Vishnevsky Institute of Surgery of Ministry of Health of Russia, Research Institute of Emergency Children Surgery and Traumatology of Moscow Healthcare Department, Moscow Healthcare Department, LLC “Russian Society of Surgeons”, International Foundation for Children in Catastrophes and Wars are planning the International scientif c practical conference “Skin and Soft Tissue Surgical Infections of Children and Adults” devoted to the 140th anniversary of Prof. V.F. Voyno-Yasenetsky birth.

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