The article is dedicated to Professor Valentin Feliksovich Voino-Yasenetsky (1877-1961) - Russian and Soviet surgeon, scientist, and author of works on anesthesiology and purulent surgery, the holder of Habilitation degree in Medicine, the winner of the Stalin Prize of the first degree (1946). Bishop of the Russian Orthodox Church, and from April 1946 - Archbishop of Simferopol and Crimean, the spiritual writer, the Doctor of Divinity (1959).

Wound infection is one of the most frequent indications for using the method of hyperbaric oxygenation (HBO) in surgical practice. The effects of HBO are not always explainable from the point of general ideas about the "super-delivery" of oxygen. During the HBO it is modified a synthesis of a number of biologically active substances and can be noted persistent changes in various biochemical processes. Periodic increases of oxygen partial pressure (pO₂ ) in damaged tissues afford evident effect on the dynamics of the wound process. Active forms of oxygen and nitrogen play the role of signaling molecules during the start of cascades of biochemical reactions leading to the synthesis of growth factors, cytokines and other hormonally active substances which are involved in wound healing.

Objective: to evaluate the efficacy of nerve block anesthesia and prolonged post-surgery analgesia for patients who had amputation of the lower limb below the knee because of diabetic foot syndrome. Materials and methods. The amputation of the lower limb at the shin-bone was made for 30 patients with the diabetic foot syndrome (20 of them at the level of the upper third of the shin-bone, and 10 patients - the guillotine amputation at the level of the lower third of the shin-bone). The operations were performed in the presence of nerve block anesthesia of the sciatic and femoral nerves with the catheterization of the perineural spatium of the nerves for post-surgery analgesia (Ropivacaine, properly, 100 and 50 mg, 4-12 mg per hour). Monitoring included a constant ECG, noninvasive blood pressure every 5 minutes, pulse oximetry and plethysmography. The quality of analgesia was evaluated by VAS. Results. All blockings were effective, they were accompanied by a vegetative, sensory and motor block below the level of knee-joint. It was noticed stabile hemodynamics. Post-surgery analgesia was made from 1 to 7 days by bolus dosing of naropin through catheters in the same volumes as in primary blocking for 20 patients (66,7 %). The intensity of pain syndrome with bolus dosing of naropin ranged from 0 to 3 points. 10 patients (33,3 %) were inserted ropivacaine using an elastomeric pump (2 mg per ml, a dose from 4 to 12 mg per h). The intensity of the pain syndrome also ranged from 0 to 3 points. When the pain intensity was 3 points, 12 patients (40,0 %) were injected of 8 mg of lornoxicamum additionally. No patients needed narcotic analgesics. Conclusions. Prolonged blockings of the sciatic and femoral nerves with catheterization of the perineural spatium are the choice-method of anesthesia and post-surgery analgesia for patients with complicated diabetes mellitus when they have amputation below the knee joint.

Complex therapy of patients with pancreatitis can include the intravenous laser irradiation of blood and local transcutaneous combined laser therapy plus minimally invasive and endoscopic interventions. The combination of these methods helps to prevent the infection of aggressive lesion, to avoid the need for open operations, to reduce the duration of in- treatment and keep mortality rate down in comparison with the generally accepted protocols for treating the contingent of patients under examination. Due to the widespread implementation of minimally invasive and endoscopic methods and low-intensity laser radiation the mortality rate with sterile pancreatic necrosis decreased from 20,4% to 4,9%. After the addition of complex laser, antioxidant and modern antibacterial therapy to the adequate surgical sanitation in the protocol of treating of patients with infected forms of pancreatic necrosis the mortality rate decreased from 43,7% to 22,3%. This fact has great social and economic importance and demonstrates the need of complex approach.

Relevance. The fundamental role of nursing staff as a personnel pool in the health care system has been undeservedly misappreciate until recently, and it has rarely been possible to find an effective using of qualified nursing staff. However, the appearance of specialists with higher nursing education (HNE) in Russia competently changes the situation and creates new prospects in the organization of medical care. The materials and methods. In this work, there was made an assessment of the existing structure basing on an analysis of a prospective medical and social study of 340 patients with diabetic foot syndrome (DFS) by using the questionnaire method. Results. The received data indicated the unsatisfying organization system of medical care for patients with DFS and, basing on patients feedback, it helped to develop a model of delivery complex ambulatory nursing healthcare and form specialized nursing teams. Conclusions. The intensive involvement of nurses with different levels of education, including management skills, into the delivery of healthcare can provide a variety of activities to improve the patienthood with diabetes mellitus, the compensation rate of the disease and improving the quality of life.

This article presents a clinical case illustrating the complexity of developing personalized treatment strategies for patients with chronic post-traumatic osteomyelitis of long bones who need long-term multi-stage surgical treatment aimed at saving injured extremities, elimination of soft tissue and bone defects.

In the given clinical example, where the patient is a child with an extensive degloving wound of the footplate of the right (not the left) foot, it is demonstrated the possibility of the rehab of the foot's support ability by the method of microsurgical muscle grafting combining with full-thickness skin autodermoplasty. The recovery of support ability of extremity with defects in the tissues of the plantar surface is an actual problem of modern surgery. When there are small and medium-sized defects, it can be used local and regional flaps, but when the defects are extensive, it is needed to create soft tissues anew, and they must be able to withstand multiple physical stresses. In the given clinical example, where the patient is a child with an extensive degloving wound of the footplate of the left foot, it is demonstrated the possibility of the rehab of the foot's support ability by the method of microsurgical muscle grafting combining with full-thickness skin autodermoplasty.

The article presents the clinical case of a successful complex surgical treatment of a young patient (47 years old) with chronic hematogenous osteomyelitis of bones that form the ankle joint (shin and huckle bones), which was complicated by phlegmon of the lower limb, pleural empyema and sepsis. Chronic hematogenous osteomyelitis is an actual and unsolved medical problem. Late or inadequate surgical treatment of the suppurative focus and inefficiency of longtime antimicrobial therapy can lead to chronic and progressive disease with frequent process exacerbations; it can threaten the life of the patient, which this clinical observation illustrates.