The article describes problems faced by military doctors in providing medical care to military personnel who had participated in armed conflicts in Iraq and Afghanistan. The authors also discuss results and achievements of multicenter study on consequences of infected wounds TIDOS (The Trauma Infectious Diseases Outcomes Study) of the U.S. Department of Defense (DoD) and the Department of Veterans Affairs (VA) within the program of clinical researches on infectious diseases (USU Infectious Diseases Clinical Research Program – IDCRP). Possible directions for further researches and their importance are also discussed.

Objective. To study the effectiveness and safety of negative pressure wound therapy in patients with combat limb injuries.

Material and methods. 248 patients who suffered of combat injuries of lower and/or upper extremities for 4–58 days (mean 15.8 ± 8.6 days) before admission to the hospital were enrolled in a prospective observational trial. All participants were males. Their age ranged from 19 to 59 years (mean 35.6 + 8.3 years). Most often, wounds were localized in the shin (29.3 % of cases) and feet (12.8 %). 27.3 % patients had amputated limbs and 47.4 % – external fixation devices.

Research results. The participants were under observation from 7 to 238 days (mean 60.4 ± 38.1 days). All patients who were included in the trial had the secondary surgical debridement. The average number of surgical interventions reached 5.9 ± 3.5, varying from 1 to 19 times. All patients had vacuum-assisted dressings. The average number of negative pressure wound therapy (NPWT) sessions was 4.7 ± 2.7, varying from 1 to 13 times. The length of hospital stay directly depended on the number of secondary surgical wound treatment (r = 0.63; p < 0.000001), as well as on the number of sessions of vacuum-assisted therapy (r = 0.67; p < 0.000001). Plastic surgery (with free split-thickness perforated skin grafts, local tissues, full-thickness free and non-free flaps) was performed in 119 patients (47.9 %). The median time from the first secondary surgical debridement in the hospital to the surgery was 34 days (Q₁–Q₃: 21–46 days), from VAC- system installation to plastic surgery – 34 days (Q₁–Q₃: 21–42 days). During NPWT, the decrease of wound size was registered in 61.4 %. The initial volume of wound surface was, in average, 2250.4 cm³, while at the last measurement it was 829.0 cm³ (p = 0.0002). The initial area of wound surface was 219.0 cm², while at the last measurement it was 94.0 cm² (p = 0.00002). By the computed tomography findings (performed in 9 patients), the primary volume of wound cavity was 494 952 mm³, and the final volume was 79064.8 mm³ (p = 0.007). Mature granulation tissue was seen in wounds of 48.1 % of patients, and young granulations – in 42.7 %. Wound cleansing was observed in 66.4 % of patients, marginal epithelization – in 5.4 %. At the initial wound revision, 41 patient had purulent discharge, while at the last one there was none. During the observational period, the following parameters decreased: C-reactive protein – from 43.7 ± 51.9 to 14.7 ± 20.6 mg/l (p < 0.000001; ESR – from 44.5 ± 22.0 to 23.4 ± 16.5 mm/h (p < 0.000001); leukocytes number – from 9.7 ± 3.5 × 10⁹/l to 7.9 ±6.3 × 10⁹/l (p = 0.0001); neutrophils number – from 6.8 ± 3.2 × 10⁹/l to 4.5 ± 1.6 × 10⁹/l (p < 0.000001); percentage of neutrophils – from 68.8 ± 8.0% to 58.8 ± 8.9% (p < 0.000001) and platelet count – from 514.7 ± 201.9 × 10⁹/l to 349.1 ± 114.1 × 10⁹/l (p < 0.000001).

Conclusion. The obtained findings demonstrate the effectiveness of local negative pressure wound therapy in the complex treatment of patients with combat limb injuries. Further research is needed to study NPWT effectiveness and safety in patients with high-energy injuries.

Objective: to evaluate the effectiveness of ultrasonic wound cavitation in patients with complicated forms of diabetic foot syndrome (DFS).

Material and methods. A comparative analysis of outcomes after surgical treatment with ultrasonic cavitation in 90 patients having purulentnecrotic complications of diabetic foot syndrome, aged 16–75, was carried out. The first (studied) group included 30 patients who had ultrasonic cavitation sessions at the intra- and postoperative periods; the second (comparison) group included 60 patients who had no any ultrasonic cavitation sessions during their treatment. Clinical effectiveness was assessed on day 10 by the dynamics of wound cleansing from purulent separated and tissue detritus, growth activation, granulation tissue maturation and wound epithelization, as well as by the intensity of pain syndrome according to the visual analogue scale (VAS).

Research results. Of all 90 patients, 37 (41.1 %) were women, 53 (58.9 %) were men. Predominant age was 60–74 years – 35 (38.9 ± 1.2 %); 45–59 years – 33 (36.7 ± 1.6 %); less were patients over 75 – 12 (13.3 ± 1.1 %) and up to 44 – 10 (11.1 ± 1.1 %). Among patients with DFS, neuropathic form was met most often – 56.8%; less often-neuroischemic form (31.1 %) and ischemic form (12.2 %). Localization: skin and subcutaneous fat were more often involved in the purulent-necrotic process (38.9 %); less often – surface fascia (33.4 %) and deep fascial structures (27.7 %). Surgical interventions: surgical wound debridement – 32.2 % and purulent foci incision – 26.7 %; less often finger disarticulation – 10.0 %, foot amputation – 6.7 %, necrectomy – 4.4 %.

Complete wound healing or epithelization of more than 70.0 % of the total area on day 10 since treatment beginning was observed in 70.0 % of patients in the studied group and in 21.7 % in the comparison group; wound epithelization over the area less than 70.0 % – in 23,3 % and 51.7 %, respectively; and no effect or wound healing over the area less than 10.0 % – in 6.7 % and 26.7 %, respectively. Unsatisfactory outcomes were mostly registered in patients with the ischemic form of diabetic foot syndrome and progressive ischemia. Pain intensity decreased by 6 points on day 3 ± 1.2 in patients of the studied group and on day 4 ± 1.4 – of the comparison group; normalization of leukocyte level, C-reactive protein and blood procalcitonin was on day 4 ± 1.3 and on day 5 ± 1.5, respectively.

Conclusion. Ultrasonic cavitation in the comprehensive surgical treatment of patients with complicated forms of diabetic foot syndrome is an effective and safe technique that allows to clean a purulent cavity in a short time, to control the pain syndrome and to create conditions for wound epithelization. Ultrasound cavitation applied in patients with complicated forms of diabetic foot syndrome statistically significantly contributes to complete healing or early epithelization of wound area over more than 70.0 %. Ultrasonic cavitation in patients with neuroischemic and ischemic forms of diabetic foot syndrome is recommended to be applied in the combination with critical ischemia relief

Hidradenitis suppurativa (acne inversa) is a chronic inflammatory skin disease that affects terminal hair follicles in the area of apocrine sweat glands. The disease is manifested by the formation of recurrent inflammatory nodes with purulent discharge, prone to the formation of fistulas and scars. The axillary region is one of the common affected areas.

The article presented a clinical case of radical surgical management of hidradenitis suppurativa of stage III by the Hurley classification. The described surgical treatment included extensive resection of pathologically changed soft tissues of the axillary region with simultaneous wound repair using a displaced fascio-cutaneous flap taken from the posterior surface of the shoulder.

The article is a review on the properties of modern Russian wound dressings containing long-acting enzymes immobilized on dialdehyde cellulose (oxidized cellulose). The authors present some clinical observations, as an example of their effective application.