The article analyzes the surgical treatment of 78 patients with deep neck total necrotic phlegmon. It was revealed that in 95 % of cases in the early period are complicated by descending mediastinitis. The pre-examination stage included: X-ray of the neck by Zemtsov and chest X-ray, ultrasound examination of pleural cavities, thoracic and mediastinal MSCT The surgical stage included opening and draining of the abscess, revision of the deep cellular spaces of the neck and upper mediastinum. In 65 (83.3 %) case thoracomediastinoscopy and decompressive mediastinotomy were performed. In 58 patients, "programmed" bilateral thoracoscopic sanations were performed, with drainage of the mediastinum. Anaerobic microflora made 84.6 % of the infection. The total necrotic phlegmon of the deep cell spaces of the neck in 95 % is complicated by descending necrotizing mediastinitis. Local signs of inflammation, with necrotic phlegmons of the neck, do not allow to determine involvement in the inflammatory-destructive process of mediastinum. The absence of early findings from radiological exam does not exclude the presence of descending necrotizing mediastinitis. Autopsy and revision of the deep cellular spaces of the neck in 87.8 % does not eliminate the spread of the necrotic process along the mediastinal fiber. Active surgical tactics in the total phlegmon of the deep cellular spaces of the neck is justified and allows us to recommend one-stage drainage on the neck and thoracic-mediastinal sanation.

The increase of the number of patients with atherosclerosis of the aorta leads to steady growth of the number of operations on aorta-femoral segment. In this regard, Federal programs of Federal funding are created for treatment of this disease. However, a high rate of mortality in cases of standard operations causes surgeons to minimize the volume of surgical treatment. The method of operation of the aorta from short-scar incision is studied quite enough; however, there are some problems, such as incision conversion and intraoperative complications. The aim of this study is to improve the results of operations on the aorta from the short-scar incision by access modeling. We analyzed the results of treatment of 88 patients operated from short-scar incision to the aorta in the Kemerovo Regional Clinical Hospital. Patients were divided into two groups - 55 patients operated without access modeling and 33 patients operated with preoperative access modeling. In the result in the second group there was reduction of incision conversions frequency to 3,03%, also there was reduction of the operation time in comparison with the first group without access modeling, with comparable characteristics of the groups and of the same frequency and nature of complications.

Estimation of transcutaneous partial pressure of oxygen is the main noninvasive method of evaluation and study microhaemodynamics and tissue blood supply. Aim of the research: to study the dynamics of transcutaneous partial pressure of oxygen at surgery of aortofemoral segment performed more distally of aortic compression. Material and methods: the survey included 49 patients with arterial sclerotic disease of aortofemoral segment with comorbid Ilb-IV stage chronic lower limb ischemia according to Pokrovsky-Fountain classification, and with II-III stage chronic infrarenal abdominal aortic aneurysm according to Pokrovsky classification. The patients' age was 52-76y.o. For the assessment of peripheral microhaemodynamics we used the technique of estimation of transcutaneous partial pressure of oxygen (ТсРО2) with application of multichannel monitor of Radiometer TCM-400 system. The suggested method offers the possibility to evaluate the severity degree of microcirculatory disorders in lower limbs and to assess effectiveness of revascularization process.

Estimation of transcutaneous partial pressure of oxygen is the main noninvasive method of evaluation and study microhaemodynamics and tissue blood supply. Aim of the research: to study the dynamics of transcutaneous partial pressure of oxygen at surgery of aortofemoral segment performed more distally of aortic compression. Material and methods: the survey included 49 patients with arterial sclerotic disease of aortofemoral segment with comorbid Ilb-IV stage chronic lower limb ischemia according to Pokrovsky-Fountain classification, and with II-III stage chronic infrarenal abdominal aortic aneurysm according to Pokrovsky classification. The patients' age was 52-76y.o. For the assessment of peripheral microhaemodynamics we used the technique of estimation of transcutaneous partial pressure of oxygen (ТсРО 2) with application of multichannel monitor of Radiometer TCM-400 system. The suggested method offers the possibility to evaluate the severity degree of microcirculatory disorders in lower limbs and to assess effectiveness of revascularization process.

The increase of the number of patients with atherosclerosis of the aorta leads to steady growth of the number of operations on aorta-femoral segment. In this regard, Federal programs of Federal funding are created for treatment of this disease. However, a high rate of mortality in cases of standard operations causes surgeons to minimize the volume of surgical treatment. The method of operation of the aorta from short-scar incision is studied quite enough; however, there are some problems, such as incision conversion and intraoperative complications. The aim of this study is to improve the results of operations on the aorta from the short-scar incision by access modeling. We analyzed the results of treatment of 88 patients operated from short-scar incision to the aorta in the Kemerovo Regional Clinical Hospital. Patients were divided into two groups – 55 patients operated without access modeling and 33 patients operated with preoperative access modeling. In the result in the second group there was reduction of incision conversions frequency to 3,03 %, also there was reduction of the operation time in comparison with the first group without access modeling, with comparable characteristics of the groups and of the same frequency and nature of complications.

Based on studying venous trunks and their syntopia, previously performed on a total of 160 cadavers we elaborated methods of cross shunting. Clinical application thereof in ten patients presenting with severe arterial hypertension accompanied by type 2 diabetes mellitus made it possible to decrease both mortality and complication rates.

The article presents data of experimental study of renoportal venous anastomoses made on cadaver material (160). The use of various techniques allowed to analyze the known variants, to suggest methods which enlarge possibility of Greyhack-Harris anastomosis. Clinical application showed efficacy of surgical treatment of severe and malignant arterial hypertension.

AIM:To substantiate administration of <> for prevention of cerebral ischemia in operations on extracranial arteries. MATERIAL AND METHODS:The present prospective randomized trial included a total of 50 patients having endured various operative interventions on extracranial arteries. Of these, 24 subjects were additionally given <> in order to prevent ischaemic complications. Conventionally accepted methods of protection were used in 26 patients. The degree of cerebral ischaemia during surgery was assessed by means of monitoring the lactate content in the blood from the internal carotid artery and internal jugular vein on the side of the operation performed. Also, as an indirect method aimed at evaluating intraoperative cerebral ischaemia we used monitoring of transcutaneous oxygen tension (TcPO2) on the side of the surgical intervention with the placement of the appropriate sensor in the temporal region. RESULTS:The patients receiving perftoran additionally in order to prevent cerebral ischaemia showed a statistically reliable decrease in the blood lactate level at all stages of the operation. Besides, with the statistically similar levels of TcPO2 in the both groups at the stage prior to pinching the major arteries amongst the patients given perftoran the decrease in TcPO2 at the subsequent stages was significantly lower. CONCLUSION:Administration of perftoran during surgery on the extracranial arteries made it possible to substantially improve cerebral oxygenation, rendering it stable at all stages of the surgical intervention. Combining this method with other techniques aimed at protecting the brain makes it possible to increase safety of the operations by promoting additional protection from circulatory hypoxia in multifocal lesions of the carotid arteries and arteries of the circle of Willis.

Estimation of Perftoran efficacy for preventive maintenance of ischemia-reperfusion complications in operative treatment of chronic infrarenal aortic aneyrysms was performed. Fourty nine patients were included into the study. Perfrtoran was administered intravenously during preoperative preparation in 20 patients. Control group (n=29) did not receive the drug. Complex estimation of Perftoran efficacy included analysis of postoperative complications and changes of the blood lactate level. The data obtained allow to consider that using Perftoran during preoperative preparation reduces risk of occurrence of ischemiareperfusion complications in operative treatment of infrarenal aortic aneurysms.