OBJECTIVE:To evaluate the effectiveness of bacteriophages in complex surgical treatment of septic diseases of the hand.MATERIAL AND METHODS:We analyzed treatment outcomes in 111 patients with septic diseases of the hand (septic arthritis, tendovaginitis, phlegmon). Surgical treatment was finished by primary sutures and drainage. They were divided into two groups. Bacteriophages were used in the main group. Other components of treatment were identical. «Pyobacteriophage complex» was injected into drainage tubes during dressings. Effectiveness of treatment was evaluated considering elimination of septic process, bacterial flora and healing of surgical wound. In addition, we performed in vitro testing of microorganisms for sensitivity to Pyobacteriophage.RESULTS:Staphylococcus and Streptococcus genus prevailed in hand infections. Pasteurella multocida has been isolated after pet bites. Growth of microflora in drainage tubes was observed in 16.7% and 21.1% of cases, respectively (p=0.02). Wound healing via primary intention was found in 83.6% and 71.4%, respectively (p=0.03). When testing in vitro, we observed lysis of cultures of Staphylococcus aureus in 83.6% of cases, Streptococcus pyogenes - in 33.3% of cases.CONCLUSION:«Pyobacteriophage complex» was effective for septic diseases of the hand. However, its partial lytic activity against the most common pathogens makes it advisable to combine phages and antibiotic therapy. Systematic renewal of phages is important due to widespread resistance of bacteria.

Objective. To study the treatment results of patients with necrotizing fasciitis (NF) of the upper limb. Methods. The authors’ observations of 9 patients with a rare and severe disease: necrotizing fasciitis (NF) of the upper limb have been analyzed. Minor skin lesions in the area of the hand became the entry gate for any infection. The median time prior hospitalization was 4,8±1,8 (M±σ) days. Immediately upon admission, the diagnosis of upper limb NF was established in 5 patients. This was followed by emergency radical surgery. The rest were also urgently operated on, but with a diagnosis of phlegmon of the hand and in insufficient volume. They were diagnosed with NF within the first day and a second operation was performed. In most cases the lesion included tissues of the hand, forearm, and arm. Primary surgery was supplemented by staged necrectomies, the number of which averaged 4,7±1,9 per patient. The complex of intensive treatment included broad-spectrum antibiotics, anticoagulants (enoxaparin 8,000 anti-Xa IU / day). Surgical closure of postnecrectomic wounds was performed using skin plastic operations: plastics with local tissues, autodermoplasty with a split graft. Results. Most of the cases were classified as type II NF (Streptococcus pyogenes or Staphylococcus aureus). In one case, a very rare and extremely severe, NF caused by Pasteurella multocida was observed. No antibiotic-resistant strains were found. Emergency radical operation became the cornerstone of success. The need for staged necrectomy was determined by the formation of secondary necrosis in connection with severe microcirculation disorders. Extensive postnecrectomic wounds were closed after the inflammation subsided with the help of skin plastic operations. The average duration of inpatient treatment was 20,8±6,2 days. There were no lethal outcomes. Conclusion. A complex approach to the treatment of necrotising fasciitis of upper limb allowed getting positive treatment results in all cases.

Negative pressure wound therapy (NPWT) has been proven to be one of the most effective techniques in the treatment of severely infected wounds of various origins and localizations. At the same time, the prospects for its application are constantly expanding. This clinical observation demonstrates the use of NPWT in the treatment of an adult patient hospitalized in severe condition with a picture of extensive post-traumatic infected subgaleal hematoma. The development of a generalized suppurative purulent process was contributed both by the patient’s late request for medical help (18th day after the injury) and, as a consequence, the lack of primary surgical treatment of the scalp soft tissue injury, as well as the anatomical features of this area. The magnetic resonance tomography as instrumental examination methods played a significant role in the diagnosis of complications in addition to clinical data. Medical tactics was based on the surgical treatment of the infected focus, the application of antibacterial therapy, taking into consideration the isolated microbial flora (Streptococcus pyogenes). To eliminate severe inflammatory changes in the tissues and to reduce the size of the vast subaponeurotic cavity, NPWT technique was applied, which made it possible in short time to prepare a postoperative wound for surgical closure. The early secondary suturing at the final stage of treatment allowed obtaining a good result.

Acute hematogenous osteomyelitis (AHO) in adults is a rare disease complicating timely diagnosis. Even greater difficulties are observed in case of pelvic bone lesion. The authors report AHO of the pelvis an adult. Osteomyelitis was complicated by generalized infection and multiple pyogenic abscesses in subcutaneous adipose tissue of the upper and lower extremities. Detection of primary infectious focus was complicated by extreme severity of the patient's condition and low informative value of X-ray and ultrasound at the early stage of disease. Staphylococcus aureus was obtained from blood culture and infectious foci. Surgical debridement along with complex intensive care ensured a positive outcome.

Purulent iliopsoitis is a quite rare and difficult disease regarding diagnosis and treatment. However, treatment outcomes are not so favorable, incidence of sepsis and mortality are still extremely high. Original up-to-date studies devoted to this issue were analyzed. The authors discuss the actual problems of etiology, pathogenesis, classification, clinical features, diagnosis and surgical treatment of iliopsoitis. Considering these data, they conclude that timely diagnosis and adequate surgical treatment are essential for favorable outcomes. Prevention of relapse is based on detection of possible cause of disease and its possible correction.

The article analyzes the results of a microbiological examination of 336 patients with various forms of non-lactating mastitis. The causative agent was identified in 321 (95.5%) patients. Monoculture was identified in the majority of observations (84.4%), microbial associations were found in 15.6% of cases. Staphylococcus aureus had prevailed as the causative agent (69.7% of cases). Microflora composition depended on the form of the disease: S.aureus was isolated from the samples in 86.1% of cases of acute form of non-lactating mastitis, in 69.8% of cases of subacute form, and in 57.4% of patients with chronic form of non-lactating mastitis. The role of gram-negative microorganisms and microbial association is constantly evolving. The frequency of isolation of multiple antibioticresistant strains of microorganisms depended on the duration of the disease, the previous intake of antibacterial drugs and the clinical course of the disease. In acute forms of non-lactating mastitis methicillin-resistant S.aureus (MRSA) was isolated in only 2% of cases among all isolated S.aureus, while in subacute and chronic forms of the disease the frequency of MRSA isolation dramatically increased to 11.7% and 23.4% of all strains of staphylococci, respectively.Microbiological monitoring of wound fluid in the treatment of patients with non-lactating mastitis in combination with rational antibiotic therapy and adequate surgical intervention is the key to successful treatment of this category of patients.

On the basis of the examination and treatment of 446 patients with carbuncles, it was found that the main infection germ is Staphylococcus aureus mainly in the form of monoculture. Among the singled out strains multidrugsresistant forms (MRSA) reached 13,8%. The most severe course of carbuncles was observed in patients with diabetes mellitus, but the true difference in frequency of methicillin-sensitive and methicillin-resistant staphylococcus release wasn't observed. All singled out strains MRSA have a high sensitivity to the vancomycin and linezolid. Much less frequently (9,8%) Streptococcus of group A was sown antibiotic resistance wasn't found. Microbical landscape of postcritically wounds was changing in the course of 3-4 days. Streptococcus releases such gram-negative microflora among this strains more than the half was characterized by multiantibioticresistance. Contamination of the postcritically wounds in patients that suffers from diabetes mellitus, with hospital microflora was much frequent than in patients without diabetes mellitus, frequency of the excretion of microbical associations are higher in those with diabetes (47,6%). In such situations the negative dynamic of the wound process. It shows the necessity of conduction of staged necrectomies and changes in antibacterial therapy regimens adjusted to the sensitivity of the singled out microflora.

On the basis of the examination and treatment of 446 patients with carbuncles, it was found that the main infection germ is Staphylococcus aureus mainly in the form of monoculture. Among the singled out strains multidrugsresistant forms (MRSA) reached 13,8%. The most severe course of carbuncles was observed in patients with diabetes mellitus, but the true difference in frequency of methicillin-sensitive and methicillin-resistant staphylococcus release wasn't observed. All singled out strains MRSA have a high sensitivity to the vancomycin and linezolid. Much less frequently (9,8%) Streptococcus of group A was sown antibiotic resistance wasn't found. Microbical landscape of postcritically wounds was changing in the course of 3-4 days. Streptococcus releases such gram-negative microflora among this strains more than the half was characterized by multiantibioticresistance. Contamination of the postcritically wounds in patients that suffers from diabetes mellitus, with hospital microflora was much frequent than in patients without diabetes mellitus, frequency of the excretion of microbical associations are higher in those with diabetes (47,6%). In such situations the negative dynamic of the wound process. It shows the necessity of conduction of staged necrectomies and changes in antibacterial therapy regimens adjusted to the sensitivity of the singled out microflora.

Проанализированы особенности хирургического лечения карбункулов. Оценена тяжесть течения гнойно-некротического процесса, показана значимость своевременной диагностики стадии воспалительного процесса и выбора сроков оперативного лечения. Изложены особенности вариантов хирургической тактики - от щадящих до радикальных оперативных вмешательств, методы интраоперационной оценки жизнеспособности тканей в очаге воспаления. Обоснована необходимость дифференцированного подхода к лечению карбункулов в зависимости от стадии заболевания, распространенности патологического процесса и его локализации. Показана значимость восстановительных кожно-пластических операций при замещении постнекрэктомических дефектов покровных тканей при лечении обширных карбункулов. Намечены пути улучшения результатов лечения пациентов с карбункулами, среди которых своевременная диагностика, дифференцированный подход к хирургическому лечению, рациональная антибактериальная терапия и адекватное общее лечение.

Novosti Khirurgii. 2019 Nov-Dec; Vol 27 (6): 716-722 Surgical Treatment of the Lower Extremity Extensive Purulent and Necrotic Soft Tissue Lesions in a Patient with Systemic Scleroderma K.V. Lipatov, V.K. Gostishchev, A.G. Asatryan, G.G. Melkonyan, A.V. Kirillin, I.V. Gorbacheva, E.S. Solodovnikov The articles published under CC BY NC-ND license К.В. ЛИПАТОВ 1, В.К. ГОСТИЩЕВ 1, А.Г. АСАТРЯН 1, Г.Г. МЕЛКОНЯН 3, А.В. КИРИЛЛИН 2, И.В. ГОРБАЧЕВА 1, Е.С. СОЛОДОВНИКОВ 1

Split-skin grafting is one of the most accepted and significant operations in the purulent surgery. In this study we appraised effectiveness and possibilitys of this method of dermepenthesis and discuss about speciality of split-skin grafting use in the purulent surgery.

В клиническом наблюдении демонстрируется развитие тяжелой стрептококковой (Streptococcus pyogenes) некротизирующей инфекции мягких тканей в результате перфорации опухоли сигмовидной кишки. Быстропрогрессирующий некротический процесс в мягких тканях поясничной, ягодичной областей, левого бедра (с преимущественным поражением поверхностной фасции, подкожной жировой клетчатки и кожи) привел к образованию обширного постнекрэктомического раневого дефекта площадью более 1000 см2. Помимо тяжести заболевания столь обширному распространению патологического процесса способствовали запоздалое обращение пациентки за медицинской помощью, а также недооценка клинической ситуации хирургами, оказывавшими экстренную помощь. Развитие сепсиса сопровождалось тяжелой полиорганной недостаточностью. Из-за тяжести состояния пациентки удаление злокачественной опухоли сигмовидной кишки, прорастающей в брюшную стенку, стало возможным только после его стабилизации в результате хирургической санации очага инфекции и комплексной интенсивной терапии в условиях реанимационного отделения. Важнейшим моментом поэтапного хирургического лечения стало решение вопроса о выборе методов пластического закрытия обширной постнекрэктомической раны, которая захватывала всю левую ягодичную область, часть поясничной и передне-внутреннюю поверхность левого бедра. С учетом размеров и локализации дефекта, пластических резервов окружающей кожи рана была закрыта в три этапа с помощью комбинированной пластики: местными тканями методом дозированного тканевого растяжения и свободным расщепленным аутодермотрансплантатом. Ключевые слова: инфекция мягких тканей, некротизирующий фасциит, streptococcus pyogenes, пластическая хирургия, кожная пластика

AIM:To improve treatment of patients with grade IV chronic ischemia of lower extremities via endovascular angioplasty combined with surgical methods for suppurative-necrotic lesions of the feet.MATERIAL AND METHODS:51 patients with grade IV chronic ischemia of lower extremities underwent endovascular interventions (balloon angioplasty, stenting). A total of 23 stents were deployed in 16 patients including 12 stents in superficial and common femoral arteries, 5 in popliteal artery, 6 in iliac artery. There were no stents in crural arteries. The most perspective artery for wound healing was preferred in case of revascularization below popliteal segment. Necrectomy was performed along with angioplasty in patients with suppurative-necrotic lesion of the feet followed by delayed reconstructive operations if it was necessary.RESULTS:Endovascular surgery for grade IV chronic ischemia of lower extremities was associated with good immediate results in most cases due to revascularization and organ-sparing interventions for suppurative lesions of the feet. Current endovascular methods allow to perform successful re-operations to restore blood flow in previously repaired arteries and implanted stents with restenosis or thrombosis.

Aim. To compare the molecular properties and antibiotic susceptibility of GAS isolates in patients with respiratory and soft tissue infections. Materials and methods. 86 GAS isolates from patients with respiratory infections and 91 isolates with soft tissue infections were studied. The antimicrobial susceptibility profile of six antibiotics (clindamycin, erythromycin, azithromycin, clarithromycin, tetracycline, levofloxacin) was performed by the microdilution method. PCR and sequencing were used in emm-typing and detection SpeA, SpeB and SpeC genes. Results. Emm-types: 49, 66, 88 and 169 were the most prevalent in patients with soft tissue infections, and 1, 3, 12, 28, 75, 89 - in patients with respiratory infections. One strain was new. Isolates were representatives of the three patterns (A-C, D, E). 116 strains of both groups comprised to pattern E. 15 strains (21%) exclusively from soft tissue infections comprised to pattern D. More than half of isolates from patients with soft tissue infections had resistant to tetracycline. Resistance to macrolides was determined in both groups. In each of the studied groups were isolated strains with multidrug resistant. Eryphrogenic toxins gene A and C was more frequently in respiratory isolates. Conclusion. The group of respiratory GAS was less heterogenic in emm-types composition. Pattern D was not contain any pharyngeal GAS strains. Eryphrogenic toxin gene speA was identified twice as likely in respiratory isolates. The use of tetracycline and macrolides would be ineffective in approximately half of the cases among the patients with soft tissue infections.

Aim. To compare the molecular properties and antibiotic susceptibility of GAS isolates in patients with respiratory and soft tissue infections. Materials and methods. 86 GAS isolates from patients with respiratory infections and 91 isolates with soft tissue infections were studied. The antimicrobial susceptibility profile of six antibiotics (clindamycin, erythromycin, azithromycin, clarithromycin, tetracycline, levofloxacin) was performed by the microdilution method. PCR and sequencing were used in emm-typing and detection SpeA, SpeB and SpeC genes. Results. Emm-types: 49, 66, 88 and 169 were the most prevalent in patients with soft tissue infections, and 1, 3, 12, 28, 75, 89 - in patients with respiratory infections. One strain was new. Isolates were representatives of the three patterns (A-C, D, E). 116 strains of both groups comprised to pattern E. 15 strains (21%) exclusively from soft tissue infections comprised to pattern D. More than half of isolates from patients with soft tissue infections had resistant to tetracycline. Resistance to macrolides was determined in both groups. In each of the studied groups were isolated strains with multidrug resistant. Eryphrogenic toxins gene A and C was more frequently in respiratory isolates. Conclusion. The group of respiratory GAS was less heterogenic in emm-types composition. Pattern D was not contain any pharyngeal GAS strains. Eryphrogenic toxin gene speA was identified twice as likely in respiratory isolates. The use of tetracycline and macrolides would be ineffective in approximately half of the cases among the patients with soft tissue infections.

AIM To improve treatment of patients with non-lactating mastitis through the study of the course, diagnosis and surgical treatment. MATERIAL AND METHODS The study included 336 women aged 18-72 years with non-lactating mastitis who were hospitalized into the clinic for the period 1999-2016. RESULTS Main clinical variants of the disease, spectrum of pathogens and its relationship with clinical forms of mastitis were determined. Also early and long-term outcomes were evaluated followed by formulation of therapeutic and diagnostic concept of surgical care for non-lactating mastitis. Thus, good results were obtained in most cases (95.8% in early period and 92.6% in long-term period). CONCLUSION Only differentiated approach to diagnostic and curative tactics will allow to achieve good cosmetic and functional results in these patients.

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.

Изучить различные виды поздних гнойных осложнений инъекционной контурной маммопластики с точки зрения необходимости разработки лечебной и диагностической тактики в отношении данной категории пациентов.Материал и методы.На основании анализа результатов лечения 8 пациенток, перенесших увеличивающую маммопластику с применением полиакриламидного геля, осложнившуюся инфицированием его, изучены причины, клиническая картина, оптимальные диагностические и лечебные мероприятия в отношении различных вариантов послеоперационных гнойных осложнений