A Hybrid Technique to Treat Inguinal Wound Infection after Arterial Surgery with Lateral Femoral Bypass and Intra-Incisional Negative Pressure Wound Therapy

Background: Patients with the inguinal wound infection after arterial surgery remains clinical challenge. Sustaining lymphatic leakage have been shown as a common and potentially serious complication. However, it remains clinical challenge for surgery to deal with this tough problem. Methods: This study describes a hybrid technique of using radical debridement, lateral femoral bypass (LFB) and intra-incisional negative pressure wound therapy (iNPWT) for single-staged treatment of complex inguinal wound infection after arterial surgery (IWI-AS).Results: Between January 2017 and June 2021, 5 IWI-AS cases treated with this new method were identified. Of the patients, 3 were males and 2 were females. The average age was 49.4 years (range, 33 to 77 years). 4 cases suffered emergent operations due to the sudden bleedings. after vascular bypass reconstructions and an average of 2.2 (range:1-3) iNWPT, all cases achieved wound healing at an average duration of 4.6 weeks (range: 3-6weeks). Moreover, all cases showed no bacterial growth and grafts patency as indicated by doppler ultrasound or CT angiography postoperatively. One case did not receive bypass imaging evaluation at postoperative 12 months. Weakness of quadriceps femoris was observed in one case. Conclusion: single-staged therapy of LFB and iNPWT hybridization is a technically handy and effective method for treatment of inguinal wound infection after arterial surgery.

A Hybrid Technique to Treat Inguinal wound Infection after Arterial Surgery with Lateral Femoral Bypass and Intra-incisional Negative Pressure wound Therapy

Background: Patients with the inguinal wound infection after arterial surgery remains clinical challenge. Sustaining lymphatic leakage have been shown as a common and potentially serious complication. However, it remains clinical challenge for surgery to deal with this tough problem. Methods: This study describes a hybrid technique of using radical debridement, lateral femoral bypass (LFB) and intra-incisional negative pressure wound therapy (iNPWT) for single-staged treatment of complex inguinal wound infection after arterial surgery (IWI-AS).Results: Between January 2017 and June 2021, 5 IWI-AS cases treated with this new method were identified. Of the patients, 3 were males and 2 were females. The average age was 49.4 years (range, 33 to 77 years). 4 cases suffered emergent operations due to the sudden bleedings. after vascular bypass reconstructions and an average of 2.2 (range:1-3) iNWPT, all cases achieved wound healing at an average duration of 4.6 weeks (range: 3-6weeks). Moreover, all cases showed no bacterial growth and grafts patency as indicated by doppler ultrasound or CT angiography postoperatively. One case did not receive bypass imaging evaluation at postoperative 12 months. Weakness of quadriceps femoris was observed in one case. Conclusion: single-staged therapy of LFB and iNPWT hybridization is a technically handy and effective method for treatment of inguinal wound infection after arterial surgery.

Organization of provision of specialized medical care for polytrauma in multidisciplinary hospital

Technical progress facilitates to a significant increase in injuries and the severity of traumatic injuries. When providing treatment for patients with polytrauma in a multidisciplinary hospital the leading place is taken by the organization of the work of the hospital’s medical personnel, the development and implementation of standards for the guidelines specialized medical care to victims. The main priority of surgical intervention in polytrauma is to bleeding control, and staged treatment with final surgical correction after stabilization of the victim’s condition in 24–36 hours after the injury. An important role is played by standardized transfusion therapy for preventing the development of the lethal triad. Practice shows that a multidisciplinary approach is the cornerstone of providing specialized medical care for patients with polytrauma.

Giant condiloma of Bushke-Levenstein of anal canal and perianal skin. Clinical case

The article is devoted to a rare disease of the perianal region — Buschke-Levenshtein tumor. A clinical case and a literature review on the etiology, pathogenesis and experience of treating such tumors are presented. Evidence based sources show that currently there is no generally accepted tactics of managing patients with this pathology. In this regard, each case of treatment of such patients is of not only scientific but also practical interest. In this case, the tactics of staged treatment with the use of high-temperature dissectors and immunocorrection was chosen, which made it possible to achieve a good clinical result without the formation of extensive and long-term non-healing wound defects in the perianal region.

Staged laparoscopic traction orchiopexy by Shehata: first experience, technical features, results

Purpose – to evaluate the results of proposed method of staged laparoscopic traction orchiopexy by Shehata on the basis of our own experience in the treatment of children with abdominal cryptorchidism. Materials and methods. During the period 2019–2021, 18 boys aged 9 months – 4 years were operated with staged laparoscopic traction orchiopexy procedure. Right unilateral abdominal cryptorchidism observed in 10 children, left – in 6, bilateral – in 2. Indications for the procedure were cases of intra-abdominal testicular retention with short vessels. Results. Pelvic and iliac retentions observed in 44% of cases. In 22% testicles were located close to the inner inguinal ring, in 33% the distance between testicle and inguinal canal opening reached 3–4 cm. The 2nd stage was carried out in 3 months. Successful orchiopexy was conducted then in 94% cases without any vascular tension. No cases of testicular dislocation or atrophy have been reported. The volume of operated testicles was smaller than the healthy ones in 78% cases objectively. Conclusions. The experience of Shehata operation showed good effect of the method for correction of abdominal cryptorchidism. Indications for staged laparoscopic traction orchiopexy are abdominal undescended testicles with insufficient length of vessels. The technique allows to achieve effective elongation of spermatic vessels in a short period of time and to minimize the risks of atrophy, compared with the 2-stage Fowler–Stephens operation. This study was conducted in accordance with the principles of the Helsinki Declaration. The research protocol was approved by the Local Ethics Committee of the institution mentioned in the work. Informed parental agreement was obtained for the research. No conflict of interests was declared by the authors. Key words: abdominal cryptorchidism, orchiopexy, staged treatment, Shehata procedure.

Staged surgical treatment of the patient with chronic pancreatitis

A clinical case of successful surgical treatment of a patient with chronic pancreatitis, complicated by suppuration of a postnecrotic cyst and the formation of a cysto-gastric fistula. As a result of the conservative and minimally invasive treatment, the pseudocyst was drained, and the cystogastric fistula was closed. The staged treatment was completed by resection of the head of the pancreas with the formation of an anastomosis.