Features of NATO’s soldiers limbs combat trauma treatment during armed conflicts on the territory of Iraq and Afghanistan (literature review)

The article describes armed conflicts on the territory of Iraq and Afghanistan. Improvement of individual and collective protection equipment has reduced the number of cases of soft tissue wounds in the extremities. The main cause of mortality and wound complications is antibiotic-resistant microflora. Purulent complications lead to chronic treatment of the wound healing process and a long period of specialized treatment and rehabilitation, which entails difficulties in the socialization of wounded servicemen, as well as significant financial costs from the state. When providing medical care to wounded military personnel, it is negative pressure wound therapy. Phage therapy is a promising method for treating infectious complications.

Povidone iodine — new possibilities of a familiar dressing (literature review)

The article provides a review of the literature on the assessment of the efficacy, safety and indications for the use of povidone iodine in modern clinical practice. The preservation of good sensitivity to the drug, despite its long-term use, as well as new opportunities associated with the effectiveness against biofilm forms of pathogens and viruses, in particular SARS-CoV-2, has been shown.

Use of negative pressure in the treatment of anaerobic non-clostridial perineal infection

The article presents a clinical case of a successful complex treatment anaerobic non-clostridial perineal infection in a 54-year-old patient with long-term diabetes mellitus. Particular attention is paid to the possibilities of local treatment using negative pressure wound therapy in the management of this patients category.

The possibility of using autologous adipose tissue for the stage shin wound closing

Extensive soft tissue defects can be complicated by systemic diseases (trophic ulcers in diabetes mellitus, chronic arterial insufficiency) or the result of trauma (domestic, military, operating, etc.). The current increase in the incidence of this pathology is due to the spread of cardiovascular diseases and diabetes mellitus. Closing an infected long-term non-healing wound, such as a tendon or bone, is one of the most difficult tasks of reconstructive surgery. For example, the use of classical methods of closing wound conditions is difficult to a degree due to the patient's polymorbid background. The clinical case presented in the article shows the possibility of closing deep shin wound with a complex relief by the transplantation of autologous adipose tissue, a patient with severe concomitant pathology.

Results of application composite hydrogel coatings based on polyvinyl alcohol in the experiment

The results of the use in the experiment of composite hydrogel coatings of prolonged action based on polyvinyl alcohol are investigated.Objective. The aim of the study is a comparative clinical assessment of the effectiveness of the developed composite hydrogel coatings of prolonged action in an experiment in laboratory rats.Materials and research methods. After modeling alloxan diabetes mellitus and neuroischemic form of diabetic foot in laboratory white Wistar rats, the developed wound dressings were applied. A clinical analysis of their effectiveness was carried out and the optimal composition was determined. The animals were divided into three groups, 10 animals in each group, as follows: the first — control with self-healing of the wound, the second — with samples No. 1 (polyvinyl alcohol + chitosan + pectin + L-aspartic acid + gentamicin), the third — with samples No. 2 (polyvinyl alcohol + chitosan + pectin + L-aspartic acid + gentamicin + methyluracil). The first dressing change was carried out on the third day with the taking of histological material, then - every other day. When changing the dressing, such parameters as the nature and amount of wound discharge, the size of the ulcer, the presence of granulations and epithelialization were assessed. Dynamic assessment was performed on the 3rd, 7th, 14th and 21st days. The measurement of the area of the ulcer was carried out by transferring the contour of the ulcer to graph paper with manual counting.Research results. The healing rate of ulcers in the experimental groups was higher than in the control group. When comparing second and third groups, a significant increase in speed was noted by the seventh day in third group (p < 0.05), which reduced the overall healing time of ulcers by 7 days.Conclusion. The study showed that the healing time of ulcers in laboratory animals with the use of the developed wound dressings is significantly reduced in comparison with the control group. The proposed method of local treatment can be considered effective in the treatment of vascular etiology trophic ulcers against the background of diabetes mellitus.

Management of complex wounds treatment with a hydrofiber dressing in a public hospital in Bogota (Colombia)

Objective. To evaluate the efficacy of the use of a last generation hydrofiber dressing with silver, for the treatment of complex wounds that are difficult to heal.Materials and research methods. A prospective observational case-follow-up study was carried out, which included patients with acute or chronic wounds that were difficult to heal, treated in the plastic surgery service of a public hospital in Bogota-Colombia, who underwent healing with hydrofiber dressings reinforced, with silver ions, benzethonium chloride and EDTA (Aquacel Agplus®, ConvaTec). The wound was monitored, evaluating infection control, exudate and biofilm, as well as the number of required dressings and the time required for the complete closure of the wound.Research results. A total of 55 patients were included, with a median age of 44 years. In all cases, a follow-up was carried out until the definitive closure of the wound. At the end of the study, it was observed that, in 35 (63.6 %) patients, the wounds evolved to complete closure by second intention in an average of 59.3 days, requiring 12.5 dressings. 20 (36.4 %) patients had adequate wound bed preparation for definitive surgical coverage with grafts, flaps or dermal substitutes, in an average of 31.4 days, requiring 6.5 dressings on average.33 (60.0 %) wounds were infected and adequate infection control was achieved on average with 5 dressings. A decrease in the direct and indirect signs of biofilm was achieved after 6 dressings.Conclusion. The results show that the dressing studied is effective to control exudate, infection and biofilm, as well as to prepare the bed for a definitive surgical coverage.

Head, chest and limbs mine-explosive wounds

The article presents the experience of treating wounded K., 29 years old, who, as a result of the suicide bombing of a homemade shell-free explosive device in a moving car of the St. Petersburg Metro 03.04.2017 received a severe mine-explosive combined wound to the head, chest and limbs with a fragmented blind skull. The trauma was accompanied by brain damage, a fracture of the cranial vault bones, lungs contusion, and fragmented fracture of the right tibia bones. The patient underwent sequential bifrontal decompressive craniotomy, external fixation of the right shin bones fractures, blocked intramedullary osteosynthesis of the latter, dura mater plasty, cranioplasty with a titanium plate after its computer modeling. The complex treatment allowed the patient to be discharged from the hospital after 4 months in a satisfactory condition.

High lower limb amputations in gangren. Russsian Consensus

The presented recommendations were developed by federal level experts, approved at the International Scientific and Practical Conference "High amputations of the lower extremities in children and adults" (Moscow, 2019) and published on the website www.woundsurgery.ru for use in work by general, purulent, cardiovascular surgeons, specialists in X-ray endovascular diagnostic and treatment methods, endocrinologists, combustiologists and general practitioners.

Post release of the Symposium on Advanced Wound Care “SAWC 2021 Virtual” (May 10–14, 2021, USA)

This article presents the chronology of the Symposium on Advanced Wound Care “SAWC 2021 Virtual” that took place May 10–14, 2021. SAWC is an annual event that has been held for more than 30 years and brings together various specialists in the field of wound care: dermatologists, plastic surgeons, orthopedists, nurses, nutritionists, sports medicine doctors, physiotherapists, research doctors. The scientific program of the symposium included 150 reports devoted to both the results of scientific and experimental research and advanced applied medical technologies aimed at improving the results of chronic wounds by various etiology and localization treatment.

Art, craft and science of limb amputation Part 2. Сraft of amputation: from Ambroise Pare to Pierre Dionis (late XVI century – early XVIII century)

Since the XVI century until the beginning of the XVII century an operation of limb amputation has undergone changes and improvements that have affected all its aspects: preparation for carrying out, the technique of performing and postoperative treatment of patients. The invention of the ligature (1552) and the tourniquet (1674) became revolutionary. Wet and dry gangrene, extensive trauma to soft tissues and bones, traumatic limb amputation and osteomyelitis were considered of indications for amputation. The deontological and legal framework for amputation was developed, including the patient’s consent to the operation and the awareness of relatives about its outcomes. The article presents an instrumental and dressing apparatus of the XVII century for the operation; medicines used for general and local treatment of the patient before and after truncation of the stump; sedation and pain relief issues; technique of circular and one soft tissue flap (1679) amputation; the choice of tissue dissection level; methods of stopping bleeding (astringents, pressure bandage, cauterization, ligation and stitching of blood vessels); a method of stitching a stump wound, applying a bandage on it and strengthening it; postoperative management (regimen and diet, dressing change, staged wound treatment, complications); the phenomenon and causes of “phantom limbs”.