[Surgical tactics in treatment of osteomyelitis of long bones].

The new osteomyelitis classification was worked out on the strength of treatment results of 361 patients. Four types of long bones lesions are marked out: medullar, superficial, focal and diffuse. The kind of surgical treatment is determined according to the lesion type.

[Hemostasis system disturbances and their correction in patients with pyonecrotic forms of diabetic foot].

Severe hypercoagulation syndrome was diagnosed in patients with various forms of diabetic foot. Pathology at coagulogram parameters reflects systemic metabolic and inflammatory disturbances. Anticoagulant therapy should be combined with correction of glycemia, treatment of infection and critical ischemia.

[The basic principles of treating patients with chronic osteomyelitis of the long bones].

Experiences with surgical treatment of 269 patients with chronic osteomyelitis of long bones based on the principles of active surgical treatment of purulent wounds were summarized. Certain aspects of surgical treatment of patients with chronic osteomyelitis were revised and supplemented. Different variants of surgical treatment of the osteomyelitis focus were shown depending on the volume and character of the injury and the methods of plastic substitution of defects of the bones and soft tissues.

[Surgical treatment of long bones' chronic osteomyelitis].

The experience in surgical treatment of 269 patients with long bone chronic osteomyelitis based on the principles of active surgical policy for purulent wounds is summarized. Some aspects of osteomyelitis surgical treatment are reconsidered and complemented. Variants of osteomyelitic focus surgical debridement dependent on severity the lesion as well as methods of plastic replacement of bones' and soft tissues' defects are demonstrated.

[Plastic and reconstructive operations in purulent surgery and traumatology].

The authors propose a complex surgical treatment of extensive purulent wounds and tissue defects based on radical debridement of the pyonecrotic focus, primary and early reconstructive operations. New views on operation "debridement of a purulent wound" were formulated: it is considered as an initial element of the reconstructive surgery. 597 patients with extensive purulent wounds and tissue defects underwent plastic and reconstructive operations with good and satisfactory results in 96.

[Early reconstructive-restorative operations in vast traumatic injuries of shin complicated by purulent infection].

The experience in treatment of 278 patients with extensive traumatic injuries of the shin complicated by purulent infection is represented. Multistage treatment typical for such category of patients in which reconstructive-restorative stage is performed late after elimination of inflammatory process is not optimal. Owing to the complex of treatment measures based on the principles of active surgical treatment of festering wounds primary operations were a success in 24.

[Patterns in the physiological and reparative regeneration of the connective tissue base of skin].

A new phenomenon of small vessel transformation is observed electron microscopically in the biopsies of normal and extended human skin as well as granulation tissue. This phenomenon appears to reflect an important mechanism in physiological and reparative regeneration of the dermis. It manifests in that endotheliocytes and pericytes may become the source of new cell formation, for example, fibroblasts.

[Computed tomography in the comprehensive radiologic diagnosis of chronic osteomyelitis of the lower extremities and pelvis].

The role of computed tomography in multimodality radiation diagnosis was assessed in the treatment of chronic osteomyelitis of the lower extremity and pelvis in 218 patients (128 with posttraumatic osteomyelitis, 46 with hematogenic osteomyelitis of long bones, and 19 with chronic pelvic osteomyelitis) aged 16-78 years. Computed tomography was used to specify the symptomatology of chronic osteomyelitis, to define indications for radical surgical treatment. The soft tissues of the shin were studied in patients with chronic osteomyelitis versus lymphedema in 103 patients, post-thrombophlebitic syndrome in 17, acute wound infection in 9.

[Staged tissue expansion in the surgery of suppurative wounds].

To close extensive infected wounds and to replace long bone defects, along with other methods a method of graded tissue strain (GTS) has been developed and introduced into practice (246 patients). The method differs from all others in that it requires no transfer of elaborate flaps while replacing soft tissue defects; and no graft or foreign body is introduced externally into the wound in replacing long bone defect. Soft tissue defect is gradually replaced by wound-adjacent intrinsic tissues, the wound is closed by related skin and bone defect is filled by an osseous regenerate which is formed during graded transposition of the osteotomized fragment.

[Treatment of extensive post-traumatic osteomyelitis of the long bones].

The principles of active surgical treatment of extensive posttraumatic osteomyelitis of the long bones made it possible to restore the anatomical and functional intactness of the affected extremities in 92 patients within a short time. All the patients were admitted from other medical institutions because the previous treatment was inefective. The developed therapeutic method consisted of the following main components: surgical debridement of the purulent focus with removal of all nonviable tissues; adequate immobilization of the bone fragments with apparatuses of external fixation; early restorative plastic operations; general intensive measures.

[Morphological and computer-tomographic analysis of reparative regeneration of the tibia by distraction osteosynthesis].

Morphological & computerized tomography analysis of tibial reparative regeneration in distraction osteosynthesis was performed in 12 & 25 patients consequently. The authors discuss the correlation between the two kinds of the data & show that development of bone regeneration with restoration of anatomical form & structure of the reconstructing tubular bone occurs in the place of osteotomy.

[Reconstructive and restorative operations in surgical treatment of suppurative diseases].

The principles of active surgical treatment of purulent wounds made it possible to perform reconstructive operations on 5,422 patients with large purulent wounds and tissue defects. In 3,887 patients the wounds were closed with sutures and drained, in 1,535 patients the wound surfaces were closed and tissue defects repaired by various methods of cutaneo- and osteoplasty, in 1,261 of these patients free skin graft was carried out. In 274 patients wounds in the region of important anatomical structures and functionally active surfaces were closed by transposed vascularized tissues with good cosmetic and functional results.

[General principles of the treatment of suppurative wounds and suppurative surgical diseases].

The article discusses the results of treatment of 7,092 patients with purulent wounds and septic surgical diseases by means of a suggested method of active surgical management. The main principles of the method are as follows: preoperative examination and preparation of the patients for operation for 12-36 hours; radical excision of all purulent and nonviable tissues followed by active drainage and treatment under conditions of controlled abacterial medium or by ointments on a water-soluble base; use of auxiliary methods for the treatment of the wound surface (pulsed stream of antiseptics, ultrasonic cavitation, vacuum treatment); performance of laboratory tests (microbial dissemination per 1 g tissue, cytologic and morphologic studies, values of tissue hemostasis) as an objective criterion of the course of the wound process and for determining whether the wound surface is ready for closure; accomplishment of intensive therapy; early closure of the wound surface with sutures or by plastic operations. Analysis of the data allows the conclusions that active surgical treatment may be accepted as an optimal and universal method for the management of purulent wounds of any etiology and septic surgical diseases.

[Bone formation after graded distraction in patients with open fractures of the long tubular bones complicated by purulent infection].

Osteogenesis under the above conditions is studied on the material of biopsies from 22 men with the open fractures of long bones complicated with a purulent infection. The increasing space between the edges of the fractured bone is filled with an osteoid tissue and subsequently a normal bone tissue is formed. The cells with a high proliferative activity (an intense DNA synthesis) are localised exclusively or predominantly in the wall of the capillary type vessels or in their vicinity.

[Electron radioautographic study of osteogenesis during distraction osteosynthesis].

Electron microscopic radioautography was used to study the osteogenesis during the replacement of bone tissue defects by graded distraction osteosynthesis in 12 patients with open fractures of the tibia. In the early stages of reparative tissue formation, the cells that intensely synthesized DNA and DNA were located exceptionally in the vascular walls or near them. The authors assume that vascular cells, most probably pericytes, are a basic source of the origin of the reparative tissue, turning firstly to fibroblast-like cells and then to osteoblasts.

[Diagnostic role of the determination of the plasma fatty acid spectrum in patients with suppurative surgical infection].

The determination of spectrum of blood plasma fatty acids was performed in patients with purulent surgical infection. The surgical infection was shown to bring about changes in the content of free fatty acids (FFA) in blood plasma. In patients with sepsis undulatory changes in the content of FFA of blood plasma were typical.