[Surgical complications in patients with COVID-19]. / Khirurgicheskie oslozhneniya u bol'nykh COVID-19.

OBJECTIVE: To analyze in-hospital perioperative complications in COVID-19 patients. MATERIAL AND METHODS: We analyzed medical records of 1.250 patients with COVID-19 for the period from April 2020 to December 2021. Mean age of patients was 62.8±2.1 years, length of hospital-stay - 44.3±3.7 days. All patients received therapy in accordance with the national guidelines on prevention, diagnosis and treatment of new coronavirus infection (COVID-19)¼ (versions 1-12). Visualization of hematomas, arterial and venous thrombosis was performed using ultrasound, CT and CT angiography. RESULTS: Mortality rate was 1.5%. Surgical complications included various hematomas, arterial and venous thrombosis of great vessels. Hematomas were detected in 15 (1.2%) patients, 2 of them died. There were hematomas of extremities in 5 cases, retroperitoneal space - 4, soft tissues of the body - 4, internal organs (spleen) -2 patients. The volume of hematoma was up to 100 ml in 6 patients, 100-500 ml in 5 patients, 500-1000 ml in 3 patietns, more than 1000 ml in 1 patient. Hematomas occurred in 23.1±1.1 days after laboratory verification of COVID-19. Four (26.7%) patients underwent emergency surgery. Conservative therapy was followed by lysis of hematoma after 25.1±2.7 days. Venous thrombosis without signs of flotation occurred in 20 (1.6%) patients, arterial thrombosis - in 3 (0.24%) patients (2 ones required surgery). CONCLUSION: Management of COVID-19 patients with various hematomas should be as conservative as possible. Arterial thrombosis and extensive spleen hematomas requiring surgical treatment are features of COVID-19.

[Multi-stage surgical treatment of woundeds with combined thermomechanic injuries in local armed conflict]. / Programmiruemoe mnogoetapnoe khirurgicheskoe lechenie ranenykh s kombinirovannymi termomekhanicheskimi povrezhdeniyami v lokal'nom vooruzhennom konflikte.

AIM: To improve the results of surgical treatment of woundeds with combined thermomechanic injuries in local armed conflict. MATERIAL AND METHODS: It was analyzed treatment of 93 victims with thermomechanic injuries. In 29 (31.2%) aptients only Early Total Care protocol (ETC) was used up to 2001. These victims received complete surgical care. Since 2002 diffirentiated approach of multi-stage surgical treatment (Damage Control Surgery) has been applied. ETC tactics was used if systolic blood pressure was more than 90 mm Hg (30 woundeds, 32.2%). DCS protocol was preferred in case of blood pressure less than 90 mm Hg or multiple-organ failure (34 patients, 36.6%). RESULTS: Diffirentiated surgical approach decreases mortality rate from 13.8% to 7.8% (p=0.453) compared with group of conventional one-stage care.

[Peculiarities of surgical treatment of wounded with combined thermomechanical injuries of the lower extremities under conditions of counter-terrorist operation].

Peculiarities of surgical treatment of wounded with combined thermomechanical injuries of the lower extremities under conditions of counter-terrorist operation. The authors analysed results of treatment of 67 wounded with injuries of the extremities, combined with burns. Two therapeutic approaches to surgical treatment were used. The first therapeutic approach (Early total Care - ETC) involved providing of a complete surgical care (the whole body is examined) during the first emergency operation and was used in 24 (35,8%) injured. The second therapeutic approach implied a differentiated approach to the treatment of wounded and treatment of injuries and was used in 43 (64,2%) patients. If arterial blood pressure was above 90 mm Hg, ETC approach was used in 19 (28,4%) wounded. If systolic blood pressure was less than 90 mm Hg programmable surgical approach Damage Control Surgery (DCS) was used in 24 (35,8%) patients. The use of differential surgical approach has led to increase in the number of complications from 45,8 to 55,8% (p=0,044) and decrease in mortality c 12,5 to 9,3% (p=0,039) compared with the group of wounded, where was used only traditional approach of single-stage treatment.

[Surgical strategy in bullet wound of the thorax accompanied by shock].

The article analyzes the experience of treatment of bullet penetrating wounds of the thorax accompanied by shock in 131 armed forces personnel of internal army and officers of the Ministry of Home Affairs of Russia during contra-terrorist operations on the North Caucasus at the period from 2000 to 2011. The postoperative lethality was reduced from 22.7% to 10.8% due to usage of the strategy which was directed to decrease of surgical aggression in 65 patients.