[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. Authors worked out a modification of osteoplastic trepanation--a "grip-sack" technique, which is used for medullar and focal femoral and tibial osteomyelitis. Long term follow-up results are obtained in 271 (77,7%) cases. The developed classification eases the standardization of follow-up results and permits treatment planning.

[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. Only this complex therapy can normalize coagulation parameters and reduce the risk of thrombotic complications.

[The basic principles of treating patients with chronic osteomyelitis of the long bones]. / Osnovnye printsipy lecheniia bol'nykh s khronicheskim osteomielitom dlinnykh kostei.

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. Main principles of antibacterial therapy for chronic osteomyelitis are described.

[Surgical treatment of long bones' chronic osteomyelitis]. / Khirurgicheskoe lechenie khronicheskogo osteomielita dlinnykh kostei.

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]. / Plasticheskie i rekonstruktivnye operatsii v gnoinoi khirurgii i travmatologii.

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 96.6% of the cases.

[Early reconstructive-restorative operations in vast traumatic injuries of shin complicated by purulent infection]. / Rannie rekonstruktivno-vosstanovitel'nye operatsii pri obshirnykh travmaticheskikh porazheniiakh goleni, oslozhnennykh gnoinoi infektsiei.

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 24.6% of patients. In 75.4% of patients early dermoplastic and osteoplastic operations were carried out to 1 month after primary surgical treatment. Good and favourable results obtained in 98.6% of patients demonstrate effectiveness of the above policy of treatment.

[Patterns in the physiological and reparative regeneration of the connective tissue base of skin]. / Nekotorye zakonomernosti fiziologicheskoi i reparativnoi regeneratsii soedinitel'notkannoi osnovy kozhi.

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. This process of vessel "destruction" is closely associated with the formation of new capillaries and precapillaries.

[Staged tissue expansion in the surgery of suppurative wounds]. / Dozirovannoe tkanevoe rastiazhenie v gnoinoi khirurgii.

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. At the same time good blood supply and tissue innervation retain, which contributes to their resistance to purulent infection. The analysis of the findings has led to the conclusion that GTS is an indispensible contribution to the development of plastic purulent surgery allowing the anatomic and functional integrity of the diseased segment to be restored.

[Computed tomography in the comprehensive radiologic diagnosis of chronic osteomyelitis of the lower extremities and pelvis]. / Rol kompíuternoi tomografii v kompleksnoi luchevoi diagnostike pri lechenii khronicheskogo osteomielita nizhnei konechnosti i taza.

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. The symptomatology of osseous regenerate in distraction osteosynthesis was studied (120 computed tomograms). It has been indicated that computed tomography is effective in studying the chronic osteomyelitis-inflicted extremity and pelvis in the pre- and postoperative periods.

[Treatment of extensive post-traumatic osteomyelitis of the long bones]. / Lechenie obshirnogo posttravmaticheskogo osteomielita dlinnykh kostei.

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. The large wound surfaces were closed and the defects in the tissues were repaired by various plastic operations. Free dermatoplasty was performed in 38 patients, plastics with local tissues in 39, dosed soft tissue stretching in 19, plastics with a full-thickness graft on a nutrient supplying pedicle in 19, free plastics with a complex of soft tissues by means of microsurgical techniques in 6 patients, and different variants of compression-distraction osteosynthesis for repair of the bone defects were applied in all 92 patients. The results were satisfactory and good in 98.9% of cases. In 2 cases, which were not included in the group of discussed patients, amputation of the extremity was conducted immediately after admission because gangrene had developed.

[Morphological and computer-tomographic analysis of reparative regeneration of the tibia by distraction osteosynthesis]. / Morfologicheskii i komp'iuterno-tomograficheskii analiz reparativnoi regeneratsii bol'shebertsovoi kosti pri distraktsionnom osteosinteze.

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.

[General principles of the treatment of suppurative wounds and suppurative surgical diseases]. / Obshchie printsipy lecheniia gnoinykh ran i gnoinykh khirurgicheskikhzabolevanii.

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. With its application, the terms of treatment are shortened due to most economical mechanisms of healing by first intention, and good functional and cosmetic results are produced. Such an effect is due to the pathogenetic character of all components of the method.

[Reconstructive and restorative operations in surgical treatment of suppurative diseases]. / Rekonstruktivnye i vosstanovitel'nye operatsii v gnoinoi khirurgii.

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. Defects in long tubular bones were repaired in 107 patients in the early stages by variants of compression--distraction osteosynthesis. Healing by first intention occurred in 89.8% of cases in which the wounds were closed with sutures and in 91.9% in plastics with local tissues and transposed grafts. After free skin graft plastics had to be repeated until complete healing in 11.1% of patients. The defects in bones were replaced in all cases, osteomyelitis developed at the site of pin introduction in 4% of cases.