[Complex surgical treatment of patients with necrotic soft tissue infections]. / Kompleksnoe khirurgicheskoe lechenie patsientov s nekroticheskimi infektsiyami myagkikh tkanei.

OBJECTIVE: To develop an optimal algorithm for complex treatment of patients with necrotic soft tissue infections (NSTI). MATERIAL AND METHODS: The study included 114 patients with NSTI who were treated between 2016 and 2021. We analyzed treatment outcomes in 2 groups: retrospective (n=43) with traditional approaches to purulent surgery (drainage of necrotic foci, local therapy with iodophores and water-soluble ointments, antibacterial and detoxification therapy, delayed skin grafting) and prospective (n=71) with active surgical treatment and modern algorithm based on a differentiated approach and high-tech methods (vacuum therapy, hydrosurgical treatment of wounds, early skin grafting and extracorporeal hemocorrection). RESULTS: The main group was characterized by shorter phase I of the wound process by 7.1±2.1 days, earlier relief of symptoms of systemic inflammatory response by 4.2±1.4 days, shorter hospital-stay by 7.7±2.2 days and lower mortality by 15%. CONCLUSION: Early surgery and integrated approach including active surgical strategy, early skin grafting and intensive care with extracorporeal detoxification are necessary to improve the outcomes in patients with NSTI. These measures are effective to eliminate purulent-necrotic process, reduce mortality and hospital-stay.

[New approaches in conservative treatment of acute adhesive small bowel obstruction]. / Novye podkhody v konservativnom lechenii ostroi spaechnoi tonkokishechnoi neprokhodimosti.

OBJECTIVE: To improve the outcomes of therapy of acute adhesive small bowel obstruction via development of a comprehensive management including CT, deep endoscopy-assisted nasointestinal drainage of small bowel with injection of a water-soluble contrast. MATERIAL AND METHODS: There were 128 patients with acute adhesive small bowel obstruction for the period from 2015 to 2018. The study included 2 groups of patients depending on therapeutic approach and duration of treatment. In the first group, conventional approach for acute adhesive small bowel obstruction was applied. Upon admission, all patients with confirmed acute adhesive small bowel obstruction underwent gastric intubation for decompression of the upper gastrointestinal tract. Barium sulfate injection followed by X-ray examination was performed to assess an effectiveness of therapy. In the second group, computed tomography was performed in addition to X-ray examination and ultrasound. Moreover, conservative treatment included deep endoscopy-assisted nasointestinal drainage and subsequent administration of a water-soluble contrast in addition to traditional approaches. RESULTS: Therapy was effective in 99 (71.2%) patients; 39 (28.8%) ones required surgery. Deep endoscopy-assisted nasointestinal drainage with injection of a water-soluble contrast was effective in 45 (78.9%) patients. Overall mortality in traditional approach was 1.4%, postoperative mortality - 3.7%. There were no lethal outcomes in case of a new approach. CONCLUSION: Deep endoscopy-assisted nasointestinal drainage with injection of a water-soluble contrast is the most effective therapeutic method for acute adhesive small bowel obstruction (78.9%). These findings can significantly improve treatment outcomes in these patients.