Introduction. The purpose of the description of this clinical observation was to demonstrate the clinical and instrumental picture and tactics of successful treatment of a patient with total infection of aortobedral-bifurcation vascular prosthesis.
A clinical example. The article describes a clinical case of successful treatment of a patient with total infection of aortobedral-bifurcation vascular prosthesis. After preoperative examination and preparation, the patient was operated on as planned. The removal of the aorto-femoral prosthesis, plastic surgery of the aortotomy opening with a patch from the autovena, ilio-hip prosthetics of the reversed PBV was performed. Suturing of a duodenal wall defect. Autovenous prosthetics of the ureteral area on the right.
Conclusion. The preferred principles of surgical treatment of patients with infections of total aorto-femoral bifurcation prostheses are the use of aggressive surgical treatment, complete resection of the infected prosthesis, replacement of an autologous venous shunt in situ from the superficial femoral vein, massive preoperative and postoperative antibiotic therapy.

Introduction. Conduction anesthesia under ultrasound control of nerve plexuses and peripheral nerves should be recognized as the most optimal type of anesthesia during surgeries on the upper and lower extremities. However, the effect of the used anesthesia tactics and various anesthetic aids on wound healing has not been clearly proved.
The aim – comparative analysis of inflammatory process expression and wound healing rate in patients with shrapnel wounds of the lower extremities after using different tactics of conduction anesthesia during surgical treatment.
Materials and methods of research. An observational prospective cohort study of 147 patients who underwent surgery for shrapnel wounds of the lower extremities was carried out. The patients were observed in 4 groups depending on the anesthesia tactics. Data analysis was performed using descriptive statistical methods, comparative analysis using Wilcoxon and Mann-Whitney criteria.
Treatment results. Intergroup analysis of one of the main indicators of the efficacy of the treatment, which characterizes the rate of wound healing, showed a significant difference in the group of patients who received conductive anesthesia of the sciatic nerve branches at the level of the fossa of the hamstrings according under ultrasound control during surgery (p< 0.05 by Mann-Whitney test), when compared to the groups that underwent surgery with conductive anesthesia of the sciatic nerve through gluteal access with blockade of the femoral nerve under ultrasound control, with conductive anesthesia of the femoral nerve under ultrasound control, as well as with local anesthesia, respectively.
Conclusion. The anesthetic aid developed during the study has a positive effect on tissue proliferation and regeneration after surgical treatment of shrapnel wounds of the lower extremities.

Introduction. Thermal injuries are an important medical and social problem of modern society. One of the most difficult challenges for surgery is presented to victims with borderline skin burns, since the use of incorrect algorithms for their management leads to a high incidence of complications. In this connection, the search for the main reasons for unsatisfactory results of treatment of this type of injury is an urgent task of surgery.
Purpose of the study. To determine the main reasons for unsatisfactory treatment results for victims with borderline (dermal) skin burns.
Materials and methods of research. The study is based on the results of an analysis of medical records of 509 victims with borderline skin burns. The microbiological composition of burn wounds was assessed; duration and reasons for delaying treatment; methods for managing this type of injury at the prehospital stage. The results obtained were processed using generally accepted methods of variation statistics.
Results and discussion. It has been established that in the first week after hospitalization and the start of treatment, the pathogenic microflora does not change to multidrug-resistant microorganisms. A significant number of patients were hospitalized later than 24 hours from the moment of injury - 28% of cases. The main reason for this was self-medication - 61% of observations; the remaining patients were observed in clinics and trauma centers, 14% and 26% of patients, respectively. The transfer of victims from primary care institutions to specialized hospitals was associated with inadequate tactics for managing such wounds. Wet-dry dressings with antiseptic solutions were used in more than 90% of cases, and cases of application of ointments, hydrogels and wound dressings were noted only in isolated observations.
Conclusion. Thus, the main reasons for unsatisfactory treatment results for patients with borderline skin burns include infection with multidrug-resistant strains of microorganisms, long delays in the provision of specialized medical care associated with self-medication and refusal to use pathogenetically based methods for treating such wounds in primary care medical institutions.

Introduction. Wound healing after purulent processes of soft tissues against the background of developed compartment syndrome is of scientific and practical interest, because in most cases, wounds after opening the phlegmon are wide, and bringing the edges together is technically impossible.
Purpose of the study. To improve the results of treatment of patients with phlegmon of the upper limb and compartment syndrome by using the developed method of plastic surgery at the final stage.
Materials and methods of research. The study included 134 patients undergoing treatment for phlegmon of the upper extremity (localization: shoulder, forearm) against the background of compartment syndrome, according to a developed algorithm protected by a patent of the Russian Federation, in the purulent surgery department of the State Budgetary Emergency Hospital in Rostov-on-Don, State Budgetary Institution RO "Central City Hospital" in Bataysk from 2016 to 2023. The control group included 62 patients. The patients were comparable by gender, age, and degree of the pathological process. A set of laboratory and diagnostic measures was carried out in accordance with generally accepted standards for the treatment of purulent pathology. When tissue hypertension was established (TD above 10 mm Hg), a Z-shaped fasciotomy was performed (RF Patent № 2755169). In 10 patients of series II (main group), an original plastic method was used to close the wound defect (RF patent № 2709726).
Conclusion. An integrated approach to the treatment of wounds and compartment syndrome and the use of a cutaneous subcutaneous fascial flap showed positive results. The results obtained allow us to recommend the developed complex of treatment measures, including a plastic component, in the treatment of patients with intermuscular phlegmon of the upper limb.

Introduction. To evaluate the effectiveness of the use of collagen bandage in the complex treatment of long-term non-healing skin wounds in patients after proctological operations.
Materials and methods. The study included 34 patients after minor proctological operations with uncomplicated wound defects of the perianal, coccygeal, gluteal and perineal regions. All patients received complex treatment with the use of collagen bandage, provided that there was a wound defect with an area of more than 2 cm² and a depth of more than 3 mm with a history of more than 1.5 months after the operation with no signs of active healing.
Results. Complex therapy of long-term non-healing postoperative wounds with the use of collagen bandage allows to achieve complete epithelization of chronic wounds in more than 75% of cases within 2 months. The use of collagen bandage did not reveal any cases of intolerance or complications in our study. In our study, we found no contraindications to their use, with the exception of complicated wounds. They have simplicity and ease of use according to patients and doctors.
Conclusion. Complex therapy of long-term non-healing wounds with collagen bandage is characterized by high efficiency and safety. Collagen bandage have no restrictions on use. They are convenient to use, including at home.

Introduction. Purpose of the study. To conduct a comparative analysis of the formation of biliodigestive anastomosis (BDA) and retrograde stenting with a metal stent (SMS) for malignant distal biliary obstruction (MDBO). Research methods. At the Botkin Hospital (Moscow) from 2015 to 2019. We conducted a retrospective analysis of the treatment of ADHD. The patients were divided into two groups: G1 – BDA formation was performed (n=34), G2 – retrograde stenting of the VMS (n=45). Characteristics of the groups: age G1 64,1±12,2, G2 68,4±9,9 (p=0,088); gender (m/f) G1 11/23, G2 14/31 (p=0,906); ECOG G1 2,1±0,4, G2 1,9±0,5 (p=0,052); Cancer (pancreas/choledochus): G1 25/9, G2 34/11 (p=0,838). Results. Patients G1 had a longer length of hospital stay of more than 10 days (61,3 % vs. 21,5 %, p < 0,05). The average duration of inpatient treatment in Group 1 was 18,1±3,8 days, in group 2 10,5±2,9 days (p=0,001). In G1, 41,2 % of hospital complications were detected, versus 17,8 % in G2 (p=0,026). In G1, hospital mortality was 2,9 %, versus 0 % in G2 (p=0,43). Readmission 59,4 % in G1, 42,1 % in G2 (p=0,115), start of the first chemotherapy procedure in G1 34,5±5,8 days, in G2 21,3±4,2 days, (p= 0,001). The likelihood of recurrent biliary obstruction was significantly lower in G2 (16,4 % vs. 73,1 % (p=0,001). Conclusion. Retrograde implantation of SMS is the preferred procedure for PVD. The formation of BDA should be carried out according to individual indications.

Introduction. Covid-associated endothelial damage and dysregulation hemostasis causes hypercoagulation, DIC syndrome and can lead to erosive and ulcerative damage of the mucous membrane of the stomach and duodenum. Basic therapy of patients with COVID-19 includes nonsteroidal anti-inflammatory and hormonal drugs, contributing to the destruction of the mucous membrane of the gastrointestinal tract, and anticoagulants that cause or increase bleeding. Objective. Analysis and comparison of endoscopic hemostasis from the upper gastrointestinal tract in patients with COVID-19-associated pneumonia.
Material and methods. A retrospective study of the results of treatment of 72 patients with Covid-pneumonia complicated by erosive and ulcerative gastroduodenal bleeding was performed. There were 2 groups: I – 45 patients (62,5 %) who underwent two-stage hemostasis. II – 27 patients (37,5 %) who underwent three-stage hemostasis.
Results. Recurrence of bleeding was recorded only in group I in 3 patients (6,65 %) with Forrest 1B. All these patients underwent a second three-stage hemostasis.
Conclusion. Three-stage endoscopic hemostasis, including submucosal infiltration of the bleeding vessel area with epinephrine solution, argonoplasmic coagulation of the vessel and application of fibrin-based glue, in most cases prevents recurrence of bleeding. The study requires more observations.

Introduction. Bulimia Nervosa – (BN) is a kind of eating disorders which is characterized by systematic compulsive overeating. In order to prevent development of obesity patients with BN use “purging” steps mostly by mean of self-caused vomiting. 'Purging' behavior has negative impact on both health status and quality of life. Since conservative treatment of BN is usually low-effective the efficacy of metabolic surgery is being studied by us since 2006.
Material and methods. Results of Laparoscopic Sleeve Gastrectomy (LSG) in 10 normally -weighted patients with BN (BMI was less than 25 kg/m2 to the moment of operation) aged 22-41 years are presented. The main purposes of LSG were cessation of “purging” behavior together with maintaining of weight within normal levels.
Results. All patients were achieved complete cessations of purging behavior just immediately after operation. Weight loss did not exceed low-normal levels. Normalization of eating behavior did not accompany with development of obesity. Positive emotional changes together with improvement of quality of life were observed. There were nor postoperative complications no deaths. To the 9-month of follow-up period only one of ten patients has returned to a purging behavior.
Conclusions. LSG due to new-created anatomical changes of the stomach brings opportunities for cessation of “purging” behavior in normally-weighted patients with BN. BN can be considered as a latent form of obesity and metabolic surgery- as an effective method of prevention of its development. Surgery of eating disorders can be considered as a new chapter of metabolic surgery when it is used in the non-obese patients with NB. In the absence of other psychiatric disorders NB should not be considered as a contraindication to LSG.

Introduction. The available literature lacks information on the advantages of different knotless tissue fixation devices for the laparoscopic intracorporeal gastroenterostomy, making their informed choice difficult.
The purpose of the study. To evaluate the short-term clinical outcomes of the monofilament barbed sutures with a helical and an oppositional barbes design in the single anastomosis formation during laparoscopic mini-gastric bypass (LMGB).
Material and methods. Knotless tissue fixation devices were used for manual intracorporeal formation of gastrojejunal anastomosis during LMGB in 80 patients: with a helical barbes design – in the first group (38 patients) and with an oppositional – in the second group (42 patients). No significant differences were detected in the baseline demographic characteristics, body mass index, comorbidity and the frequency of previous abdominal surgeries between groups.
Results. There were no differences in total intraabdominal operation time and the duration of the gastrojejunal anastomosis formation in the clinical groups. Gastrojejunostomy using knotless tissue fixation devices, on average, took up to 24,4% of the operation time. Intraoperatively, only incidents of severity grade 1 (Satava-Kazaryan classification) were recorded with a frequency of 5,3–7,1 % (р=0,999). Postoperatively, minor complications (severity grade 1 of the Clavien-Dindo-Strasberg system) were recorded in 7,9 % and 11,9 % of patients in the first and second clinical groups, respectively (p=0,715).
Conclusion. This study revealed no significant differences between short-term clinical outcomes of the monofilament barbed sutures with a helical and an oppositional barbes design in the gastroenteric anastomosis manual formation during LMGB.

Introduction. Providing surgical care to the wounded with extensive soft tissue defects of gunshot and mine-explosive etiology remains an urgent problem of modern combat trauma surgery. There is no clear algorithm for choosing one or another method of treatment and, in the future, closing the wound defect. Using a clinical example, the authors present a variant of providing surgical care to a wounded person with an extensive defect in the soft tissues of the anterior abdominal wall using a negative pressure system.
Description of the clinical case. A clinical observation of the treatment of combat trauma due to combined injury by foreign objects (metal fragments) of the abdomen, pelvis, lower extremities with damage to the abdominal organs, extensive defect of the soft tissues of the anterior abdominal wall, gunshot multi-splintered fracture of the right ilium, through wound of the scrotum and penis, wound of the soft tissues of the left shin is considered.

Introduction. At the beginning of the XXI century and, especially, in the last decade, interest in lipofilling has increased enormously, the scope of application of this method has expanded. The aim of the study was to conduct a systematic review of the literature with a view to summarizing information concerning the effectiveness of the use of lipofilling.
Results. The literature sources of foreign and domestic authors devoted to the generalization of the world experience of sampling and introduction of autologous adipose tissue are analyzed. Despite the sufficient experience of using this technique, there is a sufficient number of unsolved problems. The solution of these problems is possible when defining a standardized protocol for planning lipofilling, optimizing the technique of processing and administration of fat autograft.
Conclusion. The analysis of the literature data demonstrated that this area of surgery is effective and in demand and requires further research and development of new modern advanced surgical methods of treatment.

Introduction. To date, despite advances in conservative therapy, the only method of treating end-stage lung disease is lung transplantation, which improves the quality and increases the patient's life expectancy. The number of lung transplants is steadily increasing in the world, however, the availability of donor organs is limited, which leads to a high mortality rate of patients on the waiting list. In this regard, there is a constant discussion about donors with expanded criteria, work is underway to improve the preservation of donor lungs, new solutions are being sought for the preservation of the transplant before surgery and the cultivation of bioengineered organs. Along with this, recent advances in post-transplant therapy aimed at combating early and late rejection, graft dysfunction, as well as prevention of infectious complications, contribute to an increase in survival in this category of patients.
The purpose of the study. To study the state of the issue and prospects of lung transplantation.
Materials and methods of research. A review of literary sources among domestic and English-language publications is carried out. Pubmed, Web of Science, RSCI databases were used.
Conclusion. To date, lung transplantation is the only effective treatment method for patients with terminal lung disease. In recent years, there has been a big leap in the field of lung transplantation, clinical experience and post-transplant management of patients are increasing, more and more patients are surviving with transplants that were considered unsuitable several decades ago. Despite the big leap in the field of transplantation, the main problem of the development of lung transplantation is the limited availability of donor organs. To solve the problem of the shortage of donor organs, new technologies (EVLP, bioengineered lungs) are being introduced and criteria for the use of donor organs after circulatory arrest are being expanded.

Introduction. The article presents the literature data on the etiology, pathogenesis, diagnosis and modern methods of surgical treatment of chronic hemorrhoids, including the use of minimally invasive methods.
Materials and methods. The development of technologies used in the surgery of hemorrhoidal disease and the desire of patients to improve the quality of life in the postoperative period, as well as the widespread use of minimally invasive technologies in outpatient treatment of proctological diseases has influenced the emergence of a large number of new and modified techniques. Minimally invasive methods are inferior in efficiency to newer methods, such as dearterization of hemorrhoids with mucoperkia and laser submucosal destruction of cavernous bodies of the lower ampullary rectum. The use of modern technologies in doppler-controlled desarterization of hemorrhoids and mucopexy, as well as laser subcutaneous submucosal destruction of hemorrhoids can significantly reduce pain and the risks of complications in the postoperative period. Various variations of laser operations for hemorrhoids, as the most modern method of treating hemorrhoidal disease, also ensure the preservation of a high level of quality of life of patients after interventions. Modern laser devices and their modifications have formed several ways of performing laser operations that are not inferior to each other in efficiency and the number of complications, however, a comparative characteristic of these methods has not been carried out.
Discussion. The problem of choosing a surgical method for the treatment of hemorrhoids is currently quite acute. There is no standardized method for each clinical stage of hemorrhoids, the choice of technique remains at the discretion of the operating surgeon-coloproctologist.
Conclusion. Due to the rapid development of minimally invasive methods of hemorrhoid treatment, the effectiveness of new methods of surgical treatment of hemorrhoids and their combinations and delayed treatment results in some variations are not inferior to classical methods of performing operations.

Introduction. Currently, the use of the method of vacuum therapy of wounds of various etiologies and localization is becoming more and more popular. Many studies have been conducted proving the positive effect of this method on the course of the wound process, but it has not acquired the status of the method of choice/standard in surgical practice.
The purpose of the study. To analyze the contradictory results of wound therapy with local negative pressure in comparison with traditional care.
Materials and methods of research. The databases were searched for randomized controlled trials and reviews comparing postoperative treatment of purulent wounds with standard methods and negative pressure for the period 1993-2021. In the course of the analysis, a number of research methods were applied: historical, descriptive-analytical, Internet and content analysis. The results of the study. Currently, the VAC device is used as a universal tool in the arsenal of wound healing, in addition, they act as an additional resource in patients with a comorbid background. This method of treatment is applicable on anatomically complex wound surfaces, which distinguishes it from others. The use of vac therapy is associated with the occurrence of a number of complications, but the frequency of their occurrence is very insignificant, which makes it safe to consider it.
Conclusion. Vac therapy is a promising and effective method of treating wounds of various etiologies, course and localization, favorably differing from other methods with a low incidence of complications, high efficiency, the possibility of application in anatomically complex areas and a reduction in the cost of therapy.