Ambulatornaya khirurgiya = Ambulatory Surgery (Russia)
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The Formation and Development of Alexander Nikolayevich Bakulev at Saratov University (Marking the 135th Anniversary of His Birth)
The article provides bibliographical details concerning the professional formation and development of Alexander Nikolayevich Bakulev as a surgeon and scientist at Saratov University. This took place in the Department of Hospital Surgery within the Faculty of Medicine under the mentorship of Sergei Ivanovich Spasokukotsky.
Binding nature of clinical guidelines: deliberate ambiguity, law application illusion, lawyer speculations, law enforcement threats
Comparative effectiveness of endovenous laser coagulation techniques in preventing recurrences of varicose vein disease in the lower extremities
Introduction. In recent years, endovenous laser coagulation (EVLC) has become the primary method for treating varicose vein disease of the lower extremities. However, the long-term clinical outcomes of EVLC are similar to those of classical surgical interventions, while the anatomical causes of recurrence identified through duplex scanning differ. Aim. To compare the recurrence rates of varicose vein disease after isolated EVLC of the great saphenous vein (GSV) and a combined procedure that includes the anterior accessory vein (AASV) in the long-term postoperative period. Materials and methods. A comparative study was conducted involving 162 individuals with varicose veins in the legs. All participants underwent EVLC of the GSV. The patients were divided into two groups: Group I consisted of 81 individuals who underwent isolated EVLC of the GSV; Group II included 81 individuals who underwent combined EVLC of the GSV and AASV. Results. Early postoperative complications revealed no statistically significant differences between the groups. According to the results of follow-up ultrasound duplex scanning performed three years after the surgery in Group I (EVLC of GSV), the reflux rate in the thigh area was statistically significantly higher at 15 (18.5%) compared to Group II 1 (1.2%) (EVLC of GSV + AA SV). This difference was statistically significant (p < 0.05). Discussion. The studies show that preventive EVLC of the AASV significantly reduces the recurrence rates of varicose vein disease by 25%. Conclusions. Obliteration of the AASV, regardless of the presence of reflux and their size, is a justified strategy for reducing the number of recurrences in the long-term postoperative period.
Percutaneous laser coagulation: Clinical experience in using Magic Super Full laser system
In this paper, the authors illustrate potential options of the Magic Super Full multifunctional laser system using clinical case reports as an example. This system was designed to correct intradermal vascular anomalies of different localizations and to address a wide range of aesthetic defects. The timeliness of this topic is caused by both medical and economic considerations. The number of patients presenting with complaints of superficial vascular defects that cause aesthetic discomfort is increasing, while the availability of their efficient correction options using advanced laser technologies is limited. Furthermore, until recently, aesthetic laser medicine was dominated by expensive European and American systems with high operating costs and expensive consumables, which also was a limiting factor for this procedure. It is now recognized that the long pulse 1064-nm neodymium-doped yttrium aluminum garnet (Nd:YAG) laser systems demonstrate the best results in the correction of superficial vascular anomalies. This wavelength provides high selectivity for hemoglobin and its derivatives, due to which Nd:YAG lasers came under a denomination “vascular lasers”. In this article, we examine the general principles of using long pulse Nd:YAG lasers in aesthetic angiology and evaluate the efficacy and safety of domestic Magic Super Full multifunctional system using specific examples.
Phlebotropic therapy for early chronic venous diseases: The first clinical experience with a fixed-dose Ruscus aculeatus extract combination
Introduction. Reticular vein (RV) dilation and telangiectasia (TAE) in the pure form occur in 26% of patients with chronic venous diseases (CVD), mainly affecting female gender. Aim. To evaluate the efficacy and safety of the novel phlebotropic drug Cyclo 3® Fort (a fixed-dose combination of Ruscus aculeatus extract, hesperidin methyl chalcone, and ascorbic acid) for the elimination of vein-specific symptoms in patients with initial presentations of venous pathology (CEAP C0S and C1S) in the summer months. Materials and methods. An open-label observational study was conducted in the period from May to September 2025. One hundred thirty women aged 18 to 45 years (mean age 32.2 ± 3.1 years) were randomly selected. Seventy female patients (53.8%) had venospecific complaints and no external or ultrasound imaging findings of vein injuries, while 60 (46.2%) had dilated reticular veins (RV) and transient ischemic attacks (TIA) in both lower limbs. The patients were divided into two groups of 65 patients each (35 with C0S and 30 with C1S). Group 1 received Cyclo 3® Fort, while Group 2 received lifestyle modification recommendations, including the use of percutaneous phlebological drugs. The total observation period was 90 days. Results. In Group 1, a third of patients did not exhibit any identifiable signs of the disease, which was excluded from the CEAP classification, while 25 (83.3%) women with class C1S transitioned to CEAP clinical class C1. In Group 2, disease transition from class C0S to C0A was observed in 15 patients (42.9%), and from C1S to C1A in 8 patients (26.7%). Photoplethysmography (PPG) results showed that in Group 1 the venous refilling time increased from (22.4 ± 2.4) seconds to (26.3 ± 1.2) seconds, and the calf muscle-venous pump performance increased from (3.9 ± 1.4) % to (6.4 ± 1.1) % (p < 0.001). In Group 2, PPG findings showed no significant changes. Conclusion. The study demonstrated the safety and efficacy of Cyclo 3® Fort in reducing vein-specific symptoms at the initial stages of CVD and improving the elastic rebound properties of the venous wall.
Surgical treatment of high-risk varicose veins in patients with systemic collagenopathy: Vascular type of Ehlers–Danlos syndrome
Varicose vein disease of the lower extremities in patients with the vascular type of Ehlers–Danlos syndrome (EDS) is associated with a high risk of vascular rupture and postoperative complications. Therefore, an individualized approach to diagnosis, treatment, and postoperative management is essential for patients with varicose veins and vascular-type EDS. An analysis of two clinical cases of patients with confirmed vascular-type EDS was conducted. Diagnosis included clinical examination, genetic testing, duplex vein scanning, CT angiography, and coagulation tests. Minimally invasive treatment methods were applied. A 46-year-old female patient underwent miniphlebectomy without complications, with restored venous outflow. The surgery was successful, with a decrease in the symptoms of chronic venous insufficiency. The second case concerned a 21-year-old patient with a history of recurrent episodes of deep vein thrombosis, as well as nosebleeds and hematomas with minimal trauma. Given the high risk of complications during invasive intervention, as well as the results of genetic analysis confirming the vascular type of EDS, it was decided to refuse surgical treatment. The patient received complex conservative therapy. Surgical treatment for vascular-type EDS should be as minimally invasive as possible. Genetic testing is necessary in cases of early varicose vein development. Individualized anesthesia selection and continuous monitoring are crucial due to the high risk of vascular complications.
Chronic venous diseases in obese patients: treatment and prevention strategies
This review presents an analysis of publications on chronic venous diseases in patients with obesity (body mass index ≥ 30.0 kg/m2). The data were searched in the Pubmed and Cochrane database. Studies have shown that obesity is a significant risk factor not only for the onset of chronic venous disorders but also for the occurrence of complications and relapses after minimally invasive treatments. In this context, bariatric surgery is gaining popularity, as weight reduction has been shown to correlate with improvements in the clinical severity of chronic venous disease. There is growing interest in pharmacotherapy for this category of comorbid patients. The complex effect combination of bioflavonoids hesperidin and diosmin leads to reduction in venous symptoms. Hesperidin has been proven to have anti-inflammatory, angioprotective, andlipid-lowering properties. It can prevent weight gain and reduce the severity of visceral obesity. Phlebotropic therapy with Venarus® at a daily dose of 1000 mg (100 mg of hesperidin and 900 mg of diosmin) has demonstrated potential for effective use not only in conservative management of chronic venous diseases in patients with overweight and obesity, but also in comprehensive treatment protocols before and after bariatric surgery. Fixed dosages of the two components of the drug Venarus® contribute to a stable therapeutic effect. We present a clinical case report to illustrate the impact of bariatric surgeries on the course of chronic venous disease in the immediate postoperative period: patient M., 42 years old, weight 127 kg, BMI 49 kg/m2, CEAP 4b chronic venous disease, who underwent laparoscopic longitudinal gastric resection. In the postoperative period, the patient received pharmacotherapy with Venarus® at a dose of 1000 mg once a day for 3 months, and was recommended to use class 2 compression stockings.
Prevention of postoperative venous thrombosis in patients with low risk of venous thromboembolic complications
Introduction. Venous thromboembolic complications after elective surgical interventions are still an urgent problem, especially in low-risk patients. They require special research and analysis, which is the purpose of this work. Aim. To study and evaluate the possibilities of a personalized approach to the prevention of acute venous thrombosis during elective surgery in patients at low risk of venous thromboembolic complications. Materials and methods. 80 patients with common surgical pathology (chronic calculous cholecystitis, external abdominal hernias and varicose veins of the lower extremities) and identified as low-risk were divided into two groups. In accordance with current clinical recommendations, mechanical prophylaxis measures were used to prevent postoperative VTE in group 1 patients. In patients of group 2, taking into account the revealed hypercoagulation based on the thrombodynamics test, pharmacoprophylaxis using anticoagulants was added to the measures of mechanical prophylaxis. The plasma parameters of the hemostasis system were evaluated both before the planned surgical intervention and in the postoperative period on days 1–3, 7–9, 14–16 and 30. Ultrasound examination was performed to assess the condition of the venous system of the lower extremities and pelvis. Results. It was revealed that in the preoperative period, according to the thrombodynamics test, 23.8% of patients showed initial hypercoagulation. In the postoperative period, the number of hypercoagulation cases increased to 31.3% due to group 1 patients who underwent only mechanical prophylaxis of VTE in the perioperative period. Deep vein thrombosis in the postoperative period was detected in 15% of patients and in all cases they developed in the presence of preoperative hypercoagulation. Conclusions. The high informative value of the thrombodynamics test in the prediction and diagnosis of VTE during elective surgical interventions is shown.
Lymph outflow and dynamics of trophic changes in the lower extremities on the background of long-term use of a phlebotropic drug
Introduction. The mechanisms of the positive effect of phlebotonics on trophic changes and edema have not been fully studied. Aim. To evaluate the lymph outflow and dynamics of trophic changes in the lower extremities on the background of long-term use of phlebotonics Materials and methods. An open, direct, non-randomized study involved 62 patients with varicose veins of the lower extremities C4 according to CEAR. The patients were divided into 2 groups: the main group (n = 31) was treated with a phlebotropic drug of purified micronized flavonoid fraction (diosmin + flavonoids in terms of hesperidin) (MOFF) 1000 mg/ day for 1 year in combination with daily use of a combined action gel (sodium heparin, essential phospholipids, escin) in the morning and evening for 15 days (in courses with a break of 1 week for 3 months) on the inner surface of the thigh and lower leg in the projection of the large saphenous vein, as well as wearing second-class compression knitwear throughout the entire treatment period; The control group (n = 31) consisted of patients who underwent volume surgery using radiofrequency ablation (RF) of the large subcutaneous vein, followed by wearing second-class compression knitwear (2 months) and taking troxevazine 300 mg 2 times daily for 2 months. Patients underwent lymphography after 3, 6, 9, and 12 months. The area of trophic changes was determined using the “Analyzer” application. Results. The rate of reduction of lower leg circumference in the study groups was comparable. However, from the 9th month of the study, there was a statistically significant difference between the groups in the area of hyperpigmentation, which became significantly smaller in the control group (p < 0.05). After 6 months of using the phlebotropic drug, the predominance of the area of contrasted lymphatic vessels in the main group was determined (p < 0.05). Conclusion. The drug MPFF can be considered the drug of choice in the treatment of venous and lymphatic insufficiency. According to the results of the study, its effectiveness is not inferior to the RF of the large subcutaneous vein.
Local treatment of ecchymosis after combined percutaneous laser coagulation and sclerotherapy
Introduction. The combined technique of percutaneous laser photocoagulation and sclerotherapy is widely used due to its high effectiveness in eliminating telangiectasias and reticular veins. However, this technique can be accompanied by the formation of ecchymoses of varying sizes, which reduces patient comfort and satisfaction with the treatment. Aim. To evaluate the effectiveness of a topical combined phlebotropic gel as post-procedural therapy for ecchymoses following combined sclerotherapy with transcutaneous laser coagulation of reticular veins and telangiectasias on the lower limbs. Materials and methods. A pilot paired controlled study was conducted including 11 female patients aged 29 to 55 years (mean age 42.0 ± 9.8 years). Following combined sclerotherapy and transcutaneous laser coagulation, Detragel® was applied to one lower limb for 14 days, while the contralateral limb served as the control. The area of ecchymoses was assessed on days 3 and 17 after the procedure. Results. By day 17, the area of ecchymosis in the topical combined phlebotropic gel group decreased from 59.1 ± 11.4 to 12.8 ± 5.4 cm², while in the control group it decreased from 61.1 ± 8.6 cm² to 31.4 ± 7.0 cm² (p < 0.001). Patient satisfaction with Detragel® treatment averaged 4.9 points, and physician satisfaction 4.2 points. Conclusions. The use of a topical combined phlebotropic gel containing sodium heparin, essential phospholipids, and escin significantly reduces post-procedural ecchymosis area and enhances patient satisfaction with the treatment results.
Antiendotoxin immunity and neutrophil activity in purulent-necrotic inflammation of the feet against the background of diabetes
Introduction. As diabetes progresses, systemic vascular damage occurs, followed by the possible formation of diabetic foot syndrome and a high risk of developing ulcers and gangrene. Aim. To study and evaluate the contribution of monitoring of functional-metabolic activity of neutrophils and antiendotoxin immunity parameters in purulent-necrotic feet inflammation with underlying diabetes. Materials and methods. The study included 157 patients (67.1 ± 14.2 years) with purulent-necrotic inflammation of the feet, including 72 with transmetadarsal amputation of the foot and amputation at the level of the lower leg (main group) and 85 with necrectomy and plastic closure of wounds on the foot (comparison group). The reactivity of neutrophils was determined by the reaction of spontaneous (sLZHL) and induced (iLZHL) luminol-dependent chemiluminescence reaction. Indicators of antiendotoxin immunity were recorded in all patients using enzyme immunoassay. Glycolipid (GLP), a structural unit of endotoxin (Re-mutant Salmonella Minnesota), was used as an antigen. Results and discussion. With the progressive course of purulent-necrotic inflammation of the feet, the indicators of sLPHL of neutrophilic granulocytes (NG) increased sharply (1775.5 ± 7.133 imp/min). Depression in the generation of reactive oxygen species was recorded according to the level of iLHL (68.4 ± 9.61 pulses/min), a deficiency in the concentration of antibodies to GLP (5.02 ± 0.29 μg/ml) and significantly differed from the results of patients in the comparison group (1266, respectively, 5 ± 5.897, 87.15 ± 16.2 imp/min and 6.21 ± 0.11 µg/ml). A direct correlation was established between the biocidal parameters of NG and the concentration of high-strength antibodies to GLP (r + 0.62, p < 0.001) in patients with a widespread purulent-necrotic process on the foot. Conclusions. The results allow to consolidate the severity of the purulent-inflammatory process of the feet in patients with diabetes with markers of neutrophil metabolism and the level of antiendotoxin protection. The nature of destructive changes is closely related to the reactivity of NG, the severity of their endogenous activation and depression of the antimicrobial reserve.
Preclinical trials of remote noninvasive electromagnetic therapy of purulent wounds on experimental animals
Introduction. The development of new methods for the treatment of purulent wounds of various etiologies in surgical practice is an urgent task. Aim. Тo study the effect of noninvasive electromagnetic therapy on the healing process of purulent wounds in rabbits. Materials and methods. The experiment was conducted on the 14 mongrel rabbits. After modeling purulent skin wounds, rabbits were divided into 2 equal groups on day 5. The control group of animals underwent only local wound treatment with saline solution, the experimental group – this manipulation was combined with electromagnetic therapy. The duration of the experiment was 17 days, and the follow-up was 30 days. Clinical monitoring of the animals’ condition was carried out, clinical blood analysis was monitored, and wound discharge was seeded. Wound healing was assessed using the planimetric method. Biometric values were determined in the statistical analysis of the results, and the R.B. Strelkov table was used. Results and discussion. By day 9 of the experiment, normothermia was noted in the animals in the experimental group, while hyperthermia persisted in 14.3% of the rabbits in the control group. On day 7, in 57.14% of the animals in the control group, the wound decreased by 1.0 cm, and in the experimental group, a decrease from 0.5 to 1.0 cm was detected in 71.42%. On day 14, in the experimental group, in contrast to the control group, no microflora was detected in the wound. On day 5, leukocytosis exceeded the norm by 3.0% in the control group and by 67.7% in the experimental group. In the experimental group, thrombocytosis was observed throughout the experiment, which exceeded the initial values by 70.78% by the end of the experiment. Conclusions. The use of noninvasive electromagnetic therapy in the treatment of purulent wounds in rabbits accelerates their healing processes.
The use of collagen materials and growth factors in diabetic foot syndrome
Introduction. There is an increase in the number of patients with diabetic foot syndrome who have long-term non-healing wounds on the lower extremities. Serious complications of diabetes mellitus, such as diabetic polyneuropathy, angiopathy, and osteoarthropathy, aggravate the local process and contribute to the faster development of wound cachexia and disruption of repair and proliferation processes during wound healing. Аim of the study was to evaluate the effectiveness of using synthetic collagen structures in combination with autologous growth factors to close wound defects as an alternative to autodermoplasty using a free split flap. To conduct a study of the effectiveness of the combined use of modern interactive dressings and bioplastic agents in the complex treatment of patients with diabetic foot syndrome, to improve the quality of local therapy for skin and tissue defects, to increase the effectiveness of surgical interventions at different stages of treatment. Materials and methods. In an observational study involved 62 patients (average age 52.1 years) with trophic defects on the lower extremities with an area of 34.2 cm2 . A three-stage treatment method has been developed: necrectomy, organ-preserving surgery, plastic wound closure using bioplastic material (90% hyaluronic acid, 10% collagen) followed by the introduction of autologous growth factors. Results. The study demonstrated the onset of marginal epithelialization of the wound defect on an average of 8.2 ± 1.9 days after the start of treatment. Granulation of wounds was observed without inflammatory reactions or signs of rejection of plastic material. Regenerative processes continued due to the formation of their own granulation tissues. Conclusions. Bioplastic material has shown high efficacy in the treatment of diabetic foot syndrome. The patients showed a significant reduction in the size of wounds and pain. The inflammatory response decreased, and tissue repair intensified. In 64% of cases, the technique prevented complications and accelerated the regeneration of surrounding tissues.
Treatment of trophic ulcers of the lower extremities of diabetic etiology depending on the stage of pathogenesis
Trophic ulcers of the lower extremities (TENS) are an urgent problem in medical practice due to their high prevalence. Every year 0.6–0.8% of patients suffering from diabetes mellitus (DM) undergo lower limb amputation at various levels. Despite the emergence of high-tech methods of examination, improvement of surgical and therapeutic methods of treatment, in some patients it is not possible to achieve the expected healing of TENS or the effect is unstable. The aim of the study is to analyze theliterature and present the main and complementary treatment modalities for TENS used today. Literature indexed in eLIBRARY, Web of Science, Web of Knowledge, Medline, ScienceDirect, CINAHL, Embase, PsycINFO databases from 2004 to 2024 was analyzed. The main methods used in the exudation (inflammation) phase include primary wound care, dressings, proteolytic enzyme therapy and negative pressure therapy; in the proliferation (repair) phase: negative pressure therapy and growth factor preparations; in the remodeling (epithelialization) phase: oxygen therapy, collagen-based preparations, reparants and hyaluronic acid-based regerants. General treatment methods include adequate antibiotic therapy, glycemic control and unloading of the affected area. Chronic wounds affect millions of people around the world, posing serious problems for health systems and placing a heavy economic burden on the world. The main task of treatment of diabetic foot is complex therapy, including on all links of the pathological process. The effectiveness of healing of TENS depends largely on the adequacy oflocal treatment, taking into account the stage of the process and based on objective criteria of timely correction.
Periarterial sympathectomy in patients with systemic scleroderma, Raynaud’s syndrome and purulent complications
Introduction. In the aspect of surgical treatment of purulent complications of soft tissues of the extremities in systemic connective tissue diseases accompanied by Raynaud’s syndrome with purulent complications, the issue of tissue trophic restoration is relevant. Aim. To evaluate the effectiveness of periarterial sympathectomy on the regeneration process of chronic infected wounds in patients with systemic sclerosis. Materials and methods. A prospective, open, non-randomized study in the purulent surgery department of the Republican Clinical Hospital involved 30 patients with hand phlegmon of various localizations on the background of systemic scleroderma with lesions of the hands and forearms. On the 7th day after opening the abscess, local treatment and visual cleansing of the wound with the formation of young granulation tissue in the edges and bottom of the wound, and removal of drains, the patients were divided into 2 groups. The main group (n = 15) included patients who underwent periarterial sympathectomy at the level of the brachial artery with daily local treatment. The control group (n = 15) included patients who received only topical treatment (iodopyron or levomycetin ointment). All patients were women receiving prednisone in a maintenance dosage of 25.5 ± 9.5 mg orally. Results. The rate of maturation of granulation tissue and the rate of epithelialization were statistically significantly higher in the main group (p < 0.05). By the 11th day after sympathectomy, all patients in the main group showed healing of infected wounds by secondary tension, which in the control group was observed only in 13.3% of cases. When assessing the microbial landscape of wounds at the time of discharge from the hospital, the absence of pathogenic flora in the main group is noted, which distinguishes it from the control group. Conclusions. Periarterial sympathectomy performed at the stage of epithelialization of infected wounds with hand phlegmon in patients with systemic scleroderma with Raynaud’s syndrome leads to an acceleration of their regeneration processes and a decrease in bacterial contamination.
Hemorrhoids during pregnancy: Status update on the problem
Hemorrhoids are the most common reason for patients to visit a proctologist, accounting for 34–41% of all colon diseases. Patients with hemorrhoids during pregnancy form a specific group of patients. Currently, there are no specific guidelines for the treatment of hemorrhoids in pregnant women. Due to the introduction of new drugs and methods of treating hemorrhoids, in order to observe the current state of the problem, an analysis of publications on the topic of “hemorrhoids during pregnancy” over the past 10 years, which are in the public domain on the PubMed platform, was conducted. The search for publications was carried out using the keywords “hemorrhoids in pregnant women”. 18 works were devoted to the problem of hemorrhoids in pregnant women on the PubMed resource from 2014 to 2024. Having analyzed the literature data for the period, absence of clear guidlines for the treatment of hemorrhoids in pregnant women can be noted. Most publications note the prevalence of conservative treatment methods. At the same time, researchers evaluate the effectiveness of the conservative treatment methods used differently. Most authors note the normalization of stool with the elimination of constipation as an important pathogenetic moment. Surgical treatment is used less often. At the same time, a positive effect from it is noted. In conclusion summing up the data, we can admit that clinically significant hemorrhoids in pregnant women are widespread. However, there are no clear algorithms and guidelines for treatment. The literature data presented are often contradictory, due to the small sample, cannot be fully extrapolated to the population.
Local therapy in the treatment of acute superficial vein thrombosis
According to international and Russian guidelines, superficial vein thrombosis treatment should be comprehensive and include systemic drug therapy (i.e. anticoagulant therapy), elastic compression and topical preparations. At the same time, local preparations can be self-administered, if the length of blocked portion of the vein is short and a risk of clot breaking off and travelling to the deep veins is low. The effectiveness of topical preparations has been proven to depend, among other things, on the dosage forms, and gels are characterized by more effective transdermal delivery as compared to ointments. Also, the efficacy of the active substance is affected not only by its initial concentration in the drug, but also by the extent to which the concentration is maintained after penetration into the dermis and hypodermis. The current local therapy for superficial vein thrombosis includes heparin gels and nonsteroidal anti-inflammatory drugs, as well as local cooling. The local drug therapy has an anti-inflammatory and analgesic action, and hypothermia enhances analgetic effects. Reduction in the severity of inflammatory process improves the patients' quality of life and increases their commitment to other complex treatments.
Allohernioplasty with the introduction of platelet-rich plasma (PRP) in a chronic experiment: features of the reparative process
Introduction. Mesh has become the standard for herniorrhaphy – it helps to reduce recurrence and the development of side effects. The regulation of immunocompetent cells migration determines the therapeutic strategy to modulate the inflammatory response. Aim. To conduct a clinical and morphological analysis of the effect of platelet-rich plasma (PRP) on the course of reparative process in allogernioplasty. Materials and methods. 47 Wistar rats were divided into 3 groups: with PRP in optimal dosage (n = 15), maximum dosage (n = 15), without PRP (n = 15), two rats were used for terminal blood sampling for PRP manufacturing. All animals were operated on, creating an aponeurosis defect that was closed with a mesh implant followed by PRP application. The severity of postoperative pain syndrome was assessed using the developed by us summary scale of physiological status, behavioral reactions, and facial expressions; the state of the postoperative scar, the terms of postoperative wound hair loss were evaluated. Material for morphologic evaluation was taken on days 7, 14, 21, 28, 60. Results and discussion. The positive effects of PRP were morphologically confirmed. The biopsy specimens after PRP revealed: absence of rough fibrosis, more abundant vascularization, early formation of a “delicate” scar and lymphatic collectors in the peri-implant zone, absence or minimal expression of degenerative changes of nerve trunks. There is a reduction of the alteration phase and acceleration of repair processes. In animals of group PRP overdose in the postoperative period a pronounced destructive-inflammatory reaction with microbial contamination prevailed, up to the formation of chronic abscesses. We attribute these changes to excessive recruitment of neutrophils and macrophages secreting proteases and proinflammatory cytokines. Conclusion. The use of PRP in the optimal dosage allows to improve the integration of the mesh implant during allogerniopalasty, prevents rough fibrosis, deformation and shriveling of the implant; reduces the probability of chronic pain syndrome development.
New classification of intestinal stomas and complications OLID (Occasio, Locus, Inpedimenta, Date)
Introduction. Currently, there is a constant increase in the number of patients who have undergone intestinal stoma surgery due to various diseases, developmental abnormalities or intestinal injuries. At the same time, there is no unified classification of intestinal stomas and their complications, and difficulties arise in making a uniform diagnosis, standardizing documentation, choosing treatment tactics, and continuity between outpatient and inpatient care is not ensured. Aim. To develop and propose a unified classification of intestinal stomas and parastomal complications to standardize and improve the ability to compare different studies and their results. To make this classification useful, we decided that abstract and understandable abbreviations in the common medical language – Latin – should be used. Materials and methods. Based on a literature review and critical assessment of existing classifications, they were revised in terms of the number of different sections, relevance, accuracy and simplicity. Outpatient and inpatient physicians must fill out data sets in a uniform manner, which is simplified by modern medical computer programs. The classification uses abstract and understandable abbreviations in the generally accepted medical language – Latin. Results. The classification is designed for use in clinical and scientific practice, with the aim of improving surgical planning (choice of treatment method, time and method of surgery) and patient care. The proposed classification consists of 4 sections. All patients must initially be considered for reconstructive and restorative operations to close the intestinal stoma. This is section I (Occasio). In Section II, it is necessary to indicate the section of the intestine that is the stoma (Locus). In Section III, we suggest indicating complications of the formed intestinal stoma and peristomal skin complications (Inpedimenta). And in the last IV subsection, we suggest indicating the date (Date) of the formation of the intestinal stoma. Conclusion. The OLID classification of intestinal stomas and complications can provide sufficient information to establish registries and can be used to compare studies on their treatment and its results. Due to its simplicity and clarity, it will help surgeons formulate an accurate description of the pathology. The proposed classification should be tested and validated in clinical practice. The testing process may provide new information that will allow us to consider future modifications of the classifications.
Experimental study of the effectiveness of cutting out a skin-fat flap under the control of luminescent spectroscopy
Introduction. Currently, improvement of skin flap cutting techniques is relevant in various fields of surgery. Aim. To evaluate the effectiveness of cutting out a skin flap under the control ofluminescent spectroscopy in an experiment. Materials and methods. A prospective, non-randomized, direct study was conducted on 17 mongrel rabbits at the experimental vivarium of Kabardino-Balkarian University from March to April 2025. The first step was to separate the skin on the abdomen with alength of 12 cm. After its exposure, a total biopsy was performed, histological preparations with further morphometry were made. The obtained values were compared with theluminescence intensity. In the second stage, 14 mongrel rabbits were operated on, divided into equal groups. In the 1st group, after peeling off the flap, it was fixed to its original place without shortening, in the 2nd group, the cut flap was shortened under luminescent control. The duration of the experiment was 21 days. The clinical andlaboratory dynamics, the number and area of purulent complications were evaluated. The SPSS 17.0 software was used for statistical data processing. Results. With a signal amplitude of 0.95 ± 0.15 × 105 photons, the micro-preparations showed a minimal area of necrosis. In the control group, wound suppuration was noted in 5 animals (area – 4.35 ± 0.11 cm2 ), in 2 animals from the experimental group (area – 1.34 ± 0.14 cm2 , p = 0.005). Necrosis of the skin flap was not observed in the experimental group. A biopsy of the wound with morphometry of histological preparations on day 21 revealed a more intensive development of connective tissue in the experimental group and a greater severity of local inflammation in the control group. After withdrawal from the experiment, signs of acute sepsis were detected in the control group in the section of animals. Conclusions. The use of ultraviolet luminescent spectroscopy is effective in determining the boundaries of the cutout of the skin-fat flap in rabbits.
Organ-preserving operations for the removal of neoplasms of the hand on the example of a clinical case
The relevance of the problem of injuries, diseases, neoplasms of the hand and the search for the least traumatic, organ-preserving and minimizing dysfunction treatment methods does not lose its importance. The article presents a clinical case of a patient with a neoplasm of the first finger of the hand. For 2 years, he was worried about pain in the distal phalanx, periodically increasing, against this background, a wound with a curdled discharge opened, after which the pain practically stopped. At the outpatient stage, the patient underwent laboratory (general and biochemical blood tests, coagulogram, urine analysis) and instrumental research methods (X-ray, MSCT), as well as a biopsy of the neoplasm. Morphologically, the picture of an epidermal cyst with resorption has been established. Intraosseous resection (curettage) of the neoplasm was performed on the basis of the outpatient surgery center of the Hospital No. 1. According to the histological examination of the obtained intraoperative material, the formation corresponded to an epidermal cyst with chronic inflammation. 3 weeks after the surgical treatment, the patient began the duties of a musician (playing the piano), without noting the discomfort in his finger. The analysis of the demonstrated clinical case, as well asliterature data, emphasizes the role and importance of outpatient surgeons, the need for the correct choice of minimally invasive surgical tactics in order to preserve the functional activity of the hand and shorten the patient’s rehabilitation time.
Foreign bodies of the distal digestive tube: The current state of the problem
The article discusses important aspects related to the treatment of patients with foreign bodies in the distal digestive tube. The most significant foreign and domestic sources were analyzed through the search engines https://pubmed.ncbi.nlm.nih.gov/, https://www.elibrary.ru/ и https://cyberleninka.ru/ using keywords and their combinations: "foreign body", "foreign object", "large intestine", "rectum", "distal digestive tract", "distal digestive tract", "distal gastrointestinal tract". Recently, there has been a tendency towards an increase in observations of foreign bodies in the distal part of the digestive tract. Often, with incorrectly chosen treatment tactics or when patients seek medical help late, the presence of a foreign body can cause serious complications, which requires increased attention from medical workers. The review covers a discussion of a wide range of problems encountered in the treatment of this group of patients. The key points of the classification are presented, the main causes of entry and symptoms in patients with the presence of foreign objects in the colon are highlighted. Particular attention is paid to the features of diagnosis and treatment (from manual extraction of a foreign object through the anus to laparotomy with colotomy) of victims with foreign bodies in the distal gastrointestinal tract. The principles of patient care after removal of a foreign object were discussed. Despite the progress achieved in solving numerous issues, the problems of diagnosis and choice of treatment tactics in the presence of foreign bodies in the distal gastrointestinal tract remain relevant and require further study to improve patient treatment outcomes.
About the possibility of using a new biologically active supplement in the treatment of chronic venous diseases
Introduction. The use of various venotonic drugs is an integral part of the comprehensive treatment of patients with chronic venous diseases (CVD). Aim. To evaluate the clinical efficacy of a new domestic biologically active supplement (BAS) consisting of the flavonoid hesperidin methyl chalcone (HMC), troxerutin (HER) and ascorbic acid (VitC) in the complex treatment of patients with CVD of clinical classes C1–C3 (according to CEAP). Materials and methods. The open, comparative multicenter, prospective study included 281 patients with CVD (varicose veins) of clinical classes C1–C3 (according to CEAR). The first (studied) group of patients included 158 people who received Russian biologically active supplement (HMC + HER + VitC) for two months. The second (control) group consisted of 123 patients who did not receive biologically active supplement. In order to study the effectiveness of BAS sequentially during three patient visits, a statistical analysis of changes in quality of life according to the CIVIQ-2 questionnaire, pain intensity using a visual analog scale (VAS) and the dynamics of changes in malleolar volume (MV) on the target limb under study was performed. Results. The results of the conducted studies have shown that the inclusion of a new Russian biologically active supplement (HMC + HER +VitC) in the complex treatment of patients with CVD significantly reduces symptoms and improves the quality of life of patients. The maximum effectiveness of Russian biologically active supplement (HMC + HER + VitC) is manifested after 2 months of use in standard dosages without any side effects. The main advantage of the new biologically active supplement is its complete solubility in water and, as a result, higher bioavailability. Conclusions. The results of the conducted studies have shown that the inclusion of a new Russian biologically active supplement supplement (HMC + HER + VitC) in the complex treatment of patients with CVD significantly reduces symptoms and improves the quality oflife of patients.
Screening of metabolic function of neutrophil granulocytes in assessing the severity of acute appendicitis in patients
Introduction. Among acute surgical pathologies, acute appendicitis (AA) occupies a leading place with a tendency to transform the clinical picture due to an increase in complicated forms. Aim. To evaluate the clinical effectiveness of recording the metabolic function of neutrophil granulocytes (NG) as part of complex diagnostic monitoring of the severity of AA. Materials and methods. A total of 127 patients diagnosed with AA (59 with complicated disease and 68 with localized disease) and 32 ageand gender-matched volunteer donors (conditionally healthy controls) were studied. Peripheral blood was collected upon admission to the clinic. The level of metabolic function of NG was tested using luminol-dependent chemiluminescence (LDCL) in both spontaneous (sLDCL) and induced (iLDCL) modes. Endotoxin (E) concentration was assessed using the micro-LAL assay and immunofluorescence analysis. Results. A radical restructuring of the killing function of the NG was observed in complicated cases of OA, to a greater extent in those hospitalized at late stages of presentation to the clinic. In patients with a localized form of the disease, the iLZHL indices were 137.72 ± 22.48 imp/min; with widespread purulent inflammation, the biocidal activity of NG was 107.26 ± 27.48 (p = 0.0261); in late stages of hospitalization – 87.21 ± 8.6 imp/min. A strong negative correlation was found between the iLZHL level and the E concentration (r = -0.77, p = 0.0009). A positive correlation was observed between the sLZHL indicators and the lipopolysaccharide level (r = +0.46, p = 0.0285), reflecting intestinal microbiome dysbiosis and the massive E release into the bloodstream. Conclusions. Screening of the metabolic function of the NG in combination with diagnostic examination expands the verification of the severity of the purulent abdominal process in patients with OA and the effectiveness of surgical treatment.
Analysis of the effectiveness and safety of tranexamic acid in the prevention of bleeding after bariatric surgeries: A retrospective study
Introduction. Bariatric surgery is a safe method of weight loss when performed in certified centers by surgeons who have completed the learning curve. However, there is still a risk of serious complications of bariatric operations. According to most studies, major bleeding is the main cause of increased postoperative morbidity and prolonged hospital stay. Aim. To evaluate the effectiveness and safety profile of tranexamic acid (TXA) in the prevention of bleeding after bariatric surgeries. Materials and methods. We analyzed medical records of all patients who underwent primary bariatric surgeries according to standard protocols. A total of 2,524 bariatric interventions were performed from 2016 to 2024. From 2016 to 2023, 1,983 operations were performed – a group of patients who did not routinely receive TXA intraoperatively. From January to December 2024, 541 surgical interventions were performed – a group of patients whose surgery ended with intravenous administration of 1,000 mg of TXA. Results. In the postoperative period, 32 cases of bleeding (1.6%) were registered in the group of patients where TXA was not used intraoperatively, whereas no no cases (0%) of major bleeding were observed in the group where TXA was used (0%; p = 0.0279). Intraluminal bleeding was recorded in 3 cases, all 3 cases were identified during Roux-en-Y gastric bypass. Conclusions. TXA is an effective complement to careful surgical technique for bariatric operations to reduce the risk of bleeding and improve outcomes due to its availability, cost-effectiveness, rapid onset of action, and systemic effect.
Modern realities of distance-combined learning in the discipline “surgical diseases” in a medical university
Introduction. At the present stage in the higher education environment, distance learning is used in the main professional educational programs. At present, such issues as the adequacy of the use of distance and combined forms of training in the study of practical disciplines, the place of the distance mode in this component, the level of knowledge and practical skills that students acquire with these methods when passing cycles in surgical disciplines have not yet been fully resolved. Aim. To performance analysis the forms of distance and combined learning used by senior students of medical universities, currently in use. Materials and methods. The study included 86 respondents: 54 senior students studying at the clinical sites of the Department of Surgical Diseases at Kazan State Medical University and 32 first and second-year residents studying at the clinical sites of the Department of Surgery with a course in cardiovascular surgery at the Institute of Postgraduate Education at Samara State Medical University. The survey questions were designed in accordance with the objectives of the study. Survey data was collected using Yandex Forms, and the results were subsequently converted into Microsoft Excel spreadsheets. Results. According to the conducted research, the following results were obtained: 1. Increased emotional stress of students in the blended form of education. 2. High level of teaching staff was noted when using platforms for online education. 3. Low level of acquired skills and abilities of students in distance learning against the background of the latter’s lack of motivation and low assimilation of the material by them. 4. More than 40% of students noted that distance learning in the discipline “surgery” will not replace full-time education. Conclusions. Analysis of the results obtained in distance learning in practical disciplines (surgical diseases) demonstrated the desire of participants in the educational process for face-to-face communication to obtain practical skills.
The use of scaffold technologies to optimize the healing of skin wounds
Chronic wound care and wound healing management are a global public health burden that accounts for approximately 3% of total healthcare expenditure. Current therapeutic strategies used by healthcare institutions struggle to effectively handle the wound treatment, which results in long-term hospital stays. The gravity of the situation is compounded by the continuous growth of risk factors associated with chronic wound development. Therefore, it is necessary to investigate the treatment solutions that can restart wound healing by targeting specific mechanisms involved in wound repair. The article discusses topical issues of the improvement of skin wound healing by using scaffolds. The authors provide a review of current advancements in skin tissue regeneration, highlighting scaffold technologies. Today, scaffold technologies is an essential tool in different areas of regenerative medicine. The efficiency of these technologies is undoubtedly associated with their specific mechanisms aimed at providing mechanical support to reproduce the potential wound defect scaffold. Assessment of such potential requires studying the reaction of recipient tissues to matrix integration in vivo and determining the patterns of collagen fiber formation. We have analysed data from foreign and domestic sources using the search engines PubMed® and elibrary.ru over the past years. The review covers a broad spectrum of issues ranging from general principles of wound healing to a detailed description of various types of scaffolds, addressing all the key aspects of scaffold technologies. Detailed review of different types of scaffolds, their composition, properties and benefits when used to improve skin regeneration mechanisms is provided.