Symptoms of chronic venous insufficiency have been known since antiquity. The prevalence of chronic venous insufficiency in Western Europe and the USA has been reported within the range from from 1 to 40% in women and from 1 to 17% in men [1]. As reported by the European authors, the average prevalence of chronic venous insufficiency with class C2-C6 (according to the CEAP classification) among the European population reaches 30% [2]. Edema syndrome remains one of the leading manifestations of chronic venous disease. Compression therapy is one of the main ways to combat edema. The arsenal of devices for the treatment of edematous syndrome is steadily expanding with the development of medical science. Today, in addition to inelastic compression wrap and elastic compression garments, brand-new compression products, circaid adjustable inelastic compression wraps are available.

RETRACTED ARTICLE

Chronic venous disease (CVD) is the most common vascular pathology that has a significant negative effect on physical and psychological health outcomes, and requires high level of public spending on healthcare. Number of CVD risk factors has been identified in recent decades, but only recently have the experts begun to discuss the role of inflammation and endothelial dysfunction. Modern knowledge enables us to identify several priority strategies and goals aimed at managing the basic pathophysiological mechanisms of the development and progression of CVD. In particular, the use of venoactive drugs, which role in enhancing vascular tone and contractility, reducing inflammation and edema and improving microcirculation and accelerating the healing of venous leg ulcers has been carefully studied and presented with positive outcomes in various publications. This review provides various pathophysiological mechanisms of the development of CVD, which present the targets for venoactive drug therapies.

Aim. To evaluate clinical efficacy, safety and compliance level of outpatient application of “TONUS ELAST” compression garments in patients with chronic diseases of lower limbs of C3-C4 clinical classes according to CEAP.
Material and methods. Continuous compression therapy during 6 months with the use of “TONUS ELAST” garments was received by 34 patients (12 men and 22 women) with chronic diseases of the lower limbs of C3-C4 clinical classes. The average age was 67 ± 3.2 years. There were 26 (76%) patients with varicosity and 8 (24%) patients with postthrombophlebitic stage of different recanalization. Anamnesis duration was 16 ± 3.9 years. Dynamic analysis of subjective and objective clinical symptomatology, results of legometry, volumetry and ultrasound examination with registration of blood flow rate in the femoral vein according to the developed protocol was carried out.
Results of the study. Clinical observation in the dynamics of the study and instrumental methods of examination confirm the significant clinical efficacy of “TONUS ELAST” garments of the 2nd class of compression as a means of conservative treatment of chronic diseases of C3-C4 clinical classes. Positive dynamics of subjective symptomatology with the achievement of the most successful result in the management of convulsive (96.6%) and painful (93.8%) syndromes was revealed. Reduction of the shin circumference was recorded in 100% of observations on the left lower limb and in 96,7% on the right one. Statistically significant positive dynamics of volumetric parameters was achieved after 3 months of compression therapy. The tendency to acceleration of blood flow in the femoral vein in 71,4% of observations was revealed. Laboratory analysis of hemostasiological parameters demonstrated compensatory normocoagulation. Absence of cases of individual intolerance and adverse effects of compression products indicates their safety. A high level of adherence of patients to the therapy is registered. Doctors and patients gave a positive subjective assessment of the effectiveness and consumer properties of the studied product.
Conclusion. Compression garment “TONUS ELAST” of the 2nd class of compression can be recommended as a safe, effective and comfortable means of outpatient therapy and prevention of chronic diseases of lower limbs veins. 

The article presents various techniques to treat unaesthetic facial veins, such as periorbital, temporal, reticular veins, which pass from the neck through the angle of the lower jaw up to the temporal region, etc. Particular attention is paid to the use of the transdermal long-pulsed neodymium laser; clinical examples with photographs of areas of interest that were taken before and after treatment within 1-6 months are presented. The authors describe in detail the basic principles on the use of transdermal lasers in aesthetic medicine. It is concluded that the treatment of unwanted reticular veins with the long-pulsed neodymium laser has a number of advantages compared to other treatment methods.

The advantages and disadvantages of modern antiseptics for local treatment and prevention of wound infections are considered. On the basis of data of comparative clinical studies the advantages of topical drugs based on octenidine dihydrochloride in combination with phenoxyethanol are presented. The advantages of octenidine dihydrochloride/ phenoxyethanol as a local antiseptic for treatment and prevention of wound infections in case of wound defects, burns are described.

Thermal injuries are now ranked number one among injuries, and incidence of injury-related complications, especially infectious and purulent, does not decrease in surgical practice, despite the modern methods for treatment and prevention. Purulent complications depress the speed and quality of wound healing and increase the number of bed-days and treatment costs. Moreover, infection spreading complicates treatment and increases mortality and disability of patients with burn injuries. Choosing the most effective antiseptic agent for burn injuries is crutial both from the perspective of effective local treatment of wounds and wound complications and from the perspective of pharmacoeconomic aspects. At the current time, povidone iodine solution and ointment are one of the leading antiseptics used at all stages of care for burn patients. Its efficacy has been proven by clinical trials and many years’ experience of use by specialists and patients. We have also gained extensive positive experience in using this drug to treat 269 patients with burns of 5 to 35% total body surface area (TBSA) and various thickness without development of resistance and pain in patients and with a pronounced antiseptic effect during its use on the basis of City Clinical Hospital No. 2 of Stavropol, which once again proved high efficacy and feasibility of the widespread use of povidone-iodine in practice due to antimicrobial activity, high bioavailability, ease of use and economic benefits.

Erysipelas is an acute infectious disease of streptococcal etiology. Currently, many people lead an active lifestyle, including sports activities both in outdoor areas and in gyms. There is always a risk of various wounds, which are the entry gate for infection, in particular Streptococcus pyogenes. Infection often occurs against the background of weakened immunity. Reduced immune properties can result from frequent stress and chronic fatigue due to severe physical and psycho-emotional stress at work. All these factors in combination create favorable conditions for the development of erysipelas. The peculiarity of face inflammation is that the disease can take a recurrent course. The most important place in the complex treatment of patients with erysipelas is taken by antibiotic therapy. In the treatment of patients in the conditions of the polyclinic it is possible to prescribe antibiotics orally. In the severe course of the disease and the development of complications it is justified to prescribe parenteral therapy. Penicillins are the drugs of choice, because until now penicillins are almost 100% active against Streptococcus pyogenes. During antibiotic therapy it is desirable to combine such properties of the preparation as long-term bactericidal concentration against Streptococcus pyogenes in tissues and, consequently, much lower multiplicity of injections in comparison with benzylpenicillin. These requirements are met by benzathine benzylpenicillin, benzylpenicillin procaine. Based on the results of clinical studies, the advantages of benzathine benzylpenicillin are shown, including in combination with benzylpenicillin procaine to prevent recurrence of erysipelas.

The diverse amount of therapeutic and diagnostic manipulations and the expansion of the volume of medical care provided by the surgeon at the stage of providing primary health care to patients suggests the availability of effective, safe and affordable antibacterial drugs in the arsenal of drugs used. The review considers the possibility of using the combined antibacterial drug ciprofloxacin + tinidazole in outpatient surgical practice from the standpoint of clinical efficacy and drug safety.

Patients with malignant diseases belong to the high risk group for thrombosis and pulmonary embolism development [1-3]. Any reconstructive plastic surgery in such patients has potential complications that can reduce all efforts to zero [4-6]. Antithrombotic therapy is a complex problem of modern oncology [7-9]. For a long time, all patients with subungual melanoma underwent only one type of operation – amputation [10, 11]. In order to avoid mutilating surgery and preserve the maximum functionality of the limb, we have developed and proposed an organ-preserving operation with an optimal antithrombotic approach in the postoperative period. In the present scientificpractical article the clinical observation of the patient after removal of subungual melanoma (SM) with musculocutaneous flap-plasty on the vascular pedicle of the defect with the developed optimal approach of thrombosis and thromboembolism prophylaxis with the use of fraxyparine is presented. In the case of sonodoplerographic imaging of vessels of the I finger of the left hand, the passage of a. digitalis palmaris proprius is marked. A dissection of the vascular pedicle containing a. digitalis palmaris proprius, a fragment of m. interosseus dorsalis I, subcutaneous adipose tissue with subcutaneous venous system branches along the side surface of the I finger of the left hand to the projection of the phalangeal joint was performed. Mobilized musculocutaneous flap was placed on the defect and was fixed to the wound edges. The control of the vascular pedicle permeability by means of color and energy mapping of the blood flow was performed. The control of the flap was carried out on the 7th, 15th, 21st day [12, 13]. The flap engraftment is 100 %. The patient could already write with a pen and cut paper with scissors on the 7-10th day. She is currently in full clinical remission and has returned to her working life. Without proper thrombosis prophylaxis, it would be impossible to maintain the functionality of the vascular stem and, given the nature of malignant neoplasms, to reduce the risk of thromboembolism [14-17]. Presented experience of antithrombotic therapy opens new possibilities of surgical treatment with reconstructive-plastic component in patients with malignant neoplasms.

The current compression garment selection guide is targeted at the earliest clinical stages of chronic venous disease (CVD) and assumes a priori that application of a higher class of compression improves the calf muscle pump function, which is the major mechanism promoting venous return from the lower limb to the heart.
Objective of the study: to evaluate the calf muscle pump function in patients with the early forms of CVD using different classes of compression garments.
Material and methods: A total of 30 patients (45 lower limbs) with Class 1 CVD (CEAP classification) were enrolled in the study. The calf muscle pump function was evaluated during wearing compression garments using remote cableless photoplethysmography of Bodytronic measurement system (Bauerfeind, Germany) with automatic data processing. The investigators measured venous refilling time (T0) and pump capacity (V0) in patients without compression garments and also in those wearing classes 0, I and II compression garments (RAL standard, Venotrain micro, Bauerfiend socks). All indicators were measured three times with an interval of 30 minutes. The final values of T0 and V0 were calculated as average.
Results and discussion: when the indicators were measured without compression and with zero compression, T0 was 26.7 ± 1.2 sec and 25.4 ± 1.1 sec (p = 0.56); V0 - 8.6 ± 0.7% and 8.0 ± 0.4% (p = 0.47). When the calf muscle pump function indicators were measured using class I compression garments, its performance was improved. Thus, T0 and V0 (p <0.01) increased significantly to 38.9 ± 2.1 sec and 12.9 ± 1.4%, respectively. When the calf muscle pump function indicators were measured using class II compression garments, T0 and V0 were 38.1 ± 1.6 sec and 8.1 ± 0.6%. Thus, the use of class I compression garments significantly improved the calf muscle pump function in patients with early manifestations of CVD. The higher level of compression (class II) did not improve T0 and worsened V0. This fact can be explained by excessive compression of the muscular venous sinuses caused by wearing class 2 compression garments, which, apparently, worsened the propulsive ability of the calf pump.
Conclusion: the use of class I compression garments is optimal for the management of hemodynamic disorders in patients with early forms of chronic venous diseases (C1 according to CEAP). The higher class of compression does not improve the hemodynamic parameters of the calf muscle pump.

Target. Comparative assessment of the clinical efficacy of Aescusan I generation phlebotonics application in the complex treatment of patients with CVD.

Material and methods. Analysis of treatment of 380 patients who applied for a phlebological appointment at the polyclinic department of SamSMU Clinics for the period from September 2017 to March 2019 was conducted. Group I (n = 104) included patients with even outpatient card numbers who were prescribed Troxevasin as a first-generation phlebotonic according to the scheme recommended by manufacturers Group II (n = 276) included patients with odd outpatient card numbers who were prescribed Aescusan (an extract of horse chestnut seeds Aesculus hippocastanum, active ingredient of which is aescin) as phlebotonics of the first generation according to the scheme recommended by the manufacturers. All patients were examined by a phlebologist before and after 1 course of treatment. Clinical efficacy of the therapy was assessed by the severity of the pain syndrome, feeling of heaviness, swelling and seizures using visual analogue scale (VAS). In addition, the effectiveness of conservative therapy was assessed through interviews and questionnaires. For a comparative assessment of the severity of edema syndrome, the lower limb circumference was measured at ankle level using a graduated tape.

Results. No side effects were detected during clinical observation of the use of drugs. After the course of treatment, most of the observations showed positive dynamics. Changes in clinical symptoms (pain, seizures, heavy legs) in Group I were statistically unreliable (p>0.05). In the second group there was a decrease of pain syndrome intensity by 73,2%, a decrease of convulsions - by 63,5%, a decrease
of heaviness feeling – by 73,7%. In the course of the survey, 272 patients (98.5%) of Group II evaluated the treatment results as good, 4 patients (1.5%) did not notice any treatment results.
In the course of repeated examination after the treatment 96,5% of doctors noted the result in Group II as good, 3,5% - as satisfactory. 

Conclusion. Thus, the results of complex treatment of patients with CVD showed that the use of 1st generation phlebotonics should be considered not only as pathogenetically justified, but also effective from the clinical point of view. Application of Aescusan drug leads to statistically significant reduction of clinical symptoms (subjective and objective) of lower limbs CVD.