The article is a non-systematic review of the literature, addressing the effectiveness, safety and appropriateness of antithrombotic drugs for COVID-19 in patients undergoing treatment in different settings: in the hospital phase, including the intensive care unit, in the outpatient phase after discharge from hospital, in primary outpatient treatment. The issues of thrombotic complications during vaccination and the necessity of their prevention are discussed. The studies confirm the importance of prophylactic doses of anticoagulants in all hospitalized patients. The use of increased doses has proven ineffective in patients with a severe course of the disease who are being treated in the intensive care unit. In moderately severe infections, there is a clear benefit of increased doses of anticoagulants in reducing the risk of organ failure, but definitive conclusions can only be drawn after the final results of the studies have been published. Prolonged pharmacological prophylaxis after hospital discharge may be useful in individual patients, but the overall risk of thrombotic complications in the long-term period does not appear to be high. The available data do not support the use of anticoagulants in the treatment of coronavirus disease in the outpatient settings, since the risk of thrombotic complications is not increased in such patients, and the safety of anticoagulant use has not been evaluated. Sulodexide may be useful in selected outpatients at increased risk of disease progression. Vaccination may provoke the development of atypical localized thrombosis by immune mechanisms, but the risk of such complications is lower in the coronavirus disease itself. Anticoagulant prophylaxis during vaccine administration is not indicated.

Introduction. The basis of varicose veins is reflux in the great saphenous veins, and at present one of the basic principles of treating varicose veins is to eliminate reflux. Thermal obliteration is the gold standard, but non-thermal non-tumescent methods have several advantages.

Target. Evaluation of the safety and effectiveness of mechanochemical obliteration in patients with venous insufficiency using the Flebogrif catheter.

Materials and methods. The study included 8 women and 2 men over 18 years of age with reflux along the GSV with a target vein diameter of no more than 12 mm. The average age of the patients was 43.8 ± 11.5 years. Stage C2 (varicose saphenous veins) was detected in six patients (60%), stage C3 (edema) in 3 patients (30%), stage C4a (trophic changes of skin and subcutaneous tissues, hyperpigmentation and/or varicose eczema) in one patient (10%). Results. After the procedure, complete occlusion of the target segments of the varicose vein was achieved in 100 percent of cases (10 patients) at all study periods (up to 2 months). Palpation in the projection of the target vein was painless in all patients. The ultrasound imaging showed complete occlusion of the target vein and the absence of complete or segmented recanalization in all patients during all postoperative examinations. No adverse events or complications were reported.

Conclusions. Mechanochemical obliteration is a reliable way to eliminate vertical reflux. The main advantages for the patient are speed, painlessness, beauty and outpatient procedures. A big plus for the doctor, in addition to the speed of the intervention and patient satisfaction, is the absence of the need for complex technical devices (thermogenerators), as well as the absence of the need for tumescent anesthesia, which makes the procedure more comfortable for the patient.

Hypertrophic scars and keloids mostly develop as a result of wound healing and skin burns. Depending on their location, pathological scars can be not only aesthetically distressing, but also present challenges associated with limited function of the limbs, frequent trauma, inflammation, and persistent pain syndrome. The urgency of the problem of hypertrophic and keloid scars has led to a plethora of therapeutic strategies and innovation techniques to prevent or attenuate pathological scar formation. At the same time, preventing pathological scarring is undoubtedly more effective and cheaper than treating it later on. Next to surgical techniques, injection therapy and an appropriate general postsurgical care for fresh wounds, a multitude of topical drugs are now available for scareless wound healing. Parallel to various silicone-based products, onion extract or cepalin has been highlighted as one of the potential anti-scarring agents over recent years. Based on several studies, onion extract alone or in combination with allantoin and heparin helped to alleviate the woundhealing process in wounds of various origins and prevent their pathological scarring. Considering that hypotrophic scar and keloid formation following surgery or trauma is almost impossible to predict, it is advisable to actively use topical dosage forms to improve wound healing and minimize aesthetic defect, the more so as the prevention of pathological scarring is more effective, safe and comfortable than its treatment. The simplicity of their use opens up vast opportunities for the treatment and prevention of the pathological scar formation in outpatient practice.

Labia contour plasty is intended for the aesthetic and functional correction of the external genitalia. Labia filling procedure or external genital plastic surgery as an injection contour correction technique is one of the most popular methods for non-surgical correction. The article describes the assessment of the tolerance of aesthetic labia correction procedure, which was performed under the preliminary application of local anesthesia with the lidocaine 2.5% and prilocaine 2.5% cream. 42 women aged 32–50 years were observed over the period of 2019–2021. Before the labia correction procedures, all patients received the local application anesthesia with lidocaine 2.5% and prilocaine 2.5% cream. To identify the main complaints and assess the quality of life of the study participants, the patients were interrogated using the international quality of life questionnaires FSFI (Female Sexual Function Index). The questionnaire survey showed that 84% of patients who were ready for the injection contour plasty were afraid of pain during the procedure. 86% of patients assessed the local application anesthesia as effective and underwent the procedure comfortably and without pain, 14% of patients indicated insignificant sensitivity, which was associated with an overall low pain tolerance threshold. The use of local application anesthesia with the lidocaine 2.5% and prilocaine 2.5% cream helped perform the labia contour correction procedure comfortably and without pain, which was confirmed by the results of a repeated questionnaire survey assessing the effectiveness of the local application anesthesia.

This article presents a review of the current literature on the problem of topical therapy in the complex treatment of chronic venous insufficiency. The relevance of the study of this pathology is due to the prevalence of the disease in the world and in Russia in particular, with progression and decompensation often leading to disability. Modern therapy consists of two components – surgical treatment and conservative therapy with an emphasis on pharmacotherapy. Pharmacotherapy is aimed at phleboprotective, anti-edema and anti-inflammatory actions. The article provides a classification of the main phleboprotective drugs on the Russian market. However, comprehensive treatment of chronic venous insufficiency is not possible without the use of topical agents that have distracting and therapeutic effects. The use of ointments, gels has local anti-inflammatory, anti-edema and capillary-protective effects, which helps to alleviate the clinical symptoms of the disease. In the treatment of chronic venous insufficiency, various topical preparations of combined action are used. One of them is a gel based on an effective combination of troxerutin and indomethacin, which has a pronounced angioprotective, analgesic, anti-edema and anti-inflammatory effect, which leads to improvement of soft tissue trophism in the affected area. Clinical case is presented: patient N., 47 years old with the diagnosis “varicose vein disease of the lower extremities, сlosed trophic ulcer on the medial surface of the middle third of the left tibia, сhronic venous insufficiency according to CEAP C6”. The patient has a 12-year history of varicose veins of the lower extremities, for which he had not been operated on before. During the last 3 years before his admission to hospital the patient had an open trophic ulcer on the medial surface of the middle third of the left tibia, for which he was treated outpatiently with positive dynamics. During the last 6 months, the ulcer closed, but pain, hyperaemia and oedema persisted. In the postoperative period, along with phleboprotective agents, the patient received topical treatment using Troximetacin gel 3–4 times a day for a treatment course of 10 days. During the period of observation pain syndrome was reduced, hyperemia and swelling were eliminated, the patient had no complaints. Correction of chronic venous insufficiency is multicomponent, including surgical correction, pharmacotherapy and topical therapy. Modern topical agents have proven to be effective due to their polyvalent mechanism of action.

The modern tactics of conservative treatment of trophic ulcers and skin wounds imply the staged use of hydroactive wound dressings whose task is to activate and create optimal conditions for the natural regenerative process. This publication presents an actual clinical case of an effective sequential administration of hydroactive wound dressings HydroClean and HydroTac in a 76-year-old patient with a history of deep vein thrombosis and pulmonary embolism. Two weeks after discharge from the hospital for treatment of severe coronavirus infection (COVID-19) with 70% lung involvement, the patient developed a bubble filled with clear fluid on the anterior surface of the shin. A surgeon at the place of the residence opened the blister and administered occlusive dressings with povidone-iodine, as a result of which the wound surface was covered with a necrotic scab. The patient went to a specialized phlebology clinic due to deterioration of the wound condition and pronounced pain both at rest and during dressings. In order to remove necrotic tissues, a hydroactive dressing HydroClean was prescribed, which was fixed on the limb using cohesive bandage Peha-haft. The authors emphasize the high efficiency and safety of these hydroactive dressings, as well as the possibility of their use at home, which is especially relevant during the COVID-19 pandemic. This clinical case demonstrates the effectiveness of modern hydroactive wound dressings, the use of which in a short time allowed to close a large skin wound in a patient with an extremely negative comorbid background and demonstrates the possibility of remote management of treatment using modern means of communication.

Antiseptics are an integral part of modern medicine in the treatment and prevention of infection. Antiseptics are used as a local treatment for infected wounds. They are microbicidal and have a broader spectrum of antimicrobial activity than antibiotics. However, not all antiseptics remain effective due to the emergence of multi-resistance in many of the species of pathogens they target. Of the many currently available antimicrobials, drugs such as povidone-iodine remain relevant and effective even after decades of use in the antiseptic field. The purpose of this review was to substantiate the efficacy and safety of povidone-iodine and to determine its place in the treatment of wounds. In the work, there are analyzed modern actual native and foreign literature sources, and also there are presented the authors’ observations in the format of a clinical case about the course of povidone-iodine preparation use in the treatment of a 58-year-old patient with the clinical picture of the necrotic bullous erysipelas. The effective action of the drug was demonstrated. The authors detailed the suppressive effect of povidone-iodine on the structures critical for the survival and replication of microorganisms, which determines the effectiveness of the drug in the treatment of infected wounds. Among the many available antiseptic agents, iodophor-based preparations such as povidone-iodine remain relevant. Povidone-iodine promotes wound healing, in addition, it has a wide antimicrobial spectrum of action, lack of resistance, good tolerability, and anti-inflammatory properties. Due to its antiseptic action and the wide profile of positive properties, povidone-iodine remains effective as an antiseptic agent aimed at the treatment and prevention of surgical infection.

Introduction. In the treatment of patients with pararectal fistula, relapses of the disease are quite common, as well as postoperative complications in the form of suppression of a postoperative wound, anal incontinence, etc. The aim of the work is to improve the results of treatment of patients with pararectal fistula by reducing the number of purulent-septic complications in the postoperative period. Materials and methods. Analysis of 105 cases of treatment of patients was carried out. All patients were divided into 2 groups by random sampling: in group I, patients, in addition to standard preoperative training, underwent fistula sanitization with 1% dioxidin solution. In the postoperative period, patients underwent dressings with 5% dioxidin ointment, and also administered per rectum ointment from 1 postoperative day for 7 days. In the second group, standard preoperative training was carried out. All patients of the comparison groups were intraoperatively seeded on the flora from the fistula. Postoperative healing of postoperative wounds, subsidence of local and systemic inflammatory response were evaluated. Results. The results show a statistically significant improvement in treatment outcomes of patients in the major group. Conclusions. Application of two-stage prevention of postoperative complications makes it possible to improve results of treatment of patients with pararectal fistulas due to reduction of amount of pathogenic microflora in area of postoperative wound, faster stopping of local and systemic inflammatory reaction, and also due to increase of number of patients with primary healing postoperative wound.

Melanosis coli is characteristic of patients with a long history of constipation and the use of laxatives – anthraquinone derivatives, which are quite prescribed by doctors and patients independently. As a rule, melanosis develops after 4–9 months of taking drugs from this group and is most common in women in the older age group. Pathogenetically, melanosis is characterized by the deposition of pigment in the lamina propria of the mucous membrane, manifested by a pronounced dark coloration of the mucosa, depending on the degree of pigmentation of the colon, melanosis is divided into three degrees. The most common localization is in the right colon, but cases with the spread of pigmentation to the left colon and other parts have been described. Diagnosis does not cause difficulties, melanosis coli is detected during routine endoscopic examination, and is confirmed by pathomorphological examination. Melanosis is an actual problem in terms of the risk of developing colorectal cancer (CRC). There are already convincing data proving that the frequency of detection of adenomas increases not only due to the absence of pigment accumulation by them, but also the pathogenetic aspects of the influence of melanosis on the occurrence and development of adenomas have been described. Proteomic analysis allows to determine the expression of various proteins, which confirms the role of melanosis in the development of colorectal cancer. It is also interesting to note that sometimes there are some difficulties in the differential diagnosis of melanosis, for example, with ischemic lesions of the colon. Patients with melanosis coli require close attention, timely diagnosis and treatment.

Introduction. The prevalence of hemorrhoids in the adult population, according to various authors, ranges from 15 to 90%. In case of exacerbation of external hemorrhoids, conservative or surgical treatment can be applied. Of particular and important interest is homeopathic ointment, has an analgesic, antimicrobial, anti-inflammatory effect, and also affects the tone of the venous vessel. The purpose of our study was to study the effectiveness of Fleming’s ointment for the treatment and prevention of patients with acute hemorrhoids.

Materials and methods. A prospective comparative study was conducted with the participation of 154 patients with acute hemorrhoids. In the main group (n = 76) of patients, treatment was carried out using diosmin and homeopathic ointment, which was applied 2 times a day for 7 days. In the control group (n = 78) patients, treatment was carried out using enteral administration of diosmin at a dosage of 1000 mg 1 time per day for 30 days and direct-acting anticoagulants in the form of an ointment 2 times a day for 7 days.

Results. Within 3 months after the end of treatment, 4 (5.3%) patients of the main group and 12 (15.4%) patients of the control group had exacerbations of hemorrhoids. After 3 months, a statistically significant difference was revealed in the indicator of the subjective impact of hemorrhoidal disease on everyday life, which is associated with the development of exacerbations of hemorrhoids.

Conclusions. Homeopathic ointment is an effective and pathogenetically justified remedy for the conservative treatment of patients with acute hemorrhoids. Its use leads to a significant decrease in the severity of clinical symptoms of the disease and an improvement in the indicators of objective research methods with good tolerability, the absence of undesirable effects and better long-term results compared to the standard treatment regimen.

Introduction. Anal abscess is the most popular case in urgent coloproctology. The problem of anal fistula formation remains open. Primary fistulotomy for anal abscess reduces the incidence of fistulas, however, this method of treatment affects the muscle fibers of the obturator apparatus of the rectum and lead to anal incontinence. The role of a loose set-on in the treatment of fistulas is widely known and well studied, which cannot be said about the use of this method in the treatment of anal abscess.

Aim of the study. To research the effectiveness of a loose seton in a two-stage treatment with paraproctitis.

Materials and methods. This retrospective study included 60 patients with acute ishiorectal abscess. The patients were divided into 2 groups, 30 persons each. At the first stage of treatment, patients of group A underwent incision and drainage of the abscess, patients from group B, incision and drainage of the abscess was supplemented with a drainage ligature passing through the affected crypt. At the second stage, 22 patients from group A and 30 patients from group B underwent a combined LIFT operation with laser destruction of the fistulous tract. Before the second stage of treatment, patients of both groups underwent transrectal ultrasound in order to exclude the presence of leaks and cavities. The function of anal sphincter was assessed using sphincterometry and a Wexner scale questionnaire before and after the second stage of treatment.

Results. The average follow-up period for the patients after the second stage of treatment was 18.3 months. in group A and 16 months in group B. The recurrence in group A were registered in 5 out of 22 people (22.7%), in the group of patients with a loose set-on – in 3 out of 30 persons (10%). Dysfunctions of anal sphincter after the first and second stages of surgical treatment were not registered in any of the groups.

Conclusions. The use of loose set-on in two-stage treatment of paraproctitis allows to confidently control draining of abscess, form a consolidated fistulous tract without spurs and leaks, prepare the patient for the second stage of surgical treatment and reduce the recurrence rate after minimally invasive treatment of rectal fistulas without loss of anal sphincter function.

An anal fissure is a longitudinal tear defect in the skin of the anal canal distal to the dentate line. Anal fissure is a socially significant disease that worsens the quality of life of patients. The spasm of the internal sphincter is a guiding pathogenetic mechanism in the development of chronic anal fissures. It leads to circulatory disorder in the anoderm and non-healing wounds. Treatment of chronic anal fissure, as a rule, is based on a decrease in the tone of the internal anal sphincter and in the modern arsenal of coloproctologists there are both surgical and pharmacological ways to eliminate spasm. Lateral internal sphincterotomy is still the gold standard for the definitive treatment of anal fissure, but anal incontinence is a serious complication of the procedure. This article presents an overview of the available modern means for drug relaxation of the internal anal sphincter and the authors' experience in using the first fixed-dose combination of 0.3% nifedipine and 2.0% lidocaine topical gel authorized for use in Russia in patients with the chief complaint of pain during and after a bowel movement that requires the use of analgesics. A spontaneous wave activity in the resting phase, which indicated the presence of anal sphincter spasm, was recorded in all patients. According to our observation, the complete healing of the anal fissure and the anal sphincter relaxation was instrumentally confirmed in 70% of patients.

Introduction: the relevance of further study of the morphogenesis of changes occurring in the superficial veins of the lower extremities is due to the high prevalence of varicose veins and the lack of answers to many questions of interest to phlebologists.

The aim of the study was to study the morphological restructuring of connective tissue elements of the human great saphenous vein wall on the calf in norm, ectasia and development of varicose transformation.

Material and methods. The study of morphological restructuring of the great saphenous vein wall on the calf was carried out in 3 comparison groups (norm, ectasia, varicose veins) by light microscopy. In 1th group, the structure of the GSV wall was studied on autopsy material of people who died from various causes at the age of 5 to 80 years. In the 2nd and 3rd groups, fragments of GSV in the calf were taken by biopsy (miniphlebectomy) during the execution of the operations for varicose veins. In order to conduct a quantitative analysis of the nature of structural changes in the connective tissue elements of the GSV wall on the calf, a visual analog scale of morphological changes was developed-Visual Analog Morphology Scale (VAMS), in which a certain number of points (from 1 to 10) corresponded to a certain character of morphological changes. Statistical analysis of the obtained data in groups was performed using the IBM SPSS Statistics software package (USA).

Results. The general morphological analysis of histological preparations made it possible to visually identify various variants of changes in connective tissue elements inherent in the inner, middle and outer shells of the GSV wall.

Conclusions. Age-related morphological changes in the connective tissue elements in the GSV wall on the calf, over the course of a person’s life, do not have the same character as changes occurring in its wall during the development of its ectasia and varicose transformation.

Introduction. Currently, despite the use of modern and high-tech methods of surgical treatment of patients with varicose veins and hernias of the anterior abdominal wall in the long-term period, relapses of the disease occur in 1.7-14% of cases. The combination of postoperative recurrence of inguinal hernia and varicosis is an infrequent type of multiple surgical pathology.

Case report. The article presents a clinical observation of a patient with a relapse of varicosis and an inguinal hernia, who underwent a total of three surgical interventions before admission to the clinic. Detailed ultrasound diagnostics made it possible to establish the cause of the relapse and develop optimal surgical tactics, taking into account the individual characteristics of the disease and the nature of previous operations. Taking into account the anatomical proximity and one-sided localization of pathological processes, the patient underwent a simultaneous operation from one access. A day later, the postoperative pain intensity was rated with a visual analogue scale at 4.2 scores, a patient administered analgesics to relieve pain within two postoperative days. Class 2 compression stockings were used for the compression therapy. The patient was discharged from the clinic in satisfactory condition the following day after the intervention, complaining of minor pain in the surgical wound area. The postoperative period was uneventful, without complications. Pain, restriction of movement were observed within 4 days after surgery. The sutures were removed after 7 days, the wound healed by primary intention healing.

Conclusions. The use of a simultaneous operation allows a radical correction of both diseases, to reduce the psychological burden on the patient, to improve the aesthetic result of the intervention, to avoid thrombotic complications and hernia infringement in the postoperative period.

Introduction. It has been for a long time considered that treatment of trophic venous ulcers and varicose eczema should be operative only. However, practice shows that such treatment doesn’t guarantee the complete healing of an ulcer or eczema and doesn’t always prevent the recurrence of pathological processes. It suggests the need for an integrated approach to the treatment of trophic venous ulcers and varicose eczema.

Aim. Analyze the effectiveness of various methods of non-surgical treatment of venous trophic ulcers (TU) and varicose eczema (VE) to create an optimal algorithm for managing this category of patients in outpatient practice.

Materials and methods. A prospective comparative cohort study of 252 patients with C4-C6 CVD classes (CEAP) was conducted. 178 people (71%) had venous TU , 74 (29%) – VE. 3 groups of patients were formed: 1 gr. – (n = 68) was treated with traditional medicines and standard topical therapy (control); 2 gr. – (n = 90) received MOFF, elastic compression (Pütterbinde bandage), systemic antibiotic therapy for TU and corticosteroids for VE, dressings using Hartmann wound coverings; 3 gr. – (n = 94) in addition to the treatment similar to group 2, sclerotherapy (ST) of pathological venous reflux was performed. The follow-up lasted 6 months (8 visits) with a comprehensive clinical, laboratory and instrumental assessment. Statistical processing of the results was carried out using the STATISTICA software package (StatSoft, Inc., 2001, version 6.0).

Results. By the end of the study, the following positive trends were registered in group 2 compared to group 1: the total VCSS index was 1.5 times lower, and according to the 10 – point VAS – 3 times; TU healing/ VE remission occurred 2 months earlier, complete healing of TU was noted in 75% of patients vs 63%, remission of VE-in 81% vs 47%. The combination of elimination of pathological reflux by CT and MOFF therapy (group 3 patients) was particularly effective. When comparing group 1 with group 3, it turned out that in the latter, by the end of the study, the total VCSS index was 3 times lower; the total indicator for the 10 – point VAS was 5.5 times lower for TU, 10 times higher for VE; TU healing/VE remission occurred 4 months earlier, complete healing was noted in TU in 88% of patients vs 63%, remission of VE in 96% vs 47%. Based on the obtained data, therapeutic algorithms were proposed for the management of patients with venous TU and VE in outpatient settings.

Conclusions. Conservative treatment of venous TU and VE can be an alternative to surgical treatment, or an addition to it. MOFF is the most effective venotonic of complex action prescribed for the treatment of TU/VE in the form of monotherapy. Sclerosing therapy is a full-fledged element of the complex treatment of venous TU. The use of the proposed treatment algorithms makes it possible to speed up the healing process of venous TU and achieve remission of VE by three times.

Introduction. Chronic deep pyoderma occurs relatively rare in the surgeon practice and, due to the poor knowledge of this pathology, its diagnosis is difficult by surgeons. Misdiagnosis leads to erroneous treatment tactics. Chronic deep recurrent pyoderma includes: abscessing and disrupting perifolliculitis of the head (Hoffmann) (ADPH), axillary and inguinal-perineal suppurative hydradenitis, pilonidal cyst of the sacrococcygeal area. The diseases listed follow the same pathogenesis.

The purpose of the publication: to acquaint surgeons with the diagnosis and treatment of a particular type of chronic deep recurrent pyoderma – abscessing and disrupting head perifolliculitis (Hoffmann) in the conditions of the surgery room, since this problem is purely issued in the literature of the subject.

Material and methods. Since 2007 until to 2020, we had observed 20 cases of deep chronic recurrent pyoderma (15 men and 5 women), but only two cases were correctly detected before treatment, in other cases – retrospectively. Research method: analyzing of clinical observation data and laboratory tests.

Results. In our practice, nine men suffered from abscessing and disrupting perifolliculitis of the head. We had described and classificated the features of this disease, focused on three clinical cases.

Conclusions. Abscessing and disrupting perifolliculitis of the head is still purely diagnosable and curable disease, the treatment as follows: regimen and hygienic measures, surgical treatment, conservative treatment. Surgical treatment should be as radical as possible.

Introduction. COVID-19 infection raises many questions regarding the health condition of patients after they have had COVID-19. The aim of this study is to examine the characteristic symptoms of chronic venous insufficiency in the postcovid period.

Materials and methods. The materials that were used for work included the results of studying the medical aid appealability, characteristic symptoms, diagnosis and treatment of symptoms of chronic venous insufficiency in persons who have had the coronavirus infection. 47 patients presented with complaints about deterioration of their condition after they had had COVID-19 over March to September 2021 period. Methods: general clinical examiniation, ultrasound angioscanning of veins of the lower extremities, laboratory coagulation tests.

Results and discussion. Before deterioration, calf circumference was measured 22–24 cm at a typical measurement site in most patients (89%), after covid infection it reached 26–27 cm. Varicose veins remained soft, without intravascular formations, edema was often bilateral, asymmetric, pain was described as constant (5–6 VAS scores), patients had prominent signs of lymphostasis. 35 out of 47 people received diosmin-based venotonic drug of Russian manufacture at a dose of 1000 mg/day (one tablet twice a day), the course of treatment lasted one to two months. After that period, the edema subsided in 85% of patients, the severity of pain syndrome significantly reduced (up to 2–3 VAS scores). With regard to chronic venous insufficiency in patients with chronic diseases of lower extremity veins (mostly varicose and post-thrombotic diseases), the significant progress of disease was observed in almost 94% of follow-up cases. Diosmin is the main drug that is prescribed to treat chronic venous insufficiency. The drug has an angioprotective and venotonic effect, reduces the vein wall elasticity, increases venous tone, and decreases venous stasis, reduces capillary permeability and fragility, and increases their resistance, improves microcirculation and lymphatic drainage.

Сonclusions. In the postcovid period, clinical symptoms of some chronic diseases occur/worsen, including clinical manifestations of chronic venous insufficiency. The use of Russian diosmin-based drug for the management of edema and pain syndrome is very promising.

Introduction. Synovial cyst or hygroma is a common disease that occurs in both children and adults, but it is most often observed in people 20–45 years old. More than 60% of patients who go to the polyclinic with complaints about the presence of tumor-like formations have hygroma.

Goal. Analysis of the results of treatment of synovial cysts of the hand and wrist joint according to our own observations and literature data.

Material and methods. We observed 54 patients suffering from hygroma of the hand and wrist joint, who were treated in polyclinic No. 2 and MEDEL multidisciplinary clinic in Kazan from 2005 to 2020. The treatment of hygrom was carried out using conservative (puncture) and surgical methods. Results. Our experience showed that after a single puncture of the hygroma with the evacuation of its contents (10 patients), relapse developed in all cases. After repeated puncture of the hygroma in 10 patients with evacuation of the contents and subsequent administration of 0.5 ml of betaspan solution, 6 of them did not relapse within 5–6 months, but 4 patients had a relapse in the nearest period (1–2 months). Of the 23 patients who underwent surgery to remove the hygroma, 15 of them had no relapses. In 8 patients in the postoperative period, recurrent hygroma occurred, which could be explained by the ineffectiveness of eliminating the communication zone between the hygroma and the joint.

Conclusions. For the successful treatment of this disease, it is important to understand that for the occurrence and development of hygroma, its communication with the joint cavity or tendon vagina is of great importance. In the absence of a message, the successful use of puncture methods of treatment is possible. In the presence of such a message and its detection during preoperative examination, surgical treatment should be planned with mandatory ligation of the leg of the hygroma.

Venous malformations are the most common type of angiodysplasia, which cause both physiological and emotional discomfort to patients. Arteriovenous malformations occur most often in the upper and lower limbs at the ratio of 20.9% and 46.4%, respectively. On top of that, 70% of cases of superficial arteriovenous malformations are found in women. In this article, the authors present a clinical example of the effectiveness of microfoam sclerotherapy and show a long-term outcome in a patient with superficial venous malformations of her hands, which are accompanied with such symptoms as as pain and bleeding. As a sclerosing agent, a 1–3% sodium tetradecyl sulphate solution was used, followed by compression using class 2 garments (RAL standard) such as an arm sleeve and gloves. The interval between procedures was 4 to 6 weeks. After several sessions, the superficial venous malformations of the upper limb decreased in the size and volume, and the patient presented less complaints. A 5-year follow-up showed no growth of malformations and re-bleeding complications. Microfoam sclerotherapy of superficial venous malformations in the upper limbs (hands) has good long-term outcomes and allows patients to avoid traumatic surgery. Given this comparability of the surgical and minimally invasive techniques, the use of the latter option, in particular, the foam sclerotherapy technique, makes economic and financial sense.