Due to high prevalence of chronic venous diseases that develop in 2/3 of the adult population, this pathology can now be considered a disease of civilization. What is worrying is that over the past few decades there has been a tendency for rejuvenation of these diseases. Thus, chronic venous diseases of the lower extremities are an extremely urgent medical and social problem. Compression therapy is the gold standard for the prevention and combination treatment of every patient with chronic venous diseases in the practice of a modern specialist. Nevertheless, due to improvement of diagnostic methods and the greater availability and variety of minimally invasive treatment methods, there are different kinds of statements about the role and place of compression therapy under present-day conditions. In our interview with Professor Vadim Yu. Bogachev, a leading specialist in phlebology, Doctor of Medical Sciences, the Russian Federation Government Prize winner in Science and Technology, we ask him to share his own clinical experience and give his professional opinion on medical compression garments in the treatment of venous diseases of the lower extremities.

The rapid development of innovative medical technologies, the expansion of indications for surgical treatment, a significant increase in the number of operations performed for varicose veins entails a steady increase in the frequency of iatrogenic damage to the vascular-nerve bundle and lymphatic collectors of the lower limb. This can lead to severe complications requiring surgery, social and economic consequences associated with the need forlong-term outpatient and inpatient treatment, social security costs and a marked decrease in quality oflife. Reports on the occurrence of this pathology in the medical literature are few and, as a rule, describe extremely rare clinical cases. Timely diagnosis of complications, tactics of surgical treatment of patients with iatrogenic injuries in the surgical treatment of varicose veins and possible options for correcting emerging complications continue to cause discussion and remain one of the discussed problems of modern angiosurgery. The article provides a review of the literature devoted to the analysis of possible causes of iatrogenesis in varicose vein surgery: damage to the neurovascular bundle and lymphatic vessels of the femoral triangle, femoral vein, great saphenous vein, femoral artery, concomitant damage to the artery and vein, lymph nodes and basins, saphenous nerve during phlebectomy. The issues of diagnosis and options for correcting the complications that have arisen. The problem of mistakes and complications in the vein surgery should be resolved through comprehensive training of phlebologists, including compulsory teaching of vascular surgery skills, as well as supplying special equipment and instruments to the clinics. 

Over the last decade non-thermal non-tumescent (NTNT) methods of truncal reflux elimination in chronic venous disease (CVD) are becoming increasingly popular. The main NTNT modalities are mechanochemical ablation and cyanoacrylate adhesive closure (CAC). The advantages of non-thermal ablation are avoidance of tumescent anesthesia, low periprocedural pain and bruising, high patient comfort and satisfaction rates. CAC method has an additional benefit of avoiding the postprocedural compression. CAC is one of promising non-thermal ablation procedures, that leads to truncal vein occlusion and reflux elimination via endovenous delivery of n-butyl-2-cyanoacrylate. This review is aimed at assessment of the updated European and American clinical practice guidelines on CVD management, particularly the role of CAC. Current evidence shows high efficacy and safety of the CAC, its advantages regarding the periprocedural pain and ecchymoses, risk of adverse events, closure rates in the long-term, procedure and recovery time and patients’ quality of life. Therefore, along the current gold standard of varicose vein treatment – thermal ablation, the updated 2022 European and American clinical practice guidelines have significantly emphasized the role of NTNT modalities in general and CAC in particular. Specifically, the European Society for Vascular Surgeons guidelines recommend CAC for patients with great saphenous vein (GSV) incompetence when the NTNT technique is preferred. American guidelines recommend both thermal and non-thermal ablation for the patients with symptomatic axial reflux of the GSV, depending on the available expertise of the treating physician and the preference of the patient.

This article provides a review of the current literature on the current principles of symptomatic treatment of lymphovenous insufficiency. Lymphovenous insufficiency is an urgent problem of modern phlebology, the prevalence of this pathology reaches 50% among the world population. Underlying the pathogenesis is venous hypertension, which is caused by venous valve insufficiency, venous outflow obstruction, or combined causes. The use of compression knitwear and symptomatic therapy for lymphovenous insufficiency is an important component of the treatment at the initial stages of the disease — pharmacotherapy based on the use of venoactive drugs. The most promising to date are preparations of the micronized purified flavonide fraction (MPFF) group, which consist of micronized diosmin and flavonides. The use of МОФФ drugs reduces venous hypertension by increasing venous tone, reducing venous capacity, and extensibility of the vessel wall. MPFF also improves lymph conversion by increasing the contractility of the lymphatic capillaries and has an effect on the microcirculation of the vessels of the lower extremities, having an effect on the resistance and permeability of the capillaries. Thus, the use of preparations of the micronized purified fraction of flavonides has a more pronounced effect on the etiology and pathogenesis of the disease, thereby increasing the clinical effect and leading to a more effective result in the treatment of lymphovenous insufficiency. And as presented in this review, drugs containing micronized purified flavonoid fraction are an excellent candidate to be further studied as therapeutic agents for the treatment of lymphovenous insufficiency, because the mechanism of action of the micronized purified flavonoid fraction is directly connected with its pathophysiology and high clinical efficacy.

Introduction. Treatment of thrombophlebitis should be complex and, along with mandatory compression, include both systemic and local use of drugs.

Aim. To evaluate the efficacy and safety of the standardized use of the combined drug gel containing heparin sodium, aescin and essential phospholipids in real clinical practice in the treatment of superficial vein thrombophlebitis.

Materials and methods. The study included 68 patients with varicose veins complicated by superficial vein thrombophlebitis. In group 1 patients (n = 33), topical drugs were not used. In group 2 patients (n = 35), combined gel was used daily. The drug was applied to the skin of the lower extremities three times a day, 1 g of gel. Its total daily amount did not exceed 4 g of gel. The observation period was 10 days. A dynamic scoring of clinical symptoms was performed using alinear analog scale and thermometry of the skin of the lower extremities.

Results. On day 10, patients of the main group showed a statistically significant decrease in thermographic parameters in the area of thrombophlebitis: T_min 33.23 ± 0.12 °C, T_max 39.86 ± 0.24 °C, T_mean 40.01 ± 0.16 °С (p ≤ 0.05). When assessing the symptoms of thrombophlebitis using alinear analog scale after 10 days of treatment, there was a general decrease in the number of points in the control group to 16.4 ± 0.12 and in the main group to 12.3 ± 0.16 points (p ≤ 0.05).

Conclusion. A combined gel is an effective and safe drug for the treatment of patients with thrombophlebitis of the superficial veins of the lower extremities. 

Introduction. Bleomycin is a cytotoxic antibiotic that is used as a sclerosing agent for sclerotherapy of vascular anomalies. Bleomycin is characterized by complications: nausea, vomiting, fever, the development of allergies/anaphylaxis, skin discoloration (hyperpigmentation), damage to lung tissue.

Aim. To study the frequency of hyperpigmentation after administration of bleomycin for sclerotherapy of vascular malformations with slow flow characteristics. To present our own clinical observation of the development of skin hyperpigmentation after sclerotherapy of venous malformation with bleomycin.

Materials and methods. A systematic review was conducted in foreign (PubMed, Web Of Science, Google Scholar, Scirus) and domestic databases (eLibrary) for the period from 2012 to 2022. As a result of the selection, 17 full-text articles remained suitable for their inclusion in the analysis.

Results. In the first part of the review, 12 articles were analyzed, describing clinical observations of the development of “flaggelate” hyperpigmentation after chemotherapy of various neoplasms. In the second part of the review, an analysis of 4 articles describing clinical observations of the development of hyperpigmentation after intralesional administration of bleomycin into vascular malformation in 19 patients was carried out. Discussion. The occurrence of specific “flaggelate” hyperpigmentation after administration of bleomycin for sclerotherapy of vascular anomalies with slow flow characteristics is a rare complication. In the analysis carried out, there is no clear connection between the occurrence of hyperpigmentation and excess dosage.

Conclusion. To prevent the appearance of hyperpigmentation, it is necessary to avoid excessive traumatization on time and immediately after sclerotherapy, including with ECG electrodes; avoid excessive oxygenation during the provision of anesthesia; it is necessary to avoid excessive insolation within 24–48 hours after sclerotherapy. 

A review of the literature is presented, including data on the incidence, pathophysiology, and clinical picture of patients with chronic compartment syndrome (CCS) of the lower extremities. Chronic exercise compartment syndrome (CECS) is characterized by pain with repetitive exertion and increased intracompartmental pressure affecting the lower extremities in physically active patients. In severe chronic venous insufficiency of the lower extremities, chronic venous compartment syndrome (CVCS) develops, which is fundamentally different from previously known clinical pictures. Progressive dermatolipofasciosclerosis and cicatricial destruction of the fascia of the leg in patients with C4b-C6 clinical classes according to CEAP affect the pressure in the muscle-fascial compartments at each step. In severe cases, this leads to significant changes in the muscles, accompanied by chronic ischemia associated with necrosis and glycogen deficiency. The analysis of various diagnostic methods, conservative treatment and methods for performing surgical decompression of the CCS was carried out. The lack of a clear pathophysiology for CECS and CVCS complicates the diagnosis and treatment of this condition. Diagnosis of calf CCS is still based on pressure testing in the musculofascial compartments of the calf using the Pedowitz criteria, however standard procedures for this, including patient position, static or dynamic movements, muscles and equipment tested, are not agreed upon. In patients with CCS, if conservative treatment is ineffective, fasciotomy of the affected parts of the lower leg is the method of choice. Various techniques for fasciotomy of the lower leg include the traditional open fasciotomy, the semi-closed technique with one or more incisions, the minimally invasive technique using endoscopic compartment release, and the use of ultrasound guidance. Fasciectomy of the lower leg to correct CVCS is performed mainly for recurrence of trophic ulcers after shave therapy, severe calcification of the lower leg tissues and for the treatment of deep transfascial necrosis. Randomized, blinded, controlled trials are needed to further expand our knowledge of the diagnosis and treatment of CCS. 

Sclerotherapy is one of the most popular and most common techniques for the removal of delated reticular veins and telangiectasias on the lower limbs. Despite the vast pooled experience, this procedure can be accompanied by a number of undesirable side effects, of which post-injection hyperpigmentation, which frequency reaches 80%, is the most unpleasant one. The development of postsclerotherapy hyperpigmentation (PSHP) is associated with extravasation and destruction of red blood cells, which results in transformation of haemoglobin into hemosiderin pigment. PSHP is, by definition, a variant of post-traumatic hemosiderin pigmentation. The likelihood of occurrence and persistence of PSHP is determined by a number of hard controllable factors, including the calibre and location of the target veins, the type, concentration and physical form of the sclerosing agent, the sclerotherapy technique, the method and duration of post-procedural compression, patients’ ethnicity, iron metabolism disorders, concomitant use of a number of drugs, a menstrual cycle phase in women, etc. Hyperpigmentation significantly decreases the patients’ quality of life, which determines the need for the prevention and treatment of this undesirable side effect of phlebosclerosing treatment. Recommendations for prevention of PSHP include a detailed history taking aimed at identifying potential risk factors, in the presence of which it is advisable to use various systemic and topical drugs in the post-procedural period in order to prevent the skin hemosiderin deposition, as well as to apply the extended-cycle compression. In the case of PSHP, procedures aimed at the destruction and utilization of hemosiderin, such as Q-Switched laser and IPL therapy, as well as various peeling options intended to speed up the replacement of pigmented skin with normal, can be applied. For the PSHP prevention and treatment, the use of Contractubex containing cepalin onion extract in combination with allantoin and heparin is a matter of interest. Contractubex is a drug originally intended to optimize wound healing and prevent the formation of hypertrophic scars. At the same time, there is ample publications discussing the possible use of this drug for the management of post-traumatic hyperpigmentation due to the combined action of its components. Our clinical experience confirms the effectiveness of Contractubex in the treatment of PSHP, which determines the feasibility of conducting full-fledged clinical trials and accumulating more pooled experience in this area. 

Introduction. Pregnancy is the leading cause of varicose veins(VVs) in women. Therapeutic measures during pregnancy include the wearing of compression hosiery and the phlebotropic therapy.

Purpose. To evaluate the clinical effectiveness of graduated elastic compression and phlebotropic therapy in pregnant women with VVs.

Materials and methods. A total of 88 pregnant women were included, 30 of whom used compression stockings (group 1), 28 women received phlebotonics together with compression (group 2) and 30 were controls. VVs severity was determined using the Venous Clinical Severity Score (VCSS). Quality of life (QoL) was calculated using the Chronic Venous Insufficiency Questionnaire (CIVIQ-20). The calf circumference was measured with a measuring tape in an orthostatic position.

Results and discussion. At the end of the study there was a decrease in VCSS (p < 0.001 and p < 0.008) in both treatment groups, whereas the control group showed an increase in VCSS severity (p < 0.001). At the end of follow-up the QOL score in the treatment groups showed a tendency to improve while the control group showed a decrease in QOL. A bilateral decrease in tibial circumference (p < 0.001) was seen in groups 1 and 2 and the adjuvant phlebotropic treatment was found to be superior in controlling the oedema.

Conclusions. The combined use of elastic compression and phlebotonics is more effective in eliminating venous oedema in pregnant women with VVs. 

Trophic ulcers (TU) associated with venous circulation pathology or diabetes mellitus are considered chronic wounds with all the attributes of the complex extracellular matrix (ECM) reorganization and tissue remodelling of the edges and bed of these wounds. It was therefore determined that only a comprehensive step-wise approach to the treatment of TU can produce a stable clinical result. The article presents the experience of comprehensive management of venous and diabetic TUs. Three clinical cases of management of patients with lower limb TUs are described. The treatment of patients was planned taking into account the accepted algorithms for the management of TU associated venous circulation pathology or diabetes mellitus. The topical therapy included advanced wound coverings. The choice of dressing was determined by the clinical course of wound process. Alginate dressings were used on stages I and II wounds; hydrocolloid dressings were used on stages II and III wounds. Effects resulting from treatment included almost complete healing or readiness of a TU for skin grafting. The topical therapy of venous and diabetic TUs is part of the comprehensive treatment. During phase 1 wound process, the topical drugs should have antimicrobial, necrolytic, draining, osmotic and analgesic action. During phase 2, the granulation tissue should be induced and the balanced moist environment should be created to promote tissue regeneration. The wound coverings specified in the above clinical examples are fully consistent with the principles of the TIME concept, their ease of use and comfort for the patient are pointed out. 

Chronic venous insufficiency, being the outcome and complication of most diseases of the veins of the lower extremities, is the fundamental cause of the formation of trophic ulcers. Over the past decade, in solving the problem of treating venous trophic ulcers, certain successes have been achieved, both in theoretical and practical terms. The modern concept of curation of patients with trophic ulcers of venous origin involves a reasonable combination of the following methods of treatment: local, including compression, as well as medical, surgical, minimally invasive and additional methods (physiotherapy, photodynamic therapy, etc.). The main goal of the treatment is to eliminate the ulcer, after which measures are taken to correct the underlying cause (chronic venous insufficiency) and prevent relapse. However, the tactics of the most successful treatment of patients with trophic ulcers of venous etiology is still not defined and requires further improvement. In particular, the method of photodynamic therapy, which includes the usage of special drugs - photosensitizers, also deserves to be studied and expanded for clinical use. The mechanism of photodynamic action is based on the ability of photosensitizers to accumulate in microbial and pathological cells. Under local light exposure, the photosensitizer enters an excited state and charges oxygen, which is associated with erythrocyte hemoglobin. Thus, in cells under the influence, a photochemical reaction is triggered, which ensures the formation of singlet oxygen and its free radicals. Reactive oxygen species, in turn, have a damaging effect on pathogenic flora and necrotic tissues. The main advantages of the method are relative simplicity, no risk of developing antibiotic resistance, acceleration of reparative and regenerative processes, and prevention of secondary infection. Thus, photodynamic therapy allows non-invasive, safe and effective optimization of local treatment and preoperative preparation of patients with venous trophic ulcers. 

Introduction. The prevalence of hemorrhoidal disease is 200 people per 1000 adult population, of which 75% are professionally active people. The choice of anesthetic support affects not only the effectiveness of the operation, but also the course of the early postoperative period. At the same time, regardless of the use of various variants of neuroaxial blockades, most authors indicate the development of complications such as acute urinary retention and severe postoperative pain syndrome in the postoperative period.

Aim. To substantiate and evaluate the effectiveness of the proposed system of anesthesiological support for proctological operations.

Material and methods. The study was conducted in 100 patients who were divided into two groups of 50 people. The operations were performed under conditions of combined anesthesia (spinal anesthesia + medical sedation). Spinal anesthesia was achieved with 0.5% isobaric bupivacaine solution, the average dose was 8.5 ± 0.12 mg. For drug sedation, a continuous infusion of propofol was used at a target concentration of 5–4–3 mg/kg per hour. The criterion for including patients in the main group was the appointment in the early postoperative period of the alpha 1 adrenoblocker tamsulosin hydrochloride at a dose of 0.4 mg/day.

Results and discussion. The system of anesthetic support, including a combination of spinal anesthesia using an isobaric solution of bupivacaine at a dose of 7.5 to 10.0 mg and intravenous sedation with propofol at a target concentration of 5–4–3 mg/kg per hour, program of postoperative anesthesia based on a combination of multidirectional drug action and the appointment of alpha 1 adrenoblocker tamsulosin hydrochloride at a dose of 0.4 mg/day allows for high-quality and safe surgical treatment.

Conclusion. The administration oftamsulosin hydrochloride at a dose of 0.4 mg prevented the development of acute urinary retention of patients. 

Hemorrhoidal disease is one ofthe most common pathologies ofthe anorectal region, its specific weight in the structure of diseases ofthe colon is about 40%. Hemorrhoids are a socially significant disease, most often found in the able-bodied population. The reason for the development of hemorrhoids, on the one hand, is a violation of blood circulation in the cavernous corpuscles, due to which they increase and nodes form, and on the other hand, dystrophic changes in the ligamentous apparatus of hemorrhoids, in connection with which they gradually shift down and begin to fall out of the anal canal. One of the factors provoking the development of hemorrhoidal disease may be the presence of dissinergia of the pelvic floor muscles, which, in accordance with the Roman criteria IV, is part of the functional constipation syndrome. Not only dissinergia, but also high basal pressure in the anal canal (increased tone of the internal anal sphincter) can lead to stool retention. High rates of basal anal pressure can occur as a result of damage to the mucous membrane of the anal canal during straining, which leads to reflex spasm of the anal sphincter (anal continuity reflex). Thus, a vicious circle can form and thereby exacerbate constipation and the course of hemorrhoidal disease. Also, the relationship between dysenergic defecation and hemorrhoidal disease can be justified by the fact that physiotherapy aimed at correcting the work of the pelvic floor muscles contributes to better control over the manifestations of hemorrhoidal disease in complex therapy. The return of symptoms or, in other words, the recurrence of the disease in patients after surgery for hemorrhoids more often occurs with concomitant constipation. In accordance with clinical recommendations for the treatment of hemorrhoids, the use of an adequate amount of fluid and the intake of dietary fiber (fiber preparations) is indicated to normalize the activity of the gastrointestinal tract and eliminate constipation as part of complex therapy. If it is impossible to take dietary fiber, laxatives come to the fore of constipation therapy. This article presents clinical examples of the efficacy and safety of using sodium picosulfate. 

Introduction. When performing laser coagulation of hemorrhoids, there is a demand for the elimination of simultaneous diseases, but their laser treatment is under study and implementation in the practice of coloproctologists.

Aim. To study the features of transmucous laser thermal ablation of chronic hemorrhoids of stage 2–3 with simultaneous elimination of other anal canal diseases in outpatient settings.

Materials and methods. Transmucous ablation of hemorrhoids of 2–3 degrees was performed in 104 (27.5%) people in combination with laser removal of chronic anal fissures in 82 (75%) patients, intra-sphincter fistulas in 10 (9.6%) and other anal canal pathology in 18 (17.4%) patients. The median age of patients was 43 years, 48 men (46.2%), 56 women (53.8%).

Results. Surgical tactics of laser treatment of simultaneous and underlying pathology allowed one-step elimination of both diseases in all 100% of patients. The duration of combined operations was 20.0 min. (15; 20) the pain intensity was 2.5 points (2; 3). Intraoperative blood loss was minimal. Pain in the postoperative period persisted for 5 days. After surgery, bleeding occurred in 2 (1.9%) patients. During the year, a recurrence of hemorrhoids occurred in 2 (1.9%), anal fissure in 10 (12.2%), condyloma in 2 out of 3 operated.

Discussion. The obtained characteristics of combined operations showed that all their signs corresponded to minimally invasive interventions, both operations, the main and combined, were low-traumatic, performed under local anesthesia and had one access and a common operating field.

Conclusion. Combined pathology of the anorectal region is observed in a quarter of patients with chronic hemorrhoids. In 100%, it was eliminated by simultaneous operations that were minimally invasive, which allowed them to be performed on an outpatient basis under local anesthesia. 

Hemorrhoidal disease (HD) is a pathological enlargement of the external and/or internal hemorrhoidal piles, which may be accompanied by the bleeding and prolapse of haemorrhoids outside the anal canal. The incidence of HD among the population of the Russian Federation is 130–145 patients per 1000 people, occurring mainly in patients 45–65 years old. Among all coloproctological diseases in Russia, haemorrhoids became the reason for visiting a coloproctologist in 35–41.9% of cases. In outpatient department, the disease occurs with a frequency of 694 per 100,000 population. The treatment of hemorrhoids often begins at the coloproctologist’s office during outpatient visits. Typical clinical presentations of hemorrhoids include a complex of symptoms: periodic rectal bleeding during defecation, prolapsed hemorrhoids requiring manual reduction. Pain and itching are much less common symptoms. The treatment of hemorrhoidal disease consists of a complex of conservative measures, minimally invasive and surgical treatments, or a combination of above methods. Systemic phlebotropic drugs that affect various pathogenesis links of hemorrhoidal disease hold one of the first rightful places at the very core of modern conservative therapy regimens. Phlebotropic drugs are a large group of biologically active substances that are products of chemical synthesis or plant processing. The venotonic drugs containing flavonoids diosmin and hesperidin are the most studied ones. Various effects of diosmin and hesperidin from anti-ulcerogenic and antitumor to antioxidant and anti-inflammatory ones have been studied in clinical and experimental studies. Its venotonic and angioprotective effects are the most important actions for the treatment of hemorrhoidal disease. This review of literature is aimed determining the place of phlebotonics in outpatient practice for the treatment of haemorrhoidal disease. 

Laser (Light Amplification by the Stimulated Emission of Radiation) is a technical device that emits electromagnetic radiation focused in the form of a beam in the range from infrared to ultraviolet, with high energy and biological effect. In the first quarter of the 20th century, A. Einstein laid the foundation for its creation, believing that when atoms are excited from an external radiation source, a multiple increase in the released photons occurs, and the result of this process is recorded as light energy. Back in the late twentieth century, lasers in coloproctology were used as a scalpel, in fact, they performed traditional surgical interventions, but using energy tools, however, this did not deprive patients of extensive wounds and, as a result, pronounced pain sensations. The modern use of laser in proctology is really minimally invasive. An optical fiber is carried through small punctures on the skin or fistula, through which the laser energy flows directly to the target and acts aiming. In coloproctology, lasers are used to treat hemorrhoidal disease, rectal fistulas and pilonidal sinus this isrecorded in clinical guidelines. The use of laser treatment with these nosologies can reduce the severity of pain after surgery, significantly reduce the healing time of wounds, shorten the period of disability, without reducing the quality of life of patients. At the same time, these interventions are almost as effective as classical operations, in some cases even superior. But despite these encouraging data, it is necessary to conduct further research in order to develop clear technical regulations for the use of laser techniques and tracking long-term results. 

Introduction. Chronic venous diseases are a common group of diseases with a significant risk of complications requiring timely correction. As a rule, phlebotonic drugs based on flavonoid complexes are used for the treatment and prevention of venous diseases.

Aim. To evaluate the effectiveness of the use of various phlebotonic drugs in the conditions of experimental chronic venous insufficiency.

Materials and methods. Varicose veins were modeled in Wistar rats by partial stricture of the deep femoral vein. The studied medicines were administered orally in a course of 30 days from the moment of surgery. During the work, the change in the following parameters was evaluated: the rate oflocal blood flow in the skin in dynamics, the degree of vascular permeability, the concentration of proinflammatory cytokines (TNF-α, IL-6) and matrix metalloproteinase 9 (MMP9) in the vascular wall. The rate of local blood flow was assessed by ultrasound Dopplerography. The change of vascular permeability was studied by the degree of extravasation of the Evans blue dye in the Miles test. The content of proinflammatory cytokines and MMR9 was determined by enzyme-linked immunoassay. The results were statistically processed.

Results. The study showed that the course oral administration of all the studied venotonizing drugs led to the restoration of hemodynamics and a significant (p˂ 0.05) decrease in the degree of vascular permeability in relation to untreated animals. It is worth noting that the use of a micronised purified flavonoid fraction 1 contributed to the development of a more pronounced vasal effect, which was reflected in an increase in blood flow velocity and a decrease in vascular permeability compared to the rest of the studied drugs. At the same time, the administration of micronised purified flavonoid fraction 1 to animals led to a statistically significant decrease in the concentration of proinflammatory cytokines, which was not observed when using other drugs.

Conclusion. The course administration of the micronised purified flavonoid fraction 1leads to the development of a pronounced phlebotonic effect, expressed in the restoration of microcirculation, a decrease of the inflammation in the vascular wall. 

The article discusses the evolution of the endovenous laser ablation technique for the treatment of varicose vein disease of lower extremities. The history of studies aimed at improving the endovenous laser ablation is provided. The authors described the features of endovenous laser ablation with wavelengths from λ = 0.445 to 1.94 µm, alongside with edge- and radial-emitting working fibers, as well as fibers with radiation absorption at its distal end. The physical and biophysical mechanisms of the most popular to-date method for outpatient treatment of varicose vein disease of lower extremities are reviewed. The propagation process of laser radiation in the scattering medium is described, and the important role of the radiation scattering effect on the depth of its penetration into biological tissues is shown. The processes that take place during endovenous laser ablation are considered. The difference in physical processes that take place during the use of laser radiation mainly absorbed by hemoglobin (hemoglobin-absorbed range) and by water (water-absorbed range) is described. Expedience of simulating the processes that take place during endovenous laser ablation with the use of blood plasma has been substantiated. The blood plasma simulation demonstrated the decisive action of laser-induced boiling on thermal damage to the vein wall, which causes its fibrous transformation. It has been shown that the use of radial-emitting fibres during intense boiling generates steam bubbles around the site of radiation coupling. The contents of such steam bubbles do not absorb radiation, which thus reaches the venous wall, causing its symmetrical thermal damage. The advantages of using water-absorbing radiation with a wavelength of λ = 1.94 µm in conjunction with a radial-emitting fibre have been substantiated. 

Introduction. The wide prevalence of varicose veins of the lower extremities and relapses of this disease causes a frequent combination of this pathology with other surgical and traumatological diseases. The expediency of using simultaneous operations is manifested in their obvious economic advantages.

Objective. To substantiate the expediency and effectiveness of simultaneous laser thermal obliteration of recurrent veins of the lower extremities and Baker’s cyst.

Materials and methods. 9 patients with recurrent varicose veins and Baker’s cyst were operated on. Of these, there were 7 (77.8%) women and 2 (22.2%) men, the average age was 52.8 ± 0.2 years. The average duration of the incidence of varicose veins was 14.1 ± 0.3 years, Baker’s cyst – 3.5 ± 0.1 years. As planned, patients underwent simultaneous laser endovenous coagulation of recurrent veins and intracavitary thermal obliteration of Baker’s cyst.

Results. There were no complications, the duration of operations was 40.3 ± 0.4 minutes. The intensity of the pain syndrome in 6–8 hours after surgery was 4.1 ± 0.2 points. On the 10th day, no pain was observed in any patient. The duration of pain was 7.8 ± 0.4 days. Long-term results were studied 12–16 months after completion of treatment in 9 (100%) patients. Recurrent varicose veins were not detected. In 8 (88.9%) patients, complete obliteration of Baker’s cyst was established.

Conclusions. Reliable obliteration of Baker’s cyst and recurrent varicose veins, 100% technical success, disappearance of clinical symptoms of this pathology, absence of relapses of both diseases in 8 (88.9%) patients after 12-16 months indicates high efficiency and indisputable prospects of such an approach to the treatment of this category of patients. However, the study is based on a small number of observations, so further accumulation of experience is required to generalize the results of the study. 

Introduction. Electrical burns are one of the most common causes of burns besides flame burns and scalds. High tension electrical burns lead to greater morbidity and mortality. Active management strategies are required to manage high tension electrical burns. Common epidemiological features and surgical management of wounds are described. Role of high ligation in high tension electrical burns has been described.

Purpose. To describe the epidemiology, main features of the presentation and acute management of high tension electrical burns.

Materials and methods. This study was done for the duration of 2 months. All patients who were admitted with high tension electrical burns were included in the study. Patients’ demographics, mode of injury, % age of burn areas involved, entry-exit wounds were recorded on the day of admission. Emergency fasciotomy was done in cases of impending gangrenous changes inlimbs to prevent compartment syndrome and peripheral neuropathy. Reconstructive surgeries were done depending on thelocation and depth of burns. Results. 64% patients were below 30 years. The majority of the patients who sustained electric burns were males (82.3%). All the patients were from low and middle socioeconomic status according to the modified kuppuswamy scale. The majority of patients sustained electric contact burns (55.8%). The majority of the patients were unskilled workers working in the fields (94.2%). Surgical treatment of all patients includes fasciotomies in 15 patients, debridement/ amputation in 32 patients, reconstructive surgeries in 42 patients.

Conclusion. High tension electrical burns are one of the most common causes of burns, especially in rural areas. Public awareness and compliance with safety standards as well as respect for the potentially deleterious effects of electricity are of utmost essential for avoiding these deadly injuries.