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Treatment results of 301 patients with intraabdominal hypertension were analyzed. Indications for abdominal decompression were substantiated and defined. Algorythm, the novel surgical technique and instrumentarium for different decompressive surgery by peritonitis, acute intestinal obstruction and pancreonecrosis. The use of the algorithm allowed to decrease the postoperative complication rate. Thus, the laparotomic wound inflammation and necrosis was 24% less, eventration frequency was 4 times less and the acute respiratory failure was 43% less. The lethality rate fall from 20.9% to 11.5%.

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Methods of indirect abdominal pressure measurement by hernia repair are studied experimentally and in clinic. The study resulted in the creation of the complex of preoperative patient preparation with the use of pneumobandage. The extent of safe intraabdominal pressure gradient after hernia closure is defined. A pressure pad for the autodermal transplant preparation and a new device with dynamometer for adaptation and reposition of wound edges are constructed and introduced into practice.

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Clinical results of treatment were analyzed in 97 with patients generalized peritonitis. Application of staging hardware controlled laparostomy (HCL) allowed to halve the frequency of wound complication in comparison with semienclosed treatment mode. High clinical efficacy of control and correction of biophysical parameters of abdominal cavity was revealed: lethality from generalized peritonitis decreases in 2.4 times (from 39.3% to 14.3%) as a result of HCL application with monitoring and correction of intra-abdominal pressure in comparison with uncontrolled traditional treatment modes. Construction of the apparatus used for controlled laparostomy allows to open and close abdominal cavity under control of intra-abdominal pressure and tighting force of paravulnar tissues.

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The treatment of 200 patients with granulating wound of soft tissues was analyzed. A conventional method of treatment was used in 90 patients. In the study group (110 patients) different types of adaptive-reposition devices and the method of extrawound programmed vulnosynthesis were used. This method demonstrated technical advantages compared with standard methods of treatment of festering wounds that permitted to improve the results of complex treatment.

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The authors performed an animal model study of postoperative wound complications using 72 white Wistar rats and 36 mongrel dogs with aseptic cut wounds, granulating wounds, and relaparotomic wounds. In the control group the wounds were closed by a conventional method; in the main group a machine stitch was performed. Wound closure in the main group was performed after approximation of wound edges with specially constructed devices. Morphological and microbiological analysis showed that the key role in development of complications is played by morphofunctional wound substrate, which comprises the degree of paravulnar tissue traumatization with suture when a conventional method is used, and paravulnar tissue ischemia in case of microbial dissemination. The authors conclude that machine stitch is preferable.

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New method of suturing of median laparotomic wounds with interrupted twined (IT) suture is developed. Efficacy of IT-suture compared with other methods was evaluated in experiment (68 animals) and clinical study based on following data -- time of elimination of local inflammation in wound area, number and nature of purulent complications, long-term results of treatment (postoperative ventral hernias). Use of IT-suture in clinical practice permitted to reduce number of purulent complications from 23.4 to 6.3% compared with noose sutures and from 15.7 to 6.3% compared with uninterrupted ones. There were no eventrations, postoperative ventral hernias were seen in 2 (4%) patients.

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Arteriomesenterial compression (AMC) of a low-horizontal part of the duodenum is one of the causes of chronic duodenal obstruction (CDO). The degree of compression of this part of the duodenum was studied in 82 patients with CDO. It was revealed that distance between the aorta and superior mesenterial artery (SMA) on the level of low-horizontal part of the duodenum was less than 20 mm in the majority of cases. When this distance is 20 mm or less the duodenum is compressed by SMA and looks like sand-glass. If the distance between the aorta and SMA is 10 mm and less, delay of contrast in the middle third of a low-horizontal part of the duodenum during roentgenography is an obligate symptom. In AMC 10-20 mm this phenomenon is diagnosed less frequently. In AMC 20 mm and less endoscopy demonstrates symptoms of CDO in the majority of cases. There were no intraoperative subjective symptoms of AMC.

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Factors of risk of the appearance of wound complications were studied in experiment on a model of granulating wounds in 18 mongrel dogs. A traditional method (control group) and an apparatus method (main group) were used for suturing the wounds. In the main group of animals suturing the wounds was performed after bringing together the wound edges by specially designed devices. Morphological and microbiological investigations have shown that the leading role in the appearance of complications belongs to the morphological substrate of the wound with the main component including the degree of traumatizing the paravulnerable tissue with a suture thread when connecting the wound edges by a traditional method, ischemia of the paravulnerable tissues under conditions of microbial dissemination. The introduction of the developed method of closing the soft tissue granulating wounds into clinical practice resulted in a statistically significant reduction of pyo-inflammatory complications in the main group of patients. A conclusion is made on a more favorable course of the wound process when using the apparatus method of closing the wounds.

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The method of closure of soft tissues purulent wounds with wound-adapter of original construction has been developed and used in clinical practice. This method provides complete reposition and adaptation of wound margins without suture eruption. Good results (primary closure) were achieved in 85.8% cases in the study group, and in 49.7% cases in the control group, satisfactory results (secondary closure partly) - in 14.2 and 50.3% cases, respectively. Hospital stay was reduced from 27.6 +/- 1.5 to 22.4 +/- 0.7 bed-days (p < 0,05).

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The results of treatment of postoperative eventrations with new and improved adaptive-reposition apparatus are present. Influence of apparatus method of surgical wounds suturing on regeneration in sutured inflamed tissues of laparotomic wound was studied in experiment on 18 mongrel dogs. This method was used in 33 patients. Rate of recurrences of eventrations reduced from 35,7 to 1,3%, rate of wound complications - from 67,9 to 18,2%. Lethality decreased 3-fold.

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The results of the treatment of 250 patients with a carbuncle of various location were analyzed retrospectively. A differential approach to choice of surgical method with consideration of the degree, phase and localization of inflammation is preferable. Early and radical surgery, antimicrobic drugs, infusion therapy make base of up-to-date and adequate treatment. In the phase of infiltration deep incision often stops the disease or promotes a decrease of the necrotic zone. In suppurations linear incisions were made only on the face for cosmetic reasons. In other areas a few large connected T-, [symbol: see text]-, [symbol: see text]- or cross-formed incisions were preferable. In 30 cases I-formed incision with two rectangular flaps was used.

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A new method of treatment of postoperative ventral hernias was developed. During surgery under control over intraabdominal pressure hernial defect is closed with special devices for closure of wound margins. Plastic repair with local tissues in the form of duplication with uninterruptedly-recurrent suture (1st variant) or by contact method ("in join") with auto- or alloplasty on suture line (2nd variant) are performed when intraabdominal pressure doesn't change. If intraabdominal pressure increases, closure of the wound is stopped and polypropylene net or autodermal transplant (3rd variant) are sutured to margins of the wound. One hundred and sixty-eight patients with postoperative ventral hernias underwent surgeries with this method. Control group consisted of 110 patients. Recurrence of hernia was seen in 33 (30%) patients. There were no recurrences in the study group after the 2nd and 3rd variant of the surgery. In the 1st variant recurrence was seen in 6% cases. The method is recommended for surgical departments. Device immobilization permits to decrease tension in sutured tissue, creates optimal conditions for wound closure and prevents suture insufficiency.

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The article deals with bougies (developed by its authors) of various types and sizes designed for gullet bougienage after chemical burns. The suggested bougies ensure less trauma to the esophagus walls during the bougienage procedure, which, in its turn, essentially cuts the time of recanalization and, according to authors' data, prevents ruptures in the internal tissues.

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Information about a surgical treatment of the varicose disease, its description, and the results of practical application, specific features, used drugs and technical appliances is reported. The remote results are indicative of a sufficiently high efficacy of the offered method.

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The authors have devised a technique of consecutive performing the steps of operative interventions for varicose disease of lower extremities. The method includes extirpation after Babcock of the main trunks of the large and, if necessary, the small subcutaneous veins with the help of a spiral-shaped device; preliminary percutaneous-supracutaneous temporary ligation with kapron of sinuous lateral superficial veins; subcutaneous dissection of ligated veins between ligatures with minimal blood loss. For this purpose a phlebotom of simple construction in the shape of a clamp was used. One of its jaws was a cutting element with a point and cutting edge. The instruments proposed allow to make the technique easier, to avoid excessive traumatization of the tissues and to achieve stable obliteration of the injured veins. Recurrence of the disease was noted in 3.5% out of 145 patients with varicose disease within 1-8 years.

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A method of objective evaluation of treatment efficacy and outcomes prognosis of plastic surgeries in patients with non-healing defects has been developed. The method is based on dynamic study of free serotonin and histamine concentration in blood obtained from the elbow vein and vein of the affected limb. Level of these biogenic amines depends on disease severity and area of affection. In 32 patients phonophoresis with hydrocortisone was used that had positive influence on healing of tissue defect. This procedure is accompanied by reduction of free serotonin and histamine concentration. If their concentrations do not decrease ulcers heal very slowly. Study of biogenic amines concentration before and during treatment permitted the authors to identify favorable and unfavorable group of patients.

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Method of ultrasonic monitoring of wound process was used in 102 patients with acute surgical abdominal diseases undergone surgery from middle laparotomy. On 7th and 10th day after operation in phase of regeneration patients with uncomplicated wound process demonstrated reduce of hypoechogenic zone with appearance of zones with high echogenic structure, or transformation of hypoechogenic zones in hyperechogenic. Increase of hypoechogenic zone width in. 5-7 days after operation testifies high risk of purulent-necrotic complications in wound.

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The author proposes a new method of suturing laparotomy wounds--extrafocal connection of wound margins with adaptive-repositive devices which permit to minimize damage and microcirculatory disorders of sutured tissues, and to reduce purulent complications rate from 30.6 to 11% (2.8 times) compared with routine method of tissues connection. The proposed method is recommended for patients with high risk of pyoinflammatory complications.

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Rational method of surgery for lower extremities varicosis are developed. Method consists of Babkok's extirpation of greater and minor (if it is necessary) saphenous veins with spiral device; preliminary transcutaneous-supracutaneous temporary caprone ligation of changed superficial veins, subcutaneous dissection of ligated veins with minimal blood loss. Original flexible spiral saphenoextractor, inflatable hemostatic device, phlebotoms of simple construction are used. These devices permit to simplify surgery, to decrease tissues trauma and to achieve good cosmetic effect. Recurrence over 1-8 years was seen in 145 operated patients.

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