The article provides a literature review of the methods for the prevention of local infectious complications preoperative, intraoperative and postoperative. The analysis of the literature is devoted to the methods of prevention of postoperative purulent inflammatory wound complications. The review of scientific medical literature is based on the analysis of this problem. The article presents risk factors that contribute to the development of postoperative wound complications. Classification of surgical wounds was adopted to determine the risk of developing a surgical site infection (SSI), which distinguishes 4 classes: clean, conditionally clean, contaminated and dirty. The presented classification is based on the postoperative assessment of the wound bacterial contamination rate. The ClavienDindo classification of postoperative complications is the most relevant. This classification presents the tactics of the surgeon, depending on the class. The results of various studies indicate that antibiotic prophylaxis in the preoperative period reduces the development of local complications. The description of prevention methods focuses on intraoperative methods (devices for bringing together the edges of the wound, devices for treating wounds, surgical needles, suture material) and various types of antiseptics, which can reduce tissue damage during surgical interventions, reduce microbial contamination and the number of wound postoperative complications. Intraoperative instrumental methods allow less pronounced trauma to the wound during its processing and suturing. The postoperative method for diagnosing wound complications is an ultrasound method, which determines various formations in a postoperative wound.

AIM. To improve treatment results of patients with ligature fistulas of the anterior abdominal wall by the development of pyo-inflammatory wound complications diagnosis and prevention methods.METHODS. During the period from the beginning of 2001 to June, 2015, 34 patients with a ligature fistulas of the anterior abdominal wall were admitted to the Department of Surgery of Hospital for War Veterans, Kazan. Terms of ligature fistula occurrence ranged from 3 months to 5.5 years after surgery. 7 (20.6%) patients previously underwent herniotomy, 20 (58.8%) - laparotomy for various acute surgical diseases of the abdominal cavity, 2 (5.9%) - appendectomy, 5 (14.7%) - pelvic organs surgery. The patients mean age was 59±4.5 years. Patients were divided into two groups: the first - the comparison group, 23 (67.6%) patients. In this group suturing was performed with polypropylene or absorbable suture filaments, wound debridement was performed by the conventional technique using different antiseptics types: 0.5% chlorhexidine (chlorhexidine bigluconate) and 3% hydrogen peroxide solutions. The second group - the main one, included 11 (32.4%) patients. In this group polyglycolide-co-lactide (purple), USP 2/0 (3 Matric) 75 cm with the atraumatic tip suture materials were used and the wound debridement was performed with 10% aqueous hydroxyethyldimethyldihydropyrimidin (xymedon) solution using a device developed by us.RESULTS. The postoperative pyo-inflammatory complications rate in the control group was 17.4% (4 cases), in the main group - 9.1% (1 case); thereby infiltrates were registered in 3 patients of comparison group and in 1 patient of main group, seroma - in 1 patient of comparison group. Monoculture was isolated in microbiological assay of material from the surgical wounds in 86% of patients. Staphylococci, enterobacteria and non-fermentative Gram-negative bacteria were detected most often. Our results of microbiological assays point to the need for perioperative antibiotic prophylaxis.CONCLUSION. The infectious wound complications rate when using conventional methods of anterior abdominal wall ligature fistulas prevention and treatment is 17.4%, which makes it relevant to search for new methods of treatment and wound surface debridement; the author’s technique offered by us allowed to significantly reduce the wound complications rate.

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Aim. To improve the results of surgical treatment of patients with large soft tissue lipomas by developing and implementing of adaptation-distraction device for rapprochement of wound edges.Methods. During the period from 2012 to June, 2016, 61 patients with various localization of large soft tissue lipomas were hospitalized to the department of surgery of Kazan Hospital for war veterans. The patients were divided into 2 groups: control group included 35 (57.4%) patients who had the traditional mass excision with wound sealing, and the study group included 26 (42.6%) patients, on whom instrumental method was applied with the use of adaptation-distraction device for rapprochement of wound edges in order to reduce tissue trauma during removal of the lump and suturing tissues.Results. Clinical use of adaptation-distraction device for removing various tumors of the skin and subcutaneous tissue has demonstrated its advantage over traditional methods. Optimal conditions for radical removal of the tumor with maximum compliance with the rules of ablastics and antiblastics with minimal blood loss (20-45 ml) are created. In control group postoperative wound complications included 2 (5.7%) hematomas and 1 (2.8%) seroma. In the study group 1 (3.8%) patient had hematoma.Conclusion. Use of adaptation-distraction device provides preliminary circular local tissue compression directly near the tumor and in its base, which leads to local preventive hemostasis in surgical wound area without shutting down the blood flow in surrounding tissues; the device allows to make the imposition of primary seams not interrupting the surgery and to avoid eruption.

Aim. To improve the results of surgical treatment in patients with large lipomas by using the device for closing the edges of wounds, allowing local preventive hemostasis in the surgical wound area, to create optimal conditions for atraumatic suturing and thereby reduce the amount of intraoperative bleeding and subsequently reduce the amount of postoperative wound complications. Methods. The results of treatment of 105 patients with different localization of large lipomas were analyzed. Lipomas ranged from 8.0 to 20 cm in diameter. All patients were divided into 2 groups: the control group consisted of 53 (50.5%) patients for which used the traditional technique of tumor excision with closing surgical wounds, and the study group with 52 (49.5%) patients, for which to reduce tissue damage during tumor removal and the edges of wound suturing, one of the device variants developed by us was used, approximation-distraction device. Fisher's exact test was used for the comparison of the outcomes rate, a p-value 0.05 was considered statistically significant. Results. Surgical wound complications occurred in 7 (6.7%) of 105 patients. In the study group, surgical wound complications occurred in 1.9% (1 observation), in the control group 11.3% (6 observations). Surgical wound complications were severity grade I and grade IIIa. Complications of the first grade did not require a debridement and will regress on its own; in grade IIIa complications, an opening, excision and drainage surgical wounds were performed without general anesthesia. Conclusion. Moderate local selective near-tumor tissue compression that occurs when the device branches come closer to each other accelerates spontaneous thrombus formation in damaged small vessels. This creates favorable conditions for the surgeon to work in a dry wound.