Objective: Analysis of surgical site suppurative complications after correction of large and giant ventral hernias. Methods: Various types of hernioplasty were performed on 220 patients with large and giant ventral hernias. Among the total number of patients, tension-free hernioplasty was performed in 123 patients, which accounted for 56% of the total number of patients. Various types of mesh implants were used, as well as different techniques of mesh placement in the area of the hernia ring. Results: Surgical site suppuration in the postoperative period occurred in 7 patients, which amounted to 5.6%. Partial removal of the mesh polymer implant was carried out only in one case. Timely diagnosis of the complications and adequate sanitation of the surgical site in 6 cases showed a good effect, and the implants did not necessitate removal. In one observation with necrosis of the edges of the wound and suppuration of the surgical site, after partial removal of the implant, a hernia recurrence was noted in the area of the removed mesh. In 6 other cases, there was no recurrence of the pathology during the long-term follow-up. Conclusion: Surgical site suppurative inflammation in the postoperative period, negatively affecting the outcome of the operation, can contribute to hernia recurrence. Timely diagnosis of complications and adequate sanitation of surgical site in most cases give satisfactory results. Keywords: Large and giant ventral hernias, hernia recurrence, tension-free hernioplasty, suppurative inflammation.

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The review addresses the issues of diagnosis and surgical treatment of concomitant chronic injuries of the upper limb nerves. The role of modern additional research methods in damage to the nerves is shown, and, depending on the prevalence of damage to certain structures, the value of each technique is shown. A detailed description of the clinical manifestations of sensory and motor disorders of the hand is given. The reasons for the diagnostic and tactical errors made during the examination and treatment of victims at the stages of medical evacuation are especially indicated. Depending on the nature and the duration of the injury, the expediency of using traditional and microsurgical methods of correction for chronic damage to the nerves is shown. The issues of neurotization and tendomuscular transposition are highlighted, and indications for their use are determined. Keywords: Upper limb, chronic injuries of the nerves, neurotization, tendomuscular transposition.

Objective: To justify the use of delayed reconstructive interventions in severe complex hand injuries. Methods: The results of delayed reconstructive surgery in 22 patients with a severe complex hand injury for the period from 2010 to 2022 were analyzed. Most of the patients (81.8%) were admitted within 4 to 7 days after injury and received primary care in non-specialized institutions. The age of patients ranged from 17 to 45 years, with the mean age being 28.3 years. They had crush hand injuries with an incomplete avulsion of all fingers (3), II-V fingers (6), II-IV fingers (9), and II-III fingers (1), in three cases, an extensive wound defect of the hand was accompanied by complete amputation of II-III (1) and II-IV fingers (2). The concomitant defect of integumentary tissues had an extended character in case of damage by electric machines (101.2±3.6 cm2) and gunshot wounds (92.1±3.7 cm2). Results: The rationale for the use of delaying tactics was the severity of the injury, the time point of admission, and the decompensation of blood circulation in the fingers in 8 out of 16 admitted patients. All the patients underwent delayed necrosectomy with preservation of the maximum length of viable bone fragments. An extensive defect of the integumentary tissues was covered with a skin-fascial inguinal flap. The second stage performed was one-step directed nerve implantation with phalangization of the transplanted flap (6). For reinnervation, the superficial branch of the radial nerve was most often used as a donor’s nerve. The restoration of sensitivity was registered 3 months after the surgery. Conclusion: As a result of multi-stage complex reconstructive plastic surgery performed on a primary-delayed basis for severe complex hand and fingers injuries, followed by correcting operations to improve the sensory input of the residual segments; the adequate functional outcome was obtained with an improvement in the patient’s quality of life. Keywords: Severe hand injury, hand defects, hand reconstruction, flaps, neurotization.