Background. Vacuum-assisted closure, sometimes referred to as microdeformational wound therapy or negative pressure wound therapy, has revolutionized wound care over the last 15 years. This article describes our current understanding of these technologies, the questions that remain, and what the future may hold for technologies based on mechanotransduction principles.

Martorell hypertensive ischemic leg ulcers (hytILU) represent a unique form of lower extremity non-healing ulcers that develop in association with poorly controlled high blood pressure. the present study was performed in order to assess levels of protein regulators of angiogenesis (vascular endothelial growth factor, or VeGF, and angiostatins) and to evaluate activities of matrix metalloproteinases (MMPs) (gelatinases MMP-2 and-9) in wound cutaneous tissue in the case of patient with 2-years hytILU history. VeGF and angiostatin levels were analyzed by Western blot, MMP activities were evaluated by gelatin zymography. We report here for the first time that wound tissue in HYTILU is characterized with increased levels of VEGF (by 75 folds vs. histologically normal tissue, P < 0.01) and dramatic overproduction of angiostatin levels, which are undetectable in healthy cutaneous tissue. Approximately 10-fold elevation in MMP-2 and-9 activities is observed in wound tissue as compared with uninjured cutaneous tissue. Obtained results indicate that increased production of angiogenic inhibitors, angiostatins, may counteract VeGF-induced pro-angiogenic signaling, and together with MMP overactivation, contributes to failed healing of ischemic ulcer. Further extended studies are needed to clarify how changes of angiogenic profile and imbalance of proteolytic activities in non-healing Martorell ulcers can be considered during their management procedures to improve efficacy of surgery debridement and/or skin grafting.

The aim — to improve the diagnostic and surgical palliative treatment results in patients with unresectable pancreatic head cancer, complicated by obstructive jaundice with the canceromatous pancreatitis.Materials and methods. A comparative analysis of the various surgical techniques aimed on the bile duct obstruction syndrome correction by biliodigestive shunting in the palliative surgical treatment of patients with unresectable pancreatic head cancer and mechanical jaundice was done. The analysis of the archival material (1st group, n = 155) was performed at the first stage. It was established that although the pancreatic tumour causes obstruction of both the common bile duct and the main pancreatic duct, however, mechanical jaundice was developed in all patients, and obstructive canceromatous pancreatitis only in 8.8 % of patients. The mild forms of pancreatitis were effectively eliminated by routine methods of intensive care. However, in cases of moderate severe pancreatitis (according to the Atlanta‑92 classification, third revision), the state of patients’ health progressively deteriorated, as the mechanical jaundice background developed a life‑threatening multiorgan failure and the biliodigestive bypassing was not sufficient to avoid a postoperative complications and unsatisfactory results in all cases. Based on the obtained results analysis it was concluded that modernization is need to both surgical tactics and techniques in such patients. Therefore, it was planned and carried out original trial with the optimized treating technology approbation for such patients. To this end, 112 patients with pancreatic head cancer, complicated by mechanical jaundice (Group 2), treated in the surgical department for the period of 2007 — 2018 were included in an open, prospective, randomized study.An approbation of the original algorithm for the carcinomatous pancreatitis verification was performed; the effectiveness evaluation of the proposed tactics and the technique of surgical treatment, including the developed method of combined bilio‑ and pancreaticodigestive bypass surgery was done.Results and discussion. The safety and clinical efficacy of simultaneous with biliodigestive pancreatodigestive bypass was established in patients with locally advanced pancreatic head cancer complicated by obstructive jaundice and carcinomatous pancreatitis. The tactics of a two‑stage surgical treatment was described, which involves first performing external cholangiostomy with minimally invasive techniques or endoscopic transpapillary stenting in patients with signs of liver failure or carcinomatosis pancreatitis, and then the main stage of surgical intervention.Conclusions. The proposed tactics of two‑stage surgical treatment in patients with nonresectable pancreatic head cancer complicated by mechanical jaundice and pancreatic cancer, which includes a two stage technology of surgical interventions with the use of minimally invasive operations in the first stage of treatment and one‑step combined bilio‑ and pancreaticodigestive bypass surgery on the second one, contributes to the reduction of postoperative complications, mortality and improves the patients’ life quality.

ВступХворі з відкритими дефектами м'яких тканин, що розвинулись внаслідок складної ускладненої травми, перенесеної ранової інфекції, гострих чи хронічних гнійно-некротичних захворювань шкіри, клітковини та кісток, становлять основну частину пацієнтів відділень гнійної хірургії. Косметичні та функціональні наслідки даних захворювань настільки тяжкі та необоротні, що хірурги все більше уваги приділяють відновленню втра-чених ділянок шкіри в якомога ранні терміни [5].Шкірна пластика не може бути прерогативою лише спеціалізованих закладів -жоден хірургічний ста-ціонар не може обійтись без застосування відновних операцій, оскільки складні ситуації, що заважають за-вершити оперативне втручання глухим швом, можуть виникнути при багатьох операціях, особливо часто це відбувається у гнійній хірургії та травматології.Необхідно зазначити, що основним критерієм оцін-ки часу та якості лікування є термін повного загоєння рани (справжня тривалість лікування), а не час перебу-вання пацієнта в стаціонарі. Вимогою сучасної хірургії є швидке повернення пацієнта до нормального спосо-бу життя з найменшими функціональними, косметич-ними та фінансовими втратами. Однак, незважаючи на це, більшість пацієнтів (за нашими даними, 55-70 %) виписуються із стаціонару з відкритими виразками. До цього призводить ряд об'єктивних причин: неможли-вість виконати закриття рани, велика кількість паці-єнтів похилого та старечого віку з тяжкою соматичною патологією, а також недоцільність пластичного втру-чання у хворих із незначними ранами, які можуть бути вилікувані консервативними методами. Не можна не відмітити і суб'єктивні причини: відмова самого паці-єнта від повторної операції, відсутність бажання хірур-УДК 616-002.3-89: 615.361.014.41 DOI: 10.22141/1997616-002.3-89: 615.361.014.41 DOI: 10.22141/ -2938616-002.3-89: 615.361.014.41 DOI: 10.22141/ .4.35.2017 Петренко О.М.

Summary. The development of new technological solutions for palliative surgical treatment of patients with unresectable pancreatic cancer is relevant because the frequency of postoperative complications in such patients reaches 25 % and mortality — 20 %. Objective. Improve the diagnosis and immediate results of palliative surgical treatment of patients with unresectable pancreatic cancer complicated by mechanical jaundice and duodenal obstruction. Materials and methods. A comparative analysis of the results of surgical treatment of two groups of patients (11 patients in the first and 27 in the second) for unresectable pancreatic cancer complicated by mechanical jaundice and gastric evacuation disorders due to duodenal obstruction. Patients of group I performed only biliodigestive shunting by open surgery. Patients in group II obstruction of the bile ducts and duodenum was removed by endoscopic stenting of the biliary system and duodenum with nitinol stents. Results. It is proved that endoscopic stenting of the biliary system and duodenal obstruction by nitinol stents, compared with open surgery, is accompanied by a lower frequency of postoperative complications (72.7 % vs. 22.2 %, p < 0.05), mortality (27.3 % vs. 0 %, p < 0.001) and reduction of hospital stay (from (24.3 ± 3.74) to (8.7 ± 0.91) days, p <0.001). Conclusions. The operation of choice of palliative surgical treatment of patients with unresectable pancreatic cancer complicated by mechanical jaundice and evacuation disorders from the stomach, with a high risk of surgery (ASA III), is to perform endoscopic transpapillary stenting of the bile ducts and duodenum.