The nature of reparative and morphological changes in wounds was examined against the background of vacuum therapy in the comprehensive treatment of purulent and necrotic lesions of diabetic foot syndrome. We conducted comprehensive examination and treatment of 107 patients with DFS of grade II-IV according to Meggit-Wagner. The average age of patients was 53.2–4.3 years; there were 39 (36.4%) male and 68 (63.6%) female patients. Depending on the methods of topical treatment, patients were divided into two groups. The main group consisted of 55 (51.4%) subjects who underwent vacuum therapy during the topical treatment, and the comparison group comprised 52 (48.6%) patients who received standardized local treatment depending on the course of the wound process. In addition to the clinical studies, all patients underwent a comprehensive laboratory and instrumental examination, as well as measuring the area and pH of wounds on the 1st, 4th, 7th, 10th and 13th day after surgery. The analysis of the obtained results gives ground to establish that at a certain level of pH, there is a corresponding cytological pattern. The wide range of fluctuations in the pH of the wound medium in patients with purulent and necrotic lesions of diabetic foot syndrome leads to corresponding changes in cells, which is manifested by a long-lasting inflammatory process. In the main group, the rate of wound reduction was greatest on the 8th-10th days, and in the comparison group – on the 14th-15th days. Inpatient treatment was 14.2 bed-days in the main group and 23.5 ± 2.9 in the comparison group (p <0.05), respectively. Therefore, there is an acceleration of positive changes in clinical manifestations, cytological, morphological and pH-metric pattern against the background of conducting VT for an average of 5-7 days. The use of vacuum therapy makes it possible to accelerate the transition to the second phase of the wound process, which affects not only the time of treatment but also the outcome – preservation of the lower extremity in patients with diabetic foot syndrome.

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Among the complications of Meckel's diverticulum, which are rare, it is necessary to note Littre's hernia – the strangulation in the external abdominal hernia and its location in the hernia’s sac. Meckel's diverticulum is a protrusion of the wall of the ileum, which is formed as a result of incomplete obliteration of the bile duct, which is involved in embryotrophy. It occurs most often in inguinal and femoral hernias. This pathology is rarely observed in clinical practice, therefore, we present the clinical case of Littre's hernia. The aim of this research is to describe the features of the clinical course, diagnosis, and treatment of Littre's hernia, as well as to draw attention to the existence of such a disease. Clinical case. Patient V., born in 1960, was urgently admitted to the surgical department on January 19, 2022, with a diagnosis of “Strangulation of the left inguinal hernia”. On admission, he complained of acute pain in the protrusive area of the left inguinal zone. From the anamnesis: he had felt acute symptoms about two hours before admission. He had been noticing a bulge in the left inguinal area for 20 years. The patient was examined at the department and urgently operated on under spinal anesthesia. We conducted the resection of Meckel's diverticulum with allohernioplasty by Lichtenstein on the left. Postoperative diagnosis: strangulated left-sided inguinal hernia with strangulation of Meckel's diverticulum of the small intestine (Littre's hernia). The course of the postoperative period was uneventful. He was discharged from the hospital on the 7th day in satisfactory condition. At the time of discharge, the postoperative wound healed with primary tension. The patient was examined after 2 months: there were complaints of minor pain in the area of the postoperative wound during physical activity. The postoperative scar is in satisfactory condition. Thus, Littre's hernia is a rare surgical disease and is subject to urgent surgical treatment. At the same time, the scope of surgical treatment is determined during the operation and assessment of the condition of the intestine and diverticulum.

This article describes the study of the therapeutic efficacy in combining VAC‑therapy with periodic instillations of L‑arginine ("Tivortin") for the local treatment of purulent-inflammatory soft tissue conditions. The article presents the results of the local treatment of 44 patients with purulent-inflammatory soft tissue conditions who made up the main group and received VAC‑therapy in combination with periodic instillations of L‑arginine solution. 45 patients of the control group received standard topical treatment with gauze‑ointment dressings. Local treatment of the main group started in the purulent-necrotic phase and lasted 6 days. Instillations were done every 12 hours, with an exposure at 2 hours with subsequent renewal of special indicators of negative pressure therapy. When studying the microflora of purulent foci in the main group on the first day we found that among the pathogens S. aureus was the most prevalent as it was isolated in 30 (68.2%) cases, Enterobacter was found put in 10 (22.8%) cases, Accinetobacter – in 2 (4.5%) cases, Proteus – in 2 (4.5%) cases. The commonest microbial associations in the main group were presented by the combination of Enterobacter and E. fecalis found in 30 (68.2%) patients, the fungal flora (Candida albicans) was found in 5 (11.4%) individuals. On the 7th day among the patients of the main group no aerobic flora was isolated. Among the patients of the comparison group, monoculture was detected in 14 (31.1%) patients and microbial associations – in 5 (11.1%) patients. The patients of the main group demonstrated faster normalization of laboratory blood parameters than in the comparison group. Since the 3rd day, there was a decrease in the number of leukocytes in the peripheral blood. This tendency was more pronounced among the patients of the main group, where the indicators of leukocytosis were significantly lower (p> 0.05) than in the comparison group and on the 5th day reached the reference values, while in the comparison group the indicators got normalized only on the 7th day. Applying this therapy in the integrated treatment of patients with purulent inflammatory soft tissue conditions promotes the rapid cleansing of wounds from necrotic tissues, the appearance of "juicy" granulations in 3 days, as well as diminishes general intoxication and considerably reduces the length of hospital stay.