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Purpose. The purpose is to improve the results of treatment of patients with phlegmon of the gluteal region soft tissues by diagnosing the stage of tissue hypertension and determining the tactics of surgical treatment depending on this indicator. Materials and methods. Clinical studies were performed on 74 patients suffering from phlegmon of the gluteal region. All the patients were divided into 2 groups: in the main group (as opposed to the control group), acute tissue hypertension syndrome was diagnosed and decompressive fasciotomy was performed in tissue hypertension (30–35 mm Hg) (patent). The authors performed ultrasound cavitation and ozone therapy of a purulent wound. Results. With phlegmon of the gluteal region of soft tissues, an increase in tissue pressure by 25% above the norm is an indication for fasciotomy in the area of fascial nodes. The time of purulent wound cleaning against the background of normal tissue pressure (8–10 mm Hg) of the surgery in patients of the main group was reduced to 5 days (8 days in the control). In the long-term (0.5–1 years), good results were obtained in 92.8% of patients in the main group (64.7% in the control group). Conclusion. The developed tactics of treatment of patients with phlegmon of the soft tissues of the gluteal region are highly effective due to the development and application of new technologies for the diagnosis and treatment of tissue hypertension.

Background: Radiation-related hypopharyngeal stenoses are considered as complications after larynx sparing therapy of hypopharyngeal or laryngeal tumors. Methods: The reported patient suffered from chondronecrosis of the cricoid after radiation of a larynx carcinoma and was treated by removing the necrotic cartilage. To prevent emerging stenosis of the hypopharynx, a customized hypopharyngeal stent was constructed on the basis of CT scan data. The Y-shaped stent was placed dorsal to the larynx, caudal to the arytenoid cartilages and remained in place without dislocation or irritation of the larynx for 8 weeks. During that time, the hypopharynx was stented, and the mucosa grew around the stent covering the complete circumference of the hypopharynx again. 18 weeks after removal of the stent, the hypopharynx did not reveal any re-stenosis. Conclusion: This customized hypopharyngeal stent is the first reported approach applied with spared larynx, which has been tolerated for a long period of time.

The purpose of the work is to improve surgical treatment of foot phlegmon by developing a method for diagnosis and treatment of compartment syndrome (CS). Materials and Methods. The study involved 64 patients with foot phlegmon of non-diabetic etiology. The patients were divided into two groups. Group I (control, n=31) suggested traditional treatment techniques. Group II (main, n=33) provided a new algorithm for the diagnosis and treatment of compartment syndrome (patent No. 2683855), along with ultrasonic cavitation and ozone therapy. To assess the severity of the purulent-inflammatory process in the foot, the authors suggested to include a tissue pressure measurement technique in the diagnostic algorithm. The obtained indicators contributed to the diagnosis of the compartment syndrome and, thus, administration of decompressive fasciotomy in fascial foot structures with a high strength level and elastic modulus. The authors also evaluated the degree of reparative processes in the postoperative wound and the level of its microbial contamination (CFU calculation). Results. It was estimated that the increase in tissue pressure by more than 25 mm Hg in 87.9 % of patients is an indication for a know-how decompressive fasciotomy. The obtained results of clinical, laboratory and instrumental research allowed the authors to develop an algorithm for treatment efficacy evaluation. Conclusion. The positive treatment results observed in 90.9 % of patients make it possible to recommend the developed algorithm for implementation in clinical practice. Keywords: phlegmon, tissue pressure, surgical treatment, fasciotomy. Цель работы – улучшение результатов хирургического лечения флегмоны стопы путем разработки способа диагностики и лечения компартмент-синдрома (КС). Материалы и методы. В исследовании участвовали 64 пациента с флегмоной стопы недиабетической этиологии, разделенных на две группы. В I группе (контрольной, n=31) использовалась традиционная методика лечения, во II группе (основной, n=33) – разработанный алгоритм диагностики и лечения компартмент-синдрома (патент на изобретение № 2683855), а также методы ультразвуковой кавитации и озонотерапии. Для оценки тяжести течения гнойно-воспалительного процесса в области стопы было предложено включить в диагностический алгоритм методику измерения тканевого давления. Полученные показатели послужили основанием для диагностики компартмент-синдрома и выполнения по показаниям декомпрессивной фасциотомии в области фасциальных структур стопы, обладающих высокими уровнем прочности и модулем упругости. Также оценивались степень репаративных процессов в послеоперационной ране и уровень ее микробной обсемененности по значению КОЕ. Результаты. Установлено, что увеличение тканевого давления более чем на 25 мм рт. ст. у 87,9 % пациентов является показанием для выполнения декомпрессивной фасциотомии по оригинальной методике. Полученные результаты клинических, лабораторных и инструментальных методов исследования позволили выработать алгоритм оценки эффективности лечения. Выводы. Отмеченные у 90,9 % пациентов хорошие результаты лечения дают возможность рекомендовать разработанный алгоритм для внедрения в клиническую практику. Ключевые слова: флегмона, тканевое давление, хирургическое лечение, фасциотомия.