Objective. To evaluate the informativeness of ultrasound scanning of the lower limb arteries and angiography in patients with critical ischemia for choosing the optimal level of extremity amputation. Methods. Treatment of 289 patients with obliterative diseases of the arteries of the lower extremities of various genesis with the indications for amputation of the damaged lower extremity was analyzed. Results. Ultrasound scanning of arteries could not always characterize the severity of collateral circulation, but indicated only the level of occlusion. However, the severity of chronic ischemia of the lower limb is determined not only by the level of occlusion, but also by the severity of collateral blood flow at the same level of damage. That is why, in our opinion, the results of an ultrasound examination of the lower limb arteries cannot be decisive when choosing the level of amputation. Angiography made it possible to characterize not only the level of occlusion or stenosis, but also the state of collateral circulation, which had a decisive influence on the choice of the method of limb amputation. Conclusion. Ultrasound examination of the lower extremity vessels allows to establish the level of occlusion, but is uninformative for the assessment of collateral anastomoses, which is an important factor in choosing the level of non-traumatic amputation of the lower extremity. In patients with critical ischemia, transtibial amputations should be avoided, as they show worse results. The operation of choice should be a transfemoral amputation or non-traumatic through-knee amputation.

The article reviews the history of inguinal hernia surgery. At various times, different procedures and diverse materials were used for hernia repair. However, the effectiveness and safety of inguinal hernia repair emerged only after the anatomic features of the inguinal region had been elucidated in a monograph by Henri Fruchaud „Anatomie des hernies de l’aine” published in 1956. The Italian surgeon Edoardo Bassini began a new era in herniology. For a longtime, his classic procedure with its modifications was the most popular in surgical practice. In 1959, Lloyd M. Nyhus proposed inguinal hernia repair according to the concept of the pre-abdominal (posterior) approach that later became the basis for developing the transabdominal preperitoneal hernia repair (TAPP). In 1992, M. Arregui performed the first ТАРР using a prolene mesh. In 1986, Irving Lichtenstein proposed the concept of „tension-free repair”. Basing on his concept, Lichtenstein described an open technique of inguinal hernia repair, which now bears his name and is popular in surgical practice. In 1993, the term „extraperitoneal hernia repair” first appeared in an article by Edward H. Phillips. However, J. Dulucq developed the modern ТЕР technique. Currently, three tension-free inguinal hernia repairs (TAPP, ТЕР and Lichtenstein procedure) and one tension inguinal hernia repair (Shouldice procedure) dominate in inguinal hernia surgery.

The aim: improvement of trophic ulcer by surgical treatment with ultrasound cavitation combination. Materials and methods. The analysis of complex surgical treatment of trophic ulcers was conducted. Patients were divided into 2 groups, depending on the strategy of treatment. In the first (main) group (n=43) the combination of surgical treatment with ultrasonic cavitation was applied. By comparison, in the second group (n=43) only surgical treatment was applied. The method of treatment of trophic ulcers with the Sonoca 300 device is based on the effect of ultrasonic cavitation, which is a process of mechanical cleaning of the wound from necrotic tissues, while healthy tissue and vessels are not injured. Ultrasound machine SONOCA 300 is intended exclusively for use in human ultrasound surgery and is intended for the following applications: selective tissue dissection, mechanical grinding and cutting of bone tissue, debridement and cleaning of wounds, tissue cutting, tissue coagulation. The exact purpose of the application is determined by which tool is connected. In our case, this is a Macro ultrasonic tip designed for debridement and wound cleansing. Ultrasound is supplied at an operating frequency of 25 kHz, when you press the foot pedal, and simultaneously with the power of ultrasound, the irrigation and aspiration systems are activated. The irrigation solution from the container with the irrigation fluid passes through the tool, at the same time the aspiration of necrotic tissues and fluid, and their direction into the container for aspirate collection. Results and discussions. The ultrasonic cavitation in treatment of trophic ulcers different localization and etiological factors, achieve partial incarnation of ulcer surface on the average in (14,2±0,5) days in the first group and in (16,9±0.6) days in the second group. The level of bacterial titer of ulcer secretion by (16,5±0,6) days was not higher than the commonly accepted critical one in comparison to the classic situation, in the second group it was on the (27,2±0,9) days. Terms of inpatient treatment were: (21,2± 0,9) days in the first group and (27,2±0,9) days in the second group accordingly. The biological properties of ultrasound are due to bactericidal and bacteriostatic action on various microorganisms. In addition to its own bactericidal effect, low-frequency ultrasound significantly enhances the action of many antibiotics and antiseptics, promotes the deposition of drugs in the surface layers of the wound. Under the action of ultrasound increases the phagocytic activity of leukocytes, there is a stimulation of cellular and humeral parts of the immune system, which accelerates the wound process. Conclusion. The usage of ultrasonic cavitation in the complex surgical treatment of trophic ulcers different localization and etiological factors, significantly increases the time of trophic ulcer cleaning, accelerates incarnation by 1.2, reduce the time of treatment of patients with trophic ulcers by 1.8 times in comparison to the classical approach of cleaning, by means of mechanical cleaning of the ulcers from purulence and necrotic tissue by ultrasound of low frequency.

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