Burn injuries and their treatment is an important medical and social problem. Compartment syndrome is a serious complication of deep circular burns, which causes increased subfascial pressure and local tissue ischemia with the development of intercellular interstitial edema and a significant rise of intra−tissue pressure, which exacerbates tissue blood supply, enhancing the tissue hypoxicity. Treatment is performed by necrotomy, which due to decompression helps to reduce intra−tissue pressure and reduce the scale of necrobiotic processes in damaged tissues. To develop a method to treat deep subfascial burns, a study was conducted in 15 patients. Dynamic monitoring of tissue pressure in the fascial sheaths of each muscle allowed to determine the direction and degree of degenerative−destructive changes caused by zonal microcirculation disorders, increasing edema, hypoxia, ischemia and necrosis of individual muscle fibers, which helped to determine the need for surgery. The method of treatment included decompression necrofasciotomies with opening of zonal fascial−aponeurotic muscular bed−cases of the first order in the paranecrosis areas; general anti−shock and detoxification therapy; local ozone therapy with a complex of cytoprotectants and antioxidants; necrectomy and autodermoplasty. According to the results of the study, it is concluded that an important place in treatment of the compartment syndrome in the patients with deep burns is the objectification of intra−tissue pressure. The method of determining the dynamics of compartment syndrome and surgical tactics will allow preserving the viability of a significant part of the damaged muscle mass, reduce the volume of tissues that underwent necrectomy, restore the skin timely. Key words: burns, compartment syndrome, intratissue pressure, surgical treatment.

Summary. Objective. Improvement of the diagnosis of compartment syndrome depending on the time of thermal injury and the establishment of indications for draining operations. Materials and methods. Interstitial pressure was studied in 66 victims who were admitted to the burn center in the first 24 hours after the injury. The patients were divided into groups depending on the relative extent of the lesion and the length of hospitalization. The results of the study and their discussion. Upon admission of the patient to the department, a thorough sanitation of the burn surfaces was performed with antiseptic solutions (chlorhexidine, dekasan). In the burn area, the interstitial pressure was measured in all muscle groups deeper than the superficial fascia with a Kompartment druck Monitor System (MIPM Mammen dorfer Institut für Physik und Medizin Gmbh) apparatus for measuring interstitial pressure. Depending on the level of interstitial pressure, patients underwent conservative drug and infusion therapy aimed at reducing edema and hypoxia of damaged tissues. In the case of critical indicators of interstitial pressure, an urgent surgical intervention was performed for the purpose of decompression. When assessing the dependence of the pressure level in the tissues on the timing of burns, there is a clear dependence in all observation groups: late hospitalizations are accompanied by a large increase in pressure, the level of circular location of burns on the extremities is of great importance for high blood pressure. Conclusion. It has been determined that objectification of the diagnosis of the compartment syndrome in order to prevent ischemic tissue damage plays an important role in deep and borderline burns. Clinical indicators of tissue pressure in deep and borderline burns have been established, depending on the time of thermal injury, which allows the diagnosis of compartment syndrome and the establishment of indications for drug, infusion therapy and urgent drainage operations.

A study of the effectiveness of surgical treatment aimed at restoring the skin in 176 patients with trophic ulcers of vascular origin. An algorithm of conservative, local and surgical treatment has been developed, which provides full-fledged replacement of the ulcer defect by performing autodermoplasty operations.Objective. To improve the results of skin plastic operations in the treatment of trophic ulcers based on the optimization of the staged preparation, the performance of surgical intervention and the postoperative management of the wound defect.Materials and methods. The operations of skin grafting over the past 5 years have been performed by us in 176 patients with trophic ulcers. The area of the wound defect ranged from 10 cm2 to 1000 cm2. An algorithm of treatment was developed and used in clinical practice, consisting of 8 stages aimed at preparing ulcers, performing skin grafting, postoperative treatment, and post-transplant adaptation of skin flaps. Results and discussion. In the course of the treatment, general infusion, drug therapy and local treatment were carried out against the background of which excision of pathological granulations, preparation of wounds, skin plasty and postoperative treatment were performed.A long-lasting positive functional and aesthetic effect was obtained.Conclusions. An algorithm has been developed for the complex treatment of trophic ulcers, including a skin transplantation operation, the clinical application of which provides a longterm healing of a wound defect and an improvement in the quality of life of patients.

Summary.  A method was developed and used under clinical conditions for the stepwise preparation of deep burns for autodermoplasty after necrectomy in 57 patients with thermal injury.  The method consisted in the application of neutral wound dressings, dressings and irrigation regimen developed complex multicomponent solution at the stages of treatment.  A positive effect of the proposed treatment on the course of the wound healing process and improvement of the main clinical indicators of treatment was established.

Summary. For an objective assessment of the readiness of burn wounds for autodermoplasty, a cytological technique was used, which allowed to improve the healing of skin flaps, the number of surgical interventions and the treatment time of patients were reduced. Objective. To improve the results of skin grafting in connection with the use of an objective cytological method for studying the wound process, which allows you to determine the readiness of the wound bed for autodermoplasty. Materials and methods. In 2019, 29 victims of the main group with deep burns, the cytological method of studying wound prints was used, the comparison group consisted of 32 patients with burns of the same depth and area in which indications for autodermoplasty were determined based on visual criteria. The results of the study and their discussion. The goal of local preoperative treatment was to achieve an inflammatory-regenerative type of cytograms with a significant decrease in leukocytes, degenerative-destructive forms of neutrophils and the number of bacterial cells. At the same time, the number of polyblasts, macrophages and fibroblasts increased significantly, and there was also a tendency to increase the percentage of lymphocytes. In the main group, autodermoplasty operations were performed only when the indicated type of cytograms was achieved, which allowed to improve the percentage of engraftment of skin flaps, reduce the number of surgical interventions and the treatment time. Conclusion. For the prognostic assessment of the readiness of deep burns for skin grafting, the cytological method of wound prints was applied. Determination of regenerative types of wound prints gives rise to autodermoplasty.