Split-skin grafting takes the leading place when closing extensive soft tissue defects. Such defects can be the result of both an acute process (pyoinflammatory soft tissue diseases, surgical interventions) and chronic disorders in the skin and underlying tissues (trophic ulcers of venous and arterial genesis, fistulas, decubitus, complications of the diabetic foot syndrome). The main criterion for assessing the result of split-skin grafting is the percentage of engraftment of the skin graft. There are several classifications that characterize the degree of closure of the recipient wound (Petrova VI, Rysmana BV, Gostishcheva VK). According to most authors, the successful outcome of split-skin grafting depends on several groups of factors. Systemic factors include the content of the total blood protein, hemoglobin, which should not be below acceptable standards. To the local - the readiness of the recipient wound to skin plasty. Microcirculation in the recipient bed plays an important role. The opinions of the researchers about the bacterial contamination of the wound and its effect on the processes of engrafting the flap are opposite. Some believe that a good engraftment of an autodermotransplant is possible even in the presence of a wounded pathogenic microflora in the wound. In modern works the negative influence of microorganisms on the results of split-skin grafting has been proved. Moreover, the upper limit of bacterial contamination of wounds is determined, the excess of which inevitably leads to unsatisfactory results of the transplantation of the skin. The method of postoperative donor wound management is a separate issue in plastic and reconstructive surgery. The review examines the criteria for the readiness of a wound for split-skin grafting, various types of preparation of the wound bed for plastic closure, surgical techniques for performing split-skin grafting, and options for closing the donor wound.

The gold standard for colorectal cancer (CRC) diagnosis, colonoscopy with biopsy, is an invasive technique and has some limitations, while the known non-invasive methods do not possess sufficient sensitivity and specificity. The application of microRNA as a diagnostic and prognostic CRC biomarker may compensate for the colonoscopy limitations. However, there are no data in the literature on the existence of real test systems based on the evaluation of microRNA expression. Our pilot study is the first step to creating a test system for CRC diagnosis based on the analysis of microRNA expression in the tissue of the intact colon. The aim of the study is to assess the prospects of using the level of microRNA expression as a supplemental method for diagnosing colorectal cancer and adenomatous polyps. Materials and Methods. Patients participating in the study were divided into three groups: group 1 included patients with CRC (n=5), group 2 - patients with polyps in the colon (n=4), and patients without oncological pathology treated for hemorrhoidal disease without exacerbation (n=5) composed group 3. Tissue samples of the intact gut were taken from all patients. In groups 1 and 2, biopsy was performed in the process of right- sided laparoscopic resection of the colon with tumor. Samples of the mucous membrane from the distal part of the rectum in patients of group 3 were also collected intraoperatively; they were operated on using Milligan-Morgan technique. In groups 1 and 2, CRC and polyp samples, respectively, were taken for the analysis additionally to the intact gut area. The test panel included the following microRNAs: hsa-miR-10b-5p, hsa-miR-20a-5p, hsa-miR-141-3p, hsa-miR-181b-5p. The levels of the reference genes were analyzed with the help of real-time polymerase chain reaction using intercalating SYBR Green stain. Results. Expression of hsa-miR-141-3p in the mucous membrane of the colon in patients of groups 1 and 2 (with CRC and polyps, respectively) was statistically significantly higher than in patients without bowel tumors. At the same time, the expression level of hsamiR-10b-5p was statistically significantly lower in the tumor tissue (cancer or polyps) in comparison with patients of group 3. Lower values of expression in all tested microRNAs have been detected in the CRC tissue relative to the intact mucosa of the same patients. A similar tendency was also observed in patients with adenomatous polyps. Conclusion. The results of the study have shown that of four microRNAs, included into the test panel, hsa-miR-141-3p and hsa-miR10b-5p were found to have the diagnostic value for identifying tumor colorectal lesions. Thus, our data will assume that supplementing the endoscopic tests of the large intestine by the epigenetic analysis of the mucous membrane is a promising approach to cancer screening procedures.

Despite the active development and introduction into clinical practice of new groups of antibacterial drugs, the basis for the treatment of purulent-septic diseases of soft tissues is the opening and surgical treatment of a purulent focus. When we analyzing the literature data on the treatment of purulent soft tissue diseases, the following factors can be identified that determine the progression of the purulent-inflammatory process even with an adequately uncovered purulent focus: the presence of common co-morbid diseases that reduce the body's resistance (infectious diseases and metabolic disorders) and attachment to the pathological process multidrug-resistant virulent hospital flora [1, 2]. Progression of the purulent-necrotic process takes place along anatomically determined paths of pus spread, and therefore the absolute necessity of firm knowledge of the topographic anatomy of the human body is obvious. Perhaps the most complete and thorough description of the clinical picture and methods of surgical treatment of phlegmon of the upper limb and thorax, based on anatomical principles, is given in the classic work of V.F. Voino-Yasenetsky [3], since the first publication of which it has been almost a century. Currently, due to the prevalence of antibiotic resistance even of "wild" microorganisms, the prevalence among infectious diseases affecting the immune status of the organism (hepatitis, tuberculosis, HIV), as well as the pandemic of diabetes, the urgency of surgical treatment of common purulent processes in the region upper extremity and thorax again increased. We present the clinical case of progression of the purulent process on the left upper limb from the lower third of the arm in the distal direction to the Pirogov-Paron space and in the proximal direction to the submentoral and pre-lobular cell spaces.

The aim of the study was to systematize the results of clinical application of epigenetic biomarkers "microRNA" and "DNA methylation" in early diagnosis and prognosis in patients with colorectal cancer. Material and methods. Data review was conducted by the keywords "colorectal cancer" with "miRNA" or "methylation" in PubMed, Cochrane Library, ScienceDirect, ELECTRONIC LIBRARY and was limited by the period 2016-2021. In addition, a manual search for articles in peer-reviewed journals was performed. Exclusion criteria were: description of separate clinical cases; books and documents; experimental oncology in laboratory animals, comparison of therapeutic results of patients receiving chemotherapy. Out of 139 initially identified, 37 sources were included in the final analysis, of which 20 meta-analyzes, 1 randomized clinical trial, 14 systematic reviews and 2 practical guidelines. Results. Based on the analysis of clinical data, it has been established that the optimal environment for miR isolation for early diagnosis of colorectal cancer is the intestinal wall, furthermore, miR-139 has a proven diagnostic value. At the later stages of tumor development, fecal miRs, namely miR-21, can also be used as a screening method. MiR-181a, miR-181b, miR-20a, miR-10b and miR-145 are highly sensitive predictors of overall survival in colorectal cancer patients. They can potentially be considered as prognostic biomarkers and as decisions when administering adjuvant chemotherapy. miR21, miR106a, miR143, miR 150 and miR215 are most commonly used in clinical practice to determine the prognosis of treatment. Tumor and paratumor tissues can also be differentiated from the normal colon tissue in a healthy person by methylation of the SFRP2, SFRP1, TFPI2, BMP3, NDRG4, SPG20, BMP3 and NDRG4, SFRP1, 2, 4, 5, hMLH1 and RASSF1A genes. The analysis of methylated SEPT9 genes is the most informative of them: an increased weight of the mitylated SEPT9 gene directly correlates with progression and low tumor differentiation in patients with colorectal cancer. Conclusion. Literature data confirm that changes in the concentration of microRNA and methylated DNA in the environments of the human body correlate with the risk of oncogenesis, progression and invasion of colorectal cancer. It is reasonable to use a diagnostic algorithm differentiated by the analyzed tissues (blood, intestinal tissue, feces, urine), the expected stage of tumor development, diagnostic tasks (screening, survival prognosis) for the effective use of epigenetic markers of colorectal cancer in the clinical practice.

Relevance: the method of dosed dermotension as one of the options for plastic reconstruction of the foot with the soft tissue defects of various etiologies (including diabetes mellitus) are widely used in surgery. Local circulatory compensated hypoxia, occurs when dosed dermotension, stimulates proliferation of blood vessels, but to date no proven link between measured growth and the concentration of cytokine HIF-1α. Aim: the aim was to identify patterns between local circulatory compensated hypoxia created by carrying out the dosed dermotension and cytokine concentration of HIF-1α in stretched the flap when closing the wound of the soft tissues. Materials and methods: the experiment was carried out on 18 experimental animals, which was simulated wound scapular area and conducted a hardware apparatus dermotension under the control of laser Doppler flowmetry, formed the skin samples and performed enzyme-linked immunosorbent assay to determine the concentration of cytokine HIF-1α after 30 minutes, 24 hours from the beginning of tissue stretching. Results: the concentration of HIF-1α in the skin before the start of the dermotension was (Me [Q1; Q3]) 110 [98,1; 114,8] ng/ml. A statistically significant increase in the concentration of HIF-1α to 148 [122,2; 221,7] ng/ml (p=0.008) recorded in the group of animals who underwent tissue stretching within 30 minutes, research also showed that the concentration of HIF-1α increased to 330 [246,4; 463,3] ng/ml (p=0.007) after 24 hours from the start of the dosed strains. Conclusion: the concentration of cytokine HIF-1α in stretched the flap increases with dosed dermotension. Thus, the regulation of adaptation of the skin to stretching is performed by increasing the concentration of the cytokine HIF-1α.

Relevance. Treatment of patients with surgical complications of oncohematological diseases is difficult due to their inherent critical disorders of blood coagulation, dependence of patients on hormonal drugs taken in connection with the existing pathology, as well as instability of systemic hemodynamics. Such patients are rarely hospitalized in a surgical hospital and can be classified as "difficult patients " because of the polysyndromic nature of the underlying disease and the high risk of death from complications of the disease. One of the most common oncohematological diseases is chronic idiopathic myelofibrosis, it is characterized by bone marrow fibrosis, hepato-splenomegaly (due to extramedullary hematopoiesis), as well as anemia. The clinical picture of primary (idiopathic) myelofibrosis is diverse and has no pathognomonic syndromes. Centers of extra-medullary hematopoiesis may occur in the liver with long-term disease, and thrombosis of splenic vein is possible, which can lead to subhepatic portal hypertension. In the available literature, we have found information on the successful treatment of bleeding from varicose veins of the stomach in a patient with splenic vein thrombosis and splenomegaly by performing only splenectomy preserving gastric varices, which does not completely eliminate the risk of re-bleeding. We found no publications on splenectomy with vertical tubular resection of the stomach at the height of bleeding from varicose veins of the stomach in a patient with myelofibrosis of the spleen. The aim is to show the possibility of performing a simultaneous operation (vertical tubular resection of the stomach and splenectomy) for bleeding from varicose veins of the stomach and splenomegaly against the background of idiopathic myelofibrosis in urgent surgery with impossible endoscopic hemostasis and to draw the attention of specialists in the field of surgery to the risk of bleeding in this group of patients. Materials and methods. The article describes a clinical case of vertical tubular resection of the stomach and splenectomy for bleeding from varicose veins of the stomach and splenomegaly on the background of idiopathic myelofibrosis in urgent surgery. Results. Vertical tubular resection of the stomach with splenectomy with impossible endoscopic hemostasis eliminates the risk of gastric bleeding in oncohematological patients and saves the patient's life. Summary. This clinical observation demonstrates the relevance of timely surgical treatment of patients with bleeding from varicose veins of the stomach. Vertical tubular resection of the stomach along with splenectomy allows to exclude the risk of bleeding in this group of patients in the future.