Khirurgiia
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Results of surgical treatment of 25 patients with arrhosive bleedings were analyzed. All of them had functioning shunts and severe infectious complications of the wounds in the region of Scarp's triangle. Infected wounds existed from 15 days to 18 months. ⋯ Arrhosive bleeding from anastomosis of the synthetic graft with aorta or common iliac arteries was in 8 (32%) cases, insufficiency of distal anastomosis of femoral-tibial bypass was seen in 2 (8%) patients. Various extrafocal surgeries are method of choice in the treatment of arrhosive bleedings. These surgeries may be performed simultaneously (at first bypass, then removing of graft) or during 2-3 stages in lengthy purulent-inflammatory process.
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Short and long-term results of revascularizing osteotrepanations by Zusmanovich's method performed in 80 patients with lower limb critical ischemia were analyzed. The operation is effective in distal and diffuse forms of atherosclerosis and inflammatory diseases if it is impossible to perform reconstruction. Isolated revascularizing osteotrepanation is indicated for patients with recurrence of critical ischemia who earlier have undergone conventional surgical procedures. Duplex sonography is the main method for diagnosis and determination of indications for surgery which provides an objective criterion of the treatment failure - the index of tibial arteries resistance.
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320 gunshot wounds of the trunk in peacetime are analyzed. Wounds from hunting rifle (71.2%) dominated, penetration into pleural or abdominal cavity was revealed in 89.4% cases. ⋯ Causes of infectious complications and lethal outcomes were analyzed. Improving of care quality has reduced lethality from 21.8 to 15.6%.
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One hundred and sixty-eight thoracoscopic operations were performed in patients with closed (47.5%) and open (52.5%) trauma of the chest. Thoracoabdominal injuries were diagnosed in 23.9% patients. Thoracoscopic surgeries were performed in 79.8% patients, surgeries from the mini-approach - in 17.3%. ⋯ Surgical policy and technique of endosurgeries in open thoracic trauma are optimized. Up-to-date surgical policy based on thoracoscopy permitted us to improve results of surgical treatment: to reduce lethality by 4.7%, number of complications - 2.9 times and completely avoid unjustified 'diagnostic' thoracotomies. Mini-invasive surgical methods promoted early rehabilitation of patients with trauma of the chest.