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Application of gas-liquid chromatography methods and mass-spectrometry enabled the authors to develop objective criteria, which provided prompt acceptance of quantity information about the stage ams severity of the wound process, its influence on the organism and prognosis of expectant complications (taking into account aerobic or anaerobic components of microflora) and early correction of surgical policy.

The principles of active surgical treatment of purulent wounds made it possible to perform reconstructive operations on 5,422 patients with large purulent wounds and tissue defects. In 3,887 patients the wounds were closed with sutures and drained, in 1,535 patients the wound surfaces were closed and tissue defects repaired by various methods of cutaneo- and osteoplasty, in 1,261 of these patients free skin graft was carried out. In 274 patients wounds in the region of important anatomical structures and functionally active surfaces were closed by transposed vascularized tissues with good cosmetic and functional results. Defects in long tubular bones were repaired in 107 patients in the early stages by variants of compression--distraction osteosynthesis. Healing by first intention occurred in 89.8% of cases in which the wounds were closed with sutures and in 91.9% in plastics with local tissues and transposed grafts. After free skin graft plastics had to be repeated until complete healing in 11.1% of patients. The defects in bones were replaced in all cases, osteomyelitis developed at the site of pin introduction in 4% of cases.

The article discusses the results of treatment of 7,092 patients with purulent wounds and septic surgical diseases by means of a suggested method of active surgical management. The main principles of the method are as follows: preoperative examination and preparation of the patients for operation for 12-36 hours; radical excision of all purulent and nonviable tissues followed by active drainage and treatment under conditions of controlled abacterial medium or by ointments on a water-soluble base; use of auxiliary methods for the treatment of the wound surface (pulsed stream of antiseptics, ultrasonic cavitation, vacuum treatment); performance of laboratory tests (microbial dissemination per 1 g tissue, cytologic and morphologic studies, values of tissue hemostasis) as an objective criterion of the course of the wound process and for determining whether the wound surface is ready for closure; accomplishment of intensive therapy; early closure of the wound surface with sutures or by plastic operations. Analysis of the data allows the conclusions that active surgical treatment may be accepted as an optimal and universal method for the management of purulent wounds of any etiology and septic surgical diseases. With its application, the terms of treatment are shortened due to most economical mechanisms of healing by first intention, and good functional and cosmetic results are produced. Such an effect is due to the pathogenetic character of all components of the method.

Treatment in a controlled abacterial medium was applied to 102 patients with venous ulcer of the lower limbs. The course of the wound process was studied on the basis of objective examination methods (microbiological, cytological, morphological, study of the activity of tissue hemostasis factors). The results showed that a controlled abacterial medium causes favourable changes in the course of the wound process and allows the trophic ulcer to be prepared for operation in a short period of time (9-12 days).

Morphological and histochemical studies of biopsies from the areas of purulent wounds in the process of their treatment in a chamber with regulated environment were carried out. After 2-week course of treatment the purulent wound heals like a pure surgical wound. The granulation tissue contains a small number of leukocytes, the vessel is filled with polymorphonuclear leukocytes. A typical feature is the presence in the wound of lymphoid cell infiltrates in the maturing granulation tissue which indicates enhanced immune processes in the host. The results of treatment show that treatment of purulent wounds in a regulated environment considerably improves the condition of the wound contributing to its purification and stimulating healing processes in it.