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PURPOSE OF THE STUDY Grade III open fractures are associated with infectious complications in 25-66% of injuries. Negative pressure wound therapy (NPWT) applied to an injured soft tissue coverage provides an impermeable barrier between the injured structures and the external environment, in addition to early secretion draining and a positive effect on the site of application. All this also prevents secondary bacterial contamination. The objective of the study was to compare the results of treatment methods in view of infectious complications in patients with soft tissue injury in grade-III open fractures managed either by NPWT and primary closure or by covering with combined dressing fabric (COM) in combination with continual wound lavage. MATERIAL AND METHODS This retrospective study comprised 77 patients with 80 grade III open fractures treated in the years 2008-2012; of these, 39 patients with 41 fractures met the inclusion criteria and were finally evaluated. The patients were divided into two groups. The control group included 19 patients with 20 fractures treated by the standard surgical procedure using stabilisation with an external fixator or intramedullary nail, thorough soft tissue debridement, continual wound lavage and suture of skin lesions or using a primary coverage of the defect with COM. The trial group consisted of 20 patients with 21 fractures treated according to the same principle, but NPWT was applied to injured soft tissue coverage first and skin suture or any other type of skin defect coverage was carried out when the healing process was good and bacteriological findings were negative. The results of both methods were evaluated based on the following criteria: development of superficial or deep infection in the wound, interval to negative bacteriological findings and osteomyelitis rate. The results were analysed by Fisher's exact test and the Man Whitney U test. RESULTS Infectious complications were recorded in a total of 15 (37%) fractures: 11 (55%) in the control group and four (19.1%) in the trial group (p = 0.025). Recurrent infection was observed in five control group fractures (25%) and in none of the trial group fractures (p = 0.021). Osteomyelitis was found only in two control group fractures. The average interval before negative bacteriological results were obtained was 22 days in the control group and 12 days in the trial group (p = 0.001). DISCUSSION The NPWT use as a temporary coverage of soft tissue defects in open fractures results in a significant reduction of infectious complications, as shown by many relevant studies including this study. In comparison with Gopal's "fix and flap" concept, the NPWT in our patient group had slightly higher incidence of infectious complications (15.4% versus 19.1%). However, these results can be achieved only if a specialist in reconstructive surgery and appropriate technical facilities are readily available. If this is not possible, then the NPWT, in comparison with conventional methods, provides the best possible way of temporary protection for an injured soft tissue coverage. CONCLUSIONS Application of NPWT within the primary treatment of injured soft tissue coverage in grade III open fractures results in a statistically significant reduction of bacterial contamination at the site of injury, as well as a reduction of the subsequent incidence of infectious complications. Primary application of NPWT also significantly reduced the risk of recurrent infection.open fracture, negative pressure wound therapy, continual wound lavage, infection.

The recurrence rate of surgical treatment of incisional hernia is high. The material and surgical technique used to close the abdominal wall following every surgery contribute as important risk factors in incisional hernia formation. However, by optimising abdominal wall closure, many patients can be spared from developing this type of complication. The European Hernia Society has established a Guidelines Development Group with a goal to research the literature and write a series of recommendations of how to close the abdomen and minimize the risk of incisional hernia in accordance with the principles of evidence-based medicine. To decrease the incidence of incisional hernias, the following is recommended: To utilise a non-midline approach to a laparotomy whenever possible. To perform a continuous suturing technique using a slowly absorbable monofilament suture in a single layer aponeurotic closure technique. To perform the small bites technique with a suture to wound length (SL/WL) ratio at least 4/1. Not to close the peritoneum separately. To avoid rapidly resorbable materials. To consider using a prophylactic mesh in high-risk patients. To use the smallest trocar size adequate for the procedure and closing the fascial defect if trocars larger or equal to 10 mm are used in laparoscopic surgery. Key words: incisional hernia laparotomy laparotomy closure suturing material.

pilonidal sinus disease is a benign disease with incidence 26 cases per 100 thousands inhabitants each year. The origin of this disease is in sacrococcygeal region with maximum between 15th and 25th year of life. Males suffer from pilonidal sinus disease most often. The synonym of this disease is Jeep's disease and originate in Second World War. We distinguish acute and chronic phase of this disease. The acute phase is characterized by presence of abscess whereas the chronic phase is featured by intermittently secreting fistula. Malignant reversion is described at chronic phase in 0.1%.We performed retrospective study of our cohort of 53 patients that undewent radical surgical treatment at our department between September 1st 2006 and December 31st 2009.We evaluated 39 patients that were controlled repetitively after operation. Males were in majority. The median of age was 24 years. 38 patients underwent the incision for abscess in preoperative period. The intermittently secreting fistula was diagnosed at 46 patients at the time of operation. 41% patients suffered from wound infections and 56% from dehiscence of wound (7 patients with partial dehiscence) after radical excision. We used 5 modifications of wound closure after radical excision.The choice of adequate method of wound closure after excision of pilonidal sinus was, is and will be discussed among experts. We could find many types of methods of wound closure including plastic with flaps in the scientific literature. In our country there is preferred more primary wound closure than plastic with flap. Our results are comparable with the previously published results.The treatment of pilonidal sinus has to be radical. We can conclude that usage of our technique of underlaid sutures decreases the prevalence of postoperative infection and risk of wound dehiscence. The proper types of technique of wound closure could not be evaluated with statistical signifikance because of small number of patients in our cohort.