[Treatment of ventral hernias in patients with morbid obesity]. / Taktika lecheniya ventral'nykh gryzh u patsientov s morbidnym ozhireniem.

The review is devoted to the treatment of ventral hernias in patients with morbid obesity. This issue is important due to significant number of such patients and no unambiguous clinical recommendations. The advantages of simultaneous surgery (with bariatric intervention) are obvious, i.e. lower risk of postoperative hernia incarceration and no need for re-hospitalization with another intervention. High risk of bariatric population makes it necessary to minimize surgery time and surgical trauma. A staged approach with reducing body weight surgically or conservatively before hernia repair is often chosen. Hernia repair should be performed using laparoscopic or robotic techniques with obligatory use of mesh implants. Panniculectomy or abdominoplasty as the main surgery is a valid option. Currently, it is necessary to develop clear criteria for selecting patients with morbid obesity for staged and simultaneous treatment of ventral hernias.

[Abdominal pseudohernia: diagnosis and treatment]. / Abdominal'nye psevdogryzhi: diagnostika i lechenie.

OBJECTIVE: To present an effective treatment strategy for abdominal pseudohernia considering own clinical experience and literature data. MATERIAL AND METHODS: The authors report surgical treatment of 2 patients and therapeutic management of 1 patient with abdominal pseudohernia. Moreover, current state of this problem is analyzed according to literature data in Pubmed, Google and e-library databases. RESULTS. P: Seudohernia is followed by asymmetrical protrusion of abdominal wall, prolapsed site is not involved in breathing; patients cannot tense muscles in the affected area. T8-L2 skin sensitivity impairment or hyperesthesia may be observed. Denervation is confirmed by electroneuromyography. Ultrasound, CT and MRI reveal no defect in abdominal wall. However, its thinning within denervation area is visualized. Treatment is determined by the cause and reversibility of denervation. If mechanical damage (intersection) of T8-L2 nerves following trauma or any manipulation is absent, the main cause is herpes zoster neuropathy. Surgical treatment is not indicated. Antiherpetic therapy and physical therapy result functional restoration of abdominal wall muscles within 2-4 months. In case of mechanical cause of pseudohernia, it is advisable to wait at least a year after denervation for real assessment of situation. Partial or complete re-innervation is possible throughout this period. Surgical treatment is indicated if re-innervation is absent. An effective technique presented in this manuscript is reconstruction of the prolapsed area with several imbrication sutures in several planes up to symmetry with contralateral area with subsequent reinforcement with a mesh implant if necessary. There were no relapses in 2 our patients within 5 and 7 years, respectively. CONCLUSION: In our opinion, this report is the first manuscript devoted to systematic analysis of diagnosis and treatment of abdominal pseudohernia in available literature. Surgical treatment is not indicated for postherpetic pseudohernia. It is carried out for pseudohernia persisting for more than 1 year if its cause is trauma or any manipulation.

[Simultaneous surgery for complicated giant post-traumatic phrenic hernia in a patient with morbid obesity and diabetes mellitus type II]. / Opyt vypolneniya simul'tannoi operatsii po povodu oslozhnennoi gigantskoi posttravmaticheskoi diafragmal'noi gryzhi u patsienta s morbidnym ozhireniem i sakharnym diabetom II tipa.

Surgical treatment of post-traumatic right-sided phrenic hernia is associated with certain technical difficulties due to topographic and anatomical features. Morbid obesity combined with diabetes mellitus type II is one of the main factors complicating any surgical thoracic or abdominal surgery and further rehabilitation. We report simultaneous surgery for complicated post-traumatic right-sided phrenic hernia in a patient with morbid obesity and diabetes mellitus type II. Surgical correction of giant phrenic hernia facilitated further effective treatment of morbid obesity and concomitant diabetes mellitus type II.

[Multidisciplinary approach to surgical treatment of patients with superficial abdominal obesity]. / Mul'tidistsiplinarnyi podkhod k khirurgicheskomu lecheniyu patsientov s poverkhnostnym abdominal'nym ozhireniem.

OBJECTIVE: To analyze an effectiveness of laparoscopic surgery with simultaneous abdominoplasty in patients with superficial abdominal obesity. MATERIAL AND METHODS: Laparoscopic abdominal, retroperitoneal and pelvic surgery with simultaneous abdominoplasty was performed in 25 patients with body mass index >40 kg/m2. RESULTS: Surgery time and intraoperative blood loss were significantly higher after simultaneous surgery (p<0.05). However, these differences did not influence postoperative period. Duration of analgesic therapy, activation of patients and length of hospital-stay, as well as overall postoperative morbidity were similar in both groups (p>0.05). Simultaneous abdominoplasty resulted significantly better quality of life according to almost all parameters (p<0.05). CONCLUSION: According to certain indications, abdominoplasty is advisable as the first stage of simultaneous surgery in patients with large subcutaneous fat apron after bariatric surgery or in those with primary superficial abdominal obesity. The positive aspects of abdominoplasty are simplification of laparoscopic stage, reduced intra-abdominal pressure in postoperative period, excellent and good aesthetic effect and improved quality of life.

[Injected non-absorbable fillers in large volumes]. / In''ektsionnye nerassasyvaemye fillery miagkikh tkanei v bol'shikh ob''emakh.

AIM: To present treatment strategy for large volumes of injectable non-absorbable 'shell-less' soft tissue fillers (vaseline, synthol, silicone etc.). MATERIAL AND METHODS: The authors present an experience of surgical treatment of 8 patients who underwent injections of medical vaseline (breast augmentation, n=5) and synthol (muscles enlargement, n=3) and review of the current literature devoted to this problem. RESULTS: Injection of large amounts (over 50 ml) of non-absorbable fillers into soft tissues is unacceptable and leads to numerous complications. Oil-based 'shell-less' fillers cannot be removed by minimally invasive techniques (puncture, mini-incisions, etc.) due to multiple diffuse lesions in the form of oleogranulomas (cysts of different size) and surrounding widespread inflammation and fibrosis of tissues. Surgery is the only adequate method. However, this approach is followed by scars and often tissue contour deformation. Migration of these fillers to other anatomical areas (from the neck to the lower extremities) significantly complicates the situation, treatment and results. In case of categorical refusal of patients from surgical treatment and no complaints, they should be properly informed about possible consequences and complications and dynamic medical supervision is necessary. Intraoperative ultrasound examination is useful for the control of radical removal of pathological areas. Timely removal of non-absorbable fillers allows to avoid serious complications and to achieve good aesthetic results.

[Advanced skull defect repair]. / Rekonstruktsiia obshirnogo kombinirovannogo defekta cherepa.

It is presented case report of successful repair of advanced combined defect of parietal-temporal-occipital scalp over one-half of skull vault with an excellent cosmetic result. To do this, the authors used a staged expander dermal tension, i.e. repeated stretching of the remaining scalp tissues combined with cranioplasty using mesh titanium implant.

[The role of CO2-laser in scarring management]. / Otsenka vozmozhnostei uglekislotnogo lazera v lechenii rubtsovykh deformatsii.

AIM: To assess the role of CO2-laser in treatment of various scars and to determine the indications for its application. PATIENTS AND METHODS: It has been carried out a prospective analysis of treatment of 218 patients with scars of different duration, locations and anatomic areas with the use of CO2-laser for the period 2011-2017. POSAS scale and sonography were used for analysis. RESULTS: 1. Laser therapy is not effective for scarring-related functional defects (contractures, ectropion, microstomia), when surgery is indicated. 2. The outcomes of treatment (both surgical and laser) depend on the time of existence of the scars rather their cause and anatomical region. 3. Laser therapy is not effective enough for formed scars existing over 12 months. 4. Laser therapy is effective for immature scars, especially indicated for cicatricial deformation when the aesthetics cannot be repaired with traditional surgery. CONCLUSION: Application of CO2-laser in scars treatment with regard to its real efficiency determines the effectiveness of therapy.

[Algorithm of surgical treatment of patients with consequences of burn injury].

Rehabilitation of patients suffering from consequences of burn injury is actual problem in plastic surgery. There is no unified strategy defining optimal terms and stages of treatment, possibility and advisability of simultaneous interventions on different anatomical areas, combination of surgical and conservative treatment while it is necessary for decrease of rehabilitation terms in victims. On basis of twelve-year experience of 1246 patients with consequences of burn injury the authors developed universal algorithm for optimization of surgical treatment, improvement of results and reduction of treatment time.

[Angiodysplasias of the head and neck: present-day principles of treatment using elements of plastic surgery].

The authors assessed the outcomes of treatment of fifty-one patients presenting with angiodysplasias of the head and neck. Of these, 24 patients suffered from the venous form and 27 had the arteriovenous form. The 51 patients accounted for 23.5% of the total number of patients with congenital vascular malformations over a five-year period. The topicity and angioarchitectonics of the lesion were specified by means of the standard diagnostic complex (i. e., duplex scanning of the vessels, ultrasonographic study of the soft tissues and osseous structures, computed and magnetic resonance tomography, echocardiography, and angiography). Radical excision of the angiomatous tissues was performed in 15 patients and palliative one - in 36 cases. Eight patients were subjected to stagewise resection interventions, ten patients underwent stagewise sessions of laser coagulation, and seven patients endured stagewise roentgenoendovascular embolisations of the afferent arteries. Two patients with the venous form were postoperatively subjected to sessions of sclerotherapy of the residual venous caverns. Two patients in the remote period (7-10 days) underwent autodermoplasty with a free perforated cutaneous flap. This technique was used while closing the wound surface after removing the angiomatous tissues of the parotid region and hairy portion of the head. In five patients the wound surface was closed with a mobilized cervical fat-cutaneous flap. Taking into consideration the importance of the cosmetic outcome after excising the angiomatous tissues on the face and neck, it is necessary to seek for wide application of plastic methods of closing the wound. These methods simultaneously allow of making operative interventions for angiodysplasias more radical.

[Personality self-actualization: an independent additional risk factor of myocardial infarction and unstable angina].

It is shown for the first time that changes of self-actualization (SA) in patients with CHD are the main risk factor of myocardial infarction (MI) and unstable angina (UA). The clinical course and prognosis of MI correlate with SA prior to the development of an acute coronary event. Isolated correlations exist between CHD risk factors and results of SA questionnaire studies. SA personality peculiarities in patients with MI and UA account for more than 50% dispersion of the results of linear factor analysis.

Treatment of post-burn scar deformations using tissue expansion and endoscopy.

Background. The essential drawbacks of conventional tissue expansion, a technique widely used in reconstructive surgery, are its significant duration and the high complications rate. The experience of our clinic covers 329 patients treated with this method from 1987 to 2006. The mean time of expansion was previously 72 ± 2 days (± SD) and the rate of local complications was 38.6%. We applied effective new approaches to this method in order to reduce its drawbacks, i.e. the endoscopic implantation of expanders, intensive expansion, and a modified technique of elevation of an expanded flap. Methods. Twenty-seven patients treated in the A.V. Vishnevsky Institute of Surgery between 2001 and 2006 for post-burn scar deformities underwent endoscopic implantations of 46 silicone expanders in various anatomical areas. High-grade tissue expansion was initiated immediately after implantation. The elevation of the reconstructed flap was performed, including defective tissues in the flap, after which the expander was removed and the expanded tissues were transposed. Results. With the help of the techniques developed, it was possible to reduce the mean expansion time from 72 days to 34 (less than half) and to reduce the complications rate from 38.6% to 6.5%. Conclusions. Endoscopic expander implantation, the accelerated technique of tissue expansion, and modified elevation of the expanded flap enabled us to considerably improve results in the treatment of post-burn scar deformities, using the tissue expansion method.

[Morphological characteristics of distensible tissues with use of expanders of various types].

Distension of the skin stimulates the synthetic and protein-synthetic and proliferative activity of fibriblasts and cells of the microvascular wall (endoteliocytes and pericytes) of the dermis. The thickness of the skin increases by 2-2.5 times. The type of an expander did not depend on the capsular structure. Silicon expanders produced a less intensive inflammation than latex ones.

First experience of endoscopic implantation of tissue expanders in plastic and reconstructive surgery.

BACKGROUND: Over the last 15 years, tissue expansion has been used in the treatment of 324 patients at the A. V. Vishnevsky Institute of Surgery. The principal drawbacks of the traditional technique for tissue expansion are the prolonged time needed to complete the process and a high rate of complications. With the traditional technique, the wound created by the implantation of the expander inhibits the expansion of the tissue until healing takes place, which requires 10-14 days. However, attempts to reduce of the length of the incision have been limited by the necessity to ensure good hemostasis in the expander pocket. We describe our initial experience with the endoscopic insertion of tissue expanders. METHODS: We performed the endoscopic implantation of 20 tissue expanders in nine patients. Six patients had postburn scar deformities, one had congenital microtia, one had a capillary malformation, and one had a capillary malformation combined with postburn scar deformity. Tissue expanders were inserted in the head, face, neck, chest wall, scapular, shoulder, forearm, and calf regions. The endoscopic technique was specially adapted according to the features of the different anatomic sites. Endoscopy enabled creation of the expander pocket, with good control of hemostasis, through incisions < or =1 cm. The orientation of these incisions was parallel to forces of tension. Therefore, full expansion began immediately after placement of the expander, without any risk of postoperative wound dehiscence. The expanders were fully inflated intraoperatively accordingly to the principals followed in the traditional technique of implantation for inflation over a 3-week period. Further inflations were carried out regularly either daily or once every other day. RESULTS: The average time required for the tissue expansion was 34 days, which was less than half the time needed with the traditional technique. All flaps remained extant after reconstruction with the expanded tissues. There were no complications. CONCLUSION: The advantages of the endoscopic implantation of tissue expanders are a reduction in expansion time, a shorter hospital stay, less patient discomfort, and the prevention of complications (hematoma, seroma, infection, wound dehiscence).

[Correlations between clinical features, personality disorders and the antioxidant system in patients with peptic ulcer]. / Vzaimosviaz' klinicheskikh osobennostei zabolevaniia, lichnostykh izmenenii i aktivnosti antioksidantnoi sistemy u bol'nykh iazvennoi bolezn'iu.

The examination of 68 patients with duodenal ulcer (DU) has found correlations between relations in married couples, the level of the subjective control, behavior stereotype, anxiety, neurotism, extra-introversion of the patients and antioxidant activity (AOA) of blood plasm (BP) in various clinical symptoms of the diseases. The relations between psychological factors in DU patients and BP AOA were seen in mild disease: regular terms of scarring, rare recurrences, weak mucosal inflammation, short disease duration, minimal psychological changes. A correlation analysis of interrelations between psychological factors and activity of the antioxidant system in patients with DU can be used for prognostication of the disease course.

[Clinical features, personality changes and anti-oxidative system activity in patients with peptic ulcer]. / Klinicheskie osobennosti zabolevaniia, psikhologicheskie izmeneniia lichnosti i aktivnost' antioksidantnoi sistemy u bol'nykh iazvennoi bolezn'iu.

Examination of 54 patients with duodenal peptic ulcer revealed significant correlations between the psychological traits of the patients and their plasma antioxidative activity in the mild and moderate courses of the disease. There were no correlations in patients with severe duodenal peptic ulcer. A correlation analysis of the correlation between the personality traits and plasma antioxidative activity in patients with peptic ulcer may be used to for its prognosis.

Inferior angle of the scapula as a vascularized bone graft: an anatomic study.

In reconstructing patients with massive midface losses, the authors required a vascularized bone graft that could be used to reconstruct the palate and orbital floor, provide vertical maxillary support, and provide soft tissue. The inferior angle of the scapula appears to be a promising source of vascularized bone stock, and until now, there has been no clear description of its vascular anatomy. The purpose of this study was to define the vascular anatomy of the inferior angle of the scapula. Thirteen fresh cadavers were studied. The subscapular artery was injected with Microfil (Flow Tec, Carver, MA) at its origin. Two branches of the subscapular artery were found to converge on the angle of the scapula: the descending osseous branch of the circumflex scapular, and the transverse branch of the thoracodorsal. The descending osseous branch of the circumflex scapular artery supplied the inferior angle of the scapula in 100 percent of cases. The transverse branch of the thoracodorsal artery supplied it in 76 percent of cases. The descending osseous branch of the circumflex scapular artery is the principal artery supplying the inferior angle of the scapula.