[Clinico-anatomical grounds of using flaps with the axial type of blood supply in treatment of patients with open (gunshot) fractures of the crus]. / Kliniko-anatomicheskoe obosnovanie ispol'zovaniia loskutov s osevym tipom krovosnabzheniia pri lechenii bol'nykh s otkrytymi (ognestrel'nymi) perelomami kostei goleni.

The main aim and task of the investigation was to present clinico-anatomical substantiation for plastic operations with the application of flaps with the axial type of blood circulation in treatment of this category of patients. The investigation included 348 clinical cases (for exact statistical data); 65 volunteers (for the assessment of physiological parameters) and 16 topographo-anatomical preparations (variants of the vascular network of the leg). The methods of clinical and rentgenological control were used. The work consisted of 4 stages: 1) clinico-statistical analysis by the materials of 348 clinical observations which allowed to establish the dependence of functional results of the treatment on the sizes of leg soft tissue defects; 2) topographo-anatomical investigations which allowed the topography of the leg vessels to be associated with the typical disposition of the flaps with the axial type of blood supply; 3) physiological investigation using ultrasonic dopplerography and active distance thermography on whose basis the methods were created for exact identification of the sites of the outlet of cutaneous arteries and finding the zones of optimal blood supply of the complex skin flaps being formed; 4) clinical approbation of the results of the investigation. The operations performed on 15 patients have demonstrated high effectiveness the new developed means of preoperative planning.

[Clinico-anatomic rationale for the access and technique in video-endoscopic adrenalectomy]. / Kliniko-anatomicheskoe obosnovanie dostupov i tekhniki éndovideokhirurgicheskoi adrenalektomii.

The results of surgical treatment of 60 patients with tumors of the adrenals with the help of endovideosurgical techniques were analyzed and described. The article also presents the data of experimental investigations performed in 31 corpses of subjects of different constitution and topography of the adrenals in the retroperitoneal space and different accesses to them with the help of endovideosurgical technique. The most effective and safe accesses and the method of endovideosurgical adrenalectomy have been developed, substantiated and approbated in clinical practical work. In most cases the right laparoscopic and left retroperitoneoscopic adrenalectomies should be considered the operations of choice in treatment of patients with tumors of the adrenals. It was proved that the decision for the optimal endovideosurgical access and the corresponding adrenalectomy should be made individually for each patient with special reference to the clinicoanatomical criteria found. The endovideosurgical adrenalectomy should not be opposed to open methods of surgery which are expedient in patients with large size of the tumor, signs of malignancy and possible intraoperative complications.

[A topographic anatomical validation of the choice of the approach in reconstructive operations on the extracranial portion of the internal carotid artery]. / Topografoanatomicheskoe obosnovanie vybora dostupa pri rekonstruktivnykh operatsiiakh na ékstrakranial'nom otdele vnutrennei sonnoi arterii.

The purpose of the research was to give a topographical substantiation of the choice of an approach to the extracranial internal carotid artery (ICA) in view of individual anatomical variability of ICA and various localizations of stenosis or occlusion. In 38 human corpses ICA was uncovered using operative methods proposed by Cooper. DePalma, Pauliukas and Nelson. A comparative estimation of the approaches was given with calculation of standard parameters of the operative wound. It was established that the approach to the subcranial ICA was dependent on the type of constitution, features of the anatomical shape of the mandible, distance between the mandibular angle and mastoid process. The statistical processing of the findings has shown that all the factors in question made up 91.5% which is enough for the mathematical description of the position of ICA. Regression models of accessibility of the ICA segment for each of the four investigated approaches were made. The PC program for Windows 95/NT which allows the estimation of accessibility of ICA in each patient before operation was created. These mathematical models were used in the clinic for surgical treatment of the ICA pathology in 24 patients. The difference between the calculated data of ICA accessibility and intraoperative measurements was +/- 3 mm. It demonstrates reliability of the estimation of the approach parameters before operation.

[Topography of wound canals and possibilities of collateral blood circulation]. / Topografiia ranevykh kanalov i vozmozhnosti kollateral'nogo krovoobrashcheniia.

By complexed structural and functional study performed in 76 dogs in acute, subacute and chronic experiments, destruction of muscles of the extremity, intraorganic vascular bed of which does not participate in collateral blood circulation was shown not to be an impairing factor in vascular trauma. If the wound canal localization directly relates to the topography of most important collaterals pronounced structural and functional disorders of ischemic genesis develop in the organism and in the extremity within the next day. In case of primary adhesion of the soft tissue wound in the zone of collateral pathways or distinctly limited foci of purulent wound infection in any topography of wound canal acute arterial insufficiency is compensated due to mobilization of all vascular reserves. These are primarily arteries of remaining muscles and nerves, cutaneofascial vessels and arterial bed of the opposite extremity as well. On contrary, wound suppuration sharply suppresses vessel plastic properties, promotes tissue necrosis, including ischemic gangrene of the extremity distant segments. Basic dogma of anatomic experimental studies were supported by clinico-physiological evaluation of collateral circulation in the 16 wounded with vascular disturbances.

[Areas of safe use of bone nails on the forearm]. / Zony bezopasnogo provedeniia spits na predplech'e.

On the basis of the data of topography-anatomical study, carried out at 30 upper extremities, are proposed zones and directions of safe application of wires of the compression-distraction apparatus at 4 forearm levels, developed with allowance made for individual differences in structure and topography of vessels and nerves as well as functional position of the segment. An experimental examination (30 extremities) and clinical approval (30 patients) of the proposed zones and directions have confirmed the practical use of the obtained data that allows to recommend them to be widely introduced into the clinical practice.