Journal of Experimental and Clinical Surgery

Background. According to modern research studies, including those using polypropylene mesh, the recurrence rate after diaphragm plastic surgery for traumatic, congenital, and postoperative defects varies widely, ranging from 2% to 30% or more.

Aim. To evaluate the morphological and biomechanical features of the diaphragm musculo-aponeurotic structures regarding the application of an original surgical technique for treating patients with extensive post-traumatic diaphragmatic defects.

Materials and methods. An anatomical, morphological, and biomechanical study was conducted on 36 cadavers of both sexes from three age groups (young, middle-aged, and elderly) and various somatotypes. The shape and dimensions of the diaphragm and central tendon, as well as the parameters of hemomicrocirculatory network, the tensile strength, and the modulus of elasticity, were evaluated using the ISS-500 testing device. Additionally, 12 diaphragm specimens were examined after simulating an extensive defect and performing plastic surgery using an original technique. Statistical data were analysed using Statistica 10 (StatSoft, USA).

Results. Somatotype-associated variants in the shape of the diaphragm dome and central tendon were identified, gender-related differences in its dimensions (in men, the values of the sagittal and frontal dimensions were generally larger, with the maximum dimensions observed in brachymorphic and mesomorphic types). In the middle-aged and the elderly, there was a decreased density of the vascular network of the hemimicrocirculatory bed and a tendency towards the decreased tissue strength and elasticity. In the experiment, the original tension-free fixation of the mesh endoprosthesis with reinforcement of the U-shaped suture line using a frame thread resulted in a 71.95% increase in the tensile strength and a 70.41% increase in the modulus of elasticity compared to native diaphragm specimens (p< 0.05), regardless of the patients' somatotype and age.

Conclusion. Age-related and anatomical features of the diaphragm should be considered when planning reconstruction; the proposed technique strengthens the fixation line of the polypropylene mesh and improves the biomechanical reliability of plastic surgery in extensive post-traumatic defects.

Background. Morbid obesity (MO) does not only increase the risk of developing malignant neoplasms (MN) of various localisations, including renal cell carcinoma (RCC), but also worsens the treatment outcomes and prognosis in patients with diagnosed cancer. Bariatric surgery, as the only proven effective option for significant and persistent reduction in body mass, has recently been used in cancer patients at various stages. However, the issues regarding the prognostically most promising and beneficial treatment staging from the patient’s perspectives, and the possibility of simultaneous interventions for MN and MO remain unsolved.

Aim. Тo analyse a series of cases of surgical treatment in patients with RCC and subsequent bariatric procedures for MO, and to report on the first known experience of simultaneous implementation of bariatric and oncological stages.

Materials and methods. There were presented three clinical cases of bariatric interventions in patients with RCC: 1) kidney cancer diagnosed during preparation for bariatric surgery. The first stage was nephrectomy, the second was sleeve gastrectomy (SG); 2) SG for progressive obesity in 5 years after nephrectomy for RCC; 3) simultaneous surgical treatment involving partial nephrectomy and SG for RCC and MO. Surgical complications, oncologic and bariatric outcomes were assessed.

Results. No treatment complications were observed during oncological and bariatric surgeries in any case. All patients demonstrated significant and persistent weight loss after bariatric surgery. The excess weight loss were 110.9% (after 62 months), 85.7% (after 23 months) and 71.0% (after 24 months) in cases 1, 2 and 3, respectively. In each case, follow-up imaging (SCT) revealed no tumor recurrence.

Conclusions. Elimination of MO should be considered a crucial aspect in the treatment of patients with MN, including RCC. A personalised treatment strategy should be planned based on the individual patient’s features, prognosis and safety assessment. Simultaneous bariatric and oncological surgeries can be supportable both in terms of simultaneously addressing two interrelated conditions and in reducing the risk of malignant neoplasm progression or recurrence. The initial clinical outcomes indicate that this approach may be effective; however, such simultaneous interventions can only be performed in specialised medical institutions with the necessary level of the staff training, adequate equipment and experience.

Chronic soft tissue wounds represent one of the most pressing medical and social challenges in global healthcare. They are most common in older patients and in individuals with diabetes mellitus, chronic vascular disease, and post-traumatic conditions, including thermal injuries. The pathogenesis of such wounds is characterised by disruption of the physiological healing sequence, formation of microbial biofilms, and persistent inflammation, which markedly limits the effectiveness of conventional treatment strategies and contributes to an increased incidence of complications, disability, and mortality.

Split-thickness autologous skin grafting remains one of the most commonly used options for surgical wound closure. However, its use is limited by impaired vascularisation and infection of the recipient wound bed, which often leads to graft lysis. In this context, there is growing interest in skin micrografting—a group of techniques based on the use of skin microfragments, cell suspensions, and epidermal micrografts that can overcome existing limitations and thereby expand therapeutic options. These technologies provide high biological activity with minimal donor-site trauma and have the potential to activate neoangiogenesis, stimulate cellular proliferation, and remodulate chronic inflammation.

This review presents a systematic analysis of modern skin micrografting techniques, covering their clinical applications, current limitations, and potential for further development within pathogenetically grounded and personalised strategies for the chronic wound treatment.