Vol 12, No 3 (2019)

Relevance. Improving the electrical function of abdominal muscles in patients with extensive median hernias of the anterior abdominal wall can be facilitated by optimizing the choice of methods for combined hernioplasty, taking into account the clinical severity of connective tissue dysplasia among the hernia carriers.

Objective. Study the electrical function of abdominal muscles after the methods of combined hernioplasty of extensive median hernias, taking into account the severity of connective tissue dysplasia among the hernia carriers.

Results.  The average numbers of electromyogram frequencies of the abdominal muscles of patients with extensive median hernias from the group without clinical signs of connective tissue dysplasia were almost the same after all the applied methods of combined hernioplasty. The predominance of the rectus muscles electric function over the lateral abdominal muscles among the patients of this group was 33,5 %.

Electrofunctional rehabilitation of the abdominal muscles of patients in the second group of examinations depended on the method of combined hernioplasty and changed in the event of an increase or decrease in the severity of connective tissue dysplasia.  The recovery of electroactivity of abdominal muscles in the postoperative period in patients from the second group was more significant with an increase in the number of abdominal muscles applied to aponeuroses and vagina of relaxing sections, which contributed to an increase in mobility and contractility of the musculoaponeurotic layers of the anterior abdominal wall.

Conclusions. Thus, with an increase in the severity of connective tissue dysplasia in patients with extensive median abdominal hernias, the method of combined hernioplasty with the most pronounced relaxing effect in relation to the anterior abdominal wall promoted optimal rehabilitation of abdominal muscles.

Rationale. To date, the issues of early diagnosis and surgical treatment of patients with injuries to the retroperitoneal duodenum have not been resolved. Due to late diagnosis, the development of retroperitonitis in a short time after injury, the frequency of postoperative complications reaches 20% - 32%, and mortality - up to 18% - 27%.
Purpose of the study. Improving the results of treatment of patients with damages to the retroperitoneal part of the duodenum.
Methods. The results of treatment of 54 patients with a rupture of the retroperitoneal part of the duodenum are presented. In the study of patients with suspected damage to the retroperitoneal part of the intestine used ultrasound, EUS, FGDS and MSCT with intraluminal contrast
Results. 28 victims were sutured by a duodenal defect and cholecystostomy. In these patients, the patient was disconnected by a flashing apparatus, and a gastroenteroanastomosis was formed. The failure of the duodenal sutures developed in 10 (35.7%), 8 (28.6%) victims died
26 victims, after mobilization of the intestine by Kocher, were performed excision of the edges of the rupture of the intestinal wall and the formation of the side-to-side duodenojejunostomy with the Ruian loop of the jejunum off. The postoperative period was smooth in 20 victims. 2 patients with concomitant injuries of the liver, spleen, skeleton bones died 2 and 4 days after the operation due to severe blood loss and shock. In the postoperative period, 4 patients on the 5th and 6th day developed micrononextensity of the seams of duodenojejunostomy. Both patients were treated conservatively and were discharged.

Relevance. Thoracoplasty is an effective way to close the cavity of destruction of the lung tissue and achieve clinical recovery in case of fibro-cavernous pulmonary tuberculosis. A promising direction of creating selective collapse in thoracoplasty is the use of synthetic mesh implants.

The purpose of the study was to assess the effect of synthetic implants from the “Surgipro" polypropylene mesh on the inflammatory and reparative reaction in thoracoplasty.

Materials and methods. The work was performed on male Wistar rats weighing 250±50 grams (n=12). The “Surgipro” polypropylene mesh was implanted on the right posterolateral surface of the chest (n=9). As control, the material was taken from intact rats (n=3), which were kept in the same conditions as experimental animals. The study material was biopsy specimens of the muscular aponeurotic scar of the posterolateral surface of the chest of rats. The cellular composition and total number of mast cells were determined. A clinical study was conducted on 26 cases of thoracoplastic with the use of polypropylene mesh in the pulmonary-surgical department of the Seaside regional antituberculous dispensary in Vladivostok.

Results. During the experimental study, it was recorded that the implant used in the reconstruction of the chest has a pronounced reactogenicity from the first day, which manifests itself as a local inflammatory reaction with the concentration of mast cells. The population of mast cells progressively declined by the 30th day, while an increase in the number of macrophages and fibroblasts was observed with the advent of giant multinuclear cells of foreign bodies. On the 30th day after the operation, a widespread post-inflammatory reactive fibrosis and angiomatosis with chronic productive inflammation was observed in the experiment. In clinical observation, the resulting inflammatory reaction around the endoprosthesis spreads to the surrounding tissues and lung, which contributes to the formation of pronounced pulmonary fibrosis and restriction of a specific process.

Relevance. The rapid development of new technologies in surgery has opened up broad horizons for the implementation of complex surgical interventions. At the same time, the duration of operations was reduced, the invasiveness decreased, and broad operational approaches began to go into the past. However, the infectious process in the area of operative action remains an acute problem of surgery today. Infections of the surgical area (OSIW) are infections that develop within 30 days after surgery or within a year after installing the prosthesis (heart valves, blood vessels or joint).
Aim. Develop an algorithm for perioperative antibiotic prophylaxis for open tubular fractures based on experimental research.
Methods. An experimental study was conducted on 60 adult guinea pigs, which created a model of an open femur fracture. All animals were divided into 3 groups depending on the timing of the introduction of antibacterial drugs. The degree of local manifestations was assessed according to the developed scale from 0 to 2 points, where 0 is the total absence of inflammatory manifestations, and 2 points is their maximum manifestation. The signs of inflammation were also evaluated in the general clinical blood test.
Results. During the experiment it was revealed that the introduction of antibacterial drugs for open fractures of tubular bones is necessary for prophylactic purposes. An increase in the timing of the introduction of antibiotics to three days or more is not rational, since there are no significant differences compared with a shorter course of antibiotic prophylaxis.
Conclusions. Experimental perioperative antibiotic prophylaxis (PAP) on the model of an open fracture of the tubular bone indicated the possibility of introducing the PAP algorithm for open hand injuries in children.

The main method of joining the wound edges in surgery remains suturing with the help of threads. Unfortunately, suture materials used in surgery have a number of disadvantages. The percentage of postoperative wound complications remains high. One of these consequences is the failure of the seam, depending also on the material used in the operation. Suture material, as a genetically alien object, that is a foreign body, with a long stay in the tissues can lead to the development of complications: causes suppuration of wounds, formation of abscesses, peritonitis.

Materials and methods: The analysis of modern Russian-language and foreign literature, also Internet sources devoted to the issue of issues and modern developments of antiseptic suture material.

As a result, the choice and development of an ideal suture material that meets all the requirements, remains an unsolved and socially significant problem in surgery. Despite the variety of variations already offered, there is currently no suture material with antimicrobial activity on the market that would fully reduce the risk of developing infections in the surgical area. But the achievements of modern chemical production make it possible to develop biologically active suture materials that have the ability to resist the development of infectious complications in a wound and improve tissue regeneration without adversely affecting the body.

In addition, the analysis showed an increased interest of developers to chitosan, due to its exceptional biocompatibility, bioresorbability, non-toxicity, antibacterial properties and hemostaticity.

The article is devoted to the brilliant Russian military surgeon I. D. Kosachev. His way of life, combat and labor achievements are described in it.

Andrew G. Rusanov (03.02.1874–9.10.1949) was born on 3 February 1874 in the city of Ostrogozhsk of the Voronezh province. Andrey Gavrilovich graduated from the 1st Voronezh classical gymnasium with a silver medal and the medical faculty of Moscow University (1989). In 1900 he passed the test for a senior doctor of medicine and in 1902 became a Zemstvo doctor and then head of hospitals in the Penza and Ekaterinoslav provinces. Andrey Gavrilovich Rusanov moved to Voronezh in January 1907 and took the position of senior doctor of the provincial Department and surgeon of the provincial hospital (1907-1919), organized and headed the Voronezh medical surgical society, created a paramedic and obstetric school. In 1912, Rusanov prepared and defended his doctoral thesis. In 1918, Rusanov Was elected head of the hospital surgical clinic of the Voronezh state medical Institute. During the great Patriotic war of 1941-1945 he worked in the hospitals of Voronezh, Tambov and Ulyanovsk. In December 1943 he returned to Voronezh and again headed the Department of hospital surgery. In Voronezh, he was the first to do an appendectomy, the surgery to children about brain herniation, successfully produced orthopedic intervention, first in the USSR made a successful resection of the stomach about a perforated ulcer. One of the first to apply bestmoney method of treatment of wounds. A. G. Rusanov the author of over 70 scientific papers, 3 monographs, under his leadership were defended 3 doctor's and 19 candidate's theses. Rusanov was awarded the Order of the red banner of labor and medals. In 1946 he was elected to the Supreme Soviet of the USSR. In 1949, Andrey Gavrilovich died. A. G. Rusanov named lane in Voronezh (1962). In the state archive of the Voronezh region there is a personal Fund of Rusanov (P-2980). Memorial plaques are devoted to it: on buildings of the 2nd and 3rd city hospitals of the city of Voronezh.

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