Vol 16, No 2 (2023)

Full Issue

Original articles

Management of Donor Site Wounds after Autodermoplasty

Alekseev A.A., Bobrovnikov A.E., Malyutina N.B., Filimonov K.A.


Introduction. Autodermoplasty with split autodermografts is the major option for surgical treatment of deep burns, and it requires management of donor site wounds in the postoperative period. There is no consensus on the most optimal dressing for the treatment of donor site wounds. The main requirements for such dressings are the simplicity and availability of application.
The aim of the study was to analyse the effectiveness of diverse dressings applied for donor site wound management and to select the most optimal one.
Methods. The study included 143 patients with deep burns. The authors analysed the effectiveness of diverse dressings applied for donor site wound management.
Results. Application of diverse synthetic and biological dressings for donor site wound management resulted in the reduction in epithelialization by 1-3 days compared to conventional wet-drying gauze dressings with antiseptics; however, a complicated course of the wound process with accumulated wound discharge and suppuration was registered more often in these cases. All patients reported about moderate pain, especially in the first days after surgery, regardless of the type of dressings applied. The terms of complete donor site wound healing were almost the same in the compared groups and ranged from 14 to 18 days. This was evidenced by repeated harvesting of autodermal grafts from the donor site, the fact being an objective criterion for wound healing.
Conclusion. It is recommended to treat donor site wounds resulted from split autodermal grafting using single application of a gauze dressing impregnated with antiseptic solutions. It is reasonable to treat donor site wounds limited in area with hydrocolloid dressings.

Journal of Experimental and Clinical Surgery. 2023;16(2):104-113
pages 104-113 views

Effect of Scar Deformation on Long-Term Outcomes of Suturing Perforated Pylorobulbar Ulcers

Osmanov Z.K., Semenov D.Y., Chekmasov Y.S., Polyglottov O.V.


Despite the use of modern anti-ulcer therapy, the percentage of unsatisfactory results after suturing perforated ulcers ranges from 4.8 to 57% [1, 2, 3]. It is necessary to search for reasons explaining such significantly different values in the long-term treatment outcomes of patients with perforated ulcers. Cicatricial changes in the pylorobulbar area leading to a violation of the motor-evacuation function and, as a consequence, ulcer recurrence may be one of the causes.
The aim of the study was to investigate the effect of a suture row and a type of suture material on the long-term outcomes in suturing perforated ulcer.
Materials and methods. The study involved results of suturing perforated ulcers in 280 patients. When suturing, a single-row and double-row sutures, absorbable and non-absorbable suture materials were used. In the immediate postoperative period, the main attention was paid to the suture failure. In the long-term period, the results were evaluated in 106 patients, which accounted for 37.8% of the operated patients. The results were analysed according to the Visick score modified by M.Y. Pantsyrev [4]. Fibrogastroduodenoscopy findings in the long-term period were also analyzed in 56 patients; 31 of them were performed suturing with a single-row suture technique using absorbable threads, 25 patients were performed suturing with a double-row suture technique using dacron or silk threads. The severity of cicatricial deformation of the pylorobular area was evaluated based on B.P. Dergachev classification (1982) [5].
Results. Evaluating the immediate results of suturing, no significant increase in the percentage of suture failure was registered when using a single-row suture technique and absorbable suture material (p=0.2). In the long-term postoperative period, the number of patients with excellent results according to the Visick score was significantly higher in the group where a single-row suture was performed (p=0.023). Analyzing endoscopic examination findings, the authors obtained the following results: no pronounced scar deformation was detected under fibrogastroduodenoscopy in patients who were performed a single-row suturing. In three cases (9.7%), no signs of scarring were found. Endoscopic signs of scar deformation were detected in all cases in patients of the second group, who were performed a double-row suturing. Of these, 6 (24.0%) patients had pronounced scar deformity. After performing a double-row suturing with non-absorbable suture material, an ulcerative defect with the ligature at the bottom was detected in the duodenum under fibrogastroduodenoscopy in two cases.
Conclusion. Application of a single-row suture and absorbable suture materials is a reliable option to close perforation without increased suture failures; it results in improved long-term treatment outcomes. The use of a double-row suture and non-absorbable suture materials results in a more severe deformation of the suturing area and is one of the risk factors for ulcer recurrence.

Journal of Experimental and Clinical Surgery. 2023;16(2):114-119
pages 114-119 views

Study of morphological transformation and features of vascular blood flow of the wall of the small and large intestine in the simulation of ischemia in the experiment

Karpova I.Y., Peretyagin P.V., Orlinskaya N.Y., Shirokova N.Y., Pyatova E.D., Ptushko S.S.


Introduction. Ischemia of the small and large intestine of various degree was simulated in 45 sexually mature male rats of the Wistar line weighing 150-200 g on the basis of the Department of Experimental Medicine with vivarium at Privolzhsky Research Medical University.
Аim. To present in an experiment the effect of different degrees of occlusive ischemia on the morphological transformation of the intestinal wall and the level of changes in blood flow.
Materials and methods. The anesthetized animals underwent a median laparotomy with subsequent differentiation of the intestinal divisions: the jejunal section was selected in the small intestine, the ascending section was selected in the large intestine. With the help of a nylon thread (5-0), the blood supplying arcades of these zones were ligated and further exposed for 40, 60 and 120 minutes. During the indicated periods of ischemia, the average rate of blood supply in capillary microvessels located at a depth of 0.5-1.0 mm was estimated in relative units on 1.0 mm2-area (LACC-02, NPP Lazma, Russia). After the assessment of vascular blood flow was completed, ischemic intestinal areas were sampled for morphological examination. The study results were processed using Excel application and STADIA statistical package.
Results. In the course of study, the authors registered clear relationships between blood flow parameters in different parts of the intestine and the duration of ischemia. Local trophic disturbance was combined with a transformation in the histoarchitectonics of the intestinal wall. It is noted that adaptive-regenerative mechanisms provide tissue stress reduction in 120 min. due to compensatory mechanisms of blood supply contributing to the restoration of the "villus-crypt" system of the mucous membrane.
Conclusion. Thus, in case of local ischemia in the small and large intestine, the tissue structure is restored due to adaptive mechanisms of blood supply, this preserves the viability and functionality of the intestinal wall.

Journal of Experimental and Clinical Surgery. 2023;16(2):120-129
pages 120-129 views

Analysis of enhanced recovery protocol failure for pancreatic surgery

Drozdov E.S., Korotkevich A.G., Klokov S.S., Grishchenko M.Y.


Introduction. Enhanced recovery protocols (ERP) after surgery are evidence-based perioperative management programs aimed at reducing the response to surgical stress and accelerating recovery. These protocols have shown their effectiveness in various surgical sections, including surgical pancreatology. However, in some patients who have undergone pancreatic surgery, these protocols are not effective.
The aim of the study was to analyse risk factors for ERP failure during pancreatic surgery, and to develop a predictive model for assessing the risk of ERP failure.
Material and methods. A retrospective - prospective two-center study included 122 patients who underwent surgical interventions on the pancreas. ERP was considered unsuccessful if one or more of the following signs were found in a patient: the duration of postoperative hospitalization exceeding 14 days, in-hospital or 30-day mortality, readmission within 30 days. Patients included in the study were divided into two groups: 1) patients who did not have signs of ERP failure - the enhanced recovery group (ER), 2) patients who had signs of ERP failure (non-ER group). The authors evaluated clinical factors that might be associated with the risk of ERP failure.
Results. The non-ER group included 46 patients. Univariate and multivariate logistic analysis allowed specifying independent risk factors for ERP failure: age over 70 years (p=0.01), presence of sarcopenia (odds ratio (OR) 4.75, 95% confidence interval (95% CI) 1.7 - 11.9, p=0.01), ASA III score (OR 1.8, 95% CI 1.1 - 2.6, p=0.04), density of the pancreas parenchyma (OR 5.9, 95 % CI 1.8 – 15.4, p<0.01). To develop a score for the risk of ERP failure, each feature was empirically assigned points from 1 to 3 taking into account its severity (the odds ratio value). With a score of ≥ 4, the risk of ERP failure was assessed as high, with a score < 4, the risk of ERP failure was assessed as low. The sensitivity, specificity and overall accuracy of the developed model were 84.8%, 82.9% and 83.6%, respectively.
Conclusions. Based on the study results, the authors developed a scoring prognostic model to evaluate the risk of ERP failure in patients exposed to pancreatic surgery. This model can be used to stratify patients according to their risk of ERP failure (high or low

Journal of Experimental and Clinical Surgery. 2023;16(2):130-139
pages 130-139 views

Options for Two-Stage Extensive Liver Resections in the Surgical Treatment of Advanced Liver Echinococcosis

Krasnov A.O., Anishchenko V.V., Pachgin I.V., Krasnov K.A., Pel'ts V.A., Krasnov O.A., Pavlenko V.V.


Introduction. The major and effective option for the treatment of liver echinococcosis are surgical operations. To choose a type of surgical intervention in a common form of liver echinococcosis under suspected deficit in the functional reserves of the organ and developing post-resection liver failure remains challenging.
The aim of the study is to present and analyze the effectiveness of two-stage extensive resection interventions in patients with advanced liver echinococcosis.
Materials and methods. The study included clinical findings of 24 patients with advanced liver echinococcosis (9/37.5% men, 15/62.5% women) who underwent surgical treatment in Surgical Department №2, “Kuzbass Clinical Emergency Hospital named after M. A. Podgorbunsky " (Kemerovo). The use of a two-stage major resection protocol was the criterion for inclusion in the study. Stage I was aimed to achieve vicarious hypertrophy of the contralateral lobe using various techniques to stop blood flow along the right branch of the portal vein. A two-stage protocol for extensive resection intervention was applied due to insufficient functional liver reserves and the small volume of the potential remnant; this resulted in the inability to safely use a single-stage extensive resection due to the predicted developing post-resection liver failure and a likely lethal outcome.
Results and discussions. The applied surgical stage approaches for prevention of post-resection liver failure are effective due to the following parameters: CT volumetry (p<0.05), residual concentration of indocyanine green at the 15th minute (p<0.05), statistical model value (p<0, 05). The level of effectiveness of the above technique is comparable with the laparotomic ligation of the right branch of the portal vein; however, the laparoscopic option is less traumatic, which can significantly reduce postoperative hospital stay (p<0.05). In addition, there were no specific and nonspecific complications registered in case of the laparoscopic option.
Conclusion. Two-stage extensive resection interventions for advanced liver echinococcosis are effective and sufficiently safe when operations are performed in specialized hepatological centers using a comprehensive protocol for preoperative examination. They can be recommended in case of the initial significant deficit in the volume of the potential liver remnant and functional reserves of the organ.

Journal of Experimental and Clinical Surgery. 2023;16(2):140-149
pages 140-149 views

Evaluation of the Effect of Surgical Access on the Innate Immune Response During Liver Resections of Various Volume, Experimental Study

Panchenkov D.N., Alikhanov R.B., Ivanov Y.V., Akhmatova N.K., Kosyi V.V., Astakhov D.A., Leonov S.D.


Introduction. The major components of the immune system are affected in almost all surgical operations, including those related to the tumor removal. The volume of the operation correlates with the level of the immune system suppression and frequency of complications. The issue of the effect of surgical access for liver resection with different volumes on surgical trauma and severity of the innate immune response are still challenging nowadays.
The aim of the study is to evaluate the effect of open and laparoscopic surgical approaches on the severity of the innate immune response in small and large liver resections in laboratory animals.
Methods. The study included 4 groups of rabbits, 10 animals each, formed depending on the surgical approach and the volume of liver resection: laparoscopic small and large liver resections, open small and large liver resections. The following parameters of the innate immune response were studied: phagocytic, cytotoxic and proliferative activity in dynamics. The experimental data were processed using the STATISTICA 6.0 software package (StatSoft, 2001). The results were considered statistically significant at p<0.05.
Results. Open extensive liver resections are characterized by a more significantly decreased phagocytic activity of neutrophils - from 95.7% to 32.05% - than similar interventions using laparoscopic access - from 96.4% to 52.4%, respectively. Cytotoxic activity in the group of animals exposed to surgery with laparotomy access decreased by 40% compared to 23% in animals exposed to laparoscopy surgery. There was registered a more than twice increased spontaneous and decreased induced proliferation in the postoperative period.
Conclusion. The study results allow concluding on a positive effect manifested as a reduced surgical injury for liver resections of various volumes due to laparoscopic access; this is evidenced by the parameters of immune reactivity.

Journal of Experimental and Clinical Surgery. 2023;16(2):150-155
pages 150-155 views

A TRAM Flap Harvesting Technique for Breast Reconstruction Surgery after Mastectomy

Chernyh A.V., Popova M.P., Yakusheva N.V., Korobov I.V.


Introduction. Currently, the best option for breast reconstruction surgery after mastectomy is TRAM-flap harvesting on a vascular pedicle from the inferior epigastric artery with taking one or two rectus abdominis muscles. However, it is widely reported about cases of marginal necrosis of the lower TRAM flap in the recipient zone. This is due to the area of obstructed blood flow "choke" at the site of anastomosis of the terminal muscular branches of the superior and inferior epigastric arteries.
The aim of the study was to investigate the applied topographical features of the lower epigastric arteries in the thickness of the rectus abdominis muscles in women.
Materials and methods. The main trunk of the inferior epigastric artery and its terminal branches (III and IV blood supply zones) were dissected on the muscular-aponeurotic flap of the anterior abdominal wall in the thickness of the rectus abdominis muscle in 18 non-fixed female corpses to identify the lower site of arterial anastomosis of the muscular branches. The authors measured the distance from the white line of the abdomen to the point of entry of the studied artery into the thickness of the rectus abdominis muscle, the length of the main trunk, and the vertical distance from the conditional horizontal line drawn through the upper semicircle of the umbilical ring to the beginning of the inferior epigastric artery branching (the "choke" zone).
Research results. The length of the major trunk of the inferior epigastric artery from the level of perforation of the posterior wall of the aponeurotic sheath of the rectus abdominis muscle to the beginning of its division averaged 5.7±0.8 cm. The level of division of the major trunk into muscular branches of the inferior epigastric artery on the left and right, and, consequently, the “choke” zone, was always higher than the level of the umbilical ring. The distance from the conditional horizontal line drawn through the upper semicircle of the umbilical ring to the beginning of the branching of the major trunk averaged 1.4±0.9 cm.
Conclusion. The data obtained on the typical anatomy of the inferior epigastric arteries in women may allow improving the TRAM flap harvesting on the musculovascular pedicle technique in order to reduce the risk of developing marginal skin necrosis in the recipient zone.

Journal of Experimental and Clinical Surgery. 2023;16(2):156-159
pages 156-159 views


External Small Intestinal Fistula as a Rare Complication of Total Pelvic Infralevator Evisceration

Akhtanin E.A., Markov P.V., Goev A.A., Struchkov V.Y., Arutyunov H.R., Martirosyan T.A., Shukurov K.U.


A clinical case of a patient with external incomplete non-formed small intestinal fistula involving previously formed ureteroejunoanastomosis in infiltrate and presence of purulent cavity in small pelvis communicating with external medium in perineum is presented. This complication occurred after a planned surgery in the volume of total infralevatory evisceration of the pelvis due to local advanced rectal cancer. The patient underwent this complication for a long time and performed independent dressings. The following examinations (Rg-fistulography, multispiral computed tomography of abdominal organs with intravenous bolus contrast) revealed a purulent cavity communicating with the adductor loop of the small intestine. During the planned surgical intervention, it was intraoperatively revealed that the previously formed interintestinal anastomosis and ureteroejunoanastmoses were involved in the infiltrative process, which complicated this situation. Resection of the latter with reconstruction of anastomoses was performed. The main task in this situation was adequate drainage of the purulent cavity and the previously formed anastomosis. The postoperative period in this patient underwent no peculiarities, the drainage was removed on the 10th day. Further, the patient underwent a follow-up examination and further examination. Examination of data for intestinal fistula relapse did not reveal. A control multispiral computed tomography with contrast was performed - there are no data for relapse of the purulent cavity of the cavity, previously formed intergestinal anastomosis and conduit function adequately. In this clinical case, the patient's medical history, the clinical example of the occurrence of this complication and its cause, further treatment of the patient aimed at eliminating the small intestinal fistula, as well as an overview of the literature data on this problem are described in detail.

Journal of Experimental and Clinical Surgery. 2023;16(2):160-166
pages 160-166 views

Review of literature

Intraoperative Ultrasound in Colorectal Liver Metastases

Stepanova Y.A., Ionkin D.A., Zhavoronkova O.I., Gavrilov Y.Y., Zhao A.V., Vishnevsky V.A.


Intraoperative ultrasound (IOUS) is a diagnostic technique that allows obtaining additional information about the number and localization of colorectal cancer (CRC) metastases in the liver (especially with their intraparenchymal location), determining their relationship with the arteries and veins of the liver, navigating for puncture biopsy and / or performing minimally invasive treatment of lesions, and adjusting the amount of resection intervention on the liver during surgery. When performing minimally invasive medical procedures, IOUS application helps to avoid injuries to blood vessels, bile ducts and adjacent organs, and also allows evaluating the effectiveness of treatment and identifying potential complications. An important component of IOUS is the support of surgical procedures with a staged assessment of the liver hemodynamics, providing an immediate correction of the surgical situation. Thus, IOUS is a safe, inexpensive and highly informative diagnostic option, which should be a mandatory diagnostic step in the surgical treatment of CRC liver metastases.
Based on literature data and personal experience, the authors present indications, technical aspects and features of application of various IOUS options and modalities in the surgical treatment of CRC liver metastases.

Journal of Experimental and Clinical Surgery. 2023;16(2):167-179
pages 167-179 views

Organ-Preserving Surgeries on the Spleen: Evolution of Concepts

Kagan I.I., Nuzova O.B., Pikin I.Y.


One of the current trends in modern surgery is the study of the spleen injuries and diseases, in particular, its traumatic ruptures which are a fairly common pathology, being the most prevalent among all injuries of the abdominal organs. The improvement of hemostasis options and the choice of tactics in the surgical treatment of the spleen pathologies are crucial. Few recent decades have been dominated by the idea that splenectomy is the major surgical option for the spleen damage and diseases. Currently, as reported in Russia and globally, surgical tactics implying the use of organ-preserving surgeries in case of the spleen injury are being widely developed and applied.
If compared with organ-preserving operations, there are negative changes in the cellular and humoral links of the immunity after splenectomy. A significant number of proposed spleen preserving options are grouped into: conservative treatment, wound tamponades, splenic sutures, segmental resection, ligation of splenic arteries, wound bonding, infrared contact coagulation, autotransplantation of splenic tissue. Currently, surgeons have quite a lot of experimental and clinically tested techniques in their arsenal that allow successfully performing organ-preserving spleen surgery. However, none of them lacks of drawbacks. These drawbacks are quite diverse, ranging from the inability to provide guaranteed reliable hemostasis to technological and economic aspects of the operation, thus, the search for novel organ-preserving techniques remains promising.

Journal of Experimental and Clinical Surgery. 2023;16(2):180-185
pages 180-185 views

Pancreatic Trauma

Firsova V.G.


Traumatic pancreatic injuries are associated with significant morbidity and mortality. The review analyses recent studies on epidemiology, classification, diagnosis and treatment of patients with pancreatic injury. Pancreatic injury in abdominal trauma is observed from 3% to 12% of cases, the overall mortality ranges from 0% to 31% and is largely determined by damage to other organs. The most widely accepted grading system for defining categories of pancreatic injuries is Organ Injury Scaling developed by the American Association for the Surgery of Trauma. A high index of suspicion is necessary for early diagnosis, since in the first hours after the injury clinical manifestations and laboratory parameters are not specific, and changes in the CT picture do not correlate to the severity of the injury in 20-40% of cases. Contrast-enhanced CT is the first-line diagnostic tool in hemodynamically stable patients. MRI with MRCP and ERCP is used to evaluate the integrity of the pancreatic duct. Nonoperative management is recommended for hemodynamically stable grade I and grade II pancreatic injuries. Patients with pancreatic duct injury require predominantly surgical treatment. The preferred type of surgery for grade III and more severe injuries (distal resection, drainage of the damaged area combined with endoscopic drainage and stenting, or organ-preserving surgery in the form of pancreaticojejunostomy, pancreaticogastrostomy) remains controversial. In case of pancreatic injury proximal to the venous confluence, drainage of the damaged area is the only fairly safe option for the patient, indications for pancreaticoduodenal resection are limited to concomitant injury of the bile duct, duodenum with involvement of the major duodenal papilla, massive bleeding from crushed tissues of the pancreatic head. Larger prospective studies are warranted for better management of patients with pancreatic trauma.

Journal of Experimental and Clinical Surgery. 2023;16(2):186-193
pages 186-193 views

Wound complications after prosthetics of hernial defects of the anterior abdominal wall: causes and methods of prevention (literature review).

Chernykh A.V., Magomedrasulova A.A., Shevtsov A.N., Aralova M.V., Lopatina A.S., Fedotov E.A.


Goal. To review the literature data on wound complications after prosthetic repair of hernial defects of the anterior abdominal wall, causes and methods of prevention.Results. An analysis of the literature has shown that the problem of wound complications during endoprosthetics for external abdominal hernias has not been completely solved. Among all postoperative complications after such hernias, seroma, infiltration and prolonged exudation are most common, less often ligature fistula, subcutaneous fat infarction, postoperative wound suppuration, cyst, granuloma, rejection of the prosthesis. The effectiveness of various methods of preventing wound complications during abdominal wall prosthetics is ambiguous. Conclusions. It is necessary to improve the known and develop new endoprostheses that would cause a minimal reaction of the body with good integration into tissues and high strength (to exclude relapses).

Journal of Experimental and Clinical Surgery. 2023;16(2):194-202
pages 194-202 views

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