Vol 16, No 2 (2023)

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.

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.

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.

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.

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.

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.

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.