Pub Date : 2022-02-21DOI: 10.18484/2305-0047.2022.1.5
R.N. Chornopyshchuk
Objective. To evaluate the effectiveness of platelet-rich plasma injections in the treatment of wounds in experimental animals with burns. Materials and methods. The experiment was carried out on 30 sexually mature male Wistar rats, which, after simulation of infected burn wound with boiling water and excision of necrotic tissue to pinpoint bleeding, hemostasis, on the second day, were divided into the main and control groups, depending on the chosen strategy of subsequent treatment. Wound defect of the animals in the control group (15 rats) was treated and bandages soaked in 0.02% decamethoxin solution were applied. Platelet-rich plasma was additionally injected into the wound area of the animals in the main group (15 rats) on the 1st, 3rd, 5th day after necrectomy. The remaining plasma was applied to the wound surface followed by closure with a polyvinyl chloride film and gauze bandage. Wound dressings were performed daily. The study involved a histological examination of the wound site and surrounding tissues the collection of which was carried out on the 1st, 3rd, 7th, 14th day after the removal of necrotic tissues. Results. In animals of the main group, the treatment of which involved the use of platelet-rich plasma, on the 3rd day after necrectomy in the wound area a decrease in the depth of injury that extended only of to subcutaneous tissue, a decrease in the activity of the inflammatory reaction in the tissues, followed by the proliferation of new epidermis and almost complete healing of wound defect up to 14 days were determined. For comparison, pathological changes in the tissues of the injured area of the animals in the control group were more pronounced with signs of muscle injury. In addition, during the entire observation period in this group of animals, an intense inflammatory reaction with low proliferative activity persisted. Conclusion. The effectiveness of platelet-rich plasma injections as an element of complex local treatment of burn wounds in rats has been experimentally confirmed. What this paper adds The expediency and effectiveness of platelet-rich plasma in the treatment of burns was histologically substantiated in the work on a specific experimental model of rats. In particular, its ability to positively influence the paranecrotic zone, reduce the intensity of inflammatory reaction in tissues, actively restore skin appendages, and stimulate the processes of proliferation and epithelization was established.
{"title":"THE USE OF PLATELET-RICH PLASMA IN THE TREATMENT OF BURNS IN THE EXPERIMENT","authors":"R.N. Chornopyshchuk","doi":"10.18484/2305-0047.2022.1.5","DOIUrl":"https://doi.org/10.18484/2305-0047.2022.1.5","url":null,"abstract":"Objective. To evaluate the effectiveness of platelet-rich plasma injections in the treatment of wounds in experimental animals with burns. Materials and methods. The experiment was carried out on 30 sexually mature male Wistar rats, which, after simulation of infected burn wound with boiling water and excision of necrotic tissue to pinpoint bleeding, hemostasis, on the second day, were divided into the main and control groups, depending on the chosen strategy of subsequent treatment. Wound defect of the animals in the control group (15 rats) was treated and bandages soaked in 0.02% decamethoxin solution were applied. Platelet-rich plasma was additionally injected into the wound area of the animals in the main group (15 rats) on the 1st, 3rd, 5th day after necrectomy. The remaining plasma was applied to the wound surface followed by closure with a polyvinyl chloride film and gauze bandage. Wound dressings were performed daily. The study involved a histological examination of the wound site and surrounding tissues the collection of which was carried out on the 1st, 3rd, 7th, 14th day after the removal of necrotic tissues. Results. In animals of the main group, the treatment of which involved the use of platelet-rich plasma, on the 3rd day after necrectomy in the wound area a decrease in the depth of injury that extended only of to subcutaneous tissue, a decrease in the activity of the inflammatory reaction in the tissues, followed by the proliferation of new epidermis and almost complete healing of wound defect up to 14 days were determined. For comparison, pathological changes in the tissues of the injured area of the animals in the control group were more pronounced with signs of muscle injury. In addition, during the entire observation period in this group of animals, an intense inflammatory reaction with low proliferative activity persisted. Conclusion. The effectiveness of platelet-rich plasma injections as an element of complex local treatment of burn wounds in rats has been experimentally confirmed. What this paper adds The expediency and effectiveness of platelet-rich plasma in the treatment of burns was histologically substantiated in the work on a specific experimental model of rats. In particular, its ability to positively influence the paranecrotic zone, reduce the intensity of inflammatory reaction in tissues, actively restore skin appendages, and stimulate the processes of proliferation and epithelization was established.","PeriodicalId":38373,"journal":{"name":"Novosti Khirurgii","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48876485","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-02-21DOI: 10.18484/2305-0047.2022.1.20
A. G. Skuratov, A. Lyzikov, V. Mitsura
Objective. Development of a non-invasive assessing diagnostic and severity grading accuracy of portal hypertension in cirrhosis of the liver. Methods. To identify diagnostically significant indicators, a statistical analysis of the data of laboratory and instrumental diagnostics was carried out in 60 patients with liver cirrhosis. The followingbiochemical indicators weredetermined: general and biochemical blood tests, coagulogram, general urine analysis; the level of interleukin-6 (IL-6), matrix metalloproteinases 1 and 9 (MMP-1, MMP-9), tissue inhibitor of matrix metalloproteinase 1 (TIMP-1), hepatocyte growth factor (HGF); abdominal ultrasound examination, esophagogastroscopy. The index of the ratio of the number of blood platelets (N×109 / L) to the transverse size (D) of the spleen in millimeters (PSR - Platelet count to Spleen diameter Ratio) was calculated: PSR = NTr / D spleen. Results. The following indicators turned out to be diagnostically significant (predictive values based on ROC analysis are presented): blood levels of IL-6 (>19.9 pg/ml), MMP-1 (>8.06 ng/ml), cholesterol (≤4,5mmol/L), portal vein diameter (>13 mm), PSR (≤1.89). Diagnosticmethods for cirrhosis and portal hypertension was developed, based on a point assessment of a set of laboratory and instrumental criteria (AUC = 0.931; p <0.001). The method can be used in a complex of medical services aimed at diagnosis of portal hypertension severity in patients with cirrhosis of the liver, as well as medical prevention of life-threatening complications of the disease. Conclusion. The developed method makes it possible to identify patients with a «severe» form of portal hypertension, to recommend an unscheduled FEGDS with an endoscopic assessment of the risk of bleeding, and to carry out preventive and therapeutic procedures. If a low probability of a “severe” form of PH is identified, FEGDS should be refrained from if the patient has absolute or relative contraindications to the use of this diagnostic method. The method can be used in a complex of medical services aimed at diagnosing the severity of portal hypertension against the background of liver cirrhosis. What this paper adds For the first time, a method for diagnosis of portal hypertension in liver cirrhosis has been developed. It is based on a score assessment of a set of laboratory and instrumental criteria, including blood levels of interleukin-6, matrix metalloproteinase-1, cholesterol, platelet count, portal vein diameter and transverse size of the spleen. The method can be used in a complex of medical services aimed to estimate the severity of portal hypertension in cirrhosis of the liver, as well as medical prevention of life-threatening complications of the disease.
{"title":"ASSESSMENT OF PORTAL HYPERTENSION SEVERITY IN LIVER CIRROSIS","authors":"A. G. Skuratov, A. Lyzikov, V. Mitsura","doi":"10.18484/2305-0047.2022.1.20","DOIUrl":"https://doi.org/10.18484/2305-0047.2022.1.20","url":null,"abstract":"Objective. Development of a non-invasive assessing diagnostic and severity grading accuracy of portal hypertension in cirrhosis of the liver. Methods. To identify diagnostically significant indicators, a statistical analysis of the data of laboratory and instrumental diagnostics was carried out in 60 patients with liver cirrhosis. The followingbiochemical indicators weredetermined: general and biochemical blood tests, coagulogram, general urine analysis; the level of interleukin-6 (IL-6), matrix metalloproteinases 1 and 9 (MMP-1, MMP-9), tissue inhibitor of matrix metalloproteinase 1 (TIMP-1), hepatocyte growth factor (HGF); abdominal ultrasound examination, esophagogastroscopy. The index of the ratio of the number of blood platelets (N×109 / L) to the transverse size (D) of the spleen in millimeters (PSR - Platelet count to Spleen diameter Ratio) was calculated: PSR = NTr / D spleen. Results. The following indicators turned out to be diagnostically significant (predictive values based on ROC analysis are presented): blood levels of IL-6 (>19.9 pg/ml), MMP-1 (>8.06 ng/ml), cholesterol (≤4,5mmol/L), portal vein diameter (>13 mm), PSR (≤1.89). Diagnosticmethods for cirrhosis and portal hypertension was developed, based on a point assessment of a set of laboratory and instrumental criteria (AUC = 0.931; p <0.001). The method can be used in a complex of medical services aimed at diagnosis of portal hypertension severity in patients with cirrhosis of the liver, as well as medical prevention of life-threatening complications of the disease. Conclusion. The developed method makes it possible to identify patients with a «severe» form of portal hypertension, to recommend an unscheduled FEGDS with an endoscopic assessment of the risk of bleeding, and to carry out preventive and therapeutic procedures. If a low probability of a “severe” form of PH is identified, FEGDS should be refrained from if the patient has absolute or relative contraindications to the use of this diagnostic method. The method can be used in a complex of medical services aimed at diagnosing the severity of portal hypertension against the background of liver cirrhosis. What this paper adds For the first time, a method for diagnosis of portal hypertension in liver cirrhosis has been developed. It is based on a score assessment of a set of laboratory and instrumental criteria, including blood levels of interleukin-6, matrix metalloproteinase-1, cholesterol, platelet count, portal vein diameter and transverse size of the spleen. The method can be used in a complex of medical services aimed to estimate the severity of portal hypertension in cirrhosis of the liver, as well as medical prevention of life-threatening complications of the disease.","PeriodicalId":38373,"journal":{"name":"Novosti Khirurgii","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41818909","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-02-21DOI: 10.18484/2305-0047.2022.1.95
V. Rayn
Literature searches were carried out on the Pubmed information platform and in the elibrary and Cyberleninka libraries by Keywords. Inclusion criteria are the following: availability of the full-text version of the original article, full compliance with the topic, publication period no more than 5 years. From 144 publications received, those completely duplicated and not meeting the inclusion criteria, were excluded. A total of 36 articles are included in the review. The epidemiology of biliary fistula after pancreatoduodenal resection, modern views on pathogenesis, classification, preventive measures and therapeutic and diagnostic tactics during its development are considered. In the postoperative period of pancreatoduodenal resection, biliary fistula is formed with a frequency of 1-24%. Non-modifiable risk factors include male gender, thin common bile duct, benign biliopancreatoduodenal pathology, and cancer with previous neoadjuvant therapy. Modifiable risk factors include obesity, hypoalbuminemia, obstructive jaundice, duration of hepaticojejunostomy, and prior endoscopic biliary drainage. Nowadays, effective and safe procedures are available in modern interventional radiology for the diagnosis and treatment of postoperative biliary fistula, which can be used as an alternative to endoscopic manipulations and revision interventions when the latter are associated with high risks of complications. Timely detection and treatment ensures the prevention of severe biliary fistula and repeated interventions and favorable prognosis, as well as saving medical and financial resources.
{"title":"BILIARY FISTULA AFTER PANCREATICODUODENECTOMY","authors":"V. Rayn","doi":"10.18484/2305-0047.2022.1.95","DOIUrl":"https://doi.org/10.18484/2305-0047.2022.1.95","url":null,"abstract":"Literature searches were carried out on the Pubmed information platform and in the elibrary and Cyberleninka libraries by Keywords. Inclusion criteria are the following: availability of the full-text version of the original article, full compliance with the topic, publication period no more than 5 years. From 144 publications received, those completely duplicated and not meeting the inclusion criteria, were excluded. A total of 36 articles are included in the review. The epidemiology of biliary fistula after pancreatoduodenal resection, modern views on pathogenesis, classification, preventive measures and therapeutic and diagnostic tactics during its development are considered. In the postoperative period of pancreatoduodenal resection, biliary fistula is formed with a frequency of 1-24%. Non-modifiable risk factors include male gender, thin common bile duct, benign biliopancreatoduodenal pathology, and cancer with previous neoadjuvant therapy. Modifiable risk factors include obesity, hypoalbuminemia, obstructive jaundice, duration of hepaticojejunostomy, and prior endoscopic biliary drainage. Nowadays, effective and safe procedures are available in modern interventional radiology for the diagnosis and treatment of postoperative biliary fistula, which can be used as an alternative to endoscopic manipulations and revision interventions when the latter are associated with high risks of complications. Timely detection and treatment ensures the prevention of severe biliary fistula and repeated interventions and favorable prognosis, as well as saving medical and financial resources.","PeriodicalId":38373,"journal":{"name":"Novosti Khirurgii","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46864674","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-02-21DOI: 10.18484/2305-0047.2022.1.28
B.I. Belokonev, S. Pushkin, Z. Kovaleva, D.B. Avezova, D. Novikov
Objective. To substantiate the methods of surgical treatment in patients with postoperative ventral hernias and created intestinal fistulas based on the comparison of the outcomes of one-stage and two-stage operations. Methods. The analysis of patients (n=40) with postoperative ventral hernias and created intestinal fistulas imposed for therapeutic purposes or created as the treatment outcomes of uncreated fistulas has been performed. Jejunal fistulas were present in 7 patients (17.5%), ileal fistulas in 18 (45%), and colonic fistulas in 15 (37.5%) patients. The patients of group 1 (n=15, 37.5% ) underwent the two-stage operations. First, the fistula was closed with the access to the site of its location, and then after 3-6 months, the excision of hernia was performed. In patients of group 2 (n=25, 62.5%) fistula was simultaneously removed and hernia was excised. The «tension-free»techniquesinhernia orifice repair in those groups was performed. The outcomes were evaluated by the number of local and general complications in the period from 10 days to 6 months. Results. Wound complications after the first operation developed in 2 (13.3%) patients in the 1st group. There were no complications after the second stage of hernioplasty. In group 2, wound complications developed in 3 (12%) patients. There was no anastomotic failure in the groups. In the long terms, good results were obtained in 15 patients in group 1 and in 25 patients in group 2. The use of anterior prosthetic «tension-free»techniques of plastic surgery by the combined methods in one-stage allows obtaining results comparable to two-stage operations. Conclusion. In patients with hernias and intestinal fistulas, the method of treatment in one-stage or two-stages depends on the possibility of the gastrointestinal restoring patency from minimally invasive access in the site of the fistula location. What this paper adds For the first time, the indications for performing operations with postoperative ventral hernias and intestinal fistulas in one-stage and two-stage operations have been substantiated. Treatment option for patients with hernias and intestinal fistulas has been found to depend on the possibility of the gastrointestinal patency restoring from minimally invasive access in the site of the fistula location.
{"title":"TREATMENT METHODS OF PATIENTS WITH POSTOPERATIVE VENTRAL HERNIAS AND CREATED INTESTINAL FISTULAS","authors":"B.I. Belokonev, S. Pushkin, Z. Kovaleva, D.B. Avezova, D. Novikov","doi":"10.18484/2305-0047.2022.1.28","DOIUrl":"https://doi.org/10.18484/2305-0047.2022.1.28","url":null,"abstract":"Objective. To substantiate the methods of surgical treatment in patients with postoperative ventral hernias and created intestinal fistulas based on the comparison of the outcomes of one-stage and two-stage operations. Methods. The analysis of patients (n=40) with postoperative ventral hernias and created intestinal fistulas imposed for therapeutic purposes or created as the treatment outcomes of uncreated fistulas has been performed. Jejunal fistulas were present in 7 patients (17.5%), ileal fistulas in 18 (45%), and colonic fistulas in 15 (37.5%) patients. The patients of group 1 (n=15, 37.5% ) underwent the two-stage operations. First, the fistula was closed with the access to the site of its location, and then after 3-6 months, the excision of hernia was performed. In patients of group 2 (n=25, 62.5%) fistula was simultaneously removed and hernia was excised. The «tension-free»techniquesinhernia orifice repair in those groups was performed. The outcomes were evaluated by the number of local and general complications in the period from 10 days to 6 months. Results. Wound complications after the first operation developed in 2 (13.3%) patients in the 1st group. There were no complications after the second stage of hernioplasty. In group 2, wound complications developed in 3 (12%) patients. There was no anastomotic failure in the groups. In the long terms, good results were obtained in 15 patients in group 1 and in 25 patients in group 2. The use of anterior prosthetic «tension-free»techniques of plastic surgery by the combined methods in one-stage allows obtaining results comparable to two-stage operations. Conclusion. In patients with hernias and intestinal fistulas, the method of treatment in one-stage or two-stages depends on the possibility of the gastrointestinal restoring patency from minimally invasive access in the site of the fistula location. What this paper adds For the first time, the indications for performing operations with postoperative ventral hernias and intestinal fistulas in one-stage and two-stage operations have been substantiated. Treatment option for patients with hernias and intestinal fistulas has been found to depend on the possibility of the gastrointestinal patency restoring from minimally invasive access in the site of the fistula location.","PeriodicalId":38373,"journal":{"name":"Novosti Khirurgii","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48823610","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-12-22DOI: 10.18484/2305-0047.2021.6.699
D. Morozov, S. Sharkov, D. S. Tarasova, E. Pimenova, E. A. Okulov, D. A. Morozov
Objective. To conduct a retrospective analysis of surgical treatment and long-term outcomes of treatment of children with cloaca, admitted to clinics of Sechenov University in the period from 2015 to 2019 years. Methods. Surgical treatment and long-term results were analyzed in 16 patients with cloaca. The age of the children at the time addressing to the clinic varied from the first day of life to 17 years. Long-term results were analyzed in children aged 2.5 to 17 years. In the late postoperative period, patients’ complaints, local status, functional state of the sphincter apparatus, and urination were analyzed. Results. Patients with cloaca were admitted to clinics of Sechenov University from 10 regions of the Russian Federation. Three children were hospitalized in the first day of life, 13 patients were admitted at various stages of treatment. In 14 children, a stoma was formed on the first day of life, in two - later than a month. Correction of the defect by means of a posterior-sagittal perineal approach was performed in 13 patients, in 3 patients the abdominal-perineal approaches were applied. Reoperations were required in 10 patients (63%). In the long-term postoperative period, neoanus stenosis was detected in 4 (25%) patients, and neointroitus infestatio - in 3 (19%) patients. Constipation was registered in 7 children (43%), fecal incontinence in 2 (13%). 10 (62%) children had various urinary disorders. Conclusion. We found that 16 patients with cloaca were treated in 17 clinics at different stages of treatment. At the same time, the majority of patients in the late postoperative period had problems with defecation and urination and required repeated surgical interventions. The results of the analysis indicate that treatment prospects of such patients treatment lies in the organization of interregional centers, with the possibility of concentrating material, technical and human resources, forming the flow of patients and their competent routing. What this paper adds For the first time, a comparative analysis of the stages of surgical treatment of a significant cohort of patients with extremely rare anorectal malformations - various variants of cloaca (16 children who underwent 83 surgical interventions in 17 clinics of the Russian Federation), the results of final surgical corrections at Sechenov University has been performed. It has been found that the majority of patients required staged operations, having significant violations of defecation and urination, which confirmed the need to organize surgical treatment of children with cloaca exclusively in specialized centers.
{"title":"CORRECTION OF CLOACA: RESULTS OF TREATMENT OF 16 CHILDREN WHO UNDERWENT 83 OPERATIONS IN 17 CLINICS","authors":"D. Morozov, S. Sharkov, D. S. Tarasova, E. Pimenova, E. A. Okulov, D. A. Morozov","doi":"10.18484/2305-0047.2021.6.699","DOIUrl":"https://doi.org/10.18484/2305-0047.2021.6.699","url":null,"abstract":"Objective. To conduct a retrospective analysis of surgical treatment and long-term outcomes of treatment of children with cloaca, admitted to clinics of Sechenov University in the period from 2015 to 2019 years. Methods. Surgical treatment and long-term results were analyzed in 16 patients with cloaca. The age of the children at the time addressing to the clinic varied from the first day of life to 17 years. Long-term results were analyzed in children aged 2.5 to 17 years. In the late postoperative period, patients’ complaints, local status, functional state of the sphincter apparatus, and urination were analyzed. Results. Patients with cloaca were admitted to clinics of Sechenov University from 10 regions of the Russian Federation. Three children were hospitalized in the first day of life, 13 patients were admitted at various stages of treatment. In 14 children, a stoma was formed on the first day of life, in two - later than a month. Correction of the defect by means of a posterior-sagittal perineal approach was performed in 13 patients, in 3 patients the abdominal-perineal approaches were applied. Reoperations were required in 10 patients (63%). In the long-term postoperative period, neoanus stenosis was detected in 4 (25%) patients, and neointroitus infestatio - in 3 (19%) patients. Constipation was registered in 7 children (43%), fecal incontinence in 2 (13%). 10 (62%) children had various urinary disorders. Conclusion. We found that 16 patients with cloaca were treated in 17 clinics at different stages of treatment. At the same time, the majority of patients in the late postoperative period had problems with defecation and urination and required repeated surgical interventions. The results of the analysis indicate that treatment prospects of such patients treatment lies in the organization of interregional centers, with the possibility of concentrating material, technical and human resources, forming the flow of patients and their competent routing. What this paper adds For the first time, a comparative analysis of the stages of surgical treatment of a significant cohort of patients with extremely rare anorectal malformations - various variants of cloaca (16 children who underwent 83 surgical interventions in 17 clinics of the Russian Federation), the results of final surgical corrections at Sechenov University has been performed. It has been found that the majority of patients required staged operations, having significant violations of defecation and urination, which confirmed the need to organize surgical treatment of children with cloaca exclusively in specialized centers.","PeriodicalId":38373,"journal":{"name":"Novosti Khirurgii","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46385613","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-12-22DOI: 10.18484/2305-0047.2021.6.645
V. V. Bereshchenko, A. Lyzikov, E. Nadyrov, A. N. Kondrachuk
Objective. To study cellular and tissue reactions in experimental animals in response to the implantation of a polypropylene mesh endoprosthesis modified with a polycaprolactone solution by the different methods. Methods. The object of the study was modified with polypropylene mesh endoprostheses implanted in experimental animals. The animals were divided into three groups: the control group - with polypropylene mesh endoprosthesis without its modification; the first experimental group - with polycaprolactone modification by its uniform distribution on the endoprosthesis surface; the second experimental group - with the samples of polypropylene mesh endoprosthesis modified by method of electrospinning. The morphological assessment of reactions to the implantation of the materials was carried out by means of the calculation of the cellular elements of inflammatory and connective tissue origin along the periphery of the implants Results.A statistically significant increase in the number of fibroblasts was revealed on the 3rd day of observation in the animals of the second experimental group in comparison with the control one (р=0,047). The analogous trend was noted on the 7th day of the study in comparison with the control animals (р=0,002), as well as with the animals from the first experimental group (р<0,001). On the 7th day of the experiment the enhancement of the fibroplastic properties of the samples modified with polycaprolactone by electrospinning was characterized by a less pronounced inflammatory reaction of the peripheral tissues and it indicates a higher rate of granulation tissue maturation. Conclusion. Tissue and cellular reactions around the specimens modified with with polycaprolactone solution by the electrospinning method were found to be characterized by a less pronounced inflammatory reaction of the peripheral tissues and more expressed fibroplastic reaction in comparison with the control specimens. The endoprostheses obtained in this way can be used to stimulate the migration of fibroblasts and enhance local collagen synthesis, accelerate the processes of reparative regeneration in patients with undifferentiated connective tissue dysplasia. Thus it makes possible to recommend introducing this method of PSE modification in clinical practice. What this paper adds For the first time, morphological features of subcutaneous tissue around samples of polypropylene mesh endoprostheses modified with polycaprolactone solution by the different methods of its application have been studied. The changes in tissues around the samples of polypropylene mesh endoprostheses modified with a polycaprolactone solution by electrospinning are found to be characterized by a low peripheral inflammatory response of tissues with an increase of fibroplastic changes in comparison with control ones.
{"title":"COMPARATIVE MORPHOLOGICAL FEATURES OF SUBCUTANEOUS TISSUE OF EXPERIMENTAL ANIMALS IN RESPONSE TO THE IMPLANTATION WITH MODIFIED POLYPROPYLENE MESH ENDOPROSTHESIS","authors":"V. V. Bereshchenko, A. Lyzikov, E. Nadyrov, A. N. Kondrachuk","doi":"10.18484/2305-0047.2021.6.645","DOIUrl":"https://doi.org/10.18484/2305-0047.2021.6.645","url":null,"abstract":"Objective. To study cellular and tissue reactions in experimental animals in response to the implantation of a polypropylene mesh endoprosthesis modified with a polycaprolactone solution by the different methods. Methods. The object of the study was modified with polypropylene mesh endoprostheses implanted in experimental animals. The animals were divided into three groups: the control group - with polypropylene mesh endoprosthesis without its modification; the first experimental group - with polycaprolactone modification by its uniform distribution on the endoprosthesis surface; the second experimental group - with the samples of polypropylene mesh endoprosthesis modified by method of electrospinning. The morphological assessment of reactions to the implantation of the materials was carried out by means of the calculation of the cellular elements of inflammatory and connective tissue origin along the periphery of the implants Results.A statistically significant increase in the number of fibroblasts was revealed on the 3rd day of observation in the animals of the second experimental group in comparison with the control one (р=0,047). The analogous trend was noted on the 7th day of the study in comparison with the control animals (р=0,002), as well as with the animals from the first experimental group (р<0,001). On the 7th day of the experiment the enhancement of the fibroplastic properties of the samples modified with polycaprolactone by electrospinning was characterized by a less pronounced inflammatory reaction of the peripheral tissues and it indicates a higher rate of granulation tissue maturation. Conclusion. Tissue and cellular reactions around the specimens modified with with polycaprolactone solution by the electrospinning method were found to be characterized by a less pronounced inflammatory reaction of the peripheral tissues and more expressed fibroplastic reaction in comparison with the control specimens. The endoprostheses obtained in this way can be used to stimulate the migration of fibroblasts and enhance local collagen synthesis, accelerate the processes of reparative regeneration in patients with undifferentiated connective tissue dysplasia. Thus it makes possible to recommend introducing this method of PSE modification in clinical practice. What this paper adds For the first time, morphological features of subcutaneous tissue around samples of polypropylene mesh endoprostheses modified with polycaprolactone solution by the different methods of its application have been studied. The changes in tissues around the samples of polypropylene mesh endoprostheses modified with a polycaprolactone solution by electrospinning are found to be characterized by a low peripheral inflammatory response of tissues with an increase of fibroplastic changes in comparison with control ones.","PeriodicalId":38373,"journal":{"name":"Novosti Khirurgii","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48855562","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-12-22DOI: 10.18484/2305-0047.2021.6.710
I. Kobza, Y. Mota, R. Zhuk, Y. Orel
Objective. Improvement the surgical management for cavoatrial tumor thrombosis due to renal cell carcinoma. Methods. The results of complex clinical, laboratory, instrumental examination, intraoperative observations and morphological studies were analyzed in 62 patients with renal cell carcinoma, complicated by cavoatrial tumor thrombosis, hospitalized to the vascular surgery department of Lviv regional clinical hospital for the period 1993-2019. Surgical treatment included radical nephrectomy, thrombectomy from inferior vena cava and right atrium. Kaplan-Meier method was used to evaluate the long-term survival of patients. Results. The postoperative complications included: posthemorrhagic anemia - 22 (38,6%), acute renal failure - 15 (26,3%), pulmonary embolism - 4 (7,0%), acute liver failure - 3 (5,3%), phlebothrombosis - 3 (5,3%), pneumonia - 3 (5,3%), stroke - 2 (3,5%), wound сomplications - 5 (8,8%) cases. Perioperative mortality was 11,3%. The causes of death included: hemorrhagic shock - 4 (6,5%), pulmonary embolism - 3 (4,8%), stroke - 1 (1,6%) cases. Long-term survival indicators were evaluated among 53 patients. The median follow-up was 36,9±13,3 months. The cumulative 2-, 5-, and 10-year survival rates were 53,5%; 38,2% and 17,2%, in 32 patients without metastases - 58,7%; 43,1% and 18,5% respectively. There was no significant difference іin survival among patients with atrial and retrohepatic venous tumor thrombosis versus infrahepatic and cavarenal venous tumor thrombosis (p>0,05). Conclusion. The accurate preoperative assessment of the level of neoprocess involvement, improvement of surgical tactics, effective prevention of thromboembolic and hemorrhagic complications make it possible to provide acceptable survival rates for patients with renal cell carcinoma, complicated by cavoatrial tumor thrombosis. What this paper adds The role of intraoperative blood reinfusion in the aspect of oncological safety in patients with renal cell carcinoma, complicated by invasion of inferior vena cava and right atrium, was first determined. Based on the results of cytological examination of tumor contamination of blood sediment material from the operating field during the cavatomy and washed autoerythrocytes it has been established that intraoperative reinfusion can provide necessary ablastics and doesn’t pose an additional risk of tumor dissemination during radical nephrectomy and inferior vena cava thrombectomy. The use of combined mini-invasive approaches in the surgical treatment of supradiaphragmatic level of intracaval invasion due to renal cell carcinoma is proposed, which will reduce the volume, trauma and duration of surgery, as well as provide reliable pulmonary embolism prevention. For the first time in Ukraine the immediate and long-term results of surgical treatment of patients with renal cell carcinoma, complicated by invasion of inferior vena cava and right atrium, during the last three decades were analyzed.
{"title":"THE RESULTS OF SURGICAL MANAGEMENT FOR CAVOATRIAL TUMOR THROMBOSIS DUE TO RENAL CELL CARCINOMA","authors":"I. Kobza, Y. Mota, R. Zhuk, Y. Orel","doi":"10.18484/2305-0047.2021.6.710","DOIUrl":"https://doi.org/10.18484/2305-0047.2021.6.710","url":null,"abstract":"Objective. Improvement the surgical management for cavoatrial tumor thrombosis due to renal cell carcinoma. Methods. The results of complex clinical, laboratory, instrumental examination, intraoperative observations and morphological studies were analyzed in 62 patients with renal cell carcinoma, complicated by cavoatrial tumor thrombosis, hospitalized to the vascular surgery department of Lviv regional clinical hospital for the period 1993-2019. Surgical treatment included radical nephrectomy, thrombectomy from inferior vena cava and right atrium. Kaplan-Meier method was used to evaluate the long-term survival of patients. Results. The postoperative complications included: posthemorrhagic anemia - 22 (38,6%), acute renal failure - 15 (26,3%), pulmonary embolism - 4 (7,0%), acute liver failure - 3 (5,3%), phlebothrombosis - 3 (5,3%), pneumonia - 3 (5,3%), stroke - 2 (3,5%), wound сomplications - 5 (8,8%) cases. Perioperative mortality was 11,3%. The causes of death included: hemorrhagic shock - 4 (6,5%), pulmonary embolism - 3 (4,8%), stroke - 1 (1,6%) cases. Long-term survival indicators were evaluated among 53 patients. The median follow-up was 36,9±13,3 months. The cumulative 2-, 5-, and 10-year survival rates were 53,5%; 38,2% and 17,2%, in 32 patients without metastases - 58,7%; 43,1% and 18,5% respectively. There was no significant difference іin survival among patients with atrial and retrohepatic venous tumor thrombosis versus infrahepatic and cavarenal venous tumor thrombosis (p>0,05). Conclusion. The accurate preoperative assessment of the level of neoprocess involvement, improvement of surgical tactics, effective prevention of thromboembolic and hemorrhagic complications make it possible to provide acceptable survival rates for patients with renal cell carcinoma, complicated by cavoatrial tumor thrombosis. What this paper adds The role of intraoperative blood reinfusion in the aspect of oncological safety in patients with renal cell carcinoma, complicated by invasion of inferior vena cava and right atrium, was first determined. Based on the results of cytological examination of tumor contamination of blood sediment material from the operating field during the cavatomy and washed autoerythrocytes it has been established that intraoperative reinfusion can provide necessary ablastics and doesn’t pose an additional risk of tumor dissemination during radical nephrectomy and inferior vena cava thrombectomy. The use of combined mini-invasive approaches in the surgical treatment of supradiaphragmatic level of intracaval invasion due to renal cell carcinoma is proposed, which will reduce the volume, trauma and duration of surgery, as well as provide reliable pulmonary embolism prevention. For the first time in Ukraine the immediate and long-term results of surgical treatment of patients with renal cell carcinoma, complicated by invasion of inferior vena cava and right atrium, during the last three decades were analyzed.","PeriodicalId":38373,"journal":{"name":"Novosti Khirurgii","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44742918","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-12-22DOI: 10.18484/2305-0047.2021.6.690
N. Shestak, I. Klimchuk, V. Khryshchanovich
Objective. To conduct a comparative analysis of long-term (3-yars) results of varicose veins treatment by mechanochemical endovenous ablation (MOCA) with using polidocanol foam of room temperature and a chilled one. Methods. The study is based on the treatment results of 122 patients with great saphenous vein (GSV) incompetence. The patients were randomized into 2 groups. In the main group (n=60), mechano-chemical ablation was performed according to original technique, using a cooled sclerosant, 60ᵒ degrees leg elevation and a shin bandage; in the comparison group (n=62) standard technique was used. The median GSV diameter in the main group was Me (Q25; Q75) = 7.4 (5.8; 8.2) mm, in the comparison group - Me (Q25; Q75) = 7.3 (5.6; 8.3) mm (P=0.794). Results. One month after the surgery, the GSV was totally occluded in 100% cases in the main and in 96.7% cases in the comparison group (P=0.496). One year after the surgery, occlusion rates were 94.6% and 80.4% respectively (P=0.042). 3 years later, GSV occlusion was diagnosed in 92.6% cases and in 76.4% cases, respectively (P=0.0033). Hyperpigmentation was reported in 21.7% legs in the main group and 22.6% legs in the comparison group (P>0,99). Transient superficial phlebitis developed in 6.7% and in 8.1% legs, respectively (P=0.744). Conclusion. Endovenous mechanochemical cryoablation is more effective than the standard MOCA technique and can be considered as the most preferable method for eliminating reflux in the GSV. What this paper adds A comparative safety and efficacy of the endovenous mechanochemical cryoablation in comparison with the standard technique to eliminate GSV reflux has been evaluated for the first time. A small number of complications and significant positive dynamics of clinical symptoms were reported in both groups. After 3 years, GSV recanalization rate was 3.2 times higher using the standard technique.
{"title":"COMPARATIVE ANALYSIS OF THE RESULTS OF THE MECHANOCHEMICAL ENDOVENOUS ABLATION OF GREAT SAPHENOUS VEIN USING POLYDOCANOL FOAM OF ROOM TEMPERATURE AND COOLED ONE","authors":"N. Shestak, I. Klimchuk, V. Khryshchanovich","doi":"10.18484/2305-0047.2021.6.690","DOIUrl":"https://doi.org/10.18484/2305-0047.2021.6.690","url":null,"abstract":"Objective. To conduct a comparative analysis of long-term (3-yars) results of varicose veins treatment by mechanochemical endovenous ablation (MOCA) with using polidocanol foam of room temperature and a chilled one. Methods. The study is based on the treatment results of 122 patients with great saphenous vein (GSV) incompetence. The patients were randomized into 2 groups. In the main group (n=60), mechano-chemical ablation was performed according to original technique, using a cooled sclerosant, 60ᵒ degrees leg elevation and a shin bandage; in the comparison group (n=62) standard technique was used. The median GSV diameter in the main group was Me (Q25; Q75) = 7.4 (5.8; 8.2) mm, in the comparison group - Me (Q25; Q75) = 7.3 (5.6; 8.3) mm (P=0.794). Results. One month after the surgery, the GSV was totally occluded in 100% cases in the main and in 96.7% cases in the comparison group (P=0.496). One year after the surgery, occlusion rates were 94.6% and 80.4% respectively (P=0.042). 3 years later, GSV occlusion was diagnosed in 92.6% cases and in 76.4% cases, respectively (P=0.0033). Hyperpigmentation was reported in 21.7% legs in the main group and 22.6% legs in the comparison group (P>0,99). Transient superficial phlebitis developed in 6.7% and in 8.1% legs, respectively (P=0.744). Conclusion. Endovenous mechanochemical cryoablation is more effective than the standard MOCA technique and can be considered as the most preferable method for eliminating reflux in the GSV. What this paper adds A comparative safety and efficacy of the endovenous mechanochemical cryoablation in comparison with the standard technique to eliminate GSV reflux has been evaluated for the first time. A small number of complications and significant positive dynamics of clinical symptoms were reported in both groups. After 3 years, GSV recanalization rate was 3.2 times higher using the standard technique.","PeriodicalId":38373,"journal":{"name":"Novosti Khirurgii","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44797057","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-12-22DOI: 10.18484/2305-0047.2021.6.747
R. Kalinin, I. Suchkov, V. Karpov, A. Egorov, A. Pshennikov, D. V. Karpov, A. Krylov
The article presents the experience of using allografts from a postmortem donor in emergency surgery of the main arteries of the lower extremities. Possible tactical methods of combined use of alloartery and allovein from various donors in urgent surgery have been demonstrated. High risks of interventions aimed at relieving early and late complications of vascular reconstructions remain an actual problem in angiosurgery. Very often, operations are performed in the presence of extensive necrosis and trophic ulcers (stage IV according to the Fontaine-Pokrovsky classification). Autovenous conduit from the great saphenous vein (type of arterial bed lesions C, D according to TASS II) was and remains the gold standard for choosing a shunt for reconstructive operations on infrainguinal arteries. In case of repeated reconstructions in the absence of a suitable autovein, in the presence of trophic ulcers and necrosis, an infectious process in the area of the vascular prosthesis, it is not always possible to use a synthetic prosthesis as a reliable alternative. Unsatisfactory results of using such materials dictate the need to choose a suitable graft. The problem of using allografts requires further advanced study. In this regard, the experience of using allografts in two non-standard urgent clinical situations is presented. The conclusion is made about the possibility of effective use of allografts from a postmortem donor in patients with bleeding after endovascular treatment of critical limb ischemia with trophic changes in the staged surgical treatment, as well as in patients with thrombosed anastomotic false aneurysms after previously performed surgical interventions.
{"title":"POSSIBILITIES OF VASCULAR TRANSPLANTATION IN URGENT SURGERY OF MAIN ARTERIES","authors":"R. Kalinin, I. Suchkov, V. Karpov, A. Egorov, A. Pshennikov, D. V. Karpov, A. Krylov","doi":"10.18484/2305-0047.2021.6.747","DOIUrl":"https://doi.org/10.18484/2305-0047.2021.6.747","url":null,"abstract":"The article presents the experience of using allografts from a postmortem donor in emergency surgery of the main arteries of the lower extremities. Possible tactical methods of combined use of alloartery and allovein from various donors in urgent surgery have been demonstrated. High risks of interventions aimed at relieving early and late complications of vascular reconstructions remain an actual problem in angiosurgery. Very often, operations are performed in the presence of extensive necrosis and trophic ulcers (stage IV according to the Fontaine-Pokrovsky classification). Autovenous conduit from the great saphenous vein (type of arterial bed lesions C, D according to TASS II) was and remains the gold standard for choosing a shunt for reconstructive operations on infrainguinal arteries. In case of repeated reconstructions in the absence of a suitable autovein, in the presence of trophic ulcers and necrosis, an infectious process in the area of the vascular prosthesis, it is not always possible to use a synthetic prosthesis as a reliable alternative. Unsatisfactory results of using such materials dictate the need to choose a suitable graft. The problem of using allografts requires further advanced study. In this regard, the experience of using allografts in two non-standard urgent clinical situations is presented. The conclusion is made about the possibility of effective use of allografts from a postmortem donor in patients with bleeding after endovascular treatment of critical limb ischemia with trophic changes in the staged surgical treatment, as well as in patients with thrombosed anastomotic false aneurysms after previously performed surgical interventions.","PeriodicalId":38373,"journal":{"name":"Novosti Khirurgii","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44574985","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-12-22DOI: 10.18484/2305-0047.2021.6.680
V. Zemlyanoy, B. Filenko, B. Sigua, P. Kotkov, G.Y. Dzalatyan
Objective. Reducing the recurrence rate of adhesive disease after its surgical treatment by developing a differentiated approach to preventive measures. Methods. A retrospective study included patients (n=260) with adhesive disease complicated by recurrent attacks of acute bowel obstruction has been performed. The main (n=105) and control (n=155) groups were formed. The patients of the main group were undergone to algorithmfor prophylaxisandtreatment in patients providing the implementation of planned surgical treatment and measurestoprevent recurrence. The nature of preventive measures was determined by the volume of surgical trauma of the peritoneal mesothelium and the prevalence of cicatricial-adhesive changes. In the control group, patients underwent standard measures aimed at conservative resolution of acute adhesive bowel obstruction: depending on their effectiveness, patients were discharged for further outpatient treatment or for urgent surgical intervention without any preventive measures. The primary outcome was considered to be the incidenceandrecurrencerate of adhesive disease and the severity of clinical symptoms, which were traced to a depth from 2 to 10 years by interviewing patients. If it was impossible to assess long-term results, patients were excluded from the study. Results. The total frequency of adhesive disease relapses requiring hospitalization was 8.6% (n=9) in the main group and 27.1% (n=42) in the comparison group, respectively. The best results were obtained in the subgroup of patients operated on for adhesive disease in a planned manner - the frequency recurrence rate was 4.6%. Conclusion. The use of the developed therapeutic and prophylactic algorithm in the surgical treatment of adhesive disease led to decline in relapse ratesfrom 27.1 %-8.6% cases of an improvement of life quality of patients with acute adhesive intestinal obstruction who underwent surgical treatment. What this paper adds The differentiated approach to the choice of operative access and surgical treatment of adhesive bowel obstruction has been developed. Indications for the use of specific preventive measures, depending on operative access and the nature of the surgical intervention have been substantiated.
{"title":"PREVENTIVE MEASURES AS AN OBLIGATORY COMPONENT IN THE TREATMENT OF PATIENTS WITH ACUTE ADHESIVE BOWEL OBSTRUCTION","authors":"V. Zemlyanoy, B. Filenko, B. Sigua, P. Kotkov, G.Y. Dzalatyan","doi":"10.18484/2305-0047.2021.6.680","DOIUrl":"https://doi.org/10.18484/2305-0047.2021.6.680","url":null,"abstract":"Objective. Reducing the recurrence rate of adhesive disease after its surgical treatment by developing a differentiated approach to preventive measures. Methods. A retrospective study included patients (n=260) with adhesive disease complicated by recurrent attacks of acute bowel obstruction has been performed. The main (n=105) and control (n=155) groups were formed. The patients of the main group were undergone to algorithmfor prophylaxisandtreatment in patients providing the implementation of planned surgical treatment and measurestoprevent recurrence. The nature of preventive measures was determined by the volume of surgical trauma of the peritoneal mesothelium and the prevalence of cicatricial-adhesive changes. In the control group, patients underwent standard measures aimed at conservative resolution of acute adhesive bowel obstruction: depending on their effectiveness, patients were discharged for further outpatient treatment or for urgent surgical intervention without any preventive measures. The primary outcome was considered to be the incidenceandrecurrencerate of adhesive disease and the severity of clinical symptoms, which were traced to a depth from 2 to 10 years by interviewing patients. If it was impossible to assess long-term results, patients were excluded from the study. Results. The total frequency of adhesive disease relapses requiring hospitalization was 8.6% (n=9) in the main group and 27.1% (n=42) in the comparison group, respectively. The best results were obtained in the subgroup of patients operated on for adhesive disease in a planned manner - the frequency recurrence rate was 4.6%. Conclusion. The use of the developed therapeutic and prophylactic algorithm in the surgical treatment of adhesive disease led to decline in relapse ratesfrom 27.1 %-8.6% cases of an improvement of life quality of patients with acute adhesive intestinal obstruction who underwent surgical treatment. What this paper adds The differentiated approach to the choice of operative access and surgical treatment of adhesive bowel obstruction has been developed. Indications for the use of specific preventive measures, depending on operative access and the nature of the surgical intervention have been substantiated.","PeriodicalId":38373,"journal":{"name":"Novosti Khirurgii","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47237711","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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