Issues of Reconstructive and Plastic Surgery
Peer-rewieved journal "Issues of Reconstructive and Plastic Surgery"
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Donor site lymphedema after facial reconstruction with free flaps: assessment and pathogenesis
Purpose of a study: to analyze lymphatic complications in the donor site following the harvest of free flaps for facial reconstruction. Special attention is given to the comparative evaluation of lymphedema severity after radial forearm, anterolateral thigh, and fibular flap harvesting. Based on anatomical analysis and clinical observations we highlight the extent of lymphatic system disruption associated with each flap type. The article outlines modern preventive strategies, including lymphographic mapping, preservation of lymph axiality, and the LIFT technique. Emphasis is placed on the importance of a multidisciplinary and anatomically conscious approach to flap selection, aimed at minimizing lymphatic trauma and supporting spontaneous lymphatic regeneration.
Endoscopic colposigmopiesis technique for surgical correction of the perineum in patients with congenital absence of the vagina
Purpose of a study: to present a surgical technique based on the accumulated clinical experience in performing reconstructive plastic surgeries on the perineal organs in patients with congenital vaginal aplasia and in patients diagnosed with gender dysphoria. Material and methods. More than 10 perineal reconstructive surgeries using a segment of the sigmoid colon and employing endoscopic techniques were performed at the I.M. Sechenov First Moscow State Medical University (Sechenov University) and at Clinic of the Family Medical Centers Network LLC in the period of 2021–2023. Postoperative outcomes were assessed based on physical examination findings, patient-reported satisfaction with the surgical results, and radiologic studies in 1 and 2 weeks, as well as in 1, 2, 4, and 6 months after surgery. Results. The study resulted in the development of a structured algorithm and a detailed description of the vaginal reconstruction technique using sigmoid colpopoiesis. The described technique provides a long-term, aesthetically and physiologically successful outcome, as confirmed by objective assessment methods and patient-reported feedback. Conclusion. Vaginoplasty using sigmoid colpopoiesis a relevant, promising, and highly advanced method for female genital reconstruction, enabling the creation of a neovagina that is anatomically and functionally as close as possible to the natural structure.
Midline (Thyroglossal) neck cyst: experience with surgical treatment and soft tissue reconstruction
Congenital head and neck lesions, although they can be detected before the age of one, are often diagnosed when adult patients present to a maxillofacial surgery clinic. Pediatricians are the first to verify the presence of such pathologies. To conduct a subsequent differential diagnosis, it is important to rely on anamnesis data and the characteristics of the clinical picture, taking into account a wide range of etiological factors, Surgical treatment of median cervical cysts is complex due to the risks of adverse outcomes, such as compromised aesthetics of the anterior cervical tissues, laryngeal maladaptation, and dysphagia associated with hyoid bone resection. Furthermore, loss of the bone framework in this area causes soft tissue deformity, which leads to decreased psychosocial adaptation and quality of life in patients postoperatively. The Sistrunk procedure, which was recently the gold standard for the treatment of median neck cysts, is currently losing its status as a universal method of choice due to the integration of plastic and reconstructive surgery approaches in the treatment of neoplasms of the head and neck organs. The results of a new surgical treatment for median cervical cysts has been presented in this article. This method combines cystectomy with resection of the hyoid bone and subsequent soft tissue reconstruction of the anterior neck using a cosmetic submental approach. This approach results in early social rehabilitation of patients and reduces the risk of adverse effects on the neck.
Alternative methods of free skin graft (state of the issue)
Аn analysis of modern alternative free skin grafting techniques has been presented. New approaches to traditional free skin grafting, fragmentary skin grafting, and epidermal and dermal skin grafting are described. The historical aspects, technical features, advantages, and limitations of various methods are reviewed. Shortand long-term treatment results using various methods are presented. Particular attention was paid to recipient wound healing mechanisms, donor-site complications, and clinical indications for each method. Technological innovations and specialized skin harvesting devices are described separately, allowing for independent research in original literature and more in-depth study. The review was prepared based on an analysis of current scientific publications with the aim of demonstrating the prospects for further improvement of free skin grafting methods in wound defect surgery.
Comparative analysis of the results of temporal lifting according to A. Fogli and a combined technique
Purpose of a study: to compare the results of temporal lifting according to A. Fogli and a combined technique with hemostatic net, and to evaluate the eyebrow tail position in the early and late postoperative periods. Material and methods. A retroand prospective analysis of temporal lifting results in women was conducted from February 2015 to May 2026, with an observation period of 1 year or more. In the first group, 30 patients were operated according to A. Fogli, while in the second group, 30 were operated on using a combined technique with hemostatic net. Eyebrow position was measured via standard projections photographs taken before surgery, one month and one year after surgery, using a graphic editor. Results. In the 1st group, statistically significant changes in eyebrow height were found at the lateral brow edge (LBE), lateral canthus (LC), and lateral limbus (LL) levels one month after surgery ( p < 0.001). By the year, statistical significance is observed at the levels of the LBE ( p < 0.001) and LC ( p = 0.001). In the 2nd group, statistical significance of changes in eyebrow height per month and per year after surgery was revealed at the levels of the LBE, LC, LL, and pupil center (PC) ( p < 0.001). The maximum lift was recorded at the level of the LBE (3.77 ± 1.59) mm after the first month and (1.66 ± 0.94) mm per year after surgery in the 1[st] group, in the 2[nd] group (3.95 ± 1.54) mm and (2.10 ± 0.98) mm, respectively. At the level of the LBE per year after surgery, the eyebrow height in the first group was lower than in the second ( p = 0.0478). In an intergroup comparison of changes in eyebrow position relative to preoperative, brow elevation in the second group was greater than in the first group at one month of follow-up at the LC, LL, PC, and medial limbus (ML) levels, and at one year at the LBE, LC, LL, PC, ML, and medial canthus (MC) levels ( p < 0.05). Conclusion. Patients who underwent surgery using the combined technique demonstrated greater brow tail elevation compared to those treated according to A. Fogli's at both one month and one year postoperatively.
Secondary rhinoplasty using auricular autograft: a clinical review
Secondary rhinoplasty is a complex reconstructive procedure aimed at correcting both aesthetic and functional deformities that may occur following primary rhinoseptoplasty. One of the effective solutions in cases of septal cartilage deficiency is the use of auricular autologous cartilage. This study reviews the indications, technical features, potential complications, and preventive strategies associated with the application of this type of autograft. Auricular cartilage demonstrates anatomical compatibility, favorable elasticity, and high graft viability, making it a reliable material for reshaping the nasal tip and alar structures. The presented clinical experience confirms the safety and effectiveness of the technique, provided that individual planning and adherence to surgical technique are followed.
Low rib remodeling as a method for waist contour correction in plastic surgery
Purpose of a study: to systematize current data on the evolution, technical characteristics, efficacy, and safety profile of lower rib remodeling techniques for waist contour correction in aesthetic surgery. Material and methods. A literature search was conducted in PubMed, Scopus, Google Scholar, and CyberLeninka databases from January 2015 to August 2025. Keywords included “rib remodeling”, “waist narrowing”, and “rib osteotomy”. A total of 22 relevant publications were included in the analysis, comprising original studies, clinical case reports, and systematic reviews. Results. Modern techniques (UUAIST, RibXcar, WASP, RIBOSS, ORUS) provide an waist circumference reduction ranging from 7 to 17 cm. Postoperative compliance, particularly corset use, is a key determinant of success in techniques involving external fixation. Severe intraoperative complications, such as pneumothorax, have become extremely rare with the use of intraoperative ultrasound guidance and piezoelectric instruments. The most common complications include postoperative pain and transient paresthesia. Conclusion. The evolution from total rib resection to minimally invasive remodeling (controlled osteotomy) has significantly improved procedural safety. Method selection represents an individualized balance between invasiveness, efficacy, and dependence on patient compliance. Further prospective comparative studies with objective postoperative monitoring are required for standardization.
Comparative analysis of hernioplasty with reconstruction of the linea alba in incisional hernias with loss of domain
Objective. Incisional hernias (IH) are an urgent problem of modern surgery. For the reconstruction of largescale IH, separation of the components of the anterior abdominal wall is required in order to completely bring together the musculoskeletal and tendon structures of the abdomen. A promising method of preoperative preparation is the injection of botulinum toxin type A into the lateral abdominal muscles in order to relax them. Purpose of a study: to evaluate and compare the results of using botulinum toxin type A preparations in the preoperative preparation of patients with IH and abdominal domain loss who underwent prosthetic hernioplasty with posterior separation according to Y.W. Novitsky. Material and methods. The study included 63 patients operated on in the surgical department of the Bashkir State Medical University Clinic for the period from 2021 to 2024 for IH with abdominal domain loss according to CT abdominometry. The experimental group consisted of 30 patients, the control group 33. Intraoperative surgical criteria and postoperative indicators reflecting the dynamics of recovery after surgery were compared. The level of statistical significance was assumed at p<0.05. Results. In patients with preoperative administration of botulinum toxin type A after hernioplasty with posterior separation, there is a decrease in surgery time and an increase in the number of full-fledged reconstruction of the white line of the abdomen. In the postoperative period, patients with chemical separation have fewer complications, the duration of hospitalization and the severity of pain are reduced. Conclusion. Preoperative administration of botulinum toxin type A preparations into the lateral abdominal muscles reduces the traumatism of posterior separation plastic surgery, accelerates and improves the course of the postoperative period in patients with severe IH.
Endobronchial ultrasound with fine-needle aspiration biopsy of mediastinal lymph nodes in the diagnosis of lymphadenopathy (clinical experience)
Purpose of a study: to evaluate the effectiveness of endobronchial ultrasonography with fine-needle aspiration biopsy of mediastinal lymph nodes in the diagnosis of lymphadenopathy. Material and methods. In the period of 2023–2025, 56 patients (25 men (44.6%) and 31 women (55.4%)) with mediastinal lymphadenopathy underwent endoscopic ultrasound with fine-needle aspiration biopsy of the lymph nodes at the Novosibirsk Regional Clinical Hospital. Patients' ages ranged from 27 to 74 years (mean age (46.80 ± 12.96) years). Lung tissue changes were detected in 23 (41.8%) participants. Results. The minimum duration of the procedure was 15 minutes, the maximum was 45 minutes (mean (25.30 ± 6.37) minutes). We did not observe any complications during the interventions. A sufficient amount of puncture material was obtained in all cases. Mediastinal lymph node biopsy was performed in 52 patients (92.9%), including the majority of patients (41 people, 73.2%) diagnosed with sarcoidosis. Additionally, pathological examination of lung tissue and bronchial mucosa biopsies confirmed sarcoidosis in 16 patients (28.6%), including five (8.9%) in whom lymph node biopsy yielded non-informative material or normal lymph node tissue. Conclusion. Ultrasound-guided mediastinal lymph node biopsy is a highly informative and relatively safe procedure, eliminating the need for diagnostic thoracoscopy in 91.9% of patients. This method can be considered the gold standard in the diagnosis of mediastinal lymphadenopathy. Combining a needle biopsy with a bronchial mucosal biopsy and/or transbronchial lung tissue biopsy improves the diagnostic efficacy of endobronchial ultrasonography.
The effect of a new reconstructive stage of biliopancreatic diversion on body composition, type 2 diabetes mellitus remission, and quality of life in patients with morbid obesity
Purpose of a study: to perform a correlation analysis of the effect of a new reconstructive stage of biliopancreatic diversion on body composition, type 2 diabetes mellitus (T2DM) remission, and quality of life in patients with morbid obesity. Material and Methods. This prospective comparative non-randomized study included 36 patients with morbid obesity who underwent open biliopancreatic diversion with a Roux-en-Y anastomosis between 2014 and 2024. The main group ( n = 22) comprised patients in whom the surgeons created an anti-reflux sphincter mechanism at the gastrojejunal anastomosis using an original technique; the control group ( n = 14) comprised patients who underwent standard BPD without restoration of the anastomotic occlusive function. The investigators assessed body composition by bioelectrical impedance analysis, metabolic markers, T2DM status, and quality of life using an integral 10-point visual analogue scale at 12 months postoperatively. To identify relationships among body composition indices, metabolic markers, eating behavior parameters, and quality of life, the team applied Spearman's rank correlation analysis, which allowed them to establish not only the statistical significance of intergroup differences but also the direction and strength of associations between clinical and patient-reported outcomes. Results. The main group achieved a higher percentage of excess weight loss (78.7% vs. 72.2%; p = 0.001) and a more pronounced reduction in fat mass (22.5% vs. 24.2%; p = 0.023), while preserving active cell mass. All patients with a baseline T2DM diagnosis ( n = 20, 100%) achieved complete remission, and the main group discontinued insulin and metformin 1–2 months earlier than the control group. Quality of life scores were higher in the main group (8.5 vs. 7.0 points; p < 0.001). The researchers found a strong negative correlation between quality of life and fat mass percentage (ρ = –0.68; p < 0.001) and glycated hemoglobin (ρ = –0.64; p < 0.001), and a strong positive correlation with active cell mass (ρ = 0.61; p < 0.001). Conclusion. The formation of new reconstructive stages of BPD improves the metabolic profile due to a significant reduction in muscle mass while maintaining active cellular mass, accelerates the remission of type 2 diabetes and improves the quality of life of patients.
Heterogeneity of small intestinal tumors: from molecular-genetic characteristics to diagnostics and treatment (literature review)
Objective. Small intestine tumors (SITs) are a heterogeneous group of rare neoplasms (1–3% of all gastrointestinal tumors) characterized by the difficulty of early diagnosis, a variety of histological types, and the lack of standardized treatment protocols. Purpose of a study: to determine how the pathogenetic features of the main histological types of small intestinal tumors influence the tactics of diagnostic algorithms and treatment methods. Material and Methods . A systematic analysis of scientific publications was conducted, including systematic reviews, original studies, clinical guidelines, and rare clinical cases indexed in the PubMed, Scopus, Web of Science, and Russian Science Citation Index (RSCI) databases. Results. It was established that the most common malignant neoplasms of the GI tract are neuroendocrine tumors (NETs) and adenocarcinomas, which are characterized by a more aggressive course. Gastrointestinal stromal tumors (GISTs), on the other hand, are less common. The diagnostic paradigm has undergone a significant evolution: from intraoperative detection to multimodal stratification, including capsule/balloon enteroscopy, CT and MR enterography, as well as molecular imaging methods (PET-CT with 68Ga somatostatin analogs for NETs and 18F-FDG for GISTs). Immunohistochemical typing (chromogranin A, synaptophysin, CD117, DOG1, CDX-2, Ki-67) and molecular-genetic profiling (KIT/PDGFRA mutations, MSI status, 18q deletion), which determine the choice of targeted and immunotherapy as well as the optimal extent of surgical treatment. Conclusion . The combined use of CT/MR enterography, enteroscopy, PET/CT, and molecular typing allows for personalized surgical intervention, improving prognosis for these rare and heterogeneous tumors. The main unresolved issues remain the late detection of small bowel tumors (especially adenocarcinomas) and the insufficient number of large randomized trials to develop standardized patient management guidelines.
Reduodenation as the basic principle of surgical treatment of the operated stomach diseases
In the 50s of the 20th century, the ideology of physiological gastroplasty was formulated, according to which the restoration of the continuity of the digestive tract after gastric resection and gastrectomy should realize the main two postulates this is reduction (preservation of the duodenal passage) and reservoir capacity (creation of an intestinal reservoir). However, the implementation of these principles during repeated gastric surgeries is still far from being resolved. Purpose of a study: to improve the results of surgical treatment of diseases of the operated stomach. Material and methods. In the period up 2012 to 2024, 71 reconstructive operations on the stomach with restoration of the duodenal passage of food were performed at the A.V. Vishnevsky National Research Medical Center for Surgery (Moscow, Russia). The indication for the operation was diseases of the operated stomach. Results. In the postoperative period, 4 (5.6%) patients developed surgical complications. Hospital mortality was 1.4%. In the long-term follow-up, an increase in the quality of life of patients was noted, due to a decrease in the frequency and severity of the disease. Conclusion. Reconstructive gastric surgeries with reduction in most cases make it possible to stop or significantly reduce the manifestation of the disease, therefore, their implementation is considered practically justified.
Comparative analysis of the results of surgical treatment of chronic capitalated pancreatitis
Purpose of a study: to compare the immediate and long-term outcomes of various surgical treatment options for patients with chronic pancreatitis primarily affecting the head of the pancreas. Material and Methods. In the period of 2018–2022, the outcomes of various surgical treatment options were analyzed in 80 patients with pancreatic head pancreatitis. Patients were divided into three groups based on the type of surgery: group 1 ( n = 24) patients who underwent drainage procedures (Roux-en-Y longitudinal pancreatojejunostomy); group 2 ( n = 27) patients who underwent the Frey procedure; group 3 ( n = 29) patients who underwent subtotal pancreatectomy with longitudinal pancreatojejunostomy using an original technique. Results . The highest frequency of postoperative complications was noted after the Frey operation 8 (29.6)% in comparison with drainage interventions and the original technique: 4 (16.7) % and 4 (13.8)%, respectively. The structure of complications was dominated by pancreatic fistulas 6 (22.2 ) %, post-resection bleeding 4 (14.8) %, acute pancreatitis 2 (7.4) %. The introduction of the original resection and drainage method made it possible to reduce the frequency of pancreatic fistulas from 22.2 (8.6; 42.3) % (2[nd] group) to 3.4 (0.1; 17.8)% ( p < 0.001). When analyzing the long-term results, the highest rate of disease recurrence (8% (33.3 (15.6; 55.3) cases) and the worst quality of life indicators (MOC SF-36) were noted after drainage interventions ( p < 0.001); no statistically significant differences were found between patients in 2[nd] and 3[rd] groups. Conclusion . A differentiated approach to the choice of surgical intervention, taking into account morphological changes in the parenchyma of the gland, allows us to determine the indications for surgical treatment. The original technique of duodenum-preserving pancreatectomy is the optimal intervention for chronic capitate pancreatitis, which makes it possible to reliably reduce the incidence of specific postoperative complications and improve longterm treatment outcomes.
The Department of Pediatric Surgical Diseases of Siberian State Medical University and its contribution to the development of pediatric surgery in Tomsk Region: on 80th anniversary of the Department’s founding
The history of creation, development, and evolution of the Department of Pediatric Surgical Diseases at the Siberian State Medical University has been presented. Article also includes the names and brief biographies of the Department’s heads and staff, whose research and teaching activities have significantly influenced its contribution to the development of pediatric surgery in the Tomsk Region.