Aesthetic breast surgery is consistently a leading position in plastic surgery. According to the International Society of Aesthetic Plastic Surgery (ISAPS), in 2019, 1 795 551 breast augmentations were performed. However, as the number of primary surgeries increases, so does the percentage of complications and consequent patient dissatisfaction with the primary intervention results. Approximately 20% of women experience postoperative complications, such as breast asymmetry, implant displacement, double fold (“double bubble”), rippling, capsular contracture, seroma, hematoma, suture dehiscence, and others. Women with decreased breast tissue tone due to postinvolutive changes are at risk for postoperative complications. The risk of complications also increases when not just breast augmentation, but a combination of augmentation and mastopexy is required. In most cases, when a surgical intervention is recommended in several stages, patients are not willing to wait for a long time. This group of women is the most difficult for the clinician and therefore requires an analysis of all possible risk factors for complications development. Therefore, finding new possible ways to predict complications in reconstructive and plastic breast surgery is a relevant and priority direction.

Purpose of a study: to develop a technique for preventing complications in reconstructive and plastic breast surgery.

Material and methods. The results of 37 breast augmentation surgeries with T-shaped mastopexy in patients with different breast tissue density were analyzed, based on which an improved method of this operation was proposed. A comparative analysis of postoperative complications in early and late postoperative periods was carried out, and patients were surveyed before breast reconstruction and plastic surgery and 3, 6, and 12 months after plastic surgery to evaluate patient satisfaction with the outcome.

Results. The analysis of the obtained data showed that breast tissue density plays a key role in choosing the tactics of breast augmentation with T-shaped mastopexy and is a predictor of complications development in the postoperative period.

Conclusion. The planning of breast augmentation with T-shaped mastopexy should be carried out taking into account the determination of a patient's breast tissue density, which can affect the reduction of the risk of surgical complications during the surgery and in the postoperative period. The use of mastopexy technique with a preliminary marking of incisions with a margin of 1 cm to the central line from the classical V-shaped marking line is expedient in the presence of dense breast tissue in the patient.

Robotic surgery has expanded the capabilities of human surgical techniques by offering tremor elimination, ergonomic positioning, 3D viewing, and improved resolution.

The purpose of the study: to examine DIEAP flap harvesting techniques using minimally invasive robot-assisted techniques.

Material and Methods. The PubMed, SCOPUS, ScienceDirect, and Russian scientific electronic library databases were used for the review; the search was performed using the key phrases robotic deep inferior epigastric artery perforator flap, robotic DEIAP, robotic breast surgery, robot-assisted breast reconstruction. Inclusion criteria: case reports or cadaveric studies.

Results. Nine studies were found that met the inclusion parameters. Nine studies looking at DIEAP flap extraction using robot-assisted techniques included a total of 59 patients. Five studies defined the flap harvesting technique as transperitoneal or intraperitoneal. Only 1 study described extroperitoneal flap harvesting. Three studies used the same terminology: transabdominal preperitoneal and total extroperitoneal. A lack of consensus in terminology was found.

Conclusion. Robot-assisted DIEAP flap harvesting can be performed using transabdominally preperitoneal and total extraperitoneal techniques, as well as using monoport and multiport accesses with different port locations. However, for a more detailed study, randomized controlled trials with control of anterior abdominal wall weakness and with comparison of complications of different techniques are needed.

The purpose of a study: to study the immediate results and surgical aspects of angio- and bronchoplastic lobectomy for non-small cell lung cancer in elderly and senile patients, as well as to identify the features of their perioperative support.

Material and methods. The results of treatment of 63 patients with non-small cell lung cancer older than 60 years after angio- and/or bronchoplastic lobectomy were analyzed. The average age of the patients was (71.4 ± 5.1) years old. The oldest patient at the time of surgery was 82 years old. The majority (93.6%) of patients had one or more concomitant diseases, among them bronchopulmonary and cardiovascular pathologies were most often detected.

Results. Postoperative complications were recorded in 22 (34.9%) patients, mortality was 6.35%. The incidence of complications that did not require surgical correction was 6.3%. Prolonged air discharge through the drainage was registered in 11.1% of patients. In 2 cases (3.2%), prolonged air release and delayed expansion of the lung led to the formation of residual pleural cavity with infection. Critical complications were recorded in 4 cases (6.3%), and in 4 (6.3%) patients they caused a lethal outcome. Among them, the leading place is occupied by the failure of the bronchial suture and cardiac arrhythmias.

Conclusion. Angio- and bronchoplastic anatomical resections in patients of the older age group are accompanied by a number of technical features and specifics of perioperative curation due to age-related changes and comorbidities.

To date, dental implantation is the most common routine way to restore the continuity of dentition. Additional bone augmentation surgery is required in 50-80% of patients. In order to improve the results and reduce the risks of osseointegration, denudation and rejection of bone autografts, various ways of correcting the deficiency of soft tissues of the alveolar ridge are proposed, which include the use of free soft-woven autografts, the low efficiency of which is due to a high shrinkage coefficient.

The purpose of the study: to test an experimental model of a vascularized muco-periosteal flap to eliminate the volume deficit of the soft tissues of the alveolar ridge.

Material and methods. On the basis of the vivarium of the Stavropol State Agrarian University (StSAU), 15 biological mannequins (heads of female dwarf pigs) were subjected to a pilot experimental study. The study was conducted in accordance with the decision of the local Ethics Committee of the StSAU, as well as the provision of the World Convention on the Protection of Animals and the Procedure for the Treatment of Experimental Animals adopted by the Helsinki Council in 2002.

Results. In the course of the study, the technical stages of the tested intervention were clarified, the metric parameters of the elimination of defects of the alveolar ridge were determined.

Conclusion. The results obtained will make it possible to eliminate extended soft tissue defects of the alveolar ridge by increasing the possibility of tissue sampling in the donor bed in a volume not less than 3 times greater than the intake of free palatine flaps.

Diaphragmatic palsy due to intraoperative injury of the phrenic nerve leads to the severe ventilation disorders, a decrease in the quality of life, leveling the effect of the main operation. According to foreign authors, the reconstruction of the phrenic nerve is an optimal alternative to the diaphragm plication in acute injuries of the phrenic nerve. This case describes the first successful experience in our country of reconstruction of the phrenic nerve with intercostal nerve graft in a patient with locally advanced stage IIIB thymoma.

Oncological morbidity remains one of the first places in the structure of all human diseases. In this regard, the number of radical surgeries performed with regional lymphodissection is also increasing, which is the main cause of postoperative lymphorrhoea and lymphostasis. Unfortunately, not everyone considers lymphorrhea a dangerous consequence of lymphadenectomy, so there is little information in the literature. This article presents data on the incidence of lymphorrhea and other lymphatic complications in the postoperative period in oncosurgical patients.

The paper reports on surgical cases of treatment of dirofilariasis Dirofilaria repens in the Tomsk Region. Dirofilariasis - transmissible tissue helminthiases, characterized by damage to the skin, subcutaneous tissue, mucous membranes (Dirofilaria repens) or internal organs: heart, lungs, bronchi and large blood vessels (Dirofilaria immitis). Until recently, the disease was considered exclusively zoospecific, so doctors did not study it. To date, little is known about it and it is not immediately possible to make a diagnosis. Due to the fact that in recent years cases of infection of people in the territory of the Russian Federation, including in the Tomsk Region, have become more and more frequent, the description of the clinical picture, methods of diagnosis and surgical treatment of this disease is relevant.

Purpose of the study: to assess the state of the lymphatic bed and develop methods of lymphatic influence to improve the results of treatment of diseases of the veins of the lower extremities.

Material and methods. 692 patients with diseases of the veins of the lower extremities were examined, in whom special methods for studying phlebo- and lymphodynamics, microcirculation and regional immunity were carried out. Of these, 153 patients with acute superficial thrombosis; 154 - with deep vein thrombosis; 385 - with chronic venous insufficiency. The main group - 405 patients, using lymphological methods of treatment, the control group - 287 patients, using traditional treatment, according to clinical recommendations.

Results. Radionuclide lymphoscintigraphy revealed that with thrombosis of the veins of the lower extremities at the onset of the disease, the rate of lymph flow increased by 1.2 times (p < 0.005), and the intensity of radionuclide absorption increased by 9.3% (p < 0.05) relative to healthy people. From 12-15 days of the disease, the rate of lymph flow decreased by 1.4 times (p < 0.05), and the intensity of radiopharmaceutical excretion decreased by 25% (p < 0.005). Chronic venous insufficiency is accompanied by impaired lymph flow of varying severity. The disorders increased as the degree of venous insufficiency increased. Against the background of the use of lymphological approaches in patients with lymphovenous insufficiency syndrome, at the level of statistically significant differences, the rate of lymph flow increased, microcirculation and regional immunity were restored, which contributed to a significant improvement in both immediate and long-term results of treatment. In patients with trophic ulcers, there was an acceleration in the timing of clearance, granulation and epithelialization compared with conventional treatment (p < 0.05).

Conclusion. Diseases of the veins of the lower extremities, accompanied by phlebohypertension, already at the earliest stages of the disease lead to significant changes in the lymphatic system, with characteristic manifestations. The use of methods of conservative and surgical lymphogenous correction improves the results of treatment of the pathology in question.

According to a number of authors, the incidence of lymphorrhea after surgical treatment of breast cancer reaches 100%. In recent years, new methods of treating postoperative lymphorrhea have begun to appear, including the use of photodynamic therapy (PDT).

Purpose of the study: to determine the possibility of using photodynamic therapy in the treatment of postoperative lymphorrhea and to evaluate its impact on the quality of life of patients.

Material and methods. A prospective study involving 40 people was conducted. In 20 patients, photodynamic therapy was used in the treatment of postoperative lymphorrhea (main group), in 20 patients, punctures and pressure bandages were used (comparison group). Quality of life was assessed based on the data of the SF-36 questionnaire before the start of treatment, after 3 and 6 months. After 1 year, the condition of all patients was also assessed to identify signs of lymphostasis.

Results. In the main group, in patients who underwent photodynamic therapy, lymphorrhea was completely stopped by the end of the third week. In patients from the comparison group at the same time, the volume of daily lymphorrhea was (41.4 ± 0.3) ml. A statistically significant difference was found between the indicators of the physical component of health in patients of the two groups 3 months after the start of treatment: role functioning associated with the physical component, pain intensity, general health and vitality. At the same time, the use of photodynamic therapy did not increase the risk of developing lymphostasis of the upper limb.

Conclusion. The study showed that the use of photodynamic therapy in the treatment of postoperative lymphorrhea can reduce the amount of lymph loss, reduce the time of outpatient treatment, and also improve the quality of life of patients, while not increasing the risk of developing lymphostasis of the upper limb.

The paper narrates the early research on the lymphatic system in the city of Perm (Russia) in 1951 and the systematic study of lymph nodes during the period from 1954 to 1963 under the guidance of Professor Ivan Ivanovich Kositsyn. The second period of experimental lymphology development in Perm is associated with the name of Professor Elizaveta Nikolaevna Oleneva. Her research on the lymphatic vessels of various organs when creating typological models of experimental venous congestion and lymphostasis became the basis for understanding pathological processes in organ interstices. The development of clinical lymphology owes much to Professor Nadezhda Alexandrovna Garyaeva. Close scientific cooperation between the Perm and St. Petersburg lymphological schools led to the development of structural foundations of modern lymphodynamics theory. The discovery of the lymphatic valve tensor muscle determined the role of valves in lymph flow in a historical discussion question. Reconstructive-restorative operations on the thoracic duct for surgical lymphology are significant for the prevention of lymphostasis and thrombosis. The study of mass transfer laws of medicinal substances through the interstitium provided a scientific rationale for lymphotropic therapy at a new level. The terms “intersticiology,” “somatic lymphedema,” and “visceral lymphedema” have been introduced into scientific circulation. Analysis of fundamental lymphostasis research allowed for the development of drug treatment methods for post-radiation fibrosis and lymphedema. The Department of Human Anatomy with a course in clinical lymphology under the leadership of Professor N.A. Garyaeva, developing treatment technologies in gynecology, phthisiopulmonology, surgery, traumatology, pediatrics, and therapy, became the scientific-methodological center in the city of Perm for building knowledge in the field of lymphology. The Lymphatech Clinic, opened in 2007, gave a new impetus to the development of clinical lymphology. The Lymphatech method, providing targeted pharmacological correction of the structures and functions of the lymphatic system, has stood the test of time and proved itself as an essential pathogenetic therapy for many pathologies. Scientific and clinical results are reported and published at international conferences, including the leading journal Lymphology.