Purpose of a study: to explore the main methods of evaluating the aesthetic results of autologous breast reconstruction with a DIEP flap (deep inferior epigastric artery perforator), to identify the key factors influencing the aesthetic result of breast reconstruction.

The scientific papers in the databases PubMed, Google Scholar, SCOPUS, Science Direct, RSCI for the period from 2013 to 2023 were analyzed. The systematic review includes articles evaluating the aesthetic result of breast reconstruction with a DIEP flap. The search was carried out by keywords: “breast”, “DIEP flap”, “aesthetic result”, “symmetry of breast”.

As a result of the analysis, it was found that the evaluation of the aesthetic results of breast reconstruction is carried out using data of patient reported outcome measures, scales which is used to rate the surgeon’s perception of the aesthetic outcomes and quantitative objective measurements. The key factor influencing the aesthetic result of reconstruction is the symmetry of the breasts.

Conclusion. The most commonly used methods for assessing the aesthetic results of breast reconstruction with a DIEP flap are: self-assessment of the results of reconstruction by patients (BREAST-Q questionnaire), evaluation of the results by surgeons (professional aesthetic assessment scales), quantitative objective methods for determining the degree of symmetry. According to many studies, symmetry is a critical factor affecting the aesthetics of the breasts and, consequently, patient satisfaction with the results of reconstruction, psychosocial well-being and quality of life in the long term.

Purpose of the study: to evaluate the effect of a combination of rhinoplasty and septoplasty on the development of acute postoperative syndrome and the secretion of cortisol into the blood plasma.

Material and methods. A study was conducted in a group of 98 patients who underwent septoplasty, rhinoplasty or rhinoseptoplasty. Using a Digital Rating Scale, the intensity of pain was assessed 3, 6, 24, 48 hours after the end of surgery. The day before, immediately before and 6 hours after surgical interventions, all patients underwent blood sampling to determine the concentration of cortisol in the blood plasma. The data obtained were compared within groups over time, as well as between groups at the corresponding assessment points.

Results. The intensity of pain 3 hours after surgery was significantly lower in the group of patients after rhinoplasty and significantly decreased after 6 (p < 0.001), 24 (p < 0.01), 48 (p < 0.001) hours after surgery, compared with patients who underwent septoplasty and rhinoseptoplasty. In the early postoperative period, patients from the rhinoplasty group had the lowest cortisol concentrations in the blood plasma, compared with patients after septoplasty (p < 0.001) and rhinoseptoplasty (p < 0.01). In patients who underwent rhinoseptoplasty, the level of cortisol in the blood was significantly higher compared with patients after septoplasty (p < 0.01).

Conclusion. The assessment of acute pain using a digital rating scale after rhinosurgical interventions showed that septoplasty provokes the development of a stronger acute pain syndrome in the early postoperative period, which proves its trauma compared to rhinoplasty. Simultaneous rhinoplasty and septoplasty in the first days after surgery contributes to an increase in the concentration of cortisol in blood plasma, as well as an increase in pain syndrome.

Robot-assisted technologies are an important component of modern medicine, determining the quality of life of patients. Robot-assisted surgical techniques are among the top trends in the development of surgical specialties. The article briefly describes the history of the development of robot-assisted technologies in medicine and the possibilities of their use in reconstructive plastic microsurgery.

The discrepancy between the sound of the voice and the gender and appearance to which a person refers to himself leads to depression, the inability to socialize and carry out professional activities. To solve this problem, various ways of correcting vocal function have been proposed: hormone therapy, surgical interventions, phonopedic rehabilitation. The presented review is aimed at generalizing and systematizing the literature data on voice change, showing the possibilities of a rational approach to the management of patients with a mismatch in voice pitch to their gender and physique – both conservative and surgical methods – taking into account potential complications.

The purpose of this study is to evaluate the possibilities of various methods of voice correction in patients wishing to change the pitch of their voice, and their likely complications according to the literature.

There are a large number of operations to increase the pitch of the voice, which conditionally pursue three goals: reducing the length, total mass of the vocal folds or increasing their tension; they can be performed both openly and endoscopically – using classical instruments and a CO2 laser. In the postoperative period, dysphonia, decreased voice intensity, suture divergence, lack of increase in the fundamental frequency of the voice and even its decrease are often observed. In addition to granulomas, the need for revision with insufficient/asymmetric tension of the vocal folds, life-threatening complications in the form of infection, edema and an increase in signs of laryngeal stenosis are possible.

Hormone therapy under medical supervision eliminates the risk of complications, however, uncontrolled testosterone intake leads to an increase in systolic blood pressure, an increase in hemoglobin, hematocrit, etc. The most characteristic complications of taking estrogens are a significant increase in thrombotic and cardiovascular risks, hyperprolactinemia. Phonopedia has a minimal risk of complications, it is possible before and after surgery to increase the fundamental frequency and improve other voice characteristics.

Literature search was conducted in domestic (CyberLeninka, Google Academy) and international (PubMed) databases in Russian and English.

Currently, there is an increasing number of innovations in reconstructive surgery, one of these was the use of alternative flaps in breast reconstruction. Due to certain contraindications for the use of the usual flaps, one of these has now become a flap on the perforant lumbar arteries or LAP flap. 23 articles describing the LAP flap and its use for breast reconstruction were analyzed.

Five articles describe the experience of using a lumbar flap in breast reconstruction, two articles describe bilateral reconstruction using a LAP flap, five studies describe the technique of sampling and the topographic anatomy of the flap.

The presented article concludes that the LAP flap is an alternative option for autologous breast reconstruction according to research data due to its anatomical features, the quality of subcutaneous fat and sampling techniques. However, for a more detailed study of the issue under consideration, it is necessary to conduct randomized clinical trials to identify the results, the number of complications and the applicability of the technique in clinical practice.

Purpose of the study: to analyze the methods available in the literature for the prevention of postmastectomy lymphorrhea, systematize the data obtained, and substantiate the relevance of the search for new methods for the prevention of lymphorrhea.

A search was conducted for published scientific studies in the Pubmed and Elibrary databases using the keywords: «лимфаденэктомия», «лимфорея», «рак молочной железы», “lymphadenectomy”, “lymphorrhea”, “breast cancer”. Using the given keywords, more than 500 scientific papers were found.

Most of the currently existing methods for preventing postmastectomy lymphorrhea are systematized into groups. The disadvantages of known methods have been studied, which boil down mainly to unjustified anatomical destruction, economic unprofitability or ineffectiveness of these methods.

Thus, the search for a new method of preventing lymphorrhea is still relevant.

Objective. Although many years history of study, the issue of treating patients with Dupuytren's contracture keeps on being relevant. It is due to high incidence of this pathological condition among the population (up to 8.2%), the lack of a unified surgical treatment approach, and a high risk of postoperative complications (up to 40%). Existing approaches to the treatment do not ensure the absence of condition recurrence and are related to a long recovery period (up to 12 months).

Purpose of the study: to improve the outcomes and reduce the treatment period of the patients with Dupuytren's contracture by creating and integrating algorithm for choosing the optimal surgical intervention in clinical practice.

Material and methods. The study involved two parts. In the first part data of surgical treatment performed for 8962 patients with Dupuytren's contracture (10213 surgeries) operated during the period of 2007–2022 were analyzed. 6632 male (74%) and 2330 female (26%) were enrolled in the study. The patients’ mean age was (57 ± 6) years old (from 24 to 92 years old). 9396 needle fasciotomies (92%), 562 subtotal fasciectomies (5.5%), and 255 inspection interventions for recurrence after subtotal fasciectomy (2.5%) were performed.

In the second part of the study, we suggested a universal algorithm for choosing the optimal technique of surgical treatment of patients with Dupuytren's contracture, depending on the severity, the presence of concomitant skin problems in the operation site (tightening scars or trophic lesions), the number of recurrences, and the method having caused them.

Results and discussion. The follow-up period ranged from 3 to 15 years. Treatment outcomes were assessed using the qDASH scale and the treatment satisfaction subjective scale. Perfect treatment outcomes were obtained in 56.8% of cases, good – in 28.2%, satisfactory – in 11.1%, and unsatisfactory – in 3.9% of cases. Complications (iatrogenic damage to the dactylar nerves and arteries, flexor tendons, ruptures and deep skin cracks, and superficial infectious complications) occurred in less than 8% of patients. Contracture recurrences were noted in 5370 cases (52.6%).

The analysis of our own 15-year experience (more than 10000 surgeries) as well as the study of colleagues’ experience (according to the literature) allowed us to formulate the guidance for choosing the approach of treating the patients with various forms of Dupuytren's contracture.

In primary Dupuytren's contracture, we recommend needle fasciotomy (or collagenase injections) as a quick, minimally invasive surgical procedure causing minimal complications and contraindications (less than 8%). In severe cases, rehabilitation under the monitoring of a hand physician is recommended after the surgery.

If the recurrence takes place after needle fasciotomy, a repeated minimally invasive procedure may be conducted. The condition recurring three or more times, we recommend considering the open surgery – subtotal fasciectomy accompanying by obligatory epidermic grafting (not palmar skin): cross-finger flap, dorsal metacarpal artery bond flap (Quaba/Maruyama), or full-thickness free skin graft taken from the forearm.

The recurrence after subtotal fasciectomy occuring, the presence of tightening scars and trophic lesions should be assessed. In some cases, the tightening scars lack, a needle fasciotomy may be conducted by specialists having mastered the technique. In other cases, trophic lesions absent, we consider the inspection subtotal fasciectomy accompanied by the obligatory closure of the soft tissue defect using a full-thickness skin autograft or bond flap (not palmar skin) must be performed.

Obligatory patients’ follow-up for two years (medical examinations every six months) after the surgery to identify the early signs of recurrence, collagenase or steroids injections into the palmar aponeurosis nodes (and/or physiotherapy with Fermencol) in case of disease progression, or prophylactic radiotherapy immediately after the surgery virtually allow to eliminate the risk of the condition recurrence.

Conclusions. Analysis of the treatment outcomes of patients with Dupuytren's contracture of varying severity allowed us to work out a universal algorithm for choosing the optimal tactics of surgical treatment of the condition enabling improving the outcomes, reducing the recovery period, and decreasing the risk of recurrence.

Objective. The history of providing assistance to victims with gunshot wounds dates back more than one century, but nevertheless surgical treatment of gunshot wounds is still relevant to this day. High-quality primary surgical treatment of a gunshot wound is the key to a speedy recovery of the patient (N.I. Pirogov). The pathogenesis of gunshot wounds determines the specific tactics of surgical treatment. Gunshot wounds are zonal in nature. According to the results of morphological studies, it can be concluded that a significant part of the changes in the zone of molecular concussion of the wound canal are reversible, and the complexity of pathogenesis and the lack of reliable criteria for assessing the condition of tissues does not exclude the possibility of leaving areas with reduced viability in the wound after treatment. For maximum effect during surgical treatment of gunshot wounds, non-viable tissues should be removed with minimal damage to viable ones. To meet these requirements, it is often impossible to visually assess the boundary between damaged and parabiotic tissues objectively intraoperatively. The use of modern physical methods of wound wrapping and preparing them for plastic closure, such as low-frequency ultrasound, hydrosurgical methods and VAC therapy allows you to radically clean the wound surface with minimal damage to viable tissues and perform plastic closure operations on soft tissue defects at an early date.

Purpose of a study: to improve the methods of primary surgical treatment in patients with combat surgical trauma using low-frequency ultrasound.

Material and methods. Our study is based on the analysis of the treatment results of 93 patients aged 10 and 70 years old. All patients had combat surgical trauma of various etiology and localization. Of these, 36 (38.7%) patients in main group underwent ultrasound cavitation of the wound canal and wound defects during primary surgical treatment (PST), followed by primary or primary delayed plastic surgery within a period not exceeding 48 hours after PST. Methods of plastic wound closure were both flaps with axial circulation and autodermotransplantation. In the remaining 57 (61.3%) patients of comparison group, primary surgical treatment was not performed, or was performed at the stages of evacuation, with further conservative treatment. Upon admission to the clinic, he underwent secondary surgical treatment, opening of purulent lumps, as well as staged necrectomies, while wound plastic surgery was performed after wound cleansing and was mainly represented by autodermotransplantation.

Results. It was revealed that in the main group, the treatment time of patients in the main group was reduced by 2 times compared with the comparison group (16.3 and 34.2 bed days, respectively). The effectiveness of engraftment of autodermotransplants was evaluated according to V.I. Petrov's scheme. Lysis of autodermotransplants was noted 1.9 times less frequently in the main study group. It was also noted that there were no purulent complications in main group, unlike comparison group – 20.6%, the number of marginal necrosis was 2.6% in main group and 22.4% – in comparison group, lysis of autodermotransplanates in main group was 7.8%, in comparison group – 13.8%.

Conclusion. This study allows us to conclude that the advantage of using ultrasonic cavitation during the usual surgical treatment of gunshot wounds followed by primary or primary delayed plastic surgery.

In 2024, it will be 55 years since the birth of lymphology in Uzbekistan, as an actively developing scientific field. In 1969, a Lymphology research laboratory was created at the Department of Surgical Diseases of the Pediatric Faculty (currently the 1st Department of Hospital and Faculty Surgery) of the Andijan State Medical Institute. The initiator of the organization of the Lymphological Laboratory was the head of the Department, Doctor of Medical Sciences Satkul U. Dzhumabaev. In 1987, the laboratory was transformed into the Center for Clinical Lymphology of the Ministry of Health of Uzbek Soviet Socialist Republic. Today, Uzbekistan has its own School of Clinical Lymphology, recognized among specialists. 10 doctoral and 32 candidate dissertations have been defended, work continues on 6 doctoral and 10 candidate dissertations. More than 1 450 scientific papers, 12 monographs have been published, including the first manual in English “Regional lymphatic therapy” (Manchester, 1988), patents have been received for 14 inventions, and more than 35 lymphological techniques have been introduced into clinical practice. From 1992 to 2014 a specialized scientific and practical journal “Lymphology” was published. Cycles of training for doctors and nursing staff in lymphological treatment methods have been organized. A number of international scientific and practical conferences were held. In 2012, the scientific and practical activities and technologies developed in the field of clinical lymphology of the Republican Scientific Center for Clinical Lymphology were highly appreciated by the international foundation “International Arch of Europe for Quality and Technologies” and nominated for the award of the “golden sign” of this foundation.