The development of surgical technology, advances in a chemotherapy and radiation therapy for the treatment of the breast cancer is a solution of not only medical, but also aesthetic problems. A multidisciplinary approach to the treatment of breast cancer has made it possible to use less aggressive tactics of surgical treatment, complementing the operation with other methods of neoadjuvant and adjuvant therapy.

Despite the fact is a modern conditions the issue of rehabilitation and preservation of the quality of life of patients after surgical treatment is more acute than ever, today there are no collecting recommendations for the use of breast conserving treatment methods for breast cancer, it is can be useful to adequately assess the risk of tumor recurrence and it is advisable to determine the scope of surgical treatment. However, the experience accumulated by surgeons allows us to identify risk factors for tumor recurrence depending on the characteristics of its location and morphological structure of the tumor.

Considering the possibilities of modern neoadjuvant chemotherapy, even with an unfavorable immunohistochemical type of tumor, we can offer patients the choice of breast conserving treatment. This issue is especially acute among young patients, the proportion of whom is increasing every year. In this connection, we can achieve faster treatment of breast cancer, as well as achieve a good aesthetic result with minimal surgical interventions, without the help of foreign materials (implants or other mesh).

The aim of the study: comparing the effectiveness of Gastric Bypass and invaginational cardioplasty in patients after sleeve gastrectomy.

Material and methods. Prospective clinical research including an analysis of the surgical treatment of the 40 patients diagnosed with Gastroesophageal Reflux Disease (GERD) after sleeve gastrectomy. A clinical and instrumental analysis and a GERD-HRQL questionnaire were conducted, evaluation of the effectiveness and safety of Gastric Bypass and invaginational cardioplasty.

Results. During the observation of patients for 12 months, invaginational cardioplasty showed good tolerability, safety, and effectiveness in the treatment of GERD in comparison with gastric bypass surgery, which is confirmed by the results of the GERD-HRQL questionnaire, a reduced symptoms and an improvement in the endoscopic picture of the esophageal-gastric junction, as well as the results of gastric roentgenoscopy.

Conclusion. The study showed a relatively high efficiency of invaginational cardioplasty in the treatment of gastroesophageal reflux disease in patients after sleeve gastrectomy, in comparison with gastric bypass surgery, in the early and long-term follow-up period.

The aim of our work was to study the syntopy and pathomorphology of excised volar ganglia. The study design involved two groups: an experimental group and a control group. The experimental group consisted of 20 patients with volar ganglion of the wrist joint who underwent treatment at the Microsurgery Research Institute clinic from October 2022 to January 2023. All patients underwent open excision of the volar ganglion under the control of 3× optical magnification. During the operation, the syntopy of the ganglion was studied in all patients, and a sample of the wrist joint capsule was taken for morphological examination, where the ganglion pedicle and the ganglion itself were attached. Anatomical material (7 specimens) served as a control a similar area of the wrist joint capsule taken from patients without wrist pathology, obtained from the pathological anatomy office. To determine the syntopy of the ganglion pedicle, intraoperative radiographic examination of the wrist joint was performed. The ganglion and the excised capsule segment were fixed in 10% neutral buffered formalin, then subjected to histological examination with hematoxylin and eosin staining. The pathomorphological picture of the excised joint capsule segment, adjacent to the ganglion pedicle, showed that the visually unchanged joint capsule consisted of coarse fibrous connective tissue with hyalinosis and areas of focal myxomatosis, with an increased number of fibrocytes and fibroblasts, as well as a small number of mononuclear elements.

The assessment of the pathomorphology of the volar ganglion itself showed that it was similar to the capsule, represented by coarse fibrous connective tissue with areas of hyalinosis. The epithelial lining was absent. Numerous areas of myxomatosis with uneven mononuclear infiltration and foci with a large number of fibroblastic and histiocytoid elements were present. The capsule and the volar ganglion itself had identical histological structures.

Currently, more than half of open surgical interventions on the abdominal organs are complicated by the formation of large and giant postoperative ventral hernias. At the same time, there is no universal hernioplasty technique, and operations performed for large and giant hernias remain technically complex and traumatic. With a significant size of the hernial orifice, an attempt to connect tissues located bilaterally from the defect can present certain technical difficulties and lead to an uncontrolled and dangerous increase in intra-abdominal pressure. The article presents the clinic's first experience in the treatment of large and giant postoperative ventral hernias using the TAR (Transversus Abdominis Release) posterior separation technique. The medical histories of 18 patients (13 women and 5 men) who were treated at the General Surgery Clinic of the Siberian State Medical University (Tomsk, Russia) in 2022–2023, who underwent TAR posterior separation hernia alloplasty, were analyzed. According to CT herniometry, the volume of the abdominal cavity was on average (6903 ± 2831) cm³, the volume of the hernia – (1780 ± 1381) cm³, the ratio of the hernia volume to the volume of the abdominal cavity varied from 10 to 49%, averaging (24.3 ± 12.2) %. The postoperative period in all patients was without complications. The postoperative hospital stay was (7.5 ± 2.7) days. The observation period for patients ranged from 3 months to 1.5 years. No cases of hernia recurrence were recorded.

The analysis of domestic and foreign literature sources on сongenital pseudoarthrosis of the tibia in children. First part of the article describes about etiology and pathogenesis, methods and timing of conservative and surgical treatment, complications in the treatment of сongenital pseudoarthrosis of the tibia in children. Special attention is paid to cases of сongenital pseudoarthrosis of the tibia in combination with neurofibromatosis type 1. Indications and possible complications of the microsurgical stage – replacement of an extensive tibial defect with a free bloodsupplied fibular bone flap. The section description of the clinical case presents the result of treatment of a pediatric patient with сongenital pseudoarthrosis of the tibia against the background of neurofibromatosis type 1, complicated by an extensive defect of the tibia.

Purpose of the study: to increase the effectiveness of plastic replacement of non-extensive sternum defects through the use of de-epidermized skin-fascial flaps.

Material and methods. To perform this work, a cohort study model was selected in the form of a retrospective analysis of medical records of patients treated for postoperative sternomediastinitis. 119 medical records were selected for comparative analysis, according to the criteria for inclusion in this study. Depending on the method of plastic replacement of the bone-soft tissue defect of the anterior chest wall, patients were divided into 3 groups: 1^st group (56 patients) – plastic surgery with T-shaped deepidermized skin fascial flaps; 2nd group (29 patients) – plastic surgery with a flap of the pectoral muscle and 3rd group (34 patients) – rheosteosynthesis of the sternum with fixators made of inert materials.

The effectiveness of plastic replacement of the sternum defect was evaluated using computed tomography of the chest organs (elimination of diastasis between the sternum flaps, absence of signs of destruction of the sternum bone tissue) and microbiological studies (conducting a series of seeding of the discharge from the wound and drains to determine complete elimination or reduction of the level of CFU/g of microbial agents to 103). The obtained values were subjected to statistical analysis.

Results. Analysis of the results of the study showed that the recurrence rate of deep sternal infection in patients of 1^st and 2^nd groups did not significantly differ. However, in case of complications during transplantation of a flap of the pectoralis major muscle, the likelihood of recurrence of sternomediastinitis increases. A comparison of patients in 1^st and 3rd groups demonstrated that the incidence of recurrence of sternomediastinitis was significantly higher after sternal rheosteosynthesis.

Conclusion. The method of plastic surgery with skin fascial flaps proposed by the authors is effective in plastic replacement of non-extensive sternal defects and has a number of advantages compared with conventional methods due to its lower invasiveness and a tendency to reduce the frequency of recurrence of sternal infection.

The problems with bone healing still exist, despite the significant development of treatment methods in traumatology and orthopedics. There is a standard treatment approach with expected consolidation times of up to 6 months for diaphyseal femoral fractures. However, there are no algorithms for cases when the time for consolidation exceeds 1 year. In this article is presented the experience of treating a patient with a diaphyseal femoral fracture that had delayed consolidation.

Objective. High-energy injuries, such as gunshot wounds, combined with the general serious condition of the victim, cause difficulties in choosing tactics for providing surgical care, especially when functionally significant areas are affected. Failure to perform primary surgical treatment of such wounds or its excessive delay inevitably leads to the formation of extensive necrosis, accumulation of pus in confined spaces, disruption of physiological barriers and the development of wound infection. One of the effective methods for more radical cleansing of wounds is the use of low-frequency ultrasound. The study was based on the principle of wound treatment using low-frequency ultrasound, in particular the implementation of ultrasonic cavitation when performing primary surgical treatment with simultaneous repair of a wound defect. Depending on the location and general condition of the victim after primary surgical treatment, fasciocutaneous, muscle, or musculocutaneous flaps were used to eliminate soft tissue defects. In the event that the patient's condition did not allow wound closure using complex flaps, wound treatment was performed using ultrasonic cavitation, and wound closure was performed after stabilization of the condition, on average 2–3 days after repeated surgical treatment using ultrasonic cavitation. The tactics of using revascularization flaps in the primary surgical treatment of gunshot wounds using high-frequency ultrasound as a radical debridement in preparing wounds for plastic closure are substantiated.

Purpose of the study: to improve the methods of primary surgical treatment in patients with combat surgical trauma.

Material and methods. The study included 34 men aged 20–60 years old (average age (39.2 ± 2.4) years old) with post-traumatic soft tissue defects. All patients were treated with methods of closing wound defects using flaps on the axial circulation in the early stages after injury. On average, the time it took to deliver a wounded person to a specialized center was (18.0 ± 2.2) hours. All study participants were injured as a result of combat operations: isolated shrapnel wounds – 20 people, 14 people were admitted with combined mine-explosive trauma.

Results. In 3 patients, injuries were accompanied by open compound fractures (type III in the Gustilo classification). 8 patients had exposure of bone structures, 7 patients had exposure of tendon tissue, 1 patient had exposure of bone structures of the lower jaw, an open fracture of the upper jaw with damage to the maxillary sinus, and a fracture of the zygomatic bone. 8 patients had extensive injuries to both lower and upper extremities, 2 patients had traumatic amputation of the lower extremity, 5 also had burns of varying severity in combination with shrapnel wounds. The optimal time for reconstruction was considered to be the first 72 hours from the moment of injury. However, adhering to damage control tactics, the acceptable time for reconstruction was considered to be days from the moment of injury, taking into account that during this period wound infection does not develop and bacterial contamination is minimal.

Conclusions. Our data allows us to conclude that the use of ultrasonic cavitation is effective, which allows the use of revascularization flaps to close the wound surface in the early stages after combat surgical trauma.

Purpose of the study was to improve the results of treatment for children with secondary post-traumatic deformities of the upper lip.

Material and methods. An 11-year-old boy was admitted to our department of reconstructive plastic surgery with a post-traumatic scar on his upper lip, caused by an animal bite. An Abbe flap was used to correct the deformity and reconstruct the upper lip.

Results. After excising the scar tissue, a large defect in the upper lip formed. We used an Abbe flap to close the defect, which involved cutting out a flap from the lower lip and rotating it 180 degrees. The postoperative period went smoothly, and the results after 3 months were satisfactory.

Conclusion. Using the Abbe flap technique allows us to restore the normal anatomy of the upper lip in children with post-traumatic deformities.