Breast reconstruction with a thoracodorsal flap (TDF) in combination with a tissue expander/implant is a wellestablished technique.

The purpose of the study was to present current data on the results of delayed breast reconstruction with thoracodorsal flap and tissue expander after combined/complex treatment in patients with breast cancer.

Material and methods. The search for relevant sources was carried out in the PubMed, Cochrane Library, E-library systems, publications from 2014 to 2022 were studied. Delayed breast reconstruction using TDF in combination with a tissue expander/implant is a reliable method of reconstruction for the group of patients who have previously undergone radical mastectomy or adjuvant external beam radiation therapy in terms of combined/complex treatment of breast cancer, allowing to achieve good and excellent aesthetic results with a low incidence of surgical complications.

Results and discussion. The use of the latissimus dorsi flap is a reliable and universal method of breast reconstruction, it allows achieving good and excellent aesthetic results, high patient satisfaction. Patients with a low body mass index or obesity, a history of abdominal surgery, including abdominoplasty, are not candidates for reconstruction using anterior abdominal wall flaps, and therefore the only possible method of breast reconstruction for them is the method using the TDF. In addition, the use of the TDF may be most appropriate for women who are planning a pregnancy in the future and for whom the use of anterior abdominal wall flaps will not be an optimal method of reconstruction due to reduced abdominal wall compliance. Other reasons why the use of TDF is the method of choice for many surgeons are the possibility of closing the donor site regardless of the size of the skin flap taken, the possibility of closing such defects of the mammary gland as extrusions, protrusions, in case of insufficiency of the skin cover after skin-preserving mastectomies.

Conclusion. The use of the latissimus dorsi flap is a reliable and universal method of breast reconstruction, it allows achieving good and excellent aesthetic results, a high degree of patient satisfaction.

Purpose of a study: to identify pathomorphological features of hyperextensible eyelids for planning and predicting the outcome of blepharoplasty.

Material and methods. 352 patients (100%) with involutional eyelid changes, indications for aesthetic blepharoplasty were examined. Out of the total number of the study participants 87 patients (24.7%) had clinical signs of hyperextensible eyelids (HES): ‘festoons’, hypotonia of the lower eyelids with positive ‘pinch test’, pronounced skin folds and free easy displacement of lax tissues of eyelids, face and neck, pseudoblepharochalasis, ptosis of eyebrows, dystopia of the external corners of the eyes and risk factors of postoperative eyelid retraction. We analysed surgical biopsies of the skin, circular muscle of the eye, and tarsal plate after blepharoplasty operations from 28 patients aged from 41 to 60 years with clinical manifestations of HES combined with hyperelastosis (17 patients) and blepharochalasis (11 patients).

Results. Typical morphological signs of hyperextensibility of the eyelid skin, circular muscle of the eye, and tarsal plate have been established: sclerosis, focal dystrophy of the intercellular substance, moderate macrophagelymphocytic infiltration with eosinophils markers of chronic inflammation, and necrosis of adipocytes and meibomian glands. In HES in eyelid skin elastic fibres are registered in small quantity, fragmented, single with signs of destruction; in blepharochalasis they are absent; collagen fibres are significantly thinned, which leads to a decrease in elasticity, tone and turgor of the skin.

Conclusion. Morphological changes in tissue structure in HES combined with blepharochalasis and hyperelasticity directly correlate with clinical manifestations of HES. It is advisable to identify such patients at the stage of blepharoplasty planning, classify them as a risk group for secondary postoperative deformities and apply to them gentle blepharoplasty techniques with elements of eyelid strengthening.

Immediate breast reconstruction using endoprostheses is the most commonly performed reconstructive breast procedure in both the UK, USA and Russia, reaching 80% of all types of reconstruction. Tertiary reconstruction after previous breast surgeries may be required in case of complications of failed breast reconstruction or recurrence of disease. In foreign literature, the term tertiary reconstruction is commonly used for repeat reconstructive surgery. A literature review was conducted using the keywords: “одномоментная реконструкция молочной железы”, “reoperation in breast reconstruction”, “secondary reconstruction after immediate breast reconstruction”, “tertiary reconstruction with autologous tissue”.

It has been established that repeated operations using anterior abdominal wall flaps after one-stage breast reconstruction have a good healing outcome and satisfy the aesthetic needs of patients.

Conclusion. Tertiary reconstruction after a long period of implant placement is motivated by undesirable symptoms (breast pain, psychological discomfort), cosmetic dissatisfaction of patients, late infections, development of cancer of the contralateral breast or recurrence of the disease on the side of reconstruction.

Purpose: to study changes in heart rate variability (HRV), as an indicator of the stress response, after rhinosurgical interventions.

Material and methods. A study of heart rate variability was conducted in 98 patients in the perioperative period who underwent open rhinoplasty (1st group, 33 patients), open rhinoplasty with simultaneous septoplasty (2nd group, 33 patients), and septoplasty (3rd group, 32 patients). Heart rate variability was assessed before surgery, 3, 6, 24 and 48 hours after surgery. The low frequency component (LF), high frequency component (HF), and very low frequency component (VLF) of HRV were studied.

Results. In the 3rd group of patients, compared with the data before surgery, the high-frequency component of HRV significantly decreased on the 3rd  and 24th  hours after surgery (p < 0.001), but increased after two days (p < 0.001). 3 hours after surgery, HF HRV in patients of 1st group was significantly higher than in patients of groups 2nd and 3rd (p < 0.001). In the second group, a significant decrease in HF was noted in the first 3 (p < 0.001), 6 hours (p < 0.01), 24 hours (p < 0.05) and 48 hours (p < 0.001) of the postoperative period, compared with data before surgery. In 3rd group, at intervals after surgery of 3 and 24 hours (p < 0.001), as well as 6 hours (p < 0.001), LF was significantly lower than before septoplasty. 3 hours after surgery, the VLF in the rhinoplasty group was significantly higher than in the other groups (p < 0.001). At the 6th hour there were no differences between the groups. After 24 hours, in the septoplasty group, VLF was significantly lower than in 11st and 2nd groups (p <0.01).

Conclusion. Septoand rhinosptoplasty provoke an inadequate low response from the sympathetic nervous system in the first hours after surgery, which is manifested by low LF power and indicates a violation of adaptive responses maladaptation. A decrease in VLF power in the first 3 hours after septoand rhinoseptoplasty indicates a pronounced stressor effect, which leads to low adaptive capabilities compared to rhinoplasty, that is, maladaptation within the specified period.

Purpose of the work: to study current areas of research in plastic surgery for 2018–2023. based on determining the frequency and structure of publication topics in the PubMed electronic database (MEDLINE).

Material and methods. The literature review was carried out in accordance with the international requirements of PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). The search for literature sources was carried out in the electronic database PubMed (MEDLINE) using combinations of operators OR, AND and keywords: plastic surgery OR aesthetic surgery OR reconstructive surgery OR microsurgery AND plastic surgery OR flap in reconstr surgery. The study period was 5 years, the search was carried out from February 8, 2018 to February 8, 2023.

Results. For analysis, we selected 521 articles that fully met the inclusion criteria. Articles on reconstructive surgery predominated – 78%, compared to aesthetic problems – 22%. When evaluating articles according to the anatomical section, it was revealed that 122 articles (23.42%) were devoted to the head and neck section, 109 (20.92%) – to the mammary gland, 104 (19.96%) – to the skin, 40 (7.68%) – to limbs, 33 (6.33%) – to flaps, 26 (4.99%) – to peripheral nerves, 23 (4.41%) – to urogenital pathology, 15 (2.88%) – to lymphatic system, 14 (2.69%) – to body, 10 (1.92%) – to other questions, 8 (1.54%) – to anatomy, 6 (1.15%) – to genetics, 6 (1.15%) – to hair cover, 3 (0.58%) – to microsurgical technique, 2 articles (0.38%) – to stomach. It was noted that urogenital reconstruction remains less popular among plastic surgery articles. The topic of limb replantation is also insufficiently studied.

Conclusion. An analysis of publication activity corresponding to the research topic, as well as the inclusion criteria, demonstrated that there is a stable trend towards an increase in the number of publications in the time period 2019–2023, which is due to the relevance and demand for this area of surgical practice.

Purpose of the study: to conduct a comparative assessment of the formation of the sphincter mechanism during colostomy using titanium nickelide-based implants in an experiment.

Material and methods. The experimental study was conducted on 45 sexually mature male rats Wistar with an average body weight of (531.3 ± 13.4) g. The animals were randomized into three equal groups of 15 animals each. In the 1st experimental group, a cylindrical spiral made of titanium nickelide with invagination of the serosalmuscular layer of the colon was used to create a colostomy. In the 2nd experimental group, a similar spiral was used, but without invagination of the serous-muscular layer. The control group underwent the standard procedure of single-barrel colostomy formation. Animals were removed from the experiment on the 7th, 30th and 60th days after the operation, 5 animals at each stage. Histologic examination of the area of the formed colostomy with constipation apparatus was performed.

Results. The use of cylindrical spiral implants from titanium nickelide in colostomy formation (both with and without invagination of the serosal-muscular layer of the colon) had no significant effect on the dynamics of body weight of experimental animals compared to the classical method. Colostomy formation without invagination of the serous-muscular layer did not lead to an increase in the incidence of postoperative complications in comparison with the traditional method. However, invagination of the serous-muscular layer was accompanied by an increased incidence of complications in the postoperative period.

Conclusion. The complex analysis of experimental data, including the assessment of survival rate, body weight dynamics, incidence of postoperative complications, morphological changes, the course of regenerative processes and stoma functionality, allows us to recommend as a promising method of colostomy the use of a cylindrical spiral made of titanium nickelide without invagination of the serous-muscular layer of the intestine.

Purpose of a study: to evaluate the possibility of preserving breast implants in patients with severe burns.

Material and methods. A patient G., 52 years old, was hospitalized in the Department of Thermal Injuries of the I.I. Dzhanelidze St. Petersburg Research Institute for Emergency Medicine due to burn disease, flame burns 37% (32%)/I–II–III degree of the neck, torso, upper and lower extremities. On the 2nd day after the injury, a patient with severe burns underwent excision on pre-augmented mammary glands to the level of adipose tissue with simultaneous skin grafting.

Results. On the 4th day after treatment, at least 80% of the area of skin grafts transplanted to the mammary glands was found to be engrafted, and further skin grafting was not required on them. In our case, early surgical treatment made it possible to avoid reactive capsulitis, the need to remove implants and achieve acceptable aesthetic and functional results.

Conclusion. Presented observation demonstrates the potential for the preservation of implants in the case of localization of burns on the augmented mammary glands.

In recent years, the number of oncological diseases of the facial area and the nasal area has increased. The consequences of surgical treatment of these diseases lead to the formation of functionally and aesthetically significant defects of the face and external nose, leading to disruption of such functions as breathing and speech. In this article, we propose a method for nose reconstruction using an individualized titanium implant in combination with a radial flap. Due to the use of additive technologies in combination with visualization and 3D modeling programs at the stage of preoperative planning, it becomes possible to analyze the defect, its localization, volume, tissue composition, as well as to model and create an individual implant. This approach allows you to get good functional and aesthetic results in one operation, reduce the number of complications and rehabilitation period.

Purpose of the study: to compare the quality of life of patients who underwent mastectomy and non-flapped breast reconstructions for cancer.

The study included 90 patients, diagnosed with breast cancer 0–IIA st. T_1–2N₀M₀. The minimum age of the patients was 30 years old, the maximum was 65 years, the average age was (49.76 ± 8.54) years old. Patients were divided into three groups of 30 women depending on the type of surgical treatment of the tumor and breast reconstruction: 1st group – Madden surgery with a subsectoral expander installation and replacement with a silicone endoprosthesis, 2nd group – Madden surgery with prepectoral expander installation, staged lipofilling and replacement with silicone endoprosthesis, 3rd group – radical subcutaneous mastectomy with one-stage prepectoral breast reconstruction. The quality of life was assessed using a set of Breast-Q scales.

The data obtained make it possible to draw conclusions about the effectiveness of subcutaneous mastectomy with one-stage prepectoral breast reconstruction according to the method proposed by the authors due to the tendency to a more intensive increase of the quality of life of patients at the stages of rehabilitation in such aspects as psychosocial, physical and sexual well-being.

A hip fracture is a common injury in old age. It can be noted that the number of fractures is several times higher in women compared to men. Without surgical treatment, this pathology is highly likely to lead to complications and death of the patient within a year. High mortality rates in elderly people who have sustained a hip fracture can be attributed to various reasons. Due to prolonged forced bed rest in such patients, the risk of developing respiratory and cardiovascular complications, thrombosis, bleeding and infection significantly increases. In modern clinical practice, all fractures of the femoral neck are the reason for surgical intervention, according to vital indications. The only exception is the general severe condition of the patient in case of disruption of the normal functioning of the cardiovascular and respiratory systems, multiple organ failure and oncological diseases in the stage of decompensation.

Purpose of a study: to demonstrate successful total arthroplasty of the left hip joint in elderly patient with posttraumatic avascular necrosis.

Data from the medical documentation of the trauma hospital, data from instrumental research and the results of dynamic observation were used to write the article. The results were obtained using the equipment of the Center for Collective Use of Scientific Equipment of Tambov State University named after G.R. Derzhavin.

As a result of total hip arthroplasty, the function of the patient's limb was restored.

Conclusion. Total arthroplasty is an effective treatment method for patients with post-traumatic changes in the hip joint, allowing to restore the patient’s motor activity and prevent the development of hypostatic complications.