Objective. Implant malposition is a common complication after augmentation mammoplasty and ranks second among the reasons for revision surgery after capsular contracture. Improperly positioned implants are not only aesthetically unattractive but can also negatively affect the psychological state and quality of life of patients.

Purpose of a study: to analyze current trends in the prevention and management of lateral or medial implant displacement following augmentation mammoplasty.

Material and Methods. A literature search was conducted in the PubMed and Google Scholar databases for English-language articles published over the past 10 years on the topic of “Prevention and management of horizontal implant malposition.” Included in the analysis were clinical studies, case reports, and case series specifically addressing this issue. Brief communications, letters to the editor, reviews, meta-analyses, and experimental studies were excluded. The search strategy utilized the terms “lateral displacement” and “symmastia after augmentation mammoplasty,” as well as their synonyms and related combinations.

Results and Discussion. Using the keywords “lateral displacement” and “symmastia after augmentation mammoplasty,” along with relevant synonyms and alternative phrases, a total of 748 articles were initially identified. After removing 72 duplicates during the preliminary screening, titles were reviewed and inclusion and exclusion criteria were applied, resulting in the exclusion of 608 additional publications. Following full-text assessment of the remaining 68 articles, only 6 met the criteria for final analysis.

Horizontal implant malposition is a relatively rare and underexplored complication of breast augmentation surgery. The studies selected for final analysis addressed both lateral and medial implant displacement in the broader context of implant malpositions, including superior and inferior displacement.

Conclusion. The primary strategy for preventing lateral and medial implant displacement is careful surgical planning based on each patient’s individual anatomical characteristics. Other important factors include implant size, preservation of natural folds and fascial structures, adherence to proper surgical technique, and appropriate pocket selection. For the treatment of lateral implant displacement, the reviewed literature recommends capsulorrhaphy and the use of biological or synthetic meshes.

Gigantomastia (GM) is a physical condition of the mammary glands characterized by excessive growth, manifested by a large size and volume exceeding the average breast size by 2 or more times in relation to the individual anthropometric indicators of the patient, which leads to a decline in quality of life, pain syndrome, hygiene disorders and dysmorphic perception.

This systematic review was reported to international requirements. PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). A comprehensive reference search was undertaken by two researchers PubMed, eLibrary, Google Scholar. The retrospective search was not limited, the date of the last request was October 31, 2024.

Eight articles about surgical correction corresponded the set purpose, including the reduction mastopexy with free areola grafting and breast reduction operations with the transposition of the nipple-areolar complex (NAC) on parenchymal and dermal pedicle.

Conclusion

1. Gigantomastia is a pathological condition of the mammary glands characterized by a large size and volume, in which patients have physical and dysmorphic changes leading to a decrease in the quality of life.
2. The choice of surgical technique for gigantomastia correction should be aimed at removing the maximum volume of the breast and correspond the safety criteria and prevention of negative consequence manifested by necrosis of the NAC.
3. Perspective metods at removing a large volume of the breast and minimizing complications include breast reduction surgery with free areola transplantation and surgery using the lower pedicle.

The aging process has a significant impact on the harmony and symmetry of facial features observed at a young age. An effective strategy for assessing morphological changes associated with aging is to divide the face into three key zones: the upper third (forehead and eyebrow area), the middle (central part and nose) and the lower third (chin, jaw line), as well as the neck. The analysis of aging processes is an important area of research in plastic surgery. The middle part of the face plays a crucial role in shaping a person's aesthetic perception, since attractiveness is often determined by the combination of eyes, nose, lips, and cheekbones that make up the so-called central facial triangle. When considering this area, it is necessary to apply a three-dimensional approach, since only such an analysis allows you to accurately assess age-related changes and recreate the youthful topography of the face. This paper presents a comprehensive analysis of current research on the etiology and mechanisms of facial aging by anatomical thirds. An in-depth study of the physiological changes occurring at each of these levels can greatly facilitate the understanding of aging processes and help improve correction strategies aimed at rejuvenating the face, which is very important for choosing a more effective method of surgical correction of age-related changes.

A search for publications on the topic of our research was conducted in open databases using search engines: PubMed, Web of Science, Scopus, Google Scholar, eLibrary, Cyberleninka. By keywords and their combinations: “aging”, “age-related facial changes”, “facial aging”, “neck aging”, “facial thirds” and “rejuvenation” 1,351 articles were identified. Articles devoted to age-related changes in the organs of vision, oral and nasal cavities were excluded from the analysis.; articles with a publication date of more than 25 years; articles that do not relate to aesthetic changes in the skin and functional changes in soft tissues and the facial skeleton; articles that dealt only with cosmetic procedures; publications that are outside the scope of the study of facial anatomy and physiology; articles that advertise medical non-certified drugs. As a result of applying these criteria, 211 articles were selected, from which the relevant full-text materials were extracted, analyzed and summarized based on information from the database. The anatomy of facial aging was analyzed in thirds for further research and development of effective corrective complex techniques.

Purpose of a study: endoscopic assessment of anastomositis in the early postoperative period during the formation of single-row and double-row anastomoses in the upper gastrointestinal tract with extramucosal intestinal sutures using a probe gastrointestinal system and therapeutic and diagnostic endoscopy.

Material and methods. The results of treatment of 200 patients were studied, in whom anastomoses were applied with extramucosal serous-muscular-submucosal sutures, a probe system was installed for decompression and enteral nutrition, early therapeutic and diagnostic endoscopy with ultrasonography, endoscopic intraluminal stimulation of the function and patency of anastomoses were performed, visual and ultrasound assessment of anastomositis classified according to grade IV. The main group (142 patients) with single-row anastomoses, the control group (58 patients) with double-row anastomositis.

Results. The use of extramucosal intestinal sutures, a gastrointestinal probe system, and therapeutic and diagnostic endoscopy contributed to a reduction in treatment times and uncomplicated healing of the intestinal suture in 89% of cases with single-row anastomoses and 68% of cases with double-row anastomoses, classified as zero- and first-degree anastomositis. An increase in the length of hospital stay and a higher number of second and third degree anastomositis were observed in the control group (20%) versus 10.7% in the main group.

Conclusion. The use of extramucosal intestinal sutures, a probe gastrointestinal decompression system and enteral nutrition against the background of early therapeutic and diagnostic endoscopy allows to reduce the number of severe anastomoses, the time of restoration of the motor-evacuation function of the upper gastrointestinal tract and the duration of hospital stay of patients.

Currently, the trend towards an increase in diseases of the thyroid-parathyroid complex continues. 4 to 7% of the world's population have nodular transformation of the thyroid gland. The importance of surgical methods for treating patients with thyroid and parathyroid gland pathology has also increased. Despite significant progress and the introduction of preoperative diagnostic methods, preoperative preparation, and postoperative monitoring, the number of intra- and postoperative complications remains high, which motivates the development and implementation of new original technical solutions in thyroid and parathyroid gland surgery. The article presents a clinical case of successful surgical treatment of a patient with diffuse-nodular transformation of a large thyroid gland with retrosternal location and compression of the neck and mediastinal organs due to the use of existing new and original technical solutions developed in the clinic.

Achenbach syndrome (paroxysmal hematoma of the fingers, acute idiopathic blue finger) is a poorly understood disease of unknown etiology, characterized by episodic bruising, pain, or swelling on one or more fingers or toes. Although the symptoms resolve on their own without any treatment, their appearance against the background of complete well-being can cause anxiety in a person, forcing him to seek emergency care. Making a correct diagnosis can be difficult due to the low awareness of clinicians about this pathology, which often leads to the appointment of unnecessary and expensive methods of examination and treatment. The article presents a clinical observation of a patient with Achenbach syndrome of a finger and a literature review dedicated to this disease.

Purpose of a study: to evaluate the immediate and remote results of minimally invasive interventions in patients with achalasia cardia.

Material and methods. The study included 104 patients with achalasia cardia stage III and IV: 44 men (42.3%), 60 women (57.7%), aged from 20 to 72 years (44.5 (40.0; 64.0)) who underwent peroral endoscopic myotomy (POEM). In order to evaluate the effectiveness of POEM, its effectiveness was compared with data on the immediate and remote results of laparoscopic intervention - esophagocardiofundoplasty (ECFP) (51 patients).

Results. The duration of the postoperative period in the group after POEM was on average 3.5 days (47.3%) shorter, the total duration of hospitalization was 4.4 days (42.3%) shorter than in patients after ECFP. Over a period of more than 1 year, the dysphagia index according to the Eckardt scale in patients in the POEM group was 30.7% lower. Recurrence in the group of patients after ECFP was more frequent than after POEM (5 versus 1 (p = 0.021). The gastroesophageal reflux rate was 10.4% lower after POEM, and the reflux rate after POEM was 2 times lower. In the late postoperative periods, the GIQLI questionnaire scores in patients after POEM were significantly better compared to these scores in the group of patients who underwent ECFP.

Conclusion. POEM made it possible to significantly reduce both the duration of the postoperative period and the total duration of hospitalization, and complications that occurred in the early postoperative period were milder. The results of patient questionnaires using the Eckardt and GIQLI questionnaires at 6 months and more than 1 year, as well as the recurrence rate of achalasia cardia, indicate the high efficiency of POEM. Further evaluation of the results of minimally invasive interventions in patients with achalasia cardia is necessary.

Objective. The radical method of treating focal liver pathology is currently surgical. Despite the widespread use of endoscopic techniques, laparotomic access in liver surgery is often the only possible one. More than 70 types of accesses are known, used in various interventions on this organ, which are divided into oblique transverse, longitudinal, oblique longitudinal, transverse extended and combined. In the Tomsk Zonal Hepatology Center, an abdominal wall incision in the epigastrium to the anterior axillary line with the intersection of the right rectus muscle closer to the tendinous bridge of the second segment was developed and introduced into clinical practice, which can be extended if necessary by crossing the costal arch. The access was named after the authors’ surnames – Merzlikin– Paramonova. There is no information in the literature on the comparative effectiveness of various surgical approaches in liver pathology.

Purpose of the study: to compare the Merzlikin–Paramonova approach with other, most frequently used ones, in terms of their degree of trauma, accessibility for visualization of the organ in accordance with the criteria of A.Yu. Sozon-Yaroshevich, presented to approaches for liver surgery.

Material and methods. For anatomical and physiological justification of the access, autopsy studies of cadaveric material were performed, during which anthropometric measurements were taken. An analysis of immediate and remote results of surgical treatment of 321 patients with focal liver lesions was conducted, the main ones being hemangiomas, alveococcosis, and echinococcosis. They underwent liver resections of various volumes, supplemented by cryodestruction of the organ stump.

Results. The choice of surgical access was determined by the nature of the pathological process (malignant, benign), its prevalence, involvement of large vessels and bile ducts of the liver porta. Sectional studies have shown that with the Merzlikin-Paramonova access, the innervation and blood supply of the epigastric zone is maximally preserved. Its main parameters correspond to the assessment criteria of A.Yu. Sozon-Yaroshevich. Analysis of the results of surgical interventions using this access showed that postoperative hernias formed only in 3 people (3.87%), all patients had no restrictions on physical and social activity, pain.

Conclusion. The Merzlikin–Paramonova approach is low-traumatic due to the preservation of innervation and muscular structure of the anterior abdominal wall, as a result of which it is physiological, which allows to obtain good results in the late postoperative period. This approach allows to perform a complete revision of the operated organ and to perform the necessary volume of surgery, in the postoperative period to reduce the number of postoperative complications.

Nevus comedonicus (NC) is a rare hereditary disease caused by a somatic mutation in the NEK 9 gene, which controls follicular skin homeostasis. Nevus comedonicus should be associated with hamartomas. The etiology of NC is not fully understood, but this disease is currently classified as a congenital pathology of the development and functioning of the hair follicle. This pathology can exist either in isolation or be a component of nevus comedonicus syndrome, which is characterized, along with the pathology of the development of skin appendages, by the presence of abnormalities in the patient’s skeleton, visual apparatus and central nervous system.

The purpose was to present a rare clinical case of NC in a teenage-girl with the results of surgical treatment, clinical, instrumental and morphological studies.

A clinical method, dermatoscopy, and histological examination of the surgical material, represented by areas of NC and scarred skin stained with hematoxylin and eosin were used to examine the patient.

Conclusion. Giant congenital NC are a fairly rare pathology. Active recurrent inflammation significantly complicates treatment or makes it impossible to use the generally accepted tactics of removing such formations using tissue expanders. Treatment using only systemic antibacterial therapy and local antiseptics does not provide stable remission. Our experience indicates that recurrent inflammation of a comedonal nevus can only be effectively stopped by eliminating the cause of the inflammatory process surgically.

The history of the emergence of the most established and widespread eponymous terms characterizing injuries to the hand has been presented in the article.