Objective. Tubular breast deformity with hypoplasia and without ptosis remains a challenging congenital condition in aesthetic and reconstructive surgery. It involves structural underdevelopment of the lower breast pole, widening of the nipple–areolar complex, and medial deficiency.

   Purpose of a study: to systematize current surgical techniques for the correction of tubular breast deformity and to evaluate their effectiveness based on anatomical features and preoperative planning tools.

   Material and methods. A comprehensive literature review was conducted across databases including PubMed, Scopus, and eLibrary, covering publications from 1990 to 2024. Key classification systems, diagnostic criteria, and correction strategies were analyzed.

   Results. No unified algorithm for the surgical correction of tuberous breast deformity has been established. Current approaches range from simple periareolar techniques to complex reconstructive procedures involving lipofilling, combined implant pockets, and 3D planning. Particular attention is paid to the role of preoperative visualization and objective diagnostic criteria — including the pinch test, ultrasound imaging, and elements of elastography – in guiding the anatomical assessment and the selection of the optimal surgical strategy.

   Conclusion. This is the first Russian-language review to comprehensively integrate classification systems and modern correction strategies for tubular breast deformity with hypoplasia and no ptosis. The proposed algorithm enhances personalized surgical planning and highlights the need for further clinical validation.

   The results of a comparative morphometric study of the parameters of the anterior chest wall of different groups of patients are presented in order to identify differences in the anatomical structure, which was important for further planning of surgical treatment.

   Purpose of a study: to identify the features of the anatomical structure of the anterior chest wall in patients with congenital genetic and endocrine diseases.

   Material and methods. A morphometric study of the anterior chest wall was conducted on 60 patients divided into three groups of 20 people. The 1^st group included l women, the 2^nd group – men, and the 3^rd group included women with congenital genetic and endocrine disorders. The studies were conducted using physical examination, morphometric measurements and CT diagnostics. We developed a special questionnaire including the main anthropometric parameters of the anterior chest wall. A comparative assessment and statistical processing of the obtained data were carried out.

   Results. According to the results of the morphometric study, statistically significant differences in the structure of the anterior chest wall were revealed in 3 groups of patients.

   Conclusion. The data obtained during the study reveal the main features of the structure of the anterior chest wall in women with congenital genetic and endocrine disorders, which allows for more careful planning of the course of augmentation mammoplasty surgery and obtaining an aesthetically pleasing predictable result.

   Objective. Thumb defects are a difficult problem for reconstructive surgeons, as this finger provides more than 50 % of the hand’s function. Options for closing defects of different localization of the first finger of the hand are proposed. The flap of the first dorsal metacarpal artery (in the literature it is called the “Kite flap”) allows to close the defects located between the anatomical snuffbox and the interphalangeal joint of the first finger. The article presents a clinical case: a 16-year-old boy with a long-term non-healing ulcer in the back of the First metacarpal joint. The formation was removed. A flap on the 1st dorsal metacarpal artery was used to close the defect. A satisfactory result was obtained. The flap was first described by G. Foucher and J.B. Braun in 1979, and later various modifications of this flap were proposed. The flap ensures that the defect is closed with minimal damage to the donor area. Thus, the use of a flap on the 1^st dorsal metacarpal artery is an effective method for closing defects at the base of the first finger of the hand.

   Achieving optimal results in aesthetic surgery is impossible without a thorough understanding of the pathophysiological processes occurring in the patient’s body. This is especially important for overweight individuals, whose numbers are steadily increasing. This group of patients is most susceptible to local postoperative complications, such as wound dehiscence, persistent seromas, and flap necrosis.

   Purpose of a study: to identify the causes of local wound complications after plastic surgery associated with massive tissue detachment in overweight patients.

   Material and Methods. Morphological and immunohistochemical assessment of subcutaneous fat (SCF) was performed in 49 women aged 30–60 years with a body mass index (BMI) of 25.0–29.9 kg/m² who underwent abdominal contouring (Graser abdominoplasty) in 2019–2020. The structure of the subcutaneous fat and the course of the postoperative period were assessed, including the healing time of surgical wounds, the development of seromas, ligature fistulas, and necrosis.

   Results. The study identified two subcutaneous fat morphotypes: adipocytic (lobules of mature adipocytes with thin layers of connective tissue and interadipocyte capillaries) and adipocytic-fibrous (inflammatory) (variable ratios of adipose and fibrous tissue). The first type was detected in 3 (23.1 %) of 13 patients with uncomplicated wound healing (Group 1), while the second type was observed in 10 (76.9 %) patients in Group 1 and in all 36 patients (100 %) in Group 2. Women in Group 2 were statistically significantly more likely (43.5 % vs 15.4 %, p < 0.05) to have vascular abnormalities (hypervascularization up to 10–15 vessels/mm², changes in vascular morphology, plethora, perivascular fibrosis/edema) and an active local immune response: increased numbers of CD68⁺ macrophages, HLA-DR⁺ immune cells, and perivascular CD20⁺ B lymphocytes.

   Conclusion. Complicated and prolonged wound healing after contour plastic surgery in patients with a BMI greater than 24.9 kg/m² is directly related to subclinical chronic inflammation in the subcutaneous fat, manifested by fibrotic degeneration, vascular changes, and immune cell activation. Patients with excess body weight should be identified as a risk group with the development of preoperative assessment algorithms (morphology of the subcutaneous fat, blood biochemistry) and the use of modified abdominoplasty techniques.

   This study was based on the results of a retrospective analysis of the correction of tubular breast deformity of type II–III using lipofilling technology and a recurrent blocking suture. Analysis of the results of correction of tubular breast deformity using the developed method showed that the incidence of specific complications of mild and moderate degree does not exceed 6%. No serious complications were identified in this study. The results of the BREAST-Q questionnaire survey showed a significant improvement in the quality of life and a high degree of patient satisfaction with the aesthetic result of corrective surgery using lipofilling technology. Based on the results of the study, it can be concluded that the developed method using lipofilling technology and a return blocking suture can be considered the method of choice for correcting type II–III tubular breast deformity.

   Purpose of a study: to analyze literature review and optimization of surgical treatment of patients with delayed complications developed after polyacrylamide gel injection.

   Material and Methods. Patient B., 52 years old, came to the P.A. Herzen Moscow Oncology Research Institute with complaints about asymmetry and deformity of the breast after polyacrylamide gel injection in 1995. Instrumental examination revealed multiple heliomas and oleogranulomas in the right and left breasts. According to the results of pathomorphologic examination there was a picture of pronounced chronic inflammation with abscessing. Surgical treatment was performed in the scope of bilateral skin-preserving mastectomy with free nipple areola complex transplantation with the subsequent delayed reconstruction in combination with the Silimed endoprosthesis with the volume of 290 ml.

   Results. The optimal aesthetic outcome of breast reconstruction after polyacrylamide gel removal was obtained.

   Conclusion. Taking into account the danger of polyacrylamide gel injections, its complete removal with the expansion of the operation volume up to subcutaneous or skin-preserving mastectomy with the possibility of delayed reconstruction is recommended.

   This study extends our ongoing investigation of wrist joint ganglion, which was initiated in 2022, with preliminary findings published in 2024.

   The purpose of the present phase was to perform a detailed analysis of the syntopic relationships and pathomorphological features of ganglion with dorsal localization on the wrist joint.

   The study included 20 patients (18 women and 2 men) diagnosed with a dorsal ganglion of the wrist joint. Treatment was conducted at the clinic of the Autonomous Non-Profit Organization “Institute of Microsurgery” (Tomsk, Russia) from January 2022 to March 2023. Age of the patients ranged from 18 to 49 years, with an average of (39 ± 16) years. The pathology localization was distributed as follows: in 14 cases, the lesion was identified in the right wrist joint, and in 6 cases – in the left. All participants had an isolated form of the disease, without associated degenerative or traumatic changes in the hand. This was confirmed by clinical examinations, ultrasound diagnostics, and magnetic resonance imaging conducted during the preoperative preparation stage. Surgical intervention was performed under local infiltration anesthesia using a 1 % lidocaine solution. The ganglion was removed using an open method with threefold optical magnification. During the surgical procedure, the synoptic relationship of the ganglion was studied, and a fragment of the wrist joint capsule was collected at the site of the ganglion stalk attachment for subsequent morphological analysis. As control material, 7 samples of the wrist joint capsule were used, obtained postmortem from individuals without pathologies in this area, under the conditions of a pathological anatomy bureau. The obtained samples were fixed in 10 % neutral buffered formalin and subjected to histological examination with hematoxylin and eosin staining. The study confirms that dorsal ganglion originate from the capsule of the wrist joint in the area of the scapholunate ligament. Histological analysis of the removed capsule section, to which the ganglion stalk was attached, revealed that its structure consists of dense fibrous connective tissue with rare zones of hyalinization. Pronounced foci of myxomatous changes were also observed, accompanied by active proliferation of fibroblast-like cells and mononuclear infiltration. It was established that the joint capsule and the volar ganglion share a similar histological structure.

   Radical axillary and inguinal lymphadenectomies are associated with lymphorrhea and limbs lymphedema, which lead to disability and life quality decrease of the absolute majority of operated patients in case of no proper prevention and treatment.

   Purpose of the study: to analyze the effectiveness of advanced technologies that use endoscopic and robotic equipment, reconstructive microsurgery in terms of preventing lymphorrhea and lymphedema after axillary and inguinal lymphadenectomy.

   The literature was searched using PubMed and Google Scholar electronic databases in accordance with keywords. Full-text publications in Russian and English over the past 15 years, containing information about the use of endoscopic, robotic and microsurgical technologies for inguinal and axillary lymphadenectomy, were analyzed. The diagrams were created using MS Office Excel 2019. The incidence of lymphorrhea after endoscopic axillary lymph node dissection (EALND) ranges from 3.1 to 94.7 %. The incidence of lymphorrhea after video-endoscopic inguinal lymphadenectomy (VEIL) ranges from 0 to 30.7 %, lymphedema – from 0 to 19.0 %. The incidence of lymphorrhea after robotic-assisted video-endoscopic inguinal lymphadenectomy (RAVEIL) varies from 0 to 29.4 %, lymphedema – 0 to 27.3 %. The incidence of lymphorrhea after robotic nipple-sparing mastectomy with immediate robotic breast reconstruction (RNSM and IRBR) have the highest heterogeneity – from 0 to 94.7 %. The effectiveness of lymphaticovenous anastomoses (LVA) was noted in 87.5–100 % of patients with lower limb lymphedema, and in 80.7–93.3 % of patients with upper limb lymphedema. The effectiveness of lymph node to vein anastomoses (LNVA) was noted in 70.6–100 % of patients with lower limb lymphedema. The effectiveness of vascularized lymph node transplantation (VLNT) was noted in 66.7–100 % of patients with lower limb lymphedema, and in 71.4–100 % of patients with upper limb lymphedema.

   Conclusion. Despite the heterogeneity of results, advanced endoscopic, robotic and microsurgical surgical techniques demonstrated a positive effect on reducing the incidence of lymphorrhea and extremities lymphedema after axillary and inguinal lymphadenectomy. However, their use simultaneously with lymphadenectomy remains impossible in the majority of cases due to the high cost and the lack of necessary equipment. Therefore, the search for more effective and at the same time accessible methods for lymphorrhea and lymphedema prevention after lymphadenectomy is vitally needed.

   Objective. Treatment of obstructive jaundice still remains one of the most pressing problems in emergency surgery. Due to the complicated course of the pathological process of the organs of the hepatopancreatobiliary zone against the background of the development of obstructive jaundice, the first stage of treatment is necessary to perform temporary decompression of the bile ducts, before radical surgery, in order to relieve biliary hypertension, assess the functional reserve of the liver and predict the timing of the main stage of surgical treatment, as well as the expected course of the postoperative period. The article contains data on the staged treatment of patients with obstructive jaundice syndrome, when the main surgical intervention is performed after relieving biliary hypertension. This treatment method can reduce the number of postoperative complications and mortality.

   The main task in this case is the prevention of liver failure with the development of hypocoagulation, which is the main condition for radical surgical intervention.

   Material and methods. At the Tomsk Hepatology Center, 152 high-tech minimally invasive procedures were performed on patients with obstructive jaundice of various etiologies, which significantly improved treatment results and shortened the patient’s length of stay in the hospital.

   Results. Based on modern methods for diagnosing obstructive jaundice, an algorithm for examining and treating patients is shown, depending on the technical capabilities of the hospital. The stages of diagnostic and therapeutic procedures are shown, which may differ due to the level of bile duct occlusion, as well as its etiology. In addition, a definition of a hospital of the first, second and third levels is given and patient routing is determined.

   Conclusion. Treatment of obstructive jaundice of any origin should be carried out in two stages. The first stage includes diagnostic and therapeutic measures aimed at reducing the threat of developing organ failure. The second stage is to carry out radical treatment. The level of care is determined by the diagnostic and personnel potential of a particular medical institution.

   Wide Awake Local Anaesthetic No Tourniquet (WALANT) a relatively new method of anesthesia in hand surgery. A brief explanation of WALANT technique and our experience are described in the article.

   Purpose of a study: to present a brief description of the WALANT method and to analyze the experience of using local anesthesia without a tourniquet and sedation in hand surgery.

   Material and methods. A total of 996 surgeries were performed under local anesthesia. For local anesthesia in a small out patient operating room, the authors used a 0.6% lidocaine solution with adrenaline at a 1:100,000 dilution. The injection is administered slowly using a thin need leno larger than 27G. At least 27 minutes should lapse from the start of the injection to the surgery.

   Results. All operated patients were divided into six groups based on the tissue type being treated. Anevaluation of the effectiveness of the anesthesia used revealed that local anesthesia allows for hand surgery without the need for ananesthesiologist. No adverse effects of anesthesia were observed in the cohort being analyzed.

   Conclusion. Hand surgeries using the WALANT method are safe and effective and do not require the participation of anesthesiologists.

   Purpose of a study: to evaluate factors influencing postoperative complications in patients with acute appendicitis.

   Material and methods. A retrospective study of patients treated for acute appendicitis at Novokuznetsk City Clinical Hospital No. 1 and Novokuznetsk City Clinical Hospital No. 29, was conducted from 2017 to 2020.

   Results. From 2017 to 2020, 1410 patients underwent surgery at the Novosibirsk City Clinical Hospital No. 1 and Novosibirsk City Clinical Hospital No. 29, including 782 men (55.5 %) and 628 women (44.5 %). The minimum age of men was 18 years, the maximum was 92 years old, with an average age of (37.7 ± 15.0) years. The age of women ranged from 19 to 94 years old, with an average age of (41.4 ± 16.3) years. The main type of surgery was laparoscopic appendectomy – 1240 (87.9 %) cases, 114 (8.1 %) patients were operated on using the Volkovich–Diyakonov approach, 28 (2.0 %) – underwent laparotomy, 22 (1.6 %) had appendectomy and a periappendiceal abscess was opened, in 4 cases (0.3 %) the surgery ended with laparostomy, in one case (0.05 %) diagnostic laparoscopy was performed without appendectomy, and in another (0.05 %) – laparotomy without appendectomy. The average duration of surgery for traditional appendectomy was (50.2 ± 27.2) minutes, while for laparoscopic appendectomy it was (40.5 ± 15.2) minutes. In 90 (6.4 %) patients, the postoperative period was complicated by surgical site infection. The average time of hospital stay was (6.9 ± 3.2) days.

   Conclusion. An analysis of acute appendicitis treatment in adult patients in Novokuznetsk revealed that laparoscopic surgery is the primary surgical treatment for acute appendicitis and its complicated forms. The duration of the illness, the severity of the condition upon admission, the duration and type of surgery, and the histological type of appendicitis all influence the incidence of postoperative complications.

   The study examines the effectiveness and safety of the medical device “Wound coating based on the NovoSkin collagen-laminate matrix”, conducted from February to May 2024 at the Ryazan State Medical University (Ryazan, Russia).

   Purpose of a study: to evaluate the use of wound coating NovoSkin in patients with skin defects.

   Materials and methods. NovoSkin is a sterile, round-shaped coating with a uniform matte and transparent surface. It is made of type 1 collagen and laminin, using safe ingredients, which makes it biocompatible and absorbable within 10–14 days. The use of the coating is indicated for burns of I–III degrees, trophic ulcers and pressure sores, however, it is contraindicated in open bleeding wounds and hypersensitivity to the components. The study included 60 patients (28 men (46.67 %) were and 32 women (53.33 %)) aged from 27 to 92 years (mean age (66.8 ± ± 12.4) years old). The main procedures included demographic data collection, local screening, vital signs assessment, and NovoSkin application. Efficacy was assessed by the percentage of patients with an increase in granulation area of at least 20 % by day 14.

   The results. Absolute majority (96.67 %) of patients showed a significant increase in granulations, indicating a high coverage efficiency. The safety of the application was assessed through the frequency of undesirable events and changes in vital signs. No serious adverse events have been reported, which confirms NovoSkin’s good tolerability.

   Conclusion. NovoSkin wound coating has demonstrated high efficacy and safety in the treatment of skin defects, which makes it a promising tool in clinical practice. The test results confirm the product’s compliance with established standards and its feasibility for use in medical institutions.