Today, the DIEP flap (deep inferior epigastric artery perforator flap) is becoming the most popular method of breast reconstruction after mastectomy. The next step in the evolution of this flap should be to improve its sensitivity in the postoperative period. Recovery of sensitivity in the reconstructed mammary gland improves the quality of life of patients, as well as restores the protective function of the skin. In addition, tactile sensitivity of the breast plays a very important role in the intimate life of women. However, the question of finding and isolating the recipient nerve for the purpose of reinnervation of the flap remains open. This fact was the reason for the search for the optimal surgical technique for this stage of the operation. The world literature describes some ways of reinnervation of the DIEP-flap (flap on the perforators of the deep inferior epigastric artery). All of them have their pros and cons. We propose to use the anterior cutaneous branch of the 3^rd intercostal nerve as a recipient, which is located in the same microsurgical field as the internal thoracic vessels. This method, in our opinion, allows you to minimize the time to search for and isolate the recipient nerve.

About 50 000 new cases of breast cancer are registered annually in Russia. This is used systematically and requires a multidisciplinary approach to its appointment. The main thing in treatment it is a surgical stage, the result of which is the features of the quality of life of patients. This disease is found often in women in the prime of life and with a socially active life position.

Today, there are many options for surgical treatment of breast cancer patients. Due to the rapid development of plastic surgery, it became possible to use both synthetic materials and autologous tissues in breast reconstruction, which include the latissimus dorsi flap.

The use of tissues that cause deterioration of the condition of the reconstructed breast is a significant technique and allows preventing the development of developmental progression, both surgical and post-radiation complications in the reconstructed breast.

Objective. Damage to the tendons of the extremities is one of the most frequent injuries of the human musculoskeletal system. Tenorrhaphy, aimed at restoring their integrity, is a technically complex surgical intervention, including access with the release of the ends of the tendons, their retention and repeated interception during suturing with a thread. During surgery, the tendon inevitably undergoes additional trauma from compression by surgical instruments. As a result, there is a violation of the ultrastructure, blood supply and weakening of the ends of the sutured tendon. In turn, this prevents accurate adaptation and causes deformation in the seam area, promotes thread eruption. At the same time, tendon regeneration proceeds with a pronounced scar-adhesive process, sliding properties are violated, tenogenic contractures are formed.

Purpose of the study. To evaluate the effect of the tendon capture and retention method during tenorrhaphy on the microanatomic structure of the tendon.

Material and methods. A new instrument for performing tenorrhaphy is proposed. 12 experimental tenorrhaphies were performed on the tendons of the limbs of people amputated for medical reasons, using tweezers and an original tendon holder, followed by histotopographic examination of stitched tendon samples.

Results and discussion. In the course of the study, it was found that the method of capturing and holding the tendon during tenoraphy has a significant impact on its anatomical structure. When holding tendons with tweezers, violations of the tendon structure and damage to its membranes were observed. The tendons held during the operation with the help of a tendon holder were distinguished by the preservation of the macromicroanatomic structure of the tendon itself and the surrounding tissues.

Conclusion. The use of a microsurgical tendon holder makes it possible to ensure the safety of the macromicroscopic structure of the tendon, the anatomicity and precision of the tenoraphy, in comparison with traditional methods of tendon retention.

The paper provides information on the possible levels of performing shunting operations for limb lymphedema. The aim of the study was to study the anatomy of the lymphatic system of the skin and subcutaneous tissue in the clinic and in the experiment, comparing the data obtained with morphological changes occurring during the development of lymphedema. The substantiation of the levels of shunting operations is presented, taking into account the anatomy of the lymphatic system and pathophysiological changes in tissues during the development of chronic edema.

Carpal and cubital tunnel syndromes are the most common compressive neuropathies of the upper limb. Since the end of the 20th century, endoscopic technologies have become increasingly popular in decompression surgery for compression neuropathies. Since 2017, 194 patients have been operated on the basis of the Institute of Microsurgery (Tomsk, Russia), of which 154 with carpal tunnel syndrome (1st group) and 40 with cubital tunnel syndrome (2nd group). In the postoperative period, the results of the operation were assessed by changes in the level of neuropathic pain using the PainDetect questionnaire and the degree of hand dysfunction according to the DASH questionnaire, before and after the operation, and an analysis of early and late postoperative complications was also performed. The data obtained indicate a significant decrease in the level of neuropathic pain and a subjective improvement in hand function in patients of both groups 1 month after surgery. No early postoperative complications were detected in 1st group, late ones were noted in 7 patients, which amounted to 4.5%. In 2nd group, in the early postoperative period, 2 out of 40 patients had early postoperative complications, which amounted to 5%, late ones were not detected. It has been proven that endoscopic decompression of the median nerve in the carpal tunnel and the ulnar nerve in the cubital tunnel are effective and relatively safe types of surgery.

Objective. A new technique for waist narrowing by means of osteotomy and osteoclasia of lower ribs followed by fixation in a tightening thoracolumbar corset was proposed and patented in 2017. The preliminary results showed its high efficiency and safety, but data on the morphological changes in ribs and in chest in general have not yet been published.

The purpose of this study was to analyze changes in the chest in patients after waist narrowing using computed tomography (CT).

Material and methods. 57 waist narrowing surgeries were performed in the period of 2017–2020. All patients were female, mean age (35.6 ± 5.0) years old. Of the 57 patients, 21 underwent chest computed tomography before and 3 months after the surgery. The remaining 36 patients did not undergo CT for various reasons. Based on the CT data, a retrospective study was performed. We compared the inner and outer diameter of the chest at the level of the 10^th rib before and after the surgery and compared these data with changes in waist circumference.

Results. The mean preoperative value of the internal diameter of the chest was (25.3 ± 2.1) cm, after surgery this measure decreased to (22.9 ± 2.7) cm, and the mean difference was (2.4 ± 1.0) cm (9.6%). The average outer diameter (from skin to skin) decreased from preoperative (29.0 ± 0.8) cm to (26.0 ± 1.9) cm (10.1%). At the same time, waist circumference decreased by (8.4 ± 3.5) cm from an average of 73.1 ± 4.7 to (64.7 ± 4.4) cm (11.1%). In 18 out of 21 cases, a complete union of the ribs was observed, in 3 patients there was atrophic non-union with no changes in the waist circumference.

Conclusion. The analysis showed that after the waist narrowing surgery 85.7% of the osteotomized ribs united. It led to an irreversible changes in the diameter of the lower part of the chest and thus to a persistent decrease in waist circumference.

The purpose of the work is to improve the quality of vertical face lifting by introducing into surgical practice a laser system of the Fotona SP Spectro model with a Nd:YAG laser source. The technique of intraoperative exposure of the Fotona SP Spectro laser system with an Nd:YAG laser source to the superficial muscular-aponeurotic system (SMAS) of the middle and lower third of the face is proposed. The authors conclude that the use of Nd:YAG laser in a single procedure shortens the rehabilitation period and significantly increases the rejuvenation effect in cases with hypermobile and thinned SMAS.

Removal of large and giant vestibular schwannomas is associated with the risk of paresis of facial muscles. The probability of anatomical damage to the facial nerve is 10.3–14.0%. Treatment of mimic muscle paralysis is one of the most difficult problems in reconstructive surgery. In this study, the results of neurotization of the facial nerve by masticatory were evaluated in 4 patients after its damage during the removal of large and giant vestibular schwannomas. Neurotization was carried out 10–14 days after tumor removal. With direct neurotization of the facial nerve by masticatory in all patients, it was possible to achieve the function of mimic muscles, corresponding to grade II–III according to the House–Brackmann scale. The use of an autoinsert from the greater ear nerve led to a worse result (House–Brackmann IV).

Objective. The treatment of necrosis, perforation and traumatic damage to the small intestine has always attracted the attention of surgeons due to the high incidence of complications and mortality that occur during treatment. However, there is very little research on this paper.

Purpose of the study: to compare the results of treatment of patients using the tactics of suturing wounds or perforations and resection of the intestine with the imposition of a primary anastomosis with obstructive resection of the intestine with the formation of an anastomosis in a delayed manner.

Material and methods. The clinical study was conducted at Novokuznetsk City Clinical Hospital No. 1 named after G.P. Kurbatov and Novokuznetsk City Clinical Hospital No. 29 named after A.A. Lutsik in the period of January 2011 to February 2019. A retrospective and prospective study was conducted, including an analysis of 835 patients treated for necrosis, perforation and traumatic damage to the small intestine. All patients were randomly distributed into groups with the imposition of a primary anastomosis and bowel resection with the formation of a delayed anastomosis. The estimated indicators were lethality and developed complications associated with the chosen treatment tactics during the patient's stay in the hospital.

The results. The most common cause of surgical interventions on the small intestine was acute intestinal obstruction – 58.0%, followed by acute mesenteric circulation disorder (27.1%), inflammatory bowel perforation (6.7%) and intestinal trauma (8.3%): and the most common operation in the retrospective group was resection of the intestine with the imposition of a primary anastomosis (64.0%), then suturing of the perforations of the inte stine (5.5%) and the imposition of a stoma (4.3%), in the prospective group group anastomosis after resection of the affected area was applied in a delayed order (100%). The most common complication in the retrospective group was anastomosis or bowel suture failure (64.3%), which was only 8% in the prospective group, however, in the latter group, superficial wound infection was most common (26.8%), accompanied by wound suture dehiscence. in 11.3% of individuals. The incidence of anastomotic leaks significantly decreased after delayed formation. Intestinal fistulas/stoma leaks were detected in 11.5% of patients in the retrospective group. Patients in the prospective group had a longer median ICU stay (11 days vs 4; p < 0.001) and a longer median hospital stay (27 vs 14 days; p < 0.008). Overall mortality in the retrospective group was 47.1%, in the prospective group – 14.8%.

Conclusion. Patients in the group with bowel resection and delayed anastomosis had a significantly lower rate of mortality and complications associated with anastomosis or bowel suture failure in conditions of peritonitis compared with the group with primary anastomosis, but had a longer stay in the hospital and a greater number of surgical operations.

Reliance on authentic sources and the latest research allows the authors of the paper to characterize the Ioanno-Predtechensky Convent and the conventual cemetery. They write about most prominent citizens of Tomsk of the end 19^th – beginning 20^th century, including Professors of Imperial Tomsk University E.G. Salishchev, P.S. Klimentov, D.I. Timofeyevsky, who were buried in convent. According to the Decree on Freedom of Conscience, Church and Religious Societies, adopted by the Council of People's Commissars of Soviet Russia in 1918, the convent was closed, and the creation of a campus (studgorodok) began on its territory. In 1930, the local authorities decided to destroy the cemetery, and use the grave monuments for new construction. The authors found out that in mid-1950s a large 4-storey house was built on the cemetery site. Not a single burial or grave monument, except for Potanin’s ash, could be preserved. The authors believe that the monument to all those buried in the convent is the chapel of St. Domna Tomskaya, consecrated in 1996.

In the early 1990s, a team of scientists from the Tomsk Medical Institute, consisting of V.V. Pekarsky, G.Ts. Dambaev, O.S. Popov, and A.G. Martusevich, together with employees of the Tomsk Institute of Automated Control Systems and Radioelectronics, V.F. Agafonnikov, S.F. Glushchuk, created autonomous electrical stimulators of the gastrointestinal tract. They represent a 22 × 11 mm oval-spherical metal capsule, inside which a power supply unit made of SC-21 elements and a special hybrid microcircuit capable of generating rectangular electrical impulses that actively affect the motor-evacuation function of the digestive tract are hermetically placed.

The appearance of such a medical device in practical healthcare in those years was several decades ahead of the development of microelectronics in medicine. A miniature capsule is inserted into the patient’s digestive tract by normal ingestion. Once in the gastrointestinal tract, the capsule begins to generate physiologically adapted electrical impulses for the human body, taking on the role of an “artificial rhythm driver” by the peristalsis of the digestive tract. Having completed the task, the capsule naturally leaves the body during the act of defecation.

To date, of the few such medical devices, an endovideocapsule can be called, created by Gavriel Iddan, an engineer of the Department of General Surgery of electro-optical structures of the research group of the Israel Ministry of Defense.

Autonomous electrical stimulators of the gastrointestinal tract have spread widely across the planet. Today they are produced and successfully used in many countries of the world. A large number of analogues appeared, new names were invented: “Electronic tablet”, “Kremlin tablet”, “Erectron”, etc. But, all these products are based on the ideas of Tomsk scientists.