Multi-stage Surgical Treatment Research Articles

HYPERPLASIA OF INTERNAL ANAL SPHINCTER. CASE REPORT

It is possible to find some reports on isolated thickening of the internal anal sphincter and the causes of its development in the literature. However, no clear diagnostic program and surgical correction description has been detected for this condition. This clinical observation demonstrates a rare case of the hyperplasia of the internal sphincter syndrome with the obliteration of the anal canal, and also successful rehabilitation of the patient during the multi-stage surgical treatment.

Особенности тактики многоэтапного хирургического лечения открытых переломов

Цель. Изучить путем сравнения результаты применения при ОП классической тактики и тактики многоэтапного хирургического лечения, обсудить вопросы выбора метода фиксации ОП и возможности раннего закрытия обширных ран и дефектов мягких тканей.
 Материалы и методы. Проанализированы результаты лечения 286 пациентов с ОП костей верхних и нижних конечностей в ортопедо-травматологическом центре Киевской областной клинической больницы за период с 2008 по 2016 г. Применяли классические методы и тактику многоэтапного хирургического лечения.
 Результаты. Оценивали результаты хирургического лечения ОП костей верхних и нижних конечностей с использованием балльной шкалы Neer-Grantham-Shelton. Хорошие результаты получены у 54,84% пациентов 1-й группы и у 80,28% пациентов 2-й группы.
 Выводы. Успех лечения ОП зависит от ранней госпитализации, ранней радикальной хирургической обработки, стабильной фиксации сломанной кости, применения рациональных доз антибиотиков, коррекции иммунологического статуса. Одними из наиболее спорных и нерешенных остаются проблемы выбора метода фиксации ОП и раннего закрытия раны.

SURGICAL TREATMENT OF CHILDREN WITH CONGENITAL SPINAL DEFORMITIES ASSOCIATED WITH MULTIPLE MALFORMATIONS: A LITERATURE REVIEW

The tactics of surgical treatment of patients with spinal deformities associated with multiple malformations is of great importance because of aggressive course of disease, limited opportunities for radical correction of deformity, and a high risk of complications. The review analyzes the literature devoted to this problem. The theoretical basis behind the need for surgical treatment is considered. The current methods of surgical intervention are presented, and their principal ideological and practical differences are demonstrated. Surgical treatment of patients with spinal deformity associated with multiple malformations is of particular interest in the practice of a spine specialist. Most patients at an early age require multi-stage surgical treatment which threatens to entail serious complications. In order to minimize risks and improve the final result of treatment, it is necessary to apply existing surgical techniques, as well as correctly arrange a sequence and frequency of their implementation.

SURGICAL TREATMENT OF TUBERCULOUS SPONDYLITIS IN A PATIENT, LIVING WITH HIV INFECTION, ON A BACKGROUND OF DEEP IMMUNOSUPPRESSION

Purpose: аnalysis of typical case of complicated course of tuberculous spondylitis in a female patient living with deep immunosuppression. Materials and methods: the Examination and treatment of the patient was carried out in accordance with national clinical guidelines for TB using standardized scales and by the presence of postoperative complications. Conclusion: late referral of the patient for medical care (after 7 months from disease onset), lasting, conservative (6 months) treatment without regard to sensitivity to anti-TB drugs, ineffective surgical on the treatment of tuberculous spondylitis has led to a complicated course of tuberculosis spondylitis. The error in tactics of treatment has led to the need for further multi-stage surgical treatment.

THE USE OF THE NEGATIVE PRESSURE WOUND THERAPY SYSTEM FOR PATIENTS WITH COMPLICATED BONE INJURIES

The article presents a successful experience of complex multi-stage surgical treatment of a severe open comminuted fracture of the humerus with large detachment and crushing of the soft tissues of the upper limb. Special attention was paid to approaches to performance of staged surgical treatment and preparation of the wound to plastic closing, state-of-art treatment methods that include negative pressure wound therapy (NPWT), treatment of wounds with a "pulsating liquid jet", use of noninvasive means for the topical treatment of wounds. The whole complex of the proposed surgical and conservative methods allowed transferring of the wound process from the complicated to the normal category, reposition and closing of the fracture area with fully functional soft tissues, complete elimination of the extensive injury of the upper extremity in a functionally active region, to a greater extent at the expense of local surrounding tissues, as well as achievement of the good functional and cosmetic effect.

Multistage surgical treatment of elderly patient with multiple colon cancer: case report

А clinical case of successful multistage surgical treatment of elderly patient with primary synchronous colon cancer is presented. Locally advanced tumor are in ascending colon, the secod tumor are in sigmoid colon. The treatment realized in two stages after assessment by multidisciplinary team based on decision of council of physicians consist of oncologist, anaesthesiologist, therapeutist and neurologist. First stage include an ileotransversal bypass. After the complex rehabilitation during one month in aggregate with pre-operative council of physicians second stage are simultaneous radical right hemicolectomy with abdominal wall resection and sigmoidectomy with abdominal wall defect plastic by own tissues. Staged surgical treatment allowed to perform radical resection of the giant malignant neoplasm of the colon with good clinicasl result.

���������� ��������� ����������� ������-�������� (����) � ����������� ���������������� ������������ � ������� � �������������� ���������� ������ �����������

Purpose. To study the efficiency of using the military-field rod kit for osteosynthesis of gunshot limb bone fractures. Materials and Methods. We studied the results of treating 117 wounded persons with isolated gunshot fractures of limb bones. Damage control approach, as well as consecutive osteosynthesis of fragments was used in the tactics of the wounded managing. The results of using the device of the military-field rod kit (MFRK) were compared in 54 wounded persons, as well as those of using another rod device in 63 wounded persons at the first stage of multistage surgical treatment. Results. The results demonstrated MFRK device potential to provide external fixation of long bone fragments faster and more efficiently. Conclusion. The use of MFRK at the first stage allows early switching to internal osteosynthesis, as well as obtaining good functional and anatomical outcomes.

Tessier No. 3 and No. 4 clefts: Sequential treatment in infancy by pre-surgical orthopedic skeletal contraction, comprehensive reconstruction, and novel surgical lengthening of the ala base-canthal distance

BackgroundRepair of facial clefts implies wide tissue mobilization with multi-stage surgical treatment. Authors propose pre-surgical orthopedic correction for naso-oro-ocular clefts and a novel surgical option for Tessier No. 3 cleft. MethodsTwo male infants, a Tessier No. 3 cleft (age 7 months) and another Tessier No. 4 (age 3months), were treated with a modified orthopedic Latham device with additional septo-premaxillary molding and observed to age four years. Tessier No. 3 orthopedic measurements were obtained by image corrected cephalometric analysis. Subsequent repair included tissue expansion on Tessier No. 4 and naso-frontal Rieger flap combined with myocutaneous upper lid flap on Tessier No. 3. ResultsOrthopedic movements ranged from 18.5 mm in bi-planar to 33 mm in oblique analyses. Tissue margins became aligned with platform normalization. Tissue expansion on Tessier No. 4 improved distances from ala base-lower lid and subalar base-lip. The naso-frontal flap combined with myocutaneous upper lid flap on Tessier No. 3 had similar achievement, but also sufficiently lengthened ala base-canthal distance. ConclusionsRepairs were facilitated by pre-surgical orthopedic correction. The naso-frontal flap combined with an upper lid myocutaneous flap seems viable as a single-stage option to lengthen ala base-canthal distance to advance repair achievement in unilateral Tessier No. 3.

Multi-stage surgical treatment of woundeds with combined thermomechanic injuries in local armed conflict

To improve the results of surgical treatment of woundeds with combined thermomechanic injuries in local armed conflict. It was analyzed treatment of 93 victims with thermomechanic injuries. In 29 (31.2%) aptients only Early Total Care protocol (ETC) was used up to 2001. These victims received complete surgical care. Since 2002 diffirentiated approach of multi-stage surgical treatment (Damage Control Surgery) has been applied. ETC tactics was used if systolic blood pressure was more than 90 mm Hg (30 woundeds, 32.2%). DCS protocol was preferred in case of blood pressure less than 90 mm Hg or multiple-organ failure (34 patients, 36.6%). Diffirentiated surgical approach decreases mortality rate from 13.8% to 7.8% (p=0.453) compared with group of conventional one-stage care.

Colorectal cancer complicated by perforation. Specific features of surgical tactics

Objective: to assess the immediate results of surgical interventions for colorectal cancer complicated by perforation. Materials and methods. The immediate results of surgical treatment were retrospectively analyzed in 56 patients with colorectal cancer complicated by perforated colon cancer, who had been treated at Smolensk surgical hospitals in 2001 to 2013. Patients with diastatic perforation of the colon in the presence of decompensated obturation intestinal obstruction of tumor genesis were not included into this investigation. Results. The immediate results of uni- and multistage surgical interventions were analyzed in relation to the extent of peritonitis and the stage of colon cancer. More satisfactory immediate results were observed after multistage surgical treatment. Following these interventions, a fatal outcome of disseminated peritonitis in the presence of performed colorectal cancer was recorded in 8 (53.3 %) cases whereas after symptomatic surgery there were 11 (67.8 %) deaths. A fatal outcome was noted in 1 case (7.7 %) after multistage surgery. Discussion. The results of surgical treatment in the patients with perforated colorectal cancer are directly related to the degree of peritonitis and the choice of surgical tactics.

POST-BURN SCAR DEFORMITIES OF THE FOOT: PECULIARITIES OF CLINICAL FINDINGS AND TREATMENT

The article describes the development terms of scar deformities of the foot and secondary changes in the tendon-muscular and osteoarticular systems depending on the child’s age and localization of scars. It is shown that the most common type of the secondary deformation is extensive contracture in metatarsophalangeal joints. In almost half of the patients (46.1 %) contractures lead to dislocations in metatarsophalangeal joints. It is noted that in younger children (1-3 years old) secondary deformations developed in the earliest time, after only 8 months after burn injury. It is shown that scars located on the lateral surface of the foot with the transition to the ankle cause an increased risk of multiplanar foot deformity. Prolonged existence of multiplanar deformation leads to the changes of the shape of the articular surfaces and requires a multi-stage surgical treatment.

Hypoplastic left heart syndrome - a review of supportive percutaneous treatment.

Due to the complex anatomical and haemodynamic consequences of hypoplastic left heart syndrome (HLHS), patients with the condition require multistage surgical and supportive interventional treatment. Percutaneous interventions may be required between each stage of surgical palliation, sometimes simultaneously with surgery as hybrid interventions, or after completion of multistage treatment. Recent advances in the field of interventional cardiology, including new devices and techniques, have significantly contributed to improving results of multistage HLHS palliation. Knowledge of the potential interventional options as well as the limitation of percutaneous interventions will enable the creation of safe and effective treatment protocols in this highly challenging group of patients. In this comprehensive review we discuss the types, goals, and potential complications of transcatheter interventions in patients with HLHS.

Body contouring after massive weight loss - case report.

The paper presents a 25-year-old woman who is using a strict diet of 1000 kcal lost 83 kg in 18 months. Despite her young age, weight loss caused numerous cutaneous fatty folds, because her skin was not elastic or resilient enough. The patient undergo a multi-stage surgical treatment aiming to rectify the deformations. This example illustrates the problems of patients having undergone intensive slimming procedures and presents surgical treatment methods that rectify typical deformations in these patients.

FEATURES OF SURGICAL TREATMENT OF THE SACRUM FRACTURES

The analysis of the frequency, structure and circumstances of the sacrum fractures in 148 patients, as well as evaluated the results of treatment 65 patients using conventional techniques and 83 with multiphase surgical tactic. The use during the first stage of external fixation devices, Ganz pelvic frame and active surgical treatment due to a quick stop the intrapelvic bleeding led to a decrease of the frequency of mortality by 2.6 times. The use of highly informative diagnostic methods and multi-stage surgical treatment in patients with concomitant pelvic injuries have reduced mortality by 1.4 times, the number of physical complications - by 1.6 times, local complications - by 2.4 times, the length of hospital stay - by 1.6 times, the frequency of permanent disablement - up to 28.9%, to restore the ability to work with 76.7% of patients within the first year.

FEATURES OF GAS EXCHANGE DURING MULTISTAGE SURGICAL INTERVENTION FOR TRAUMATIC SPINE INJURY

Objective. To study gas composition and acid-base balance of blood in the course of multistage surgical intervention for traumatic spine injury. Material and Methods. Gas composition and acid-base balance of blood were analyzed in 51 patients with traumatic spine injuries during multistage surgical treatment in a single operation. Patients were divided into two groups: Group 1 included 26 patients operated on under TIVA with propofol, fentanyl, and еsmeron; and Group 2 included 25 patients operated on under general anesthesia with sevoflurane in low-flow ventilation mode, fentanyl, and еsmeron. Results. In both groups acid-base balance parameters in blood were characterized by unidirectional changes depending on the state of compensated metabolic acidosis. More essential fluctuations in pH, and in the excess or deficit of buffer bases depended on the type of surgical intervention. They were more statistically significant during anterior procedures in condition of open pneumothorax requiring changes in lung ventilation parameters. Values of paO2 and paCO2 remained relatively stable in both groups at the study stages. Conclusion. Main factors determining changes in blood gas parameters during spine surgery are specific features of the anterior fusion procedure and its succession in the course of multistage surgical intervention. Hir. Pozvonoc. 2012;(2):79-86.

RETROSPECTIVE ANALYSIS OF INTRAOPERATIVE BLOOD LOSS DURING SURGERY FOR IDIOPATHIC SCOLIOSIS

Objective. To perform quantitative assessment of intraoperative blood loss volume and severity during stages of idiopathic scoliosis surgical correction. Material and Methods. Data of intraoperative blood loss during stages of surgical correction of idiopathic scoliosis were analyzed in 1241 operated patients. Multi-stage surgical interventions were performed in 581 (46.8 %) patients, posterior fusion - in 660 (53.2 %), and multilevel corrective vertebrectomy - in 72 (12.4 %) patients. Two methods of general anesthesia were used: TIVA with propofol, fentanyl, tracrium, and with inhaled sevoflurane, fentanyl, and tracrium. Volumes of intraoperative blood loss were assessed at main stages of surgery. Results. Total intraoperative blood loss during multistage surgical treatment with segmental hook instrumentation was 967.4 ± 43.6 ml, and with hybrid instrumentation - 1135.9 ± 139.5 ml. Blood loss during posterior only fusion procedure was 865.5 ± 40.1 ml with segmental hook instrumentation, and 1049.9 ± 75.5 ml with hybrid instrumentation. Multilevel vertebrectomy was associated with maximum intraoperative blood loss of 1242.9 ± 121.8 ml. Conclusion. Intraoperative blood loss during surgical correction of idiopathic scoliosis varies considerably and averages from 20.0 to 40.0 % of the circulatory blood volume. The duration of surgical intervention is the main proved factor influencing the volume of blood loss. Hir. Pozvonoc. 2012;(2):70-78.

КОМПЛЕКСНОЕ ЛЕЧЕНИЕ ПАЦИЕНТА С МНОЖЕСТВЕННЫМИ ПОРОКАМИ РАЗВИТИЯ ПОЗВОНОЧНИКА И СПИННОГО МОЗГА

Clinical case of the patient with the congenital deformation of thoracic and lumbar parts of the spine due to multiple congenital anomalies of vertebrae (disturbance of formation, fusion and segmentation), a terminale filum lipoma at the level of L5, tethered cord, rightside lower leg monoparesis. Multistage surgical treatment was performed: removing of intracanal deformity, correction and stabilization of the deformity at the thoracic and lumbar part of the spine. Patient was followed up during 2,5 years after the last step of the surgical operation. No evidence of recurrence or neurological deterioration were observed.

Long term results of the right ventricle-to-pulmonary artery shunt in Norwood procedure for children with hypoplastic left heart syndrome

Purpose: The hypoplastic left heart syndrome (HLHS) is still a challenge for pediatric cardiac surgeons. The aim of this study was to present the multistage surgical treatment long term results of children with HLHS with application in the first stage palliation of the right ventricle-to-pulmonary artery shunt (RV-PA).

Electrical injuries

Electrical trauma can be caused by low-voltage current (from 60 to 1000 V, usually 220 or 360 V), high-voltage (more than 1000 V) current, lightning, and voltaic arc. Often victims are little children, teenagers, and working-age adults. Electrical injuries and clinical manifestations can vary a lot and range from mild complaints undemanding serious medical help to life-threatening conditions. Lightning causes serious injuries in 1000–1500 individuals every year worldwide. The case fatality rate is about 20–30%, with as many as 74% of survivors experiencing permanent injury and sequela. The primary cause of death in victims of lightning strike or other electrical trauma is cardiac or respiratory arrest. That is why appropriate urgent help is essential. Subsequently electrical burns, deep-tissue and organ damage caused by electricity, secondary systemic disorders often demand intensive care and prompt, usually later multistage surgical treatment; therefore, prevention of electrical trauma, which would help to reduce electrical injuries in children and working-age population, is very actual. The most important is to understand the possible danger of electricity and to avoid it.

COSTAL HUMPBACK RESECTION AS A FINAL STAGE OF IDIOPATHIC SCOLIOSIS SURGICAL TREATMENT

Objective. To analyse results of multistage surgical treatment of idiopathic scoliosis including costal humpback resection. Material and Methods. From 1996 to 2005 twenty girls with idiopathic scoliosis underwent spine deformity correction with Harrington distraction rod with Drummond interspinous wires (Group I) or with Cotrel – Dubousset Horizon Instrumentation (Group II). The final long-dated stage after correction of deformity included the costal humpback resection at the convex side only. Radiologic and topographic examinations were performed, and lung vital capacity parameter was used for lung function assessment. Patients answered the Russian version of SRS-24 questionnaire after correction and at each follow-up examination. Results. In Group I the mean curvature was 81.7° ± 26.7° (range, 55–107°) before correction and 34.5° ± 13.1° after correction (primary curve correction 57.8 ± 14.1 %). Mean correction loss in dynamics before resection was 8°, after resection 4.3°. In Group II the primary curve magnitude before correction was 87.4° ± 27.1° (range, 48–126°), after correction 42.7° ± 16.9° (primary curve correction 51.9 ± 9.6 %). Average correction loss in dynamics before resection was 3.5°, after resection 2.4°. Spirometric findings presented the following dynamics: lung vital capacity before resection was 1980 ml with mean early postoperative decrease by 16.8 % and subsequent reversion to the preoperative level or increase to 2010 ml. According to the questionnaire survey 100 patients gave the consent for surgery. Conclusion. Costal humpback resection as a cosmetic intervention improves the patient’s assessment of spine deformity surgical correction result.