Reconstructive Interventions Research Articles

Opponens pollicis in fetuses: classifications, measurements, and clinical implications

A fetal investigation on the anatomical properties of opponens pollicis was not encountered in the literature in terms of surgical procedures performed in the early childhood period. In this context, this study aimed to examine the origin, insertion, and morphometric characteristics of opponens pollicis in human fetuses. Fifty-two sides of 26 fetuses (mean age: 24.08±4.22 weeks, sex: 11 males and 15 females) were dissected. The origin and insertion of the opponens pollicis were noted. The area, length, and width of the opponens pollicis were measured with the surgical microscope. Furthermore, according to the literature review, the origin and insertion of opponens pollicis were classified as seven and four types, respectively. The mean width, length, and area of the opponens pollicis were found as 3.28±1.15 mm, 7.12±2.44 mm, and 20.45±16.14 mm2, respectively. In this study, opponens pollicis most commonly started from the flexor retinaculum plus the tubercle of the trapezium (22 sides) and ended on the anterolateral side of the first metacarpal bone (41 sides). Fetal information related to morphometric characteristics and variations of opponens pollicis may be important for clinicians in reconstructive interventions on the thumb muscles in the early childhood period. Our classifications performed for the first time in the literature may guide future studies, especially those focused on thumb anomalies such as polydactyly and syndactyly.

Experience of using the passive exoskeleton EXAR-34 in complex rehabilitation of a patient with post-traumatic plexopathy due to gunshot cervicothoracic wound (clinical observation)

The use of passive exoskeletons is a promising direction in the treatment of patients with severe combat injuries to the shoulder girdle, leading to disability in 30 % of cases. Aim: To demonstrate the capabilities of the passive exoskeleton EXAR-34 in the rehabilitation and habilitation of a victim with damage to the branches of the brachial nerve plexus. Materials and methods: An analysis of medical documentation, physical examination, morphometry, and goniometry were carried out. Clinical observation and discussion: A patient with post-traumatic left-sided plexopathy due to a gunshot perforating shrapnel cervicothoracic wound with gunshot fractures of the transverse processes of C6, C7, Th3 vertebrae, I–III ribs on the left after reconstructive intervention on elements of the brachial nerve plexus, when previously carried out rehabilitation measures were ineffective, during the first fitting of the EXAR-34 device, the range of active movements in the joints of the injured limb increased to 37,1–60,7 %, and routine motor skills were restored. Conclusion:The experience of using the EXAR-34 device demonstrates high promise in complex rehabilitation and habilitation of patients after reconstructive interventions on the brachial plexus for combat wounds.

Reconstructive interventions on bile ducts in patients with benign obstructive jaundice

Aim. To evaluate immediate and long-term results of surgical reconstruction of the biliary system in various types of benign obstructive jaundice.Materials and methods. The study enrolled 110 patients with choledocholithiasis, iatrogenic biliary strictures, common bile duct strictures, as well as strictures of biliodigestive and biliobiliary anastomoses. Patients were divided into 3 groups. Group 1 included 43 patients with multiple choledocholithiasis and bile duct dilatation >15 mm. Group 2 enrolled 35 patients with multiple choledocholithiasis and hepaticolithiasis who were intraoperatively diagnosed with stricture, injury, or pressure ulcers of the common bile duct wall. Group 3 included 32 patients with cicatricial and iatrogenic biliary strictures. The immediate and long-term results of surgical treatment were compared.Results. In group 1, the survival rate comprised 89.4%, the average duration of surgery amounted to 137 minutes, complications involved wound infection, bile leakage, bile peritonitis. In group 2, the survival rate accounted for 91.4%, the average duration of surgery comprised 192 minutes; strictures of biliodigestive anastomosis were detected in the remote period, and reconstructive surgeries were performed. Group 3 revealed the survival rate of 100%, the average duration of surgery of 215 minutes, and no complications in the long term.Conclusion. The diameter of the common bile duct, its wall changes, size of gallstones, signs of cholangitis, patency of the bile papilla, and localization of biliary stricture determine the surgical tactics, when performing biliary reconstruction in patients with non-cancerous obstructive jaundice. In case minimally invasive surgery is found impossible under conditions of multiple choledocholithiasis, common bile duct diameter >15 mm, and preservation of its wall, choledocholithotomy with Kerr drainage is considered to be optimal. In case of damage to the CBD wall and patency of the bile papilla, preference shall be given to hepaticoenterostomy. Bile duct reconstruction with stent drainage is indicated for treatment of cicatricial and iatrogenic biliary strictures.

Lower leg shortening technique in treatment of the wounded with gunshot tibial fractures

Background. The severity of gunshot wounds to the extremities is due to the formation of bone and soft tissue defects. The relevance of this publication is determined by the need to introduce simple and effective methods into the practice of providing assistance to the wounded. The technique under consideration fully satisfies these requirements. The aims of the study: 1) to optimize the lower leg shortening technique and analyze the short-term results of its application in treatment of the wounded with gunshot tibial fractures; 2) to assess the indications for surgical restoration of the lower leg length after its shortening. Methods. The study enrolled 45 wounded patients with gunshot fractures of the lower leg bones. Reconstructive interventions were performed on 51 segments. In the absence of purulent-necrotic lesions of the fragments ends, closed reduction and convergence to tight contact without resection were performed (13 cases, group I). In the case of necrosis of the fragments ends, resection and convergence were performed with significant shortening of the segment (38 cases, group II). Results. The amount of shortening accounted for 4 cm [3; 6] in group I and 8 cm [7; 10] in group II (p0.001). Due to the convergence of the fragments, the reduction of the soft tissue defect was 25 cm2 [11; 41] and 38 cm2 [20; 81] in group I and II respectively. In 2 (15.4%) patients in group I and 4 (10.5%) patients in group II no fusion occurred. In the remaining cases the fusion occurred, the consolidation period was 50 [45; 59] weeks in group I and 36.5 [29; 43] weeks in group II (p0.001). Conclusions. Depending on the condition of fragments ends, there are two possible options of the shortening technique: without resection and with resection of the fragments ends. Shortening without resection is possible in the absence of signs of fragment necrosis. The disadvantage is the risk of delayed fusion, the advantage is the ability to avoid traumatic intervention in the form of resection of the fragments ends. In case of the fragments ends necrosis, their transverse resection and convergence with the elimination of diastasis between them is necessary. The advantage of this shortening technique is the optimization of conditions and reduction of fusion time, the disadvantage is the formation of significant bone defects. The need for lengthening of the shortened segment does not always arise. Lengthening as a second stage after conducting rehabilitation is considered as an optimal choice.

Effect of body mass index on post-treatment oral function in patients with oral cancer: a cross-sectional study

This single-center cross-sectional study used sequential sampling to examine the influence of body mass index (BMI) on oral function after oral cancer treatment. Patients who completed primary oral cancer treatment between September 2019 and March 2023 (102 patients, 74 male [72.5%] and 28 female [27.5%]; mean age, 69.6 years) were analyzed. Patient background data were collected from electronic medical records. Post-treatment oral function measurements were conducted on all patients using six assessment tools. Statistical analysis was conducted using Pearson’s correlation coefficient, one-way analysis of variance, the Jonckheere–Terpstra test, and multiple linear regression. Pre-treatment BMI showed a statistically significant relationship with postoperative oral function, particularly tongue pressure (P = 0.01). While the mean values of the groups showed no significant differences, the Jonckheere–Terpstra test revealed a statistically significant trend toward a stepwise increase in tongue pressure for each BMI group (P = 0.03). Multiple linear regression analysis revealed a statistically significant correlation between tongue pressure and pre-treatment BMI (P < 0.05). Pre-treatment BMI was significantly associated with tongue pressure. Since BMI is a variable factor that can be controlled by nutritional therapy even before treatment, nutritional intervention, weight control, and treatment strategies including reconstructive interventions to maintain tongue pressure may be important in oral cancer treatment.

Modern aspects and clinical perspectives of changing the biotype of the mucous membrane in the projection of the dental implant

Today, there is a growing scientific interest in the condition of the soft tissues surrounding dental implants and their impact on the long-term prognosis of implant treatment. It is known that risk factors for the development of peri-implantitis include deficiency or complete absence of attached keratinized gum in the implant area. The paper provides a comparative literature analysis of various methods of mucogingival surgery in the field of dental implants. The paper presents a comparative literature analysis of various methods of mucogingival surgery in the field of dental implants. It is shown that information on the terms of use of dental implants and the conditions of their functioning is quite contradictory. Loss of implants occurs for a number of reasons, among which an important place is occupied by periimplantitis, progressive loss of bone tissue and attached gum in the periimplant zone. The risk of remote postoperative complications remains very high. Complications may be associated with the fact that in clinical practice the features of the histostructure of the gum in the adentia zone are not taken into account. It is concluded that soft tissue plastic surgery as one of the stages of surgical preparation after reconstructive interventions on the jaws is justified according to the literature. At the same time, the problem of creating a peri-implant “buffer” zone, despite significant advances in the development of new technologies for its formation, has not been finally resolved. Discussions continue about the role of attached keratinized gum around implants.

Leakage of Intestinal Anastomoses: A New Solution to the Old Problem

Leakage of intestinal anastomoses remains an issue in view of the increasing number of patients who need reconstructive interventions in different parts of the gastrointestinal tract. Researchers around the world are actively looking for methods of strengthening intestinal anastomoses. The literature presents various approaches to sealing intestinal anastomoses in experimental animals using allografts, biological sealants, polymer film materials, etc. This article classifies and analyzes innovative methods of strengthening intestinal anastomoses to prevent their leakage. We also describe a concept of developing polymer membranes for interventions on hollow organs and our experience in this field of work and making of medical devices at the premises of a university research laboratory.

Dynamics of feet dorsiflexion after percutaneous Achilles lengthening for correction of flat feet in children

BACKGROUND: Achilloplasty is one of the most common procedures in the reconstruction of various foot deformities. Achilles tendon lengthening is often used in most reconstructive interventions in patients with flatfeet. Literature data reflecting the dynamics of foot dorsiflexion after percutaneous achilloplasty are limited. AIM: This study aimed to determine the foot dorsiflexion dynamics in children with flatfeet at different time points after foot reconstruction in combination with percutaneous Achilles tendon lengthening. MATERIALS AND METHODS: The study included the observation results of 159 children (260 feet) aged 12 (9–17) years having flatfeet with Achilles tendon shortening after flatfoot reconstruction and percutaneous Achilles tendon lengthening. Dynamic follow-up was performed for 3 years after foot reconstruction. The obtained data were analyzed statistically by nonparametric one-factor analysis of variance, Kruskal–Wallis and post hoc test, pairwise comparisons, and Dwass–Steel–Critchlow–Fligner test. RESULTS: At follow-up after Achilles tendon lengthening, significant differences were obtained in the magnitude of the initial foot dorsiflexion up to 2 years after surgery, and other indicators were not significantly different. Foot dorsiflexion with tarsal joint stabilization was significantly different at all stages of follow-up compared with baseline. Foot dorsiflexion tended to decrease throughout the follow-up period. CONCLUSIONS: After reconstructive interventions on the feet in combination with percutaneous Achilles tendon lengthening, the dorsiflexion of the feet decreased over time. At 2 and 3 years after Achilles surgery, dorsiflexion was not significantly different from baseline. The angle of dorsiflexion of the feet with the tarsal joint stabilization 3 years after Achilles tendon lengthening was significantly different from the initial level, but throughout the follow-up there was also a tendency to its gradual decrease.

The role of preoperative D-dimer blood level in assessing the risk of open abdominal aortic surgery (statistical study)

Introduction. Changes in the hemostasis and fibrinolysis system in patients with aortoiliac segment lesion can cause the development of specific thromboembolic and hemorrhagic complications, accompanied by a high level of mortality. Preoperative laboratory analysis of the D-dimer blood level may help to objectify the risk assessment of open surgery in this category of patients. Objective. Assessment of the significance of preoperative blood D-dimer level in predicting the development of morbidity and mortality after open surgery on the aortoiliac segment. Materials and methods. The study included 108 patients who were determined the D-dimer blood level before planned reconstructive intervention on the aortoiliac segment at the Pavlov University from 2013 to 2021. The first group consisted of 56 patients with aneurysmal aortoiliac segment lesions, and the second group included 52 patients with occlusive-stenotic lesions of the aortoiliac segment. Results. 92 (85%) patients had an increase of D-dimer level above 500 μg/L, among them 18 patients developed early postoperative complications, and 4 cases were fatal. In 16 (15%) patients with normal D-dimer levels, the postoperative the period was uneventful. Both groups showed statistically significant differences in preoperative blood D-dimer levels depending on the presence or absence of early postoperative complications. In the first group, the median of D-dimer level in the smooth course of the postoperative period was 2035 μg/L, and in patients with complicated course – 3770 μg/L (p=0.04), in the second group these indicators were 635 μg/L and 1231.5 μg/L (p=0.02), respectively. The threshold value of D-dimer level in predicting the risk of death in the first group was 4150 μg/L (p=0.001). Conclusion. The blood D-dimer level may be an additional laboratory risk factor for adverse outcome of open surgery in patients with aortoiliac occlusive disease.

First experience of distal hybrid surgery on lower limb arteries with port-system installation

Cases of occlusive lesions of the arteries of the lower leg occupy a special place in the treatment of critical lower limb ischemia. In this regard, performing open reconstructive interventions is unpromising. A new era in the treatment of occlusions of the arteries of the lower leg has become endovascular surgery. However, due to extensive occlusive lesions of the arteries of the lower leg, direct endovascular revascularization is often impossible. Currently, vascular surgeons adhere to the angiosome principle, according to which the goal of balloon angioplasty is to restore blood supply to the artery supplying the angiosome with purulent-trophic changes. In the clinical example provided, the universality of the angiosome theory is questioned, and clinical success achieved due to the discovery of collateral blood fl ow is demonstrated. The patient underwent surgery with the use of an original hybrid operation technique with the installation of a port system followed by active therapeutic-diagnostic measures on an outpatient basis for 30 days. As a result of the treatment, epithelialization of the trophic defect and cessation of critical ischemic phenomena were noted.

Analysis of reconstructive interventions in case of failures in hiatal hernia surgery

INTRODUCTION. The method of laparoscopic fundoplication for hiatal hernia is today the most common surgical intervention for this pathology. However, there are a significant number of complications, one of the most severe is relapse of the disease. Today, according to the world literature, there is not enough information about the causes of relapse, methods of prevention and long-term postoperative results of reconstructive operations.The OBJECTIVE was to analyze of reconstructive surgeries in patients who underwent surgery for gastroesophageal reflux disease associated with hiatal hernia.METHODS AND MATERIALS. The work was performed on the basis of data from two clinics – Oncology Department ¹ 2 of the RCOD of the Ministry of Health of the Republic of Tatarstan and Thoracic Department ¹ 2 of the RCB of the Ministry of Health of the Republic of Tatarstan. 1,661 laparoscopic interventions were performed in patients with hiatal hernia. The basis of the work is the analysis of reconstructive operations in 99 patients.RESULTS. The most common reasons for reconstructive operations were relapses of diseases in gastroesophageal reflux disease associated with a hiatal hernia: destruction and (or) migration of the fundoplication cuff – 77 (77 %) cases, recurrence of paraesophageal hiatal hernia – 10 (11 %). Reconstructive surgery in patients with relapse of hiatal hernia remains the method of choice and leads to positive results in 83 % of cases.CONCLUSION. Surgical treatment of hiatal hernia should be carried out in a specialized hospital and experienced surgeons who own both laparoscopic and open methods of treating this pathology.

Distal Bypass Surgery for Critical Ischemia Using a Related Donor Vein

The article presents a case of using the trunk of the great saphenous vein from a living related donor in elective surgery for the main arteries of the lower leg. The possibility of using a vein from a relative in special clinical situations is shown. High risks of repeated interventions aimed at relieving early and late complications of vascular reconstructions remain an urgent problem in angiosurgery. Very often, operations are performed in the presence of extensive necrosis and trophic ulcers (stage IV according to the Fontaine-Pokrovsky classification). The gold standard for choosing a shunt during reconstructive operations on the infrainguinal arteries was and remains an autovenous conduit from the great saphenous vein (C, D type of arterial bed lesion according to TASC II). During repeated reconstructions in the absence of a suitable autovein and with the distal position of the peripheral anastomosis, it is not always possible to use a synthetic prosthesis as a reliable alternative. Unsatisfactory Results of using such materials dictate the need to choose a suitable graft. The problem of using allografts requires further in-depth study. In this regard, the case of using a donor vein as a material for reconstruction is given. It was concluded that it is possible to effectively use allovein from a related donor in a patient after previously performed reconstructive interventions and in the absence of autologous material for bypass surgery.

Assessment of arterial blood flow in the microvasculature of the lower extremities in patients with chronic ischemia using a single-photon emission computed tomography (SPECT)

Introduction. Obliterating atherosclerosis of the lower extremity vessels is a chronic, steadily progressive disease of the leg arteries, with a high risk of limb amputation and death. Timely diagnosis and adequate treatment will help slow the disease progression, maintain the patient’s good health for a long time and avoid complications. Purpose. To study arterial blood flow in the microvasculature of the lower extremities, to qualitatively and quantitatively assess perfusion disturbances in functionally significant muscles of the lower extremities. Material and methods. Radionuclide examination of the main vessels and microvasculature of the lower extremities was performed in 36 patients, five of them with a diagnosis of lower extremity obliterating atherosclerosis in dynamics. Radiopharmaceuticals was administered through a catheter installed endovascularly above the aortic bifurcation when patients underwent arteriography of the lower extremity vessels, which also involves intra-arterial administration of a radiopaque contrast agent. Results. When processing the radiological study results, we visually assessed the distribution of radiopharmaceuticals in the vascular bed of the lower extremities, identified the asymmetry in the accumulation of radiopharmaceuticals as a percentage, quantified the accumulation of radiopharmaceutical pulses in the projection of the pelvic, thigh, leg and foot muscles, determining the level of accumulation in each of the areas of interest as a percentage. The radiological study results and direct aortic arteriography of the lower extremities with determination of the level of arterial stenosis confirmed the ischemic nature of the pain syndrome; and in the control study, the effectiveness of treatment with an improvement in perfusion parameters. Conclusions. Intra-arterial administration of radiopharmaceuticals makes it possible to assess the condition of the peripheral arterial bed, which has a significant role in the prognosis of lower extremity atherosclerosis and the results of reconstructive interventions. The method makes possible a hybrid topometric comparison of arterio-perfusion maps for diagnosis, planned treatment and monitoring of its results in dynamics.

Markers of oncological prognosis in the surgical treatment of oral squamous cell carcinoma

The progression of head and neck squamous cell cancer (HNSCC) may be influenced by the characteristics of the local and systemic immune response, including the peculiarities of systemic inflammatory response during surgical interventions. The dependence of the prognosis of cancer patients on the preoperative general somatic status and postoperative complications is demonstrated precisely through the prism of a systemic inflammation development promoting the progression of oncological process. It is necessary to study the interaction of a typical inflammatory reaction and the features of reparative processes to understand the correct treatment strategy for patients with oral cancer in the conditions of the existing oncological process. It was found that chronization of inflammation is associated with m2-macrophage polarization which contributes to the tumor progression. And systemic inflammation indices correlate with treatment results. It is also necessary to identify prognostic factors of postoperative complications that affect the chronization of inflammation. They may include the general somatic and nutritional status of patients, concomitant diseases and indices of systemic inflammation. It is obvious that improving the results of surgical treatment of patients with oral cancer can be influenced by various ways of managing the inflammatory response, including the peculiarities of performing the reconstructive interventions and improving the preoperative general somatic and nutritional status.

Сексуальная дисфункция и репродуктивные нарушения как осложнения реконструктивных вмешательств на уретре.

Introduction. Reconstructive interventions on the male urethra present a complex surgical challenge. It is crucial not only to restore the anatomical patency of the urethra but also patients’ quality of life. The onset of sexual dysfunction after the operation significantly reduces the patients' quality of life and their perception of treatment outcomes. Objective. To conduct a review of the current literature on sexual and reproductive disorders following reconstructive interventions on the male urethra. Material and methods. Literature search was conducted using the PubMed, Google Scholar, and eLibrary databases up to August 2023. The search was performed using keywords in both Russian and English, including urethroplasty, urethral stricture, sexual dysfunction, ejaculatory dysfunction, penile shortening, penile curvature, and cold glans. Results. The development of sexual dysfunction after reconstructive interventions on the urethra depends on anatomical factors, surgical technique, and the extent of urethral involvement. Erectile dysfunction is present within the first 6 months after the surgery, followed by gradual recovery. The development of ejaculatory dysfunction, penile shortening or curvature, as well as impaired sensitivity, depends on the chosen surgical approach. Conclusion. The literature on sexual dysfunction is characterized by heterogeneous studies, making their analysis challenging. Data on reproductive disorders following urethroplasty are presented only in a few studies. To further assess surgical und functional outcomes it is necessary to conduct multicenter studies using validated questionnaires.

Клинический случай этапной хирургии последствий открытой травмы глаза

Purpose. To present a clinical case of staged surgical treatment of a patient with a battle-open eye injury. Material and methods. Patient M., born in 1976, with a condition after an open eye injury of the V degree, type B, zone II (1, 2, 3, 4, 5), with prolapse of the inner membranes, post-traumatic aniridia, post-traumatic aphakia, total hemophthalmos. From the anamnesis it is known that the patient during the shelling received several «blows» in the left side of the face. Primary surgical treatment of facial soft tissue wounds, left paraorbital area, lacerations of the upper eyelid laceration was performed. Prescribed with recommendations of conservative treatment of the left eye. The patient performed a phased surgical treatment of open eye trauma. Results. Surgical treatment was performed routinely, there were no intra- and postoperative complications. The recommended vitreoretinal and optico-reconstructive interventions ensure maximum functional, anatomical and cosmetic recovery of the operated eye. Conclusions. In stage surgical treatment of the consequences of open eye trauma, the duration of each surgical intervention is reduced. This minimizes intraoperative trauma to intraocular structures, which subsequently allows to assess the scope of optical reconstructive interventions and the need for surgical compensation of intraocular pressure. Similarly, delayed implantation of the actually required intraocular lens and iris-lens diaphragm ensures maximum refractive result and cosmetic effect. Keywords: fighting uncovered eye injury, stage-by-stage surgical treatment, optoreconstructive vitreoretinal surgery

Concomitant Glenohumeral Pathologies in Patients with Acromioclavicular Joint Dislocations: How Do Acute and Chronic Instabilities Differ?

Background: Concomitant glenohumeral pathologies may be present in patients with acromioclavicular joint (ACJ) dislocations. This study aims to record and compare the prevalence and treatment of CGP in cases with acute and chronic ACJ dislocations. Methods: This retrospective cross-sectional binational, bicentric study included patients that underwent arthroscopically assisted stabilization for acute (group A) and chronic (group C) ACJ dislocations. Intraoperatively, CGPs and eventual treatments (debridement and reconstructive measures) were recorded. Results: The study included 540 patients (87% men; mean age 39.4 years), with 410 (75.9%) patients in group A and 130 (24.1%) in group C. Patients in group C were older (p < 0.001). The CGP prevalence was 30.7%, without a difference between groups A and C (p = 0.19). Supraspinatus tendon (SSP) and labral lesions were most common. Within group C, CGPs were more prevalent in surgery-naïve patients (p = 0.002). Among 49 patients with previous surgical treatment, CGPs tended to be more common in patients with prior open surgery than arthroscopically assisted surgery (p = 0.392). Increased CGP prevalence was associated with higher age (r = 0.97; p = 0.004) (up to 63% in the oldest age group, but also 17% for youngest age group) and higher in cases with Rockwood type-IIIB injuries compared to type-V injuries (p = 0.028), but type-IIIB injuries included more group C cases (p < 0.001). The most frequently found CGPs were treated by debridement rather than reconstructive interventions (SSP and labrum: p < 0.001, respectively). Conclusions: This study shows that one in three patients with ACJ instabilities has a CGP, especially elderly patients. Most of the CGPs were treated by debridement rather than constructive interventions.

Diagnostic and therapeutic cholangioscopy performed by various accesses to the bile ducts

Aim. To summarize data, define indications and estimate outcomes of cholangioscopy performed by various accesses to the bile ducts. Materials and methods. In the period of 2017–2024, 68 cholangioscopies were performed in 24 (35.3 %) men and 44 (64.7 %) women. The age of patients ranged from 18 to 85 years (mean age comprises 61 years). 10 (14.7 %) cholangioscopies were performed by retrograde access, 42 (61.8 %) by antegrade access, and 16 (23.5 %) were performed intraoperatively. Results. The total amount of interventions include 21 (30.9 %) lithoextractions, 16 (23.5 %) targeted biopsies, 12 (17.6 %) recanalizations of anastomosis strictures, and 1 (1.79 %) case involved a retrieval of the “lost” bile duct stent. In 7 (10.3 %) cases cholangioscopy failed due to a small diameter of the bile ducts. Conclusion. Contemporary minimally invasive endoscopic methods considerably enlarge the possibilities for treatment of complex lesions of the bile ducts. Antegrade cholangioscopy contributes to a wider application of modern technologies for direct examination of the bile ducts and to expansion of the range of therapeutic manipulations. The introduction of antegrade cholangioscopy avoids extensive traumatic reconstructive interventions with their potential risk of complications.

Is it possible to anticipate complications after reconstructive surgery in patients with trophic disorders on the background of peripheral atherosclerosis in combination with diabetes mellitus?

Background. Complications after revascularization in individuals with peripheral atherosclerosis and diabetes mellitus can lead to negative results of surgical interventions against the background of critical ischemia. Objective. The aim of the study was to identify predisposing circumstances for the development of certain complications after reconstruction in patients with critical ischemia and diabetes mellitus. Materials and methods. A prospective study of the results of reconstructive interventions was carried out in 78 patients with trophic disorders on the background of peripheral atherosclerosis and diabetes mellitus. Complications were detected in 25 cases (the main group), 53 patients had uncomplicated course of the postoperative period. The influence of concomitant diseases, peculiarities of surgical treatment on the occurrence of adverse outcomes was analyzed. Results. Manifestations of heart failure increase the likelihood of arterial thrombosis (p &lt; 0.05). Signs of hepatic dysfunction increase the frequency of PE in the perioperative period (p &lt; 0.05). Adequate correction of hypergly-cemia reduces the risk of stroke. Conclusion. The data on the circumstances predisposing for the development of complications make it possible to prepare more carefully for reconstruction against the background of critical ischemia in people with peripheral atherosclerosis and diabetes mellitus and minimize the number of adverse outcomes of intervention.

Reconstructive Paradigms: Unraveling the Interplay between Plastic Surgery and Rehabilitation in the Aftermath of Severe Burn Injuries

The contemporary landscape of burn care and rehabilitation stands at the nexus of medical innovation and interdisciplinary collaboration. This article delves into the tangled web of implications arising from the integration of plastic surgery within the rehabilitative continuum for victims of extensive burn injuries. Through a comprehensive exploration of cutting-edge surgical techniques, patient outcomes, and the symbiotic relationship between plastic surgery and rehabilitation, this discourse aims to illuminate the transformative potential of reconstructive interventions. By elucidating the dynamic interplay between surgical innovation and rehabilitative strategies, our investigation seeks to contribute to the evolving paradigm in the holistic management of victims enduring the aftermath of severe burns.