The aim – to develop an algorithm for reconstructive surgery in patients with the fistulas of the cicatrical-changed esophagus.

Materials and methods. 23 patients with the esophageal fistula developed on a cicatrical stenosis background were treated in surgery unit from 1985 till 2011. Most frequent reason of gullet damage (with the subsequent fistula forming) was «blind» bouginage – in 56.5 % cases. Above half of patients had lower thoracic part esophageal fistulas – 56.6 %, 8.7 % had neck fistulas localization, in 13 % – at upper thoracic part, in 27.7 % – at middle thoracic part. Esophageal-mediastinal fistulas prevailed on frequency – 9 (39.1 %) and esophageal-pleura fistulas – 6 (26.1 %), more rare were esophageal-tracheal and esophageal-bronchial – for 2 (8.7 %), esophagealpulmonary – in 3 (13.0 %). One (4.3 %) patient had a refractory esophageal-skin fistula on a neck. Only in 2 (8.7 %) patients after enteral nutrition adjusting and fistula closing, it was succeeded to complete treatment by bouginage. Other patients needed different highcomplicated surgical interventions, character of which depended on the fistula level, connection with other mediastinal and chest organs and actual esophagus status.

Results and discussion. 2 (8.7 %) patient with the of esophageal fistula were cured conservatively, in 5 (21.7 %) local esophagoplasty applied in different variants allowed to remove a fistula and recover the natural esophageal function, in 16 (69.6 %) patients: bypass (11) and resection (5) esophagoplasty was done, from which the total was in 4 cases, subtotal – in 10, segmentary – in 2. During 14 retrosternal coloesophagoplasty performing fundamentally important was a correct neck anastomosis variant choice.

Conclusions. Conservative treatment can be effective for esophageal-mediastinal fistulas, relatively short fistula (to 2 cm), mediastinitis signs absence and «depot» in a mediastinum. The fistula treatment basic type for cicatrical-changed esophagus is surgical intervention, the variant of which depends on the esophageal stenosis extension, diameter, fistula type and complications caused by a fistula.

Keywords: esophagus, fistula, cicatrical stenosis, esophagoplasty.

The aim – to assess the effectiveness and concurrent reaction development rate for cefoperazone with beta-lactamase inhibitor sulbactam (C/S) in patients with abdominal surgical disease.

Materials and methods. 84 patients (45 men and 39 women aged from 19 to 75 years) who were treated at the surgical hospital department in the period from October 2011 to February 2012 and received C/S (Faytobact by Сadima Pharmaceuticals Ltd, India) during surgical interventions on abdominal wall and abdominal organs took part in the study. C/S was prescribed by 1.0–2.0 intramuscularly or intravenously twice a day every 12 hours. Dosage was picked up individually depending on the severity, location of infection, the microorganism sensitivity. Duration of treatment was from 1 to 7 days. Other antibacterial drugs were not used.

Results and discussion. 45 strains of microorganisms were allocated. Gram-negative flora was found in 59.9 %, Gram-positive – in 40.1 % patients, 32.3 % in monoculture, microbial associations – in 67.7 %. Among gram-negative strains prevailed: E. coli – 26.1 %, Proteus spp. – 15.4 %, Enterobacter spp. – 16.6 %; among gram-positive – Staphylococcus aureus – 17.2 %. The sensitivity of microorganisms to C/S was 92.7 %. Significant (p < 0.05) reduction in the white blood cells level and WBC intoxication index were noted a on the fifth postoperative day. Microorganisms were inoculated in 3 (13.6 %) patients on the third day after surgery: in one with peritonitis caused by perforated gangrenous appendicitis, in one with perorated duodenal ulcer, in one with micro perforated sigmoid colon cancer. No inoculation was on the fifth day.

Conclusions. High clinical effectiveness C/S (95.7 %) and microorganism sensitivity (92.7 %) in patients with non-nosocomial intraabdominal infections at the same time with good tolerance allows to recommend this drug for empiric antibacterial prophylaxis and treatment.

Keywords: intra-abdominal infection, antibiotic prophylaxis, antibiotic therapy, cefoperazone/sulbactam.

The aim – to determine the immune status indicators predictive value for traumatic disease (TD) course in the injured patients with blunt combined abdominal trauma (BCAT).

Materials and methods. The immunogram indicators in 83 injured patients with BCAT at the TD first period, 56 – at the beginning of the second period (3 day), 58 – at the beginning of the third period (8 day) and in 62 – at the beginning of the fourth period (21 day) were studied. The results were compared with immunograms in 20 donors.

Results and discussion. Detected changes of the immune status in the injured patients with BCAT indicate the immune deficiency formation in the TD first period, especially in those patients who died. The BCAT severity affect on immunity parameters was not found, but immune system suppression was directly proportional to the blood loss volume. In the first period of TD most immune status parameters had no statistically significant difference, in the second period – in part of immune status indicators in recovered and died patients was reliable difference, thus this indicators may be auxiliary TD course prognostic markers. In the injured patients with BCAT who died in the third period was the immune system significant violation: lymphopenia, lower levels of CD3⁺, especially of CD4⁺, lower level of CD22⁺ and the main immunoglobulins. These rates significantly differed from those in patients who recovered. As major lethal TD complications in the third period were infectious, therefore the negative dynamics in immune status indicators were infectious complications risk factor. In the beginning of the fourth period TD in patients with BCAT without infectious complications immunogram indicators were slightly different from the normal but IgG rate remained very low, and CD16⁺ – high.

Conclusions. In the victims with BCAT immunodeficiency formed in the TD first period, but immunogram indicators prognostic value is not substantial, in the TD second period immunological markers may be TD course auxiliary predictors, in the third – immunological markers predict the TD course, in the fourth- immune status indicators deviations from normal is reliable markers of infectious complications high risk after planned surgery intervention.

Keywords: blunt combined abdominal trauma, traumatic disease, immunological parameters.

The aim – to improve the surgical treatment results in patients with colon perforation after the colonoscopy (CS) through the defect closure from the intestinal lumen.

Materials and methods. In 2009–2011 at the endoscopy department one endoscopist performed 1294 diagnostic CS and 293 therapeutic CS. 468 parts of the colon mucosa with neoplasia were resected, 271 of which by endoscopic mucosal resection (EMR) type, including 4 EMR with distal cap, 5 – piecemeal EMR; 91 – loop polypectomy, 82 – forceps polypectomy, 24 – argon-plasma ablation.

Results and discussion. Complication of diagnostic CS was perforation – in 1 (0.08 %, 95 % CI 0.002–0.400) case, therapeutic CS complications were: bleeding in 1 (0.3 %, 95 % CI 0.009–1.900), perforation – in two cases (0.7, 95 % CI % 0.08–2.40). In both cases the defects were closed intraoperative from the intestinal lumen with a rotating endoscopic clipator. Antibacterial therapy (1.5 g cefurotoxim i/m 3 times per day, 500 mg metronidazole i/v 3 times per day) during 3 days, mesalazin suppositories (Salofalk by Dr. Falk Pharma GmbH, Germany) 500 mg 3 times per day for 2 months after discharging. After the intraluminal closure of perforation of the colon patients were discharged from hospital at 3d to 7th day of post-operative period. Follow-up terms ranged from 13 mouths to 21 mouths. Bleeding, septic complications, recurrences were not revealed

Conclusions. Iatrogenic colon perforation intaluminal closure after CS may be done with metal clips and endoscopic clipator. In postoperative period patients need in-patients department observation (bed regimen, parenteral nutrition, resuscitation, antibacterial, anti-inflammation therapy)

Keywords: endoscopic mucosal resection, iatrogenic colon perforation, endoscopic clipping.

The aim – parastomic complications prevention by principles of intestinal stoma formation developing and implementation.

Materials and methods. The study included 85 patients who were treated from 2006 to 2011 in the hospital. Patients were divided into two groups. The basic group included 44 patients to which the stoma formation according to our principles was performed (adequate intestinal blood supply preservation, right-size aperture in the anterior abdominal wall forming, bowel layers fixing, forming a «proboscis» stoma, extraperitoneal stoma output, the control group included 41 patients in which 1–4 of the above stoma formation principles were ignored.

Results and discussion. The use of propose by us principles allowed to avoid complications in 97.8 % cases while in the control group and they were 48 %. Formation of «proboscis» stoma with layer by layer intestine fixation to the anterior abdominal wall on different levels reduces the inflammatory skin changes development around the constructed colon, improves reliability colostomy bag fixation and improves patient’s life quality.

Conclusions. Using the developed by us intestinal stoma formation principles allowed reducing parastomy complication rate from 48 to 2.2 %. Creation of a «proboscis» stoma reduces around the ulcer inflammatory skin changes risk on 26.8 %.

Keywords: parastomy complications, colostomy, ileostoma, intestinal stoma.

The aim – to study and analyze the liver resections results, to estimate effectiveness of haemostatic sealing agents compared with argon-bipolar coagulation for liver resected surface.

Materials and methods.We have studied 1153 liver resections results in patients treated at the Transplantation and liver surgery department from 2001 to May 2011. Different extension types of liver resection were made in patients – for liver disease (n = 1061) and living related donor liver transplantation (n = 92). 46 % of all resections performed in patients with liver cancer. Patients were divided into two groups. In the study group (n = 451) to achieve final hemostasis on resected liver surface application with haemostatic sealing agents – fibrin-collagen plate Tachocomb (TC) produced by Nycomed: aTakeda Company was applied, in the control group patients (n = 702) the argon-bipolar coagulation of the liver resected surface was used. Efficacy was assessed by postoperative bleeding and biliary leakage from liver resection surface rate.

Results and discussion. The average time of final hemostasis in the treatment group (5.6 minutes) was lower compared with the control group (9.0 minutes). Postoperatively, the amount, nature and duration of the exudation from the abdominal cavity (in drainages) were not significantly different between two groups, however, the number of postoperative complications (liver resection surface bleeding and biliary leakage) in the study group was significantly less than in the control group (5 (1.1 %) vs. 43 (6.1 %) cases).

Conclusions. For haemostasis and biliary leakage prevention the use of fibrin-collagen plates Tachocomb during hepatic resection is fairly effective and prospective in liver resection surgery.

Keywords: liver resection, hemostasis, haemostatic sealing agents, fibrin-collagen plate.

The aim – comparative evaluation of the conservative and surgical treatment results for varicothrombophlebitis (VTF) on the 3-year monitoring of the patients life quality basis.

Materials and methods. On the hospital basis from 2001 to 2010 362 patients with WTF were examined: 224 (61.9 %) were women and 138 (38.1 %) – men aged from 19 to 73 years, an average of 47.01 ± 0.71 years. Conservative treatment was performed in 79 patients (CT group), a radical surgery – in 211 (ST-R group), palliative care – 72 (ST-P group). For conservative treatment, as well as in the postoperative period and after hospital discharge anticoagulants, compressive stocks, NSAIP, phlebotonics (Detralex, Servier) were used. Radical phlebectomy includes crossectomy (CE), insufficient perforating veins ligation (LP), accessory veins phlebectomy, stripping. In ST-P group only CE in 43 patients was performed, combined with thrombectomy (TE) – in 22, in combination with LP – in 7. The venous dysfunction severity was evaluated by a VSS scale, the life quality (LQ) – by CIVIQ2 scale. Comparative analysis of treatment outcomes was done over three years.

Results and discussion. LQ indicators in the ST-R group in three months were significantly better compared with other groups and the original score. Between groups of CT and ST-P, no significant differences were found. After three years in ST-P group life quality improved in 4.25 times vs. 1.62 times in group ST-P and in 1.52 times in CT group (p < 0.05). LQ improvement in the ST-P group was noted in all scale categories and was associated with a reduction in the venous dysfunction severity by VSS scale.

Conclusions. Active surgical tactics with radical phlebectomy in VTF patients is associated with a significantly better life quality indicators caused by disease (by CIVIQ2 scale) in all controlled terms compared to other treatment methods due to pain and psychological factors reducing, physical activity improvement and social adaptation: in 2 and 3 year general life quality limiting score was in 1.5 and 2.1 times lower in comparison with other groups and in 3.6 and 4.1 times lower than the original one.

Keywords: acute varicothrombophlebitis, CIVIQ2 scale, VSS scale, life quality.

The aim – optimal treatment tactics development for peripheral vestibular dysfunction, and sensorineural deafness in patients with diabetes mellitus.

Materials and methods. 466 patients (294 women and 172 men) with diabetes mellitus had vestibular disorders and were treated in period from 2004 till 2011 at ENT department in Endocrinology institute and clinical hospital. Patients were divided in two groups. In first 115 patients with peripheral cochlear vestibular syndrome were treated by stem cells introduction and intravenous vasoactive drugs and succinic acid compositions. The second group includes 351 patients with central vestibular syndrome. Patients from this group received day tranquilizer and practice vestibular exercises.

Results and discussion. As a result of stabilography vestibular function improvement was observed in 96 (83 %) in the basic group and in only 172 (49 %) patients in the control group, hearing improvement occurred in 77 (67 %) and 133 (38 %) patients respectively. Sensorineural deafness treatment with complex method promotes significant in 45 (39,1 %), moderate – in 49 (42.6 %). Effect was not revealed in 21 (17.5 %) cases (by audio- and vestibulometry). Clinical study results testify positive changes in patients after complex treatment.

Conclusions. The proposed complex method with stem cells introduction and intravenous vasoactive drugs and succinic acid compositions in 86.7 % cases had positive effect on auditory and vestibular functions restoration, reduced disease progression probability, promoted auditory and vestibular functions improvement or restitution, and reduced repeated hospitalization need.

Keywords: peripheral vestibular dysfunction, sensorineural hearing loss, diabetes mellitus.

The aim – to compare the effectiveness of surgical and conservative treatment methods of vertebral artery syndrome (VAS) in patients with extravasal compression (ECVA) in V1–V2 segment depending on the compression degree in the early and remote period.

Materials and methods. The study included 250 patients with compression genesis VSA, which were examined and treated at clinical sites in heart and vessels surgery department in 2007–2011 are presented in the article. Of these, a surgical treatment was done in 150 people with compression genesis VAS and they were referred to the main group. Other people with similar clinical and instrumental data have received traditional medical treatment (control group). The age of the patients ranged from 23 to 65 years, the mean age was 47.3 ± 6.7 years. The number of females was 129 (51.6 %) persons, male – 121 (48.4 %). According to Doppler positional tests on the compression degree the patients were divided as follows – isolated compression of the middle (pattern A), subtotal (pattern B) and total (pattern C) the degree of compression VA; bilateral average (pattern D) and subtotal (pattern G) combined average of the subtotal (pattern E) and total (F pattern) compression VA.

Results and discussion. Our developed surgical treatment program significantly improved the efficiency of treatment for pathological ECVA. Thus, the percentage of immediate positive results (good and satisfactory) increased to 92.6 against 52.0 % – in the control group (p < 0.05), good remote results – to 84.0 against 48.7 % in control.

Conclusions. Surgery requires patients referred to the E, F, G Doppler patterns, and A, B, C, D – in the case of medium or high flow instability in VA and / or the presence of the patient low or critical CVR and in all selected patterns with chronic cerebral circulation (CICS) II–III stage symptoms. Performance of unilateral and bilateral staged VA decompression in the V1–V2 segment provides a quick and safe blood flow restoration in compressed artery. Surgical treatment for pathological EVCA increased efficacy of treatment for 40.6 % (p < 0.05) in early and 35.3 % in remote periods relative to the control group.

Keywords: vertebral artery syndrome, extravasal compression, surgical treatment, conservative treatment.

The aim – to study intubation decompression, sanitation and gastroenterosorbtion role in аnastomosis suture fail preventive in patients with an urgent and emergency intestinal resection.

Materials and methods. Results of surgical treatment in 576 patients operated in an emergency and urgent order for intestinal cancer complicated forms, various aetiology acute intestinal obstruction, a widespread peritonitis, open and blunt intestinal damages, a mesenteric thrombosis and thromboembolism were analyzed. 332 patients have made the basic group (BG) and 244 comparison group (СG). In BG patients, in parallel with other treatment methods, intubation decompression, sanitation and gastroenterosorbtion were made.

Results and discussion. At complications frequency and some postoperative period indicators dynamics study it was found out that the intestinal anastomosis suture failure in BG patients was observed in 8 (3.4 %) from 235, and in СG – in 17 (15.5 %) from 110. Intestinal peristalsis restoration in BG patients was observed on the 2nd–5th day (mean rate 2.92 ± 0.08 (2–5) day) after operation, and in СG patients on 3rd–6th (mean rate 4.31 ± 0.12) day after operation. A leukocyte intoxication index and other blood serum toxicity indicators in BG patients have normalized more intensively, than in СG patients.

Conclusions. For intestinal anastomosis sutures failure prevention, is expedient to perform intubation decompression, sanitation and gastroenterosorbtion with other treatment methods. Application of the given method has led to decrease in аnastomosis suture failure frequency on 12.1 % (р < 0.001), earlier intestinal peristalsis restoration after the operation, more intensive leukocyte intoxication index and other blood serum toxicity indicators normalization in BG patients than in СG patients.

Keywords: intestinal obstruction, intestinal intubation, gastroenterosorbtion, intestinal anastomosis suture failure.

The aim – a description of laparoscopic diagnostic and cholecystectomy successful cases in pregnant.

Materials and methods. During 2009 – 2010 years five laparoscopic diagnostics for typical clinical appendicitis and a one laparoscopic cholecystectomy for acute calculous cholecystitis were performed in patients in the II trimester of pregnancy.

Results and discussion. In the 5 patients with a 16–19 weeks pregnancy term during admission the acute appendicitis clinic was not in doubt, but after laparoscopic diagnosis revealed that appendix was not changed. In one case, the patient, aged 32, with 17 weeks of pregnancy, was admitted in urgent order with acute calculous cholecystitis clinic. She underwent laparoscopic cholecystectomy. The postoperative period was uneventful. All patients were discharged in satisfactory status.

Conclusions. Clinical cases of successful laparoscopic diagnosis and treatment in patients in the II pregnancy trimester with acute surgical pathology clinic testify advantages of this method over conventional classical surgical treatment methods for acute surgical diseases in pregnant.

Keywords: laparoscopy, pregnancy, acute appendicitis, acute calculous cholecystitis, laparoscopic cholecystectomy.

The mini-invasive method of access for appendectomy has been proposed and implemented in practice. Method differs by the skin incision performed over the upper edge of the symphysis in hairy area; the intrusion into the abdominal cavity is performed through the arcuata line. The technique of the operation is described in this article. Offered access advantages are shown. The mini-invasive method of access for appendectomy was performed in 199 patients (female were 132 (66.3 %), male – 67 (33.7 %)) with acute appendicitis diagnosed in the period of 2009–2011 at surgery department. Good cosmetic effect was achieved.

Keywords: appendectomy, MAS-technologies.

The aim – to improve the functional and aesthetic treatment results in patients with deep wound defects by introducing effective technology with propeller flaps plastic on a detailed vascular pedicle.

Materials and methods. During the period from 2008 to 2011 in 12 patients an operations aimed on extremities and body skin and soft tissue defects closure were done in the clinic; skin-fascia propeller flaps on ulnar artery perforante (5), thoracodorsal flaps with propeller type transposition (2), the flap based on of the posterior tibial artery perforating arteries (1), the lateral supramaleolar flaps on perforating cutaneous branches of the fibular artery (4) were used in them.

Results and discussion. In all cases the wound defects were closed. Complications associated with inflammation (2 cases) or temporary venous stasis (4) were not critical. All flaps survived, in 3 cases required secondary suture after the distal edge zone of necrosis excision. The flaps, which were moved to the wound defect area, were similar in structure and color to the surrounding tissues, and they do not change the recipient zone contours.

Conclusions. The obtained results testify effectiveness of plastic propeller flaps on a selected vascular pedicle, especially for the small and medium-sized wound defects closing on the extremities. In this method the lost skin is replaced by closest to it on the anatomical characteristics one by flap transposition from a nearby area. That allows supporting function restoration with minimal aesthetic damage and at one stage. The described technique of local flaps is not perfect yet, because complications inherent for any plastic with any flaps type can occur. Development and introduction of reconstructive and plastic surgery techniques with the propeller flap, allows increasing the treatment efficiency in patients with deep wound defects.

Keywords: wounds, wound defects, plastic, propeller flaps, perforator flaps.

In the review main principles of thromboembolic complications preventive maintenance in patients of surgical units with low-molecular weight heparins application on the basis of modern national and foreign consensuses and recommendations are resulted. Schemes of preventive maintenance for patients in various specialized hospitals are given.

Keywords: thromboembolic complications preventive maintenance, the recommendation, low-molecular weight heparins, a surgical hospital.

Botulinum toxin has been successfully used in many facial and extra facial regions to limit face muscles movement for aesthetics rids correction and in other body regions for neurologic and muscles disease. Available literature analysis resumes positive results after botulinum toxin use for certain types of scars treatment and prophylaxis. Pathophysiology mechanism theories concerning its influence on scars appearing and formation were formulated. Further in – vitro experimental studies and randomize studies in patients with hypertrophic and keloid scars are required to understand botulinum toxin role and effects on scars formation.

Keywords: botulinum toxin, hypertrophic and keloid scarring, treatment.

Seminars study role in post-graduate medical education and basic knowledge remote control significance of is highlighted.

Keywords: post-graduate education, seminars, distance control.

Цель работы — изучить и проанализировать результаты резекций печени, оценить эффективность применения гемостатических средств по сравнению с аргон-биполярной коагуляцией резекционной поверхности печени.

Материалы и методы. Проанализированы результаты 1153 резекций печени у больных, находившихся на лечении в отделе трансплантации и хирургии печени Национального института хирургии и трансплантологии им. А.А. Шалимова НАМН Украины в период с 2001 по май 2011 г. Больным были выполнены различные по объему резекции печени — по поводу заболеваний печени (n = 1061) и живым родственным донорам при трансплантации печени (n = 92), 46 % резекций проведено пациентам с онкологическими заболеваниями печени. Больные были распределены на две группы. В основной группе (n = 451) для достижения окончательного гемостаза резекционной поверхности печени применена аппликация гемостатического средства — фибрин-коллагеновой пластины «Тахокомб» (ТК) производства компании Nycomed: aTakeda Company, в контрольной (n = 702) — аргон-биполярная коагуляция резекционной поверхности печени. Эффективность оценивали по количеству послеоперационных кровотечений и желчеистечений из резекционной поверхности печени.

Результаты и обсуждение. Среднее время окончательного гемостаза в основной группе (5,6 мин) было меньшим по сравнению с контрольной группой (9,0 мин). В послеоперационный период объем, характер и длительность экссудации из брюшной полости (по дренажам) незначительно отличались между группами, однако количество послеоперационных осложнений (послеоперационное кровотечение и желчеистечение из резекционной поверхности печени) в основной группе было значительно меньшим, чем в контрольной, — 5 (1,1 %) случаев по сравнению с 43 (6,1 %).

Выводы. Использование фибрин-коллагеновой пластины ТК при резекциях печени с гемостатической и билиостатической целью является достаточно эффективным и перспективным для применения в резекционной хирургии печени.

Keywords: резекция печени, гемостаз, гемостатические средства, фибрин-коллагеновая пластина.

Предложен и внедрен в практику новый малоинвазивный способ доступа для аппендэктомии, который отличается тем, что разрез кожи выполняют над верхним краем лонного сочленения в волосистой части, вход в брюшную полость осуществляют через Спигелиеву линию. Описана техника выполнения операции. Показаны преимущества предложенного доступа. В хирургическом отделении Александровской клинической больницы г. Киева за период с 2009 по 2011 г. малоинвазивный доступ был применен у 199 больных с острым аппендицитом (женщин — 132 (66,3 %), мужчин — 67 (33,7 %)). Получен хороший косметический эффект.

Keywords: аппендэктомия, MAS-технологии.

В обзоре представлены основные принципы профилактики тромбоэмболических осложнений у больных хирургического профиля с применением низкомолекулярных гепаринов на основании современных отечественных и зарубежных консенсусов и рекомендаций. Приведены схемы профилактики для больных стационаров различной специализации.

Keywords: профилактика тромбоэмболических осложнений, рекомендации, низкомолекулярные гепарины, хирургический стационар.

Botulinum toxin has been successfully used in many facial and extra facial regions to limit face muscles movement for aesthetics rids correction and in other body regions for neurologic and muscles disease. Available literature analysis resumes positive results after botulinum toxin use for certain types of scars treatment and prophylaxis. Pathophysiology mechanism theories concerning its influence on scars appearing and formation were formulated. Further in – vitro experimental studies and randomize studies in patients with hypertrophic and keloid scars are required to understand botulinum toxin role and effects on scars formation.

Keywords: botulinum toxin, hypertrophic and keloid scarring, treatment.

Цель работы — улучшить функциональные и эстетические результаты лечения пострадавших с глубокими раневыми дефектами путем внедрения эффективной технологии пластики лоскутами типа пропеллер на выделенной сосудистой ножке.

Материалы и методы. За период с 2008 по 2011 г. в клинике с целью закрытия дефектов кожи и мягких тканей на конечностях и туловище прооперированы 12 пациентов, у которых использованы кожно-фасциальные лоскуты типа пропеллер на перфоранте из бассейна локтевой артерии (5 случаев), торакодорзальные лоскуты с транспозицией по типу пропеллера (2), лоскут на базе перфорантной артерии из бассейна задней большеберцовой артерии (1), латеральные надлодыжечные лоскуты на перфорантной кожной ветви малоберцовой артерии (4).

Результаты и обсуждение. Во всех случаях раневые дефекты были ликвидированы. Осложнения, связанные с воспалением (2 случая) или временным венозным застоем (4), не носили критического характера. Все лоскуты выжили, в 3 случаях потребовалось наложение вторичного шва после иссечения зоны дистального краевого некроза. Перемещенные в область раневого дефекта лоскуты были схожи по структуре и окраске с окружающими тканями и не изменяли контуры реципиентной зоны.

Выводы. Полученные результаты свидетельствуют об эффективности пластики лоскутами типа пропеллер на выделенной сосудистой ножке, особенно для закрытия малых и средних раневых дефектов на конечностях. При выполнении данной методики утраченный кожный покров замещают наиболее приближенным к нему по анатомическим характеристикам путем транспозиции лоскута из ближайшей зоны. Это позволяет обеспечить восстановление функции с минимальным эстетическим ущербом и в один этап. Описанная техника применения локальных лоскутов еще не идеальна, так как могут возникнуть осложнения, присущие лоскутной пластике. Развитие и внедрение реконструктивно-пластических операций с техникой лоскутов типа пропеллер позволит повысить эффективность лечения пострадавших с глубокими раневыми дефектами.

Keywords: раны, раневые дефекты, пластика, лоскуты типа пропеллер, перфорантные лоскуты.

Освещена роль семинарских занятий в системе медицинского последипломного образования и важность дистанционного контроля базовых знаний.

Keywords: последипломное образование, семинар, дистанционный контроль.

Ботулотоксин успешно используют для уменьшения мышечных сокращений в области лица с целью эстетической коррекции морщин и в других областях при лечении неврологических и мышечных заболеваний. Анализ литературы свидетельствует о положительных результатах при использовании ботулотоксина для лечения отдельных видов рубцов. Выдвинуты теории относительно патофизиологических механизмов его влияния на процесс образования и формирования рубца. Для понимания роли и влияния ботулотоксина на процессы рубцеобразования необходимо провести экспериментальные исследования in vitro и рандомизированные исследования пациентов, имеющих гипертрофические и келоидные рубцы.

Keywords: ботулотоксин, гипертрофические и келоидные рубцы, лечение.