The outstanding Russian scientist and teacher in the field of topographic anatomy and operative surgery, one of the initiators of the creation of the Academy of Medical Sciences of the USSR and its full member (1944), Honored Scientist of the RSFSR (1935), winner of the Stalin Prize of the first degree (1943), Lieutenant General of the Medical Service (1943), Professor (1912) Viktor Nikolayevich Shevkunenko was born on February 17 (29 new style), 1872 in the county town of Mezen, Arkhangelsk province. In 1895, he graduated from the Imperial Military Medical Academy. From 1912 to 1948, he headed the Department of Operative Surgery and Topographic Anatomy of the Academy. V.N. Shevkunenko is the founder of the doctrine of the type and age variability of human anatomy. As a result of many years of research carried out by the staff of the department, atypical forms of the structure and location of organs and anatomical structures were described in detail, optimal accesses and rational technique were justified when performing surgical interventions on different organs, depending on the typical, sexual and age topographic and anatomical features of patients. V.N. Shevkunenko is the founder of a major Russian school in the field of operative surgery and topographic anatomy: 44 of his students became professors. Academician V.N. Shevkunenko died on July 3, 1952 and was buried at the Theological Cemetery in Leningrad.

OBJECTIVE. Assessment of the mid-term results after various types of debranching in hybrid surgery of the aortic arch and descending thoracic aorta.

METHODS AND MATERIALS. 47 patients with various pathologies of the aortic arch and descending thoracic aorta were operated on. Six of them suffered from type IIIa dissection and 26 from type IIIb dissection according to DeBakey classification, 15 patients had true aortic aneurysms. The following interventions were performed: total aortic arch debranching (n=5), cross subclavian-subclavian-left-common carotid (n=14) or cross carotid-carotid-subclavian bypass (n=7); subclavian-carotid transposition or bypass (n=12); Chimney technique for the aortic arch aneurysm (n=8); in situ fenestration of the endoprosthesis (n=1). Elective surgery was performed in 32 patients, emergency in 15.

RESULTS. Technical success achieved in 100 %. The overall hospital mortality rate was 10.6 % (n=5), elective surgery mortality rate was 9.3 % (n=3), in emergency cases - 13.3 % (n=2). Causes of mortality: stroke (n=1), multiple organ failure after prosthetic ascending aorta due to retrograde dissection after stent graft implantation (n=1), pneumonia (n=1), acute myocardial infarction (n=1), profuse bleeding (n=1). Cumulative survival rate was 87.5 % over 5 years, freedom from reinterventions - 89.1 %. During the first year of observation, 3 patients underwent stent graft replacement of the descending thoracic aorta due to formation of a dissection below the primary stent graft (n=1), open prosthesis of the ascending aorta due to it retrograde dissection (n=1), endofixation of the stent graft with embolization of the false lumen (n=1).

CONCLUSION. Hybrid surgery on the aortic arch and the descending thoracic aorta is safe and effective treatment. Regular follow-up and timely treatment of complications in the long term after hybrid or endovascular interventions are necessary to improve long-term results.

OBJECTIVE. Identification of predictors of dysfunction of biological aortic valve prostheses in the long-term period after surgical treatment.

METHODS AND MATERIALS. We analyzed the completed treatment cases for the period from 2015 to 2020 and echocardiography data of 74 patients (42 men and 32 women) with an average age of 67.0±4.2 years with bioprostheses implanted in the aortic position. The average follow-up period was 4 years. The transaortic flow velocity, the average and peak transvalvular gradients, the area of the effective opening of the prosthesis, the myocardium mass index, the thickness and mobility of the cusp of the biovalve were evaluated. The presence of the pronounced PPM in a patient was determined at iEOA values less than 0.65 cm²/m², moderate - at values from 0.65 to 0.85 cm²/m², mild - up to 0.85 cm²/m².

RESULTS. PPM was recorded in 27% of cases. Structural dysfunction was observed in 12.5% of cases, it mainly included stenosis of the bioprosthesis (10%). In 2.5% of cases, reintervention was performed for severe stenosis of the AV bioprosthesis. During the multifactorial analysis, we revealed that PPM was a predictor of the development of structural dysfunction of aortic valve bioprostheses in the long-term period after surgery (p<0.005).

INTRODUCTION. Evaluation of myocardial viability in chronic coronary occlusion determines the feasibility of revascularization of this zone.

The OBJECTIVE was to evaluate the significance of the angiographic index in determining the viability of the myocardium at various times after occlusion of the coronary artery.

METHODS AND MATERIALS. 156 patients with coronary artery disease (CAD) with chronic coronary occlusion according to coronary angiography (CG) were examined and treated during the period from 2012 to 2021. All patients underwent endovascular recanalization of chronic coronary occlusion. All patients were divided into 4 groups depending on the time of coronary occlusion (up to 3 months, 3-6 months, 6-9 months, more than 9 months) The results of recanalization were compared to the preoperative evaluation of myocardial viability based on the volume of collateral blood flow (Renrop score).

RESULTS. The angiographic index of non-viable myocardium was highly specific from the first months in all observation groups (77, 94, 97, 97.5 %), however, its sensitivity had diagnostic value only in patients with occlusion duration of more than 6 months (80 % or more).

CONCLUSION. The diagnostic value (sensitivity and specificity) of detecting non-viable myocardium based on retrograde collateral blood flow is significant for occlusion duration of more than 6 months. Refusal of revascularization based on the absence of retrograde blood flow during the first 6 months after coronary occlusion is not correct.

The OBJECTIVE was to identify prognostic factors of long-term air leak after lobectomies based on the analysis of the main preoperative and surgical clinical and functional indicators.

METHODS AND MATERIALS. A retrospective study included 71 patients who underwent lung resection in the volume of lobectomy for lung cancer. The patients were divided into three groups - group 1 (n=42, 59 %) - air leak through the drains stopped within a day after surgery; group 2 (n=10, 14 %) - the duration of air leak from the pleural cavity from 1 to 5 days; group 3 (n=19, 27 %) the duration of air leak more than 5 days after surgery.

RESULTS. The average values of the main clinical, surgical and functional indicators, such as the frequency of concomitant COPD, the severity of its course, smoking status, access (thoracotomy / thoracoscopy) in the three groups were almost the same. The difference in the average value of DLCO was characterized by the greatest tendency to reliability: the longer the pulmonary air leak was, the lower the values of this indicator turned out to be. Correlation analysis revealed a noticeable feedback between the long-term pulmonary air leak and the preoperative level of FEV1 (r=-0.59), a direct relationship between the level of FEV1 and DLCO (r=0.51), as well as a noticeable feedback between the long-term pulmonary air leak and the level of DLCO (r=-0.61) and a direct moderate relationship between the pulmonary air leak and the time spent on the stair climbing test (r=0.38).

CONCLUSIONS. The combination of a low level of FEV1, a low level of DLCO and a long duration of the stair climbing test makes it possible to assess the risk of prolonged pulmonary air leak as significant and take this into account during the surgical intervention.

The OBJECTIVE was to evaluate the results of using dual mobility endoprostheses in patients with unsatisfactory outcomes of osteosynthesis of trochanteric fractures using a sliding hip screw system.

METHODS AND MATERIALS. A single-center, retrospective, randomized study was conducted in 60 patients with unfavorable consequences of osteosynthesis of the proximal femur with the DHS system. All patients were divided into 2 groups. The first group consisted of 31 (51.6 %) patients who were implanted with standard cemented acetabular components. The second group included 29 (48.4 %) patients who were implanted with cement-retained dual mobility endoprostheses. We assessed the functional state using the Oxford Hip Score, the level of pain on the visual analogue scale, the degree of disability, the duration of the operation, blood loss, the nature and structure of complications, the frequency of revision interventions.

RESULTS. The functional state on the Oxford score did not have significant differences between the groups, amounting to 41.7 points after 12 months. The level of pain syndrome did not differ significantly between the groups, amounting to 0.4 points after 12 months. The average volume of intraoperative blood loss was 629.2 ml, which is significantly higher in comparison with standard primary arthroplasty. In the 1st group, there were significantly higher rates of dislocations (6 patients or 19.35 %). The relative risk of endoprosthesis dislocation was 5.8. A total of 5 (8.34 %) infectious complications were noted in both study groups, which is significantly higher in comparison with the results of primary arthroplasty among patients without previous fractures. According to the degree of disability, there was no significant difference between the groups after 12 months. The average score was 2.06 points.

CONCLUSION. In conversion hip arthroplasty using standard acetabular components, a greater number of orthopedic complications (25.81 %) are noted. The use of dual mobility slightly increases the duration of arthroplasty without causing an increase in blood loss or the number of infectious complications. The frequency of dislocations in conversion arthroplasty using standard implants is 19.3 %.

RELEVANCE. The surgical treatment of patients with diaphyseal forearm fractures has a variety of methods and requires a precision technique. The need for postoperative immobilization after osteosynthesis of diaphyseal fractures remains a controversial issue, since osteosynthesis failure and the formation of a pseudoarthrosis are sometimes observed.

In addition, very little information about the role of the interosseous membrane in the rotational function of the forearm during osteosynthesis is available in the literature.

The OBJECTIVE was to determine the forces occurring during rotational movements of the forearm that lead to the above complications.

METHODS AND MATERIALS. The clinical part included the results of surgical treatment of 330 patients with diaphyseal fractures of the forearm; it consisted of the main group (170 - interlocking osteosynthesis) and the comparison group (138 - plate osteosynthesis). The third group consisted of 22 patients with complications of surgical treatment of diaphyseal fractures of the forearm. We performed a comparative assessment of plate and interlocking osteosynthesis of radial bone fractures by mathematical modelling to determine the forces occurring during forearm rotation that lead to nonunion, instability and plate fractures.

RESULTS. In the main group, healing was achieved in all (170 patients), in the comparison group, healing was achieved in 128 (92.8 %), consolidation was achieved in all 22 patients with fracture complications who underwent reconstruction. A comparative assessment revealed that during plate osteosynthesis, zones of high stress concentration were located around the plate opening above the area of fracture and the nearest to it holes from both sides. In interlocking osteosynthesis of the radius, the stresses are evenly distributed around the nail. Pronation-supination movements with an amplitude of (±90)°, according to the experimental results, should lead to the destruction of the cortical plate fairly soon after implantation, while the nail made of ultra-fine Ti-6Al-7Nb alloy will maintain its integrity.

CONCLUSION. Based on these findings, external immobilization is advisable to avoid complications such as osteosynthesis instability or plate fracture.

The OBJECTIVE was to demonstrate an original minimally invasive way to restore the continuity of the lobar duct after its complete intersection.

METHODS AND MATERIALS. The study included 3 patients aged 38, 56 and 69 years who underwent laparoscopic cholecystectomy for cholelithiasis, cholecystolithiasis in various medical institutions of the city. In all patients, the intersection of the right lobar duct with the formation of an external biliary fistula in the postoperative period was revealed. RESULTS. All patients underwent recanalization of the crossed duct on the first attempt. After the fistula was formed on the frame drainage, the flow of bile through the external biliary fistula gradually regressed: in one patient, bile leakage from the abdominal cavity stopped after two days, in two patients after a week. Drainages from the subhepatic space were removed in all patients on the 9th day after restoration of the continuity of the intersect duct. Kehr's drainage was removed after 12 days in one patient, after 21 days in another. Retrograde external drainage was removed from the third patient on the 5th day after restoration of the patency of the duct on the frame drainage. After control X-ray images, the external-internal frame drainages were blocked for patients on the 5-10th day after the operation. There were no leaks of contrast agent through the restored section of the duct.

CONCLUSION. The developed method of minimally invasive restoration of continuity and patency of the intersected and excised hepatic duct is an alternative to the traditional reconstructive biliodigestive bypass surgery. Long-term frame drainage of the bile duct in the area of damage allows forming sufficient diameter for an unobstructed passage of bile.

INTRODUCTION. Existing classifications of various forms of obesity are poorly adapted to the practical goals of bariatric surgery from the standpoint of personalizing the choice of method and volume of intervention.

The OBJECTIVE was develop new approaches to stratification of patients with morbid obesity based on cluster analysis; to evaluate of the effectiveness and safety of metabolic surgical interventions, depending on the belonging of patients to a particular bariatric cluster.

METHODS AND MATERIALS. The study included 745 bariatric patients. To form clinical and demographic groups, a two-stage cluster analysis procedure was used using the SPSS 16.0 package with 11 categorical and 2 quantitative variables. The efficacy and safety of metabolic surgical interventions depending on the patients' belonging to a particular bariatric cluster was evaluated.

RESULTS. As a result of cluster analysis in the general population of patients with morbid obesity, 3 unique clinical and demographic groups (clusters) of patients were identified, characterized by an initial set of similar indicators that differed from that in patients of other groups (clusters): the1st cluster: «premorbid obesity»; the 2nd cluster: «morbid obesity without metabolic syndrome and complications»; the 3rd cluster: «morbid obesity with metabolic syndrome and/ or complications». The best long-term results on the BAROS scale were generally observed in patients of the 1st cluster (87.8 % of excellent and good results compared to 66.7 % in patients of the 2nd clusters and 65.5 % in patients of the 3rd cluster, p<0.001). The total risk of serious complications in patients of the 3rd cluster was 2.4 times higher than in patients of the 1st cluster (P<0.05) and 1.9 times higher than in patients of the 2nd cluster (P>0.05).

CONCLUSION. The procedure of clustering patients with obesity allows individualizing the indications for conducting and choosing bariatric interventions.

The OBJECTIVE of the study was the pathomorphological features, diagnosis, and treatment outcomes of diaphragm ruptures in closed trunk trauma.

MATERIALS AND METHODS. We prospectively studied diaphragmatic ruptures in 35 hospitalized patients with blunt trunk trauma and diaphragmatic defects in 9 patients with chronic traumatic diaphragmatic hernia, previously not recognized in other hospitals. Damage severity was assessed using the MFS-D (MI) scale; statistical data were processed using the WinPepi program: calculation of the boundaries of 95 % CI of medium and extensive values using the fisher method.

RESULTS. Diaphragmatic ruptures were observed in 3.25 % of the victims. Damage to the left side occurred 2.4 times more often than the right side; on the left, they were mainly localized in the lumbar and adjacent costal parts. The average length of the rupture of the right half was 13.5, the left half was 9.8 (2-25) cm. More often, the greater omentum, colon, liver and stomach fell into the pleural cavity. During the first day, 2/3 of diaphragm ruptures were diagnosed, mainly during thoracotomy and laparotomy due to bleeding. Missing a rupture of the left half of the diaphragm was allowed at 6 laparotomies. Mortality rate was 31.4 %, the main causes were acute blood loss, severe brain damage; 2 out of 11 deaths were due to a complicated course of an unrecognized diaphragmatic rupture. All patients with chronic diaphragmatic hernia recovered after surgery.

CONCLUSION. Diagnosis of diaphragmatic rupture in severe trunk injury on the first day is difficult, radiation methods: radiography, MSCT, ultrasound are not informative enough. When performing diagnostic studies and abdominal operations, it is necessary to study the diaphragm. Repeated survey radiography and MSCT of the chest during the first three weeks of inpatient treatment of the victim increases the detection of acute traumatic diaphragmatic hernia.

The OBJECTIVE of the study, based on our own experience, was to determine the frequency, structure and specificity of long-term complications after replacement of soft tissue and leg bones defects, and to develop treatment tactics.

METHODS AND MATERIALS. A retrospective study of the case of 53 patients who underwent treatment in the trauma department of the hospital for the period 2000 to 2008 was carried out. These patients had soft tissue wounds and circular defects of the tibial diaphysis because of severe open injuries of 17 (32.1 %) and gunshot wounds to the lower leg (36 (67.9 %). Patients underwent replacement of soft tissue and lower leg bones using the Ilizarov method and microsurgical reconstruction free flaps. The analysis of treatment results was carried out.

RESULTS. After the end of inpatient treatment, patients were dynamic observation carried out. 39 (73.6 %) of 53 patients sought medical help, as for various complications, the average long-term follow-up was (42.2±5.5) months. The most frequent complications were relapses of soft tissue inflammation in 13.7 % and osteomyelitis in 24.5 % of cases, non-inflammatory complications were tibia fractures (5.7 %) and pseudarthrosis (7.6 %). The analysis of treatment methods of these complications is presented.

CONCLUSION. Simultaneous replacement of extensive leg defects with a free vascularized flap and Ilizarov's distraction osteogenesis creates favorable conditions for wound healing and tibial restoration, however, in the long-term period there are complications in the form of recurrent osteomyelitis, tibia fractures and pseudarthrosis, which require specialized treatment based on a detailed analysis of the pathology and the previous treatment method.

INTRODUCTION. Total elbow arthroplasty (TEA) is a good alternative surgical solution for many patients with severe traumatic and inflammatory joint injuries. However, this surgical procedure is characterized by a rather high incidence of periprosthetic joint infection (PJI): from 3 to 8 %. At present, the issue of the influence of various factors on the risk of PJI is relevant.

The OBJECTIVE of the study was to identify risk factors for the development of PJI after primary TEA.

METHODS AND MATERIALS. In a retrospective study, the data of 485 patients who underwent primary and revision TEA from 2003 to 2019 were analyzed. The total number of studied patients was divided into 2 groups. The main group consisted of 51 patients who underwent revision TEA for PJI. The control group included 434 patients who underwent primary TEA.

RESULTS. Evaluation of the effect of the primary diagnosis on the risk of PJI development showed a statistically significant relationship only in patients with gunshot wounds of the elbow joint (p=0.01). In the study of possible anamnestic factors, the following were significant: a history of previous interventions on elbow joint (p=0.004), previous infection (p <0.001) and open fracture of the elbow (p=0.009).

CONCLUSION. In the course of the study, we proved the influence of anamnestic factors in the occurrence of PJI. Performing a two-stage revision allows stopping the infectious process with high efficiency in most cases.

The OBJECTIVE of the study was to show the effectiveness of multilevel situational tasks in the generalization and analysis of personal and collegial experience of surgeons.

METHODS AND MATERIALS. Research and evaluation of archival materials of surgical departments and multilevel situational tasks created on their basis.

RESULTS. More than 100 surgical case histories have been analyzed, the results of which have been published in two volumes. Professional retraining and/or thematic certification development for 15 years (2002-2017) was received by surgeons, endoscopists, coloproctologists, transfusiologists and thoracic surgeons, more than 713 people in total, as well as interns - 119 people, residents - 104, postgraduate students - 3 and doctoral students - 2. A total of 941 people, including doctors of other specialties and foreign trainees.

CONCLUSION. The work clearly demonstrates that it is impossible to separate university and postgraduate education, this process is continuous, it is one and indivisible, consistent and continuous. We have presented one of the pedagogical techniques in the form of multilevel situational tasks, which allows us to solve many educational and methodological issues.

Spontaneous esophageal hematoma is an extremely rare pathological condition, diagnosed mainly in patients with coagulopathy. We present the rarest case report of spontaneous esophageal hematoma, which occurred on the 5th day after allogeneic cadaveric kidney transplantation in a 53-year-old woman. Early diagnosis and treatment helped to achieve complete hematoma regression without complications.

Necrosis of the stomach as an independent disease is quite rare, even less often - total idiopathic necrosis. We present a case of successful treatment of a patient with idiopathic stomach necrosis with a good outcome.

The article presents the problem of the development of complications of bariatric surgery in the early postoperative period. After the start of the use of endovideosurgical technologies in bariatric surgery, the incidence of general surgical complications in the early postoperative period dropped sharply to 2-6 %. Nevertheless, serious complications still arise, the frequency and type of which largely depends on the patient's comorbidity and the complexity of the operation. The most formidable and difficult complication in treatment is the failure of the sutures of the stomach stump (stapler line), which is more often characteristic of longitudinal resection of the stomach and occurs in 1.5-2.4 % of cases. Deep vein thrombosis is another serious complication in bariatric surgery - the incidence ranges from 2.4 to 4.5 %. Bleeding is no less serious complication of obesity surgery. The frequency of repeated interventions associated with bleeding in the early postoperative period is 11 %. Moreover, in 85 % of cases, conservative methods of stopping bleeding are successful. Considering that the permissible operational lethality of bariatric operations should not exceed 0.1 %, the issues of developing a unified concept of prevention methods to reduce the incidence of complications in patients with morbid obesity remain relevant.

This literature review focuses on the problem of peripheral arterial thrombosis in patients with COVID-19. Russian and international recommendations for the treatment of this cohort of patients were created in the period before the pandemic and do not take into account the new genesis of the development of the disease. In turn, this leads to the ineffectiveness of the existing methods of reperfusion, aimed primarily at removing the thrombus and administering anticoagulants/antiplatelet agents. The elimination of endotheliitis, as one of the key factors of arterial thrombosis, is not always possible, which is accompanied by the development of repeated thrombosis with further unfavorable events. The lack of prospective randomized trials, as well as information in the Interim Guidelines for the Prevention, Diagnosis and Treatment of New Coronavirus Infection (COVID-19) of the Ministry of Health of the Russian Federation, where infectious coronavirus hospitals operate, creates uncertainty in the choice of methods for treating arterial thrombosis when infected with SARS-CoV -2. This trend is associated with a high rate of amputations and deaths in patients with COVID-19. To date, there is no method of revascularization in the presence of arterial thrombosis that demonstrates optimal results for patients with new coronavirus infection.

The article is devoted to the history of gastric surgery in Saint Petersburg (Russia) in the XIX century. In the last decades of the 19th century, there was a breakthrough in surgery - surgeons from all over the world began to operate on the stomach. For the first time in Saint Petersburg and in Russia, Russian surgeons M.K. Kitaevsky, D.M. Monastyrsky and N.V. Ekk performed stomach resection for cancer by Billroth I method (M.K. Kitaevsky, 16.07.1881) and gastroenteroanastomosis for cicatrical pyloric stenosis (N.D. Monastyrsky, 13.03.1882), and at the meeting of the Society of Russian Doctors in Saint Petersburg in May 1882, V. Ekk proposed to overlap an anastomosis between the stump of the resected stomach and the loop of the small intestine that was realized by the Viennese surgeon T. Billroth only 3 years later in 1885, and got the name of the modification of gastric resection by the Billrot II method. It should be noted that M.K. Kitaevsky and N.D. Monastyrsky worked at Petropavlovsky Hospital - on the basis of which the Women's Medical Institute was established in 1897 (now the Pavlov First Saint Petersburg State Medical University).

The OBJECTIVE was to replenish and systematize the ideas about the achievements of Soviet scientists in the field of combustiology based on the analysis of the publication array on the problem of «Thermal injury» for the period 1920-1930s.

METHODS AND MATERIALS. A structural and substantive analysis of the array of publications on the problem of treating thermal injuries, revealed as a result of attracting a wide range of bibliographic resources, such as catalogs of leading libraries, current and retrospective indexes, and databases, has been carried out. The inclusion of new sources of information in the research space made it possible to discover and for the first time to introduce into scientific circulation a large number of scientific works that require a new understanding of the achievements of domestic doctors in the field of treating burns during this period, differently prioritizing, assessing the personalization of the contribution of scientists and research teams. The bibliographic indexes of Russian traumatology for 1924-1940, catalogs of the largest universal and branch (medical) libraries of St. Petersburg and Moscow have been investigated.

RESULTS. We found out that in the period from 1924-1940, 579 works on various aspects of thermal injury were published on the pages of the Soviet medical press, including materials from the speeches of researchers at scientific conferences and meetings of medical societies in various cities of our country.

CONCLUSION. The obtained results made it possible to restore and clarify many undeservedly forgotten facts of the history of Russian combustiology.

August 4, 2022 marks the 100th anniversary of the birth of professor, doctor of medical sciences Aleksandr Matveevich Karyakin. Aleksandr Matveevich graduated from the Naval Medical Academy (NMA) in 1945. In 1978, A.M. Karyakin was elected to the post of head of the Department of General Surgery of Leningrad Sanitary and Hygienic Medical Institute - now North-Western State Medical University named after I.I. Mechnikov. During the years of the clinic's leadership, his natural qualities, organizational abilities and breadth of academic interests were especially clearly manifested. Unprecedented dedication, extremely responsible attitude to the work were the main features of Professor A.M. Karyakin.