An outstanding traumatologist and orthopedist, the founder of Russian prosthetics, the creator of a large scientific school, the organizer of specialized traumatological and orthopedic care in the USSR, Academician of the USSR Academy of Medical Sciences, Honored Scientist of the RSFSR, Professor Nikolai Nikolaevich Priorov was born on May 28 (June 10, new style), 1885 in the small town of Shenkursk, Arkhangelsk province, in the family of an official of the Arkhangelsk postal and Telegraph office. He graduated from the Petrozavodsk Theological College, then – the Arkhangelsk Theological Seminary, and in 1907, entered the Medical Faculty of the Imperial Tomsk University. Having received his doctor’s degree with honors in June 1913, N.N. Priorov worked at the Soldatenkov Hospital (now the Botkin Moscow City Clinical Hospital) under the supervision of renowned Professor V. N. Rozanov from 1913 to 1915, and then from 1919 to 1927. At the same time, from 1916 to 1921, he was in charge of the orthopedic department and served as chief physician of the Central Hospital for Crippled Soldiers. He actively participated in the organization of prosthetic workshops and a prosthetic factory in Moscow. From 1921 to the end of his life, N. N. Priorov was the director of the Medical Prosthetic Institute that he founded in Moscow, which became the Central Research Institute of Traumatology and Orthopedics (CITO) in 1940. In 1931, on the basis of the Institute, he organized the Department of Orthopedics and Traumatology of the Central Institute for Advanced Medical Training, which he headed almost until the end of his life. From 1933 to 1938, he simultaneously headed the Department of Traumatology and Orthopedics at the 1st Moscow Medical Institute. From 1945 to 1947, he served as Deputy Minister of Health of the USSR.
N. N. Priorov made a great contribution to the creation of the state program for injury prevention and occupational safety, to the organization of specialized orthopedic care for children, is rightfully considered the founder of Russian sports traumatology. N. N. Priorov was the author and co-author of more than 250 scientific papers, 65 PhD and doctoral dissertations were completed under his leadership. In 1932, on his initiative, the Society of Traumatologists and Orthopedists of Moscow and the Moscow Region was organized, and in 1946, the All–Union Society of Orthopedic Traumatologists was organized, of which he was the permanent chairman until the end of his life. Academician N. N. Priorov died on April 15, 1961 and was buried at the Novodevichy Cemetery in Moscow. The street in Moscow and the passage in Arkhangelsk are named after N. N. Priyorov. The National Medical Research Center of Traumatology and Orthopedics (CITO) in Moscow, the Shenkurskaya Central District Hospital in the Arkhangelsk Region and the leading specialized journal Bulletin of Traumatology and Orthopedics bear his name.

Introduction. Bleeding is an extremely urgent problem in aortic surgery, where its frequency and significance are greater than in other cardiac operations. Among the measures to prevent bleeding, surgical technique plays a fundamental role, especially the methods of forming the anastomosis with the aorta to ensure its tightness. The scientific literature presents many technical modifications of aortic anastomoses, but there are currently no large comparative studies with a high degree of evidence.

The objective of this study was to evaluate the efficiency of the protocol of intraoperative support and control of surgical hemostasis, which describes the principles of surgical technique when performing interventions on the aorta, the technique of forming anastomoses and methods of staged control of hemostasis stability during ascending aorta replacement.

Methods and materials. Patients who underwent ascending aorta replacement were divided into two groups. The group where the above protocol was used (n=24) and the group with the standard surgical technique (n=19). These groups were compared with each other by the following parameters: bleeding frequency, blood loss volume, frequency of resternotomies, volume of transfused blood components, treatment duration, complication and mortality rate.

Results. Statistically significant differences (p<0.05) were obtained in the volume of intra- and postoperative blood loss, as well as in the frequency of all postoperative bleeding and bleeding requiring resternotomy. Statistically significant differences were also obtained in the volume of transfusion of erythrocyte-containing blood components, fresh frozen plasma and cryoprecipitate. It was found that patients from the first group had a shorter stay in the intensive care unit and a shorter postoperative stay. There were no statistically significant differences in complication and mortality rate in the available patient sample.

Conclusions. The protocol of intraoperative support and control of surgical hemostasis is an effective approach to prevent bleeding during ascending aorta replacement.

The objective was to estimate the impact of competitive blood flow on the development of dysfunction of the mammarocoronary artery bypass graft to the anterior interventricular branch of the left coronary artery (MCABG-AIVB), as well as the role of the instantaneous wave-free ratio (iFR) in the development of dysfunction.

Methods and materials. The research included 57 patients who were hospitalized between January 2020 and December 2022. Postoperative coronary artery bypass graft was performed for all patients which revealed dysfunction of MCABG-AIVB and a functioning AIVB. Then the iFR of AIVB was measured. Regarding the obtained iFR values, the patients were divided in two groups: group I with a negative iFR value included 40 (70.2 %) patients, and group II with a positive iFR value included 17 (29.8 %) patients. The main endpoint of the study was the development of dysfunctions of mammary conduit due to the presence of competitive blood flow.

Results. Among 57 patients, 46 (80.7 %) had complete occlusion of a conduit with the absence of antegrade blood flow; the «string phenomenon» of the internal thoracic artery (ITA) was detected in 11 (19.3 %) patients. Whilst the values of instantaneous wave-free ratio, graft dysfunction occurred significantly more often in vessels with negative iFR than in vessels with the positive value, 40 (70.2 %) versus 17 (29.8 %), respectively (p<0.001).

Conclusions. According to the results of the research, the dysfunction of the mammary conduit in most cases was due to the presence of competitive blood flow. The use of iFR before coronary artery bypass graft is necessary in order to assess competitive blood flow and prevent dysfunction of conduits in the long-term period.

Introduction. Septum surgery is one of the most common otolaryngological surgical interventions. Techniques of recent years demonstrate trends towards the use of endoscopic equipment in septum surgery. Also, the use of autocartilage to restore nasal septum skeleton has proven itself to be effective in order to avoid undesirable effects in the future.

Methods and materials. The medical records of 78 consecutive patients who underwent nasal septum surgery for various reasons over a 12-month period (from May 2023 to June 2024) were analyzed. The study group included 68 people who underwent reimplantation of autocartilage prepared by thinning it and making relaxing intersecting incisions on both sides during nasal septum surgery. The average age of the patients was 36.49±10.69 years (min – 18 years, max – 66 years), 23 (33.8 %) surgeries were performed on women (95 % CI: 22.8–46.3), 45 (66.2 %) – on men (95 % CI: 53.7–77.2).

Ten patients were excluded from the study: 7 patients did not undergo cartilage reimplantation for various reasons. Also, 3 patients underwent cartilage crushing in addition to incisions, which subsequently caused its pronounced edema for up to 2–3 weeks. All operations were performed under 0-degree endoscope control. For data comparability, surgical interventions performed by one surgeon were evaluated.

Results. All 68 patients had an uneventful surgery, with a good long-term result without the formation of adhesions and significant residual septal deviations. The tampons were removed the day after the surgery. In the early postoperative period, temporary cartilage edema was observed in 2 patients (2.94 %; 95 % CI: 0.4–10.2). In 1 patient (1.47 %; 95 % CI: 0.1–7.9), a hematoma in the posterior parts of the nasal septum was detected and opened. In the late postoperative period, the thickness of the nasal septum at the site of cartilage reimplantation, according to computed tomography, was 3–3.5 mm.

Conclusions. Preparation of autocartilage using the method of intersecting incisions, as well as its thinning, allows preserving the structure of cartilage tissue and eliminating the deviation of the cartilage plate before reimplantation. With this approach, temporary adverse events such as cartilage edema and septum hematoma occur in less than 3 % of cases. Endoscopic control during operations provides good visualization at all stages of treatment. The use of autocartilage allows preventing thinning of the nasal septum in the postoperative period and reducing the likelihood of adverse events associated with atrophy of the mucous membrane.

Introduction. Morbid obesity is a leading factor in the development of ventral hernias, including hernias of the white line, umbilical and postoperative. This is due to the structural features of the aponeurosis of the white line of the abdomen in patients with morbid obesity, and the predominance of type III collagen over type I collagen.

The objective was to develop measures to combat postoperative ventral hernias in patients with morbid obesity

Methods and materials. Study and comparison of the structure of the aponeurosis of patients with normal body mass index and morbid obesity.

Conclusion. The predominance of type III collagen over type I collagen has been experimentally proven, and therefore – deterioration in the quality of the aponeurosis and an increase in the risk of postoperative ventral hernias in patients of this group. The need for additional strengthening of the suture line has been proven.

The Objective was to study changes in serum C-reactive protein (CRP) concentration in the postoperative period in patients with Crohn’s disease (CD), as well as to substantiate and develop an algorithm for using predictors of inflammation to prevent the possible development of postoperative complications.

Methods and materials. In 62 patients, who underwent surgical interventions performed for CD complications, CRP parameters was studied daily during the first seven days and on the twelfth day of the postoperative period.

Results. In 27.4 % of cases in the postoperative period, CD patients showed activation of the immune-inflammatory process, which increased the risk of postoperative complications. The threshold values of CRP were determined, which can serve as predictors of the activation of immune-inflammatory processes in the early postoperative period in Crohn’s disease.

Conclusion. A pathological increase in CRP on the 3–4th day after surgery should be considered as a predictor of activation of immune-inflammatory processes and as an indication for therapeutic correction.

Introduction. The choice of optimal surgical access in the treatment of abdominal trunk compression syndrome remains a subject of discussion to date. Traditional laparotomy in the era of minimally invasive surgical technologies seems to be excessively traumatic, while laparoscopic interventions are associated with a high risk of complications that are difficult to eliminate with this access, primarily bleeding.

The objective was to analyze the six-year experience of laparoscopic decompression of the abdominal trunk on the basis of the Scientific Research Institute of Surgery and Emergency Medicine of the Pavlov University.

Metods and materials. In the period from November 2018 to July 2024, 27 laparoscopic abdominal trunk decompression procedures were performed at the clinic of the Research Institute of Surgery and Emergency Medicine of the Pavlov University. To prevent massive blood loss in case of injury to the abdominal artery during its laparoscopic decompression, a method for preventive installation of an endovascular balloon catheter into the abdominal trunk before performing the main stage of surgery was proposed.

Results. Two cases (7.4 %) out of 27 were complicated by the development of intraoperative bleeding due to injury to the abdominal trunk or its branches. In one case (3.7 %), laparotomy was performed. In the second case (3.7 %), the bleeding was stopped laparoscopically using the technique of preventive installation of a balloon catheter into the abdominal trunk. The volume of blood loss was 2,100 and 300 ml, respectively. Technical success was achieved in 96 % of patients. During the follow–up period of 6 months or more, good results were found in 84.6 % of patients, satisfactory – in 15.4 %. The average operation time was 85 minutes (85.15±32.45); the average postoperative bedday was 3.8 days (from 3 to 5 days).

Conclusion. Laparoscopic decompression of the abdominal trunk is an effective and sufficiently safe technique in the surgical treatment of abdominal trunk compression syndrome.

Introduction. The variability of the anatomical structure of the deep femoral artery is well known and described in many publications by Russian and foreign authors. Being a vessel with an extensive collateral ways, it becomes an excellent reservoir in case of bypass interventions on the aorto-femoral segment, and sometimes is an in-flow artery during reconstruction of the femoro-popliteal segment. Despite its good study, the question of the effectiveness of surgical interventions performed with a launch on the deep femoral artery with its magistral or scattered type of structure remains open.

The objective was to evaluate the results of open surgery – aorto-femoral bypass, with a launch on the deep femoral artery, taking into account the type of its anatomical structure.

Methods and materials. An analysis of the results of surgical treatment of 63 patients with the aorto-femoral segment occlusion, corresponding to type D, according to the TASC II classification, was carried out. All patients were divided into 2 groups depending on the type of structure of the deep femoral artery: I – magistral type; II – scattered type. The analysis included the results of the immediate and remote patency of the structure, the effectiveness of the interventions performed, patient survival, as well as the presence of factors that can directly or indirectly affect the course of the postoperative period.

Results. The immediate results of the interventions performed showed their effectiveness, manifested by an increase in the distance of pain-free walking, relief of pain, healing of trophic ulcers, regardless of the type of structure of the deep femoral artery (p<0.001). Five years after the operation, a greater number of thromboses of the aorto-femoral bypass graft was noted with a scattered type of artery structure (p=0.03). Factors that increase the risk of thrombosis in the late postoperative period were the scattered type of structure of the deep femoral artery and atrial fibrillation (p=0.04).

Conclusion. Aorto-femoral bypass grafting with initiation to the deep femoral artery is an effective treatment method regardless of the type of structure of the deep femoral artery, but late results show a significant advantage of the magistral type in terms of patency of the structure and maintaining quality of life.

The objective of the study was to develop an algorithm for searching perforator vessels and preoperative planning of the design of the anterolateral thigh perforator flap (ALT) and superficial circumflex iliac artery perforator flap (SCIP) using ultrasound triplex angioscanning (UTAS) and compare the data obtained with intraoperative localization of perforator vessels.

Methods and materials. From January 2023 to May 2024, 8 patients with defects and neoplasms of the maxillofacial area, who underwent preoperative preparation with bilateral UTAS of soft tissues of the anterolateral thigh and groin area, were monitored at the University Clinic. At the level of the interested anatomical structures, the maximum systolic blood flow velocity (maxSBFV), resistance index (RI), perforator vessel localization and the depth of it were assessed. All patients underwent surgery soon, during which a comparison was made between angioscanning data and the intraoperative view. The UTAS protocol for two flaps with parameter settings of the ultrasound diagnostic device was described in detail.

Results. Thus, eight patients underwent head and neck reconstruction. The average age of the patients was 41.25 years (25–63 years), the average body mass index (BMI) was 27.2 (26.14±2.47 kg/m2), 5 ALTPF and 3 SCIAPF were transplanted. The average maxSBFV values at the level of the superficial circumflex iliac artery in SCIAPF were 28.56±18.46 cm/s, in ALTPF at the level of the descending branch of the lateral circumflex femoral artery were 49.86±15.02 cm/s. The results of measuring maxSBFV and RI in perforator vessels at the level of deep and superficial fascia were also described.

Conclusion. Triplex angioscanning of blood vessels provides both anatomical and hemodynamic information for donor and recipient sites. The surgeon’s training in UTAS techniques allows the operator to carefully assess the donor area before surgery, which will reduce unpredictable situations intraoperatively.

Transcatheter aortic valve implantation is one of the most modern and promising techniques of surgical interventions in the arsenal of X-ray endovascular surgeon. Despite all the advantages of this technique, there are a number of complications associated with it; one of them is deformation of the prosthesis with subsequent impairment of its function. The choice of the tactics of further treatment of patients with deformation of the implanted prosthesis is a complex and multifactorial task. The surgery of choice in this complication is repeated transcatheter aortic valve implantation using the «valve in valve» technique.

Penetrating gunshot wounds to the chest are among the most severe types of combat trauma in modern armed conflicts, as they are accompanied by high mortality. The article describes a case of surgical treatment of a penetrating chest wound with damage to the right ventricle of the heart in a separate medical battalion with limited diagnostic and instrumental capabilities. Such cases are rare due to the fact that death occurs before admission to the stage of qualified surgical care. The clinical case of treatment of a 44-year-old patient who was admitted to the advanced medical group after receiving a gunshot wound during the performance of special combat missions in a state of moderate severity is described. Diagnostics were made according to the extended protocol of first aid for injuries, clinical signs, additional instrumental examination: radiography and ultrasound protocol of an abbreviated study (Extended Focused Assessment with Sonography for Trauma (EFAST)) – initial signs of cardiac tamponade were detected. The wounded man was taken to the operating table according to urgent indications. Surgical intervention in the volume: longitudinal sternotomy, opening of the pericardium, suturing of the heart wound, drainage of the pericardium, layer-by-layer suturing of the wound. The wounded man was evacuated by air ambulance transport to the Military Clinical Hospital, then to the S.M. Kirov Military Medical Academy.

A trichobezoar is a cluster of hairs in the gastrointestinal tract that are stuck together with mucus. It can be formed by the patient’s or another person’s hair, or fibers of various objects. A giant trichobezoar with Rapunzel syndrome in childhood is a rare pathology. The article describes a rare clinical observation of a large gastric trichobezoar and Rapunzel syndrome in a 15-year-old girl. The possibilities of ultrasound, computed tomography (CT) and radiographic examination in diagnosing this pathology are presented. The giant trichobezoar was removed by open surgery. The effect of the operation is good. Due to the lack of early pathognomonic symptoms, early diagnosis of gastric trichobezoar is difficult. A number of instrumental research methods are used to diagnose the disease. The most reliable of them is contrast computed tomography. The only correct method of treating giant gastric trichobezoars is open surgical treatment.

Myelolipoma is a benign mesenchymal tumor composed of mature fat and hematopoietic cells in its histological structure. Most often, they are solitary and non-functioning neoplasms. The incidence occurs in the fifth and sixth decades of life. Most often, these tumors are found in the adrenal glands. A rarer situation is when myelolipomas occur in other various parts of the body. Sometimes they are found in the pelvic cavity, chest, retroperitoneal space and some other areas of the human body. The clinically myelolipomas of various localizations remains unclearly. They are often discovered accidentally during computer tomography (CT) for other diseases. Thus, due to the fat content in the histological composition, these formations are interpreted as liposarcomas when performing visualization methods of research. Works devoted to the diagnosis of extra-adrenal myelolipomas due to their rarity are few, while even less is devoted to the treatment of such formations. The article describes a clinical case of diagnosis of extra-adrenal myelolipoma of the presacral space, diagnosed on positron emission computed tomography (PET-CT) as liposarcoma, as well as the features of its minimally invasive surgical treatment.

An outstanding surgeon, scientist, teacher and healthcare organizer, one of the “patriarchs” and founders of the surgical school in Azerbaijan, Honored Scientist of the Azerbaijan SSR, Academician of the Academy of Medical Sciences of the USSR, Hero of Socialist Labor, Professor Mustafa Agabek oglu Topchibashev was born on August 5, 1895 in the village of Goygumbat, Irevan province (West Azerbaijan). After graduating from the university in 1919, M. A. Topchibashev worked as a surgeon in hospitals in Nakhichevan and Baku, during the next 10 years (1920–1930) as an ordinator, and then as an assistant at the faculty surgical clinic of the Medical Faculty of Baku University. After defending his doctoral thesis in 1930, he was awarded the academic title of professor and M. A.Topchibashev was elected head of the Department of Faculty Surgery at the Azerbaijan Medical Institute (now the Azerbaijan Medical University), which he fruitfully led until the end of his life. In 1937, M. A. Topchibashev, for the first time in the world history of anesthesiology, developed and introduced into clinical practice an original method of anesthesia – injectable essential oil anesthesia, later called “Analgesin”. The use of the new method, characterized by the absence of negative effects of this type of anesthesia on the reflex autoregulatory mechanisms of the patient’s body, revealed previously unknown neuropsychiatric and neurophysiological phenomena. M. A. Topchibashev made a great contribution to the organization and provision of medical care to the wounded during the Great Patriotic War in the territory of Azerbaijan. On his initiative, a hospital specialization system was introduced, providing for profiling for the wounded and for the sick, which was taken over by the Department of Evacuation Hospitals. During these years, the result of M. A. Topchibashev’s innovative work was the “Apparatus for removing foreign bodies” designed by him, which made it possible to determine the localization of a foreign body in the body using the stereoscopic method. In 1941, the new device was first used by M. A. Topchibashev in a neurosurgical hospital in Baku to remove fragments from a wounded man with a shrapnel wound to the head. M. A. Topchibashev was the first in the world to use seawater as an effective blood substitute for massive blood loss in wartime conditions. Academician M. A. Topchibashev was a major surgeon of a wide range and successfully performed the most complex operations on the organs of the pleural and abdominal cavities, the skull. He made significant contributions to the development of gastric, biliary and pancreatic surgery and neurosurgery. He developed rational methods for the treatment of gunshot wounds to peripheral nerves and operative access to organs located in the subdiaphragmal space. His multifaceted scientific interest included issues of traumatology, thoracic and abdominal surgery, vascular surgery, oncology, neurosurgery, reconstructive surgery and urology. M. A. Topchibashev proposed an original method for plasticizing bone defects of the skull. M. A. Topchibashev is the author and co-author of more than 300 scientific papers, including 8 monographs and a 5-volume textbook “Private surgery”. Under his leadership and with his participation as a scientific consultant, 12 doctoral and 30 candidate dissertations were defended. M. A. Topchibashev was active in public activities. He was one of the 15 first founding members of the Academy of Sciences of the Azerbaijan SSR. For many years, he worked as chairman of the Peace Protection Committee of Azerbaijan, a member of the Friendship Committee with Asia, Africa and Latin America. Academician M. A. Topchibashev died on November 20, 1981 and was buried in the Alley of Honor.