Absolutely every girl dreams of staying young and beautiful for a long time. This is probably the reason most women are desperate to hide their age. A woman's age is indicated by her hands, posture, clothing style. But the first thing that can give out a woman's age is her face. Namely, such signs of aging as aging skin and wrinkles.

In order for the first signs of aging to appear as late as possible, you need to properly care for your skin. And you need to start doing this at the age of 20. However, at a young age, our skin seems to be perfect, and no one thinks that real age will be noticeable in a few years.

If a girl has not started caring for her face back in young age, then after 25 years, various skin problems may well arise, which will definitely give out her age. Of course, all this can be corrected with the help of facial plastic surgery.

Facial plastic surgery is very popular among the fairer sex. But at the same time, facial plastic surgery is the most feared, because operations performed on the face are considered very dangerous. But is it really so, and is it worth being afraid of facial plastic surgery? These and other issues should be discussed in more detail.

Contraindications and restrictions

Despite the fact that facial plastic surgery is very popular, not everyone can do it. There are a number of contraindications in which you can not perform plastic surgery on your face. It is worth remembering that before any plastic surgery, you need to consult a doctor. And of course, you need to pass various tests. Even if plastic is allowed for all other indications, testing is a prerequisite.

Need to know, that analyzes have a certain expiration date. Therefore, if everything is fine with you now, this does not mean that in six months, when you are going to do plastic surgery, everything will be just as great. All examinations must be carried out immediately before the cosmetic procedure at the time indicated by the doctor:

Here, only the main contraindications are considered, in which it is impossible to do facial plastic surgery. Of course, in fact, there can be much more of them, so only a doctor can allow or prohibit plastic surgery.

However, the physician may delay carrying out this procedure if the patient has ARVI or herpes. In other cases, in particular with oncology or poor blood clotting, it is necessary long-term treatment until all symptoms preventing plastic surgery are eliminated.

Varieties of plastic procedures

There are a large number of different types of plastics, and each of the options is suitable in order to eliminate a particular problem.

Without surgery

If you are afraid of undergoing surgery, then you have a direct road to a good beautician. Many people believe that facial imperfections cannot be corrected without a surgeon, but this is far from the case. There are a large number of methods that will help correct flaws and improve the overall appearance of the face. This:

You need to keep in mind: less complexity and the traumatic nature of non-surgical plasty, do not mean at all that it is possible to make lower demands on the clinic and staff, trying to find a more economical option. The consequences of any of the procedures described above, performed by a specialist with low qualifications or with violations of technology, can have very serious consequences for health.

Moreover, the lower complexity and responsibility of non-surgical plastic surgery attracts not only different kind dark businessmen trying to make money on the desire of women to be beautiful, but also outright scammers.

Surgical methods

In order to achieve significantly noticeable changes in the skin of the face, it is necessary to resort to the help of a surgeon. There is a fairly large number of plastic surgeries on the face:

Plastic surgery, like any other, cannot be called completely safe. Of course, it carries certain risks, this must be understood. And before deciding to take such a step, you need to think very carefully and weigh the pros and cons. Under what conditions is it still worth doing plastic surgery:

Finally, we must remember that no plastic methods will allow you to save the result achieved forever. After some time, a new intervention by a doctor will be required. These are both new monetary costs and an increase in the potential danger of procedures, especially when it comes to surgical methods of exposure. Thus, plastic is a struggle for beauty without an epilogue. And before you join this fight, you need to use completely safer ways: the use of various cosmetics that have the desired effect on the skin, massage, spa treatments.

Introduction

IN modern society It is very important how a person looks, therefore, more and more often, not only women, but also men pay attention to their appearance. Nowadays, seeking help from a professional in the field of plastic surgery is not considered uncommon. According to marketing research experts, every fifth woman in the world is not averse to resorting to services to improve her appearance through a surgical knife, and men's interest in plastic surgery almost doubles every year.

Do not forget that initially this type of surgery set itself the task not to change the appearance for the better, but only to solve serious health problems.

plastic surgery aesthetic knife

Plastic surgery, types of plastic surgery

Plastic surgery is a branch of surgery that deals with surgical interventions aimed at eliminating deformities and defects of any organ, tissue or surface of the human body.

The goal of plastic surgery is to restore most often the superficial tissues of the body, leveling defects in such a way that they do not attract the attention of others. The end result is that the patient acquires an appearance with which it is possible to lead a natural lifestyle.

Also, plastic surgery operations are associated with the displacement or movement of tissues using local tissues, their free transfer from distant areas to create new forms.

Plastic surgery has a sufficient number of methods for eliminating defects. Very important in predicting the results of the operation is: the choice of method, indications and contraindications for the intervention, the high qualification of the surgeon, the correct assessment of the general condition of the patient and the competent description of the defect.

The term "plastic surgery" was introduced in 1798 by the French surgeon Desolt, and came into wide use in 1893.

"Plastikos" (Greek) - to create a form;

"plasticus" (lat.) - forming.

Plastic surgery can be divided into two main types - reconstructive and aesthetic.

Reconstructive (restorative) plastic surgeries help eliminate deformations, defects of tissues and organs, and restore their functions using plastic surgery methods. Such operations are performed on people who have received bodily injury as a result of injury, illness or birth defects. A successful reconstructive operation can radically change the quality of a person's life, helping him regain a sense of a fulfilling life.

Aesthetic plastic surgery is the application of plastic surgery techniques to improve appearance. Thanks to such operations, people can not only prolong their youth and feel their beauty, but also get rid of the emotional stress of realizing their real or imagined imperfections, and thereby also significantly improve the quality of life. Aesthetic plastic surgery can be classified according to the area of ​​performance:

facial rejuvenation (skin tightening) - facelift

brow and forehead lift - front lifting

eyelid surgery - blepharoplasty

rhinoplasty

Rhinoplasty is the correction of congenital or acquired deformities of the nose, as well as the complete restoration of the missing nose.

septoplasty - surgery to correct the shape of the nasal septum

plastic surgery of the auricles - otoplasty

neck plastic - platysmaplasty

lip plastic surgery - cheiloplasty (using injections and implants)

hair transplantation

chin plastic - mentoplasty

cheekbone surgery - mandibuloplasty

change in the severity of the zygomatic areas - malarplasty

plasty of the neck and subchin area - cervicoplasty

breast plastic - mammoplasty

tummy tuck - tummy tuck

change in the nature of body fat - liposuction

buttock plasty - gluteoplasty

hand plastic surgery - brachioplasty

shin plastic - cruroplasty

plasty of small and large labia - labioplasty

hymenoplasty - hymenoplasty

vaginal plasty - vaginoplasty

penile plastic surgery - phalloplasty

skin tightening after weight loss

removal of the skin-fat fold on various parts of the body - panniculectomy

elimination of ptosis - torsoplasty

laser resurfacing of the patient's skin

excision of post-traumatic scars

combined plastic - two or more areas

reconstructive plastic - with massive external lesions

Nowadays, the following are considered the most popular aesthetic operations: nose, chin and ear correction, facelift, forehead and neck lift, blepharoplasty, eyebrow plastic surgery, lip correction, Botox injections; liposuction in the abdomen and waist, breast augmentation, reduction and correction, hand rejuvenation; buttock augmentation, liposuction in the "breeches" zone, reshaping of the labia minora and labia majora.

In reconstructive surgery - restoration of the shape of the breast after oncological diseases, auricles after injuries, skin after negative thermochemical or chemical exposure. Most of these types allow a person to change his life for the better in the near future.

However, Robert Goldwyn, a famous American plastic surgeon, argues that every operation that starts as a reconstructive one always ends up as an aesthetic one. The difference between them, he believes, is "a purely academic concept."

Almost everyone today knows, and sometimes firsthand, what plastic is. Many people are unhappy with their appearance. Small flaws that people around do not notice at all become just an obsession.

Fashion dictates They change every year. And in pursuit of an ideal appearance, people resort to the help of plastic surgeons. Everyone wants to look good and feel confident. Therefore, without fear, they lie under But in fact, you can do without plastic surgery. In any case, everyone decides for himself whether he needs it or not, and no one can give an unambiguously correct answer.

Plastic - what is it?

To understand whether it is necessary to resort to this type of surgical intervention, you should understand all the pros and cons. What exactly is meant by this concept?

So, let's figure out what plastic is and what it is for.

This concept has Greek roots. "Plastic" means "formed". Therefore, this branch of surgery is the creation or change of appearance.

Today, most people have ambiguous attitude to plastic surgery. Someone believes that this surgical intervention will save from many problems, while others do not believe that external changes will eliminate internal problems.

Types of plastic surgery

The list of services offered by clinics for the transformation of appearance is amazing. Almost every part of the body can be modified at will.

Plastic surgery is divided into two main types: reconstructive and aesthetic. The first are aimed at eliminating the consequences of injuries, deformations. Such plastic surgeries are performed to recover from bodily injuries from accidents, birth defects, and so on. Qualitatively performed surgical intervention of this type radically changes a person's life. He has self-confidence, a desire to develop.

Another type of plastic surgery is aesthetic. In this case, the main goal is to improve the appearance of the patient, depending on his desires. With the help of aesthetic plastic surgery, a person can prolong youth, beauty, which will help get rid of negative emotions and far-fetched shortcomings. This type of surgery also improves the lives of patients.

Aesthetic plastic surgery is classified depending on the area of ​​intervention. The most common operations:

• on the body (mammoplasty, vaginoplasty, liposuction and others);
• plastic surgery on the face (rhinoplasty, platysmaplasty, and so on);
• various suspenders;
• combined.

For plastic

Operations can save a person from complexes and practically give new life. When meeting new people, a former plastic surgeon patient will feel confident.

Operations do not require medical indications, only the desire of a person is necessary for carrying out. No one has the right to prohibit changes in appearance through surgical intervention, since this is a purely personal matter for everyone.

An indisputable plus is the ability to return to its former youth. And everyone knows how a person sees himself in the mirror, and feels internally. A youthful reflection will add strength and vigor to the body.

A significant advantage is the level of development of the current plastic surgery. Currently, various non-surgical changes in appearance are being carried out. They are performed using a laser or ultrasound. The patient after non-surgical plastic surgery does not have any wounds and punctures. The rehabilitation period passes much faster, scars are completely absent. Also, during the procedure, the person does not feel discomfort.

Against plastic

Before going under the surgeon's scalpel, you should definitely conduct a complete examination of the body. It should be prescribed by a doctor, if there was no such recommendation, then you need to consider the option of changing a specialist.

The main disadvantage of plastic surgery is recovery. The reaction of the body is sometimes unpredictable. Be sure to ask the surgeon about the postoperative period before the operation. How it goes, whether the doctor will monitor this process and so on.

Dissatisfaction with the outcome - half of those who have undergone surgery face this. Seeing themselves in the mirror with swelling, hematomas, patients feel terrible. In time they will pass. However, some people take the intermediate result too close to their hearts, and their recovery process after the operation is significantly delayed. There are cases when the help of a psychologist is needed.

Most often, the patient does not stop at one operation. Gradually it turns into an addiction. A person begins to remake with the help of surgeons everything that does not suit him in the slightest way. Stars are prime examples of addiction to plastic surgery. So, Donatello Versace is always unhappy with the size of her lips, Jocelyn Wildstein is in the eternal pursuit of youth.

We must not forget that everything has a price. That is why before making a final decision, it is worth going to a consultation with a surgeon. And best of all, if there are several of them - this way you will have the opportunity to compare clinics and doctors.

"Before" and "after" plastic surgery

Money can't always buy beauty. Evidence of this are unsuccessful plastic surgeries. Such unfortunate results most often occur due to the patient's excessive frugality. Undoubtedly, everyone does not want to be taken away from him undeservedly money. But this does not mean at all that you need to contact a doctor with insufficient qualifications. In low-cost clinics, hygiene is often neglected, the technologies used in operations are out of date, and the doctor is irresponsible for consultations. Plus, sometimes unexpected things happen. And this may well happen in expensive clinics. Examples of unsuccessful operations are such stars as Sylvester Stallone and Mickey Rourke. No one is immune from an incorrect dose of anesthesia, an allergic reaction to a drug component, or a banal medical error. The latter can be eliminated only by carrying out a new plastic surgery. Before and after photos can be seen below.

Each surgical intervention is a risk, which, it is worth noting, not everyone is able to take.

Do plastic surgery?

Without a doubt, the surgical intervention will change appearance, will improve you, raise your self-esteem, opening up a new world for you.

And yet, to make plastic surgery or not is a purely personal matter for everyone. However, do not forget that it will not be possible to return the original state. You will have to get used to yourself new, regardless of whether you like the result or not. Also, all plastic surgeries are unsafe for health, especially those that use silicone. It is for these reasons that the decision must be considered several times.

Only realizing what plastic is, what it is capable of, all possible results, you can make a decision.

CHAPTER 17 PLASTIC (RECOVERY) SURGERY

CHAPTER 17 PLASTIC (RECOVERY) SURGERY

The field of surgery concerned with restoring the form and function of tissues and organs is called plastic or reconstructive surgery.

The task of plastic surgery is the elimination of various defects, they can be congenital or acquired, arise as a result of injuries, diseases, surgical interventions and cause functional or anatomical changes. Any surgical operation contains elements of plastic surgery, as it involves the restoration of tissues and organs.

IN ancient india to restore the nose defect, plastic surgery was performed with a skin flap on a leg, cutting it out on the forehead. The method came to Europe and is still called the "Indian method of rhinoplasty". In Italy, in the 15th century, another method of rhinoplasty appeared - they used the skin of the shoulder area, it was called Italian. N.I. Pirogov (1852) developed a method of osteoplastic amputation of the foot, which provides a good supporting function of the limb. V.P. Filatov (1917) proposed the transplantation of a migratory skin stalk (Filatov stalk). Ts. Ru and P.A. Herzen (1907) developed an ante-thoracic esophagoplasty with a loop of the small intestine.

Nowadays, plastic surgery has acquired a leading role in all areas of surgery, and a new section has appeared - organ and tissue transplantation. In addition to purely surgical problems, its task is to study the issues of conservation of organs and tissues, tissue compatibility.

Types of plastic surgery

Depending on the source of transplanted tissues or organs, there are the following types of transplantation.

Autogenous transplantation: the donor and recipient are the same person.

Isogenic transplantation: donor and recipient are identical twins.

Syngeneic transplant: donor and recipient are first-degree relatives.

Allogeneic transplant: donor and recipient are of the same species (human-to-human transplant).

Xenogeneic transplantation: donor and recipient belong to different types(transplantation from animals to humans).

Prosthetics of organs and tissues using synthetic materials, metals or other inorganic substances.

The most widely used autoplasty, as well as prosthetics of organs and tissues. Xenoplasty (heart biovalves, vascular xenografts, embryonic tissues) is rarely used because of the difficulty of overcoming tissue incompatibility.

Types of tissue plastics

Tissue transplantation is possible with complete separation of the graft from maternal tissues - loose plastic, or transplant. There are the following types.

Transplantation of tissues and organs - moving them from one part of the body to another or from one organism to another.

Replantation - the affected tissues and organs are transplanted back to their original place (scalp, severed limbs or their fragments).

Implantation - tissues or cells are transferred to a nearby area.

not free,connected, or plasticity on a feeding leg, provides for the connection of the cut tissue flap with the original bed until the displaced part completely grows into a new place.

Skin plasty

Skin grafting is the most common type of tissue grafting. Skin autoplasty, its free or non-free variant, is more often used.

Loose skin grafting

Free skin grafting has a century-long history. In 1869 J.L. Reverden (J.L. Reverden) first transferred several small pieces of skin to a non-healing granulating surface in the elbow area. Subsequently, S. Shklyarovsky (1870), A.S. Yatsenko (1871),

M.S. Yanovich-Chainsky (1871), as well as J.S. Davis (J.S. Davis, 1917) developed and improved the grafting of skin in small pieces on the granulating surfaces of wounds in detail.

Yatsenko-Reverden method

Under local anesthesia with a scalpel or a razor, small grafts (a thin layer of the epidermis) with a diameter of 0.3-0.5 cm are cut off from the outer surface of the thigh, forearm or anterior abdominal wall and transferred in a tile-like manner to the wound. Then, a bandage with indifferent fat (vaseline oil) is applied to the wound with transplants for 8-10 days. The method is rarely used due to the rapid destruction of the epidermis.

Yanovich-Chainsky-Davis method

The grafts are prepared to contain all layers of the skin, since full-layer grafts do not autolyse or dislodge. Pieces of skin are placed in a checkerboard pattern on the granulating surface at a distance of 2.5-5 mm from one another.

Thiersch's method

With a razor or a sharp knife, strips of the epithelium are cut off to the tops of the papillary (Malpighian) layer 2-3 cm wide and 4-5 cm long. It is better to form grafts on the anterior surface of the thigh. The surface of the defect is covered with wide epidermal strips of skin and an aseptic dressing is applied on the 6-10th day. This method allows you to achieve good long-term results. It is more suitable for the treatment of long-term non-healing wounds and trophic ulcers.

Lawson-Krause method

A large graft cut into the entire thickness of the skin is transferred to the granulating surface and fixed with separate sutures to the edges of the defect. Disadvantages of the method: a transplant taken in the entire thickness of the skin takes root worse; the large size of the flap makes it difficult to close the donor site.

With the introduction of the dermatome into clinical practice, it became possible to take a flap of any area and thickness. Currently, manual and electrodermatomes are used; with their help, extensive skin defects (up to 2000 cm 2 in area) can be covered in one step. With the use of

By forming a dermatome, it is possible to obtain long split skin flaps consisting of the epidermis and part of the skin itself. The transplant is taken under general anesthesia. Through cuts of a certain length are applied in a checkerboard pattern on the resulting split thin flap with a special apparatus. When such a graft is stretched, it is possible to obtain a surface with an area 3-6 times greater than its original dimensions. Mesh autografts are widely used to close extensive wounds (Fig. 179).

Non-free skin grafting

Non-free skin grafting involves the formation of a flap of skin and subcutaneous tissue that maintains a connection with the mother tissue through the feeding leg. The pedicle of the flap must be wide enough to ensure a good blood supply. The leg should not be squeezed with a bandage, and when moving the flap, twisting of the leg around the longitudinal axis should be avoided.

Local (regional) skin grafting performed using the surrounding tissues by moving them.

In some cases, after mobilization of the surrounding tissues, the skin defect can be sutured in the usual way.

Relaxation incisions, made at a distance of several centimeters from the edges of the defect, allow you to bring the edges of the wound closer together and suture.

Z-shaped plasty is used for skin deformation with rough scars to restore normal ratios of body parts altered by scar adhesions. After excision of scar tissues, skin flaps are cut out and moved (Fig. 180).

A rotating tongue-shaped skin flap is cut out on a healthy skin area next to the defect and, by moving it, the defect is closed (for example, rhinoplasty according to the Indian method). The donor area is closed with a free skin flap or sutured in the usual way (Fig. 181 a).

Plasty by moving the flap from distant parts of the body, they are used in cases where there are no tissues in the defect circumference suitable for the formation of a flap.

Direct transplant a skin flap from distant parts of the body is used if it is possible to closely compare the donor site and the defect site, i.e. make a one-time closure of the defect - the Italian method (Fig. 181, b, c, 182, see color incl.).

Rice. 180.Options for closing skin defects. Roman numerals indicate the types of operations, Arabic - the stages of operations, Latin letters - landmarks of movement.

bridge plastic, recommended by N.V. Sklifosovsky, is used for plastic surgery of skin defects of the fingers, hand, forearm. The donor site can be a skin flap on the abdomen, in the area of ​​the forearm. Two parallel incisions are made in the area of ​​the donor site, a skin area is mobilized between them - a “bridge” is created, under which the damaged fragment of the limb (finger, forearm) is placed so that the detached flap covers the defect. The flap is sutured to the wound. Engraftment, as with the Italian method, occurs on the 10-15th day. At this time, it is possible to cut off the flap from the pedicle.

Rice. 181.Plasty with a skin flap on a pedicle using Indian (a) and Italian (b, c) methods.

Migratory flap plasty involves the formation of a flap in distant parts of the body, it is gradually moved to the defect.

stalked flap are formed by stitching the edges of the skin flap together with the formation tubular stem in the form of a suitcase handle - "Filatov stem" (Fig. 183). On the anterior surface of the abdomen, two parallel incisions (1) are made to the muscle fascia (the length of the skin incisions depends on the size of the defect), the edges of the skin-fat flap are sutured (2), and the place where the flap was taken is sutured (3, 4). The ratio of the length of the skin stalk to the width is not more than 3:1. After 10-14 days, blood vessels sprout into the stem, after 4 weeks the end of the stem is cut off, sutured to the arm (5, 6), and after 10-14 days it is sewn into the defect site (7, 8).

Rice. 183.Skin plasty with a tubular skin flap (“Filatov stem”). Explanation in the text.

Round migratory stemare used in the plastic surgery of extensive skin defects, trophic ulcers and non-healing amputation stumps, facial plastic surgery (creating an artificial nose, lips, closing the "cleft palate"), in surgery of the esophagus, pharynx, trachea, in plastic surgery of the vagina in case of atresia and in the treatment hermaphroditism.

If, for some reason, autotransplantation cannot be performed, allotransplantation is used.

allotransplantation

Skin allotransplantation is used for extensive burns or in cases where the general severe condition of the patient (intoxication, sepsis)

sis, etc.) does not allow the use of one or another modification of autoplasty.

Fresh and preserved skin allografts are used in the early stage of burn disease (on days 14-21) or after excision of necrotic tissues. Short-term (for 2-3 weeks) coverage of a large surface with a graft improves the general condition of the patient. Often, autotransplantation is combined with allo- and even xenotransplantation.

Brephoplasty- transplantation of the skin of a stillborn fetus (gestation period is not more than 6 months). With this type of allotransplantation, it is necessary to take into account the isoserological compatibility of the donor and recipient.

Currently, for large skin defects, free transplantation of a segment of the skin and subcutaneous adipose tissue with vascular anastomosis using microsurgical techniques is increasingly being used. In this case, the presence of a well-pulsing artery and at least one vein with sufficient drainage capacity is mandatory, vessels of small diameter are sutured under a microscope.

Muscle plastic

Leg muscle transplant sometimes used for filling bone cavities in patients with chronic osteomyelitis and bronchial fistulas. Regional muscular plasty is used to close defects in the muscles of the abdominal wall, in the plastic of inguinal hernias, hernias of the white line of the abdomen, to eliminate the inconsistency of the anus sphincter.

Transplantation of muscles on the leg is possible, provided that blood circulation and innervation are preserved. Tissue flaps, including an artery, allow for the replacement of extensive tissue defects.

Free muscle plasticity used in surgical practice to stop bleeding from parenchymal organs, filling damaged sinuses of the dura mater.

Tendon and fascia plasty

Tendons are transplanted to restore the lost functions of the limb, as well as the functions of a group of paralyzed muscles. In this case, the tendons of neighboring potentially healthy synergistic muscles are implanted into paralyzed ones.

Tendon plasty with primary suture is performed for tendon ruptures. If diastasis is detected between the ends of the damaged

Rice. 184.Tendon plasty: a-c - options for local plastic surgery.

tendon, various options are used local plastic surgery(Fig. 184).

Fascia plasty is used in plastic surgery. Free plasty with a flap of the fascia lata is used to strengthen the joint capsule, replace a defect in the dura mater, and form an artificial rectal sphincter. Canned fascia allografts can be used. Fascia plasty is used to close tissue defects in hernias of the spinal cord and abdominal wall.

Bone grafting

To restore the lost functions and cosmetic form of the organ, bone grafting is performed using bone grafting, eliminating the defect of the cranial vault or jaw, while restoring the shape and functions of the organ.

not freeplastic was first used by N.I. Pirogov (1852), who performed osteoplastic amputation of the foot with restoration of the support function of the lower limb. R. Greeley and Yu.K. Shimanovsky developed osteoplastic amputation of the lower leg.

Osteotomy according to the “Russian lock” method (N.V. Sklifosovsky) is used to fix bone fragments. In craniotomy, skin and bone grafts are used to close tissue defects.

Freebone grafting is used in the form of autotransplantation or allotransplantation.

Autotransplantation is used to fix bone fragments in case of delayed consolidation of fractures in false joints, to fill bone defects in chronic osteomyelitis.

Bone allografts are preserved by lyophilization or quick freezing (-70 to -196°C). Transplanted allografts dissolve after 2-3 years without inhibiting the ability of the bone to regenerate in the transplant area. Bone allografts are used as fixators during operations on the spine, resection of a joint or bone section.

Nerve plasty

The purpose of surgical intervention for injuries of the nerve trunk is to bring its ends closer together and eliminate the causes that interfere with regeneration. The use of microsurgical techniques has increased the efficiency of plastic surgeries on the nerves.

Options for operations on peripheral nerves are different: primary or secondary suture, nerve transplantation, neurolysis. The primary suture is used during the operation - during the primary surgical treatment of the wound against the background of a good general condition of the patient, the absence of crushing of tissues in the wound, with an injury prescription of not more than 12 hours. In other cases, nerve restoration is postponed, secondary stitching of the transected nerve is performed.

Before suturing the nerve, both of its stumps are resected within healthy tissue in the transverse direction. Sutures are placed on the connective tissue sheath without piercing the "cables" of the nerve itself, using atraumatic needles and threads 6/0 or 7/0.

When applying an epineural suture, tension should be avoided, for which it is necessary to mobilize the ends of the nerve. With a significant defect of the nerve, its transplantation is performed.

Vascular plastics

Restoration of blood supply to organs is increasingly being used. Use a manual or mechanical (hardware) seam. Microsurgical vascular technique allows restoring the patency of vessels up to 1-2 mm in diameter.

Used in vascular surgery autografts veins and arteries or synthetic prostheses from dacron, teflon, teflon-

Rice. 185.Prosthesis of an artery: a-d - stages of suturing a vascular prosthesis.

fluorolone, polytetrafluoroethylene, etc. The replacement of arteries with an autovein is widely used. The wall of the implanted vein thickens with time, “arterializes”, aneurysms are observed very rarely.

Of particular importance in vascular plastics is vascular prosthetics(Fig. 185). Vascular prostheses are used for vascular resection, bypass grafting, or for "synthetic patches" (eg, aortic plasty). In some cases, preserved allografts (umbilical cord vessels) or xenografts are used.

Organ transplant

Transplantation of organs and tissues has recently become increasingly popular. greater value. More than 130,000 kidney transplants, about 6,000 heart transplants, more than 4,000 liver transplants, and 1,500 pancreas transplants have been performed worldwide. The maximum follow-up period after kidney transplantation exceeds 25 years, heart - 15 years, liver - 12 years, pancreas - 5 years. In our country, more kidney transplants are performed (about 7,000 operations), transplantations of the liver and pancreas have begun, since 1987 heart transplants have been resumed.

Allotransplantation of organs from donors at the stage of brain death is used, organs of a corpse or close relatives are less often used (transplantation of only paired organs, such as a kidney, is possible).

Preservation of tissues and organs

Tissues and organs of people who died as a result of accidents (traumas) or died suddenly from various causes (for example, myocardial infarction, cerebral apoplexy) are suitable for transplantation. Contraindications for the removal and conservation of tissues and organs are such causes of death as poisoning, AIDS, malignant tumors, malaria, tuberculosis, syphilis, etc. It is advisable to take the internal organs from a potential donor immediately after ascertaining brain death. Tissues (skin, tendons, cornea, etc.) are removed and preserved in the first 6 hours after death.

The removal of tissues and organs for transplantation is carried out in special rooms in compliance with the rules of asepsis and antisepsis. The taken tissues and organs are thoroughly washed from blood and tissue fluid and then preserved using various methods.

Placement in solutions containing antiseptics or antibiotics, followed by storage in cooled solutions, plasma or blood of the recipient.

Rapid freezing at temperatures from -183 ?С to -273 ?С with subsequent storage at temperatures from -25 ?С to -30 ?С.

Lyophilization (freezing followed by vacuum drying) is used to preserve bones.

Immersion in paraffin, solutions of aldehydes (formaldehyde, glutaraldehyde). In special containers, tissues and organs from the laboratory are delivered to the clinic, where they are kept in special solutions at a temperature of 4 °C.

Complete engraftment of tissues and organs is observed during autotransplantation, transplantation from identical twins (syngeneic, or isotransplantation). With allo or xenogenic transplantation, a rejection reaction develops - a reaction of transplant immunity.

transplantation immunity response

The reaction of transplantation immunity (graft-versus-host disease - GVHD) develops in the recipient within 7-10 days after transplantation and is aimed at transplant rejection. Cells play a direct role in the rejection reaction. immune system, in particular T-killers, but macrophages and T-lymphocytes are involved in the implementation of the process.

In the first 4-5 days after transplantation, engraftment of the transplanted tissue occurs, the recipient's immunocompetent cells in this

period identify foreign antigen. From the 4-5th day, microcirculation is disturbed in the transplanted tissue, edema develops, invasion of the transplanted organ by mononuclear cells begins. T-lymphocytes acquire cytotoxic properties, and the B-lymphocyte system synthesizes antibodies, as a result, the allograft or xenograft is rejected. Repeated allotransplantation from the same donor causes a transplant immune response 2 times faster, since the body is already sensitized.

The modern immunological concept of tissue and organ transplantation is associated with the interaction of subpopulations of T- and B-lymphocytes, where the leading role is assigned to subpopulations of T-lymphocytes (helper, killer and suppressor cells).

Each living organism has a certain immune status, and its assessment creates the basis for typing the immune compatibility of the donor and recipient. According to the basic laws of genetics, each individual has HLA-sublocus antigens, referred to as tissue compatibility antigens, they are localized in cell membranes. The presence of several SD- and LD-determinants of the HLA complex determines the difficulties that accompany the selection of compatible donor and recipient. The probability of selecting an identical genotype is no more than 1:640,000.

The selection of a donor and recipient is based on immunological typing according to the main systems of antigens: AB0, Rh (erythrocyte antigens) and HLA (leukocyte antigens - histocompatibility antigens). The creation of organ banks that record and register thousands of recipients facilitates the selection of organs. Special recipient cards contain complete information about the immunological, hematological and clinical status of recipients. There are several such banks in Europe.

In order to increase the efficiency of allotransplantation, various activities are carried out.

Nonspecific immunosuppression - blockade of the recipient's immunocompetent system with antimitotic agents (azathioprine), glucocorticoids (prednisolone) and antilymphocyte sera. As a result of such exposure, a state of immunodeficiency is formed in recipients and resistance to infections is sharply reduced.

Replacement of the recipient's hematolymphoid system before allotransplantation by total radiation suppression of lymphoid tissue, followed by transplantation of the donor's bone marrow.

Selective elimination of T-killer cells with simultaneous stimulation of the activity of T-suppressor cells. A similar selective action is characterized by cyclosporine.

From the point of view of tissue compatibility, transplantation of one's own organ or tissues is ideal.

Replantation

Replantation of a severed limb or its fragment is possible in the first 6 hours after injury, provided that the severed limb is stored at a temperature of 4 °C, with perfusion of its vessels before transplantation. After the primary surgical treatment, the bone is restored, then the plastic surgery of the vein and artery is performed, after which the nerves, muscles, tendons, fascia, and skin are sutured. In the postoperative period, measures are taken to prevent the syndrome of traumatic toxicosis, using hypothermia, an abacterial environment.

kidney transplant

Kidney transplantation is widely used today. The indication for kidney transplantation is its functional insufficiency with increasing uremia. The kidney is usually transplanted in a heterotopic position - it is placed retroperitoneally in the iliac fossa. The blood flow is restored by anastomosing the vessels of the donor kidney with the common iliac artery and vein of the recipient; the ureter is implanted in the bladder (Fig. 186). Before surgery and in the immediate postoperative period, hemodialysis sessions are performed to reduce uremia. A sign of kidney rejection is the appearance of lymphocytotoxins in the blood and lymphocytes in the urine.

Rice. 186.Heterotopic kidney transplantation: 1 - iliac artery; 2 - iliac vein; 3 - ureter; 4 - bladder; 5 - transplanted kidney.

Liver transplant

The indication for liver transplantation is its rapidly progressive insufficiency (cirrhosis, malignant tumors, atresia of the biliary tract in newborns).

After removal of the recipient's liver, the allogeneic liver is transplanted into a normal bed in the upper right quadrant. abdominal cavity (orthotopic transplant).

For heterotopic transplantation the donor liver is placed in another area of ​​the recipient's abdominal cavity.

Liver function for a short period can be supported by short-term extracorporeal perfusion of the liver of a corpse or animal (pig, calf).

Heart transplant

Heart transplantation is performed in severe heart failure associated primarily with progressive cardiomyopathy, aneurysms of the left ventricle of the heart, uncorrected congenital heart defects, including a two-chambered heart, atresia of the right atrioventricular (tricuspid) valve, etc.

The rationale for heart transplantation in the clinic was the experimental studies of A. Carrel (1905) and V.P. Demikhov (1946-1960). A. Kantrowitz in New York repeated a similar operation on an infant. Later it turned out that the first attempt at heart transplantation was made in 1964 in the state of Mississippi by an American J. Hardy, who performed xenotransplantation of a chimpanzee heart to a 68-year-old patient.

The heart is implanted in an orthotopic position (in place of the removed organ) under cardiopulmonary bypass. The recipient leaves the posterior wall of both atria with the mouths of the vena cava, thus preserving the zone of autonomic innervation of the heart. Transplantation begins with the suturing of the posterior wall of the left atrium, the interatrial septum and the right atrium, then the aorta and pulmonary trunk are connected.

Signs of heart rejection are first detected on the ECG (tachycardia, extrasystole, a decrease in the voltage of the teeth). Repeat endocardial biopsies of the heart confirm the diagnosis.

The use of a mechanical heart is of particular importance. Currently, an artificial heart with a pneumatic drive is used for short-term replacement of the heart in the absence of a donor.

Transplantation of endocrine glands

The clinic uses transplantation of the thyroid gland, pituitary gland, adrenal glands, testis, pancreas.

Free transplantation of endocrine glands has been performed for a long time, but the functions of the glands are realized only until the implanted tissues are resorbed. Transplantation of endocrine glands on a vascular pedicle preserves the entire structure and function of the gland.

The collection of endocrine glands for transplantation is performed in the first 6-10 hours after death. At the same time, the vascular pedicle of the gland is isolated with washing of the vessels with special solutions and then frozen at a temperature of -196 °C. Most often, the vessels of the glands anastomose with the femoral or brachial artery. The functional effect of transplantation is clearly manifested: after the transplantation of the testis, inhibition and inertia disappear in men, ejaculation appears; in women after ovarian transplant menstruation appears; with myxedema, thyroid transplantation is effective; tetany, convulsions are eliminated by transplantation of parathyroid glands; in diabetes insipidus, pituitary transplantation significantly reduces the feeling of thirst. In addition to effective transplantation of the pancreas (body, tail, lobe) with vascular anastomosis in the iliac fossa, a hormonal effect was obtained by transplantation of isolated islets of Langerhans or the smallest fragments of the pancreas into the liver through the portal vein.

Plastic surgery in modern medicine is an integral part of reconstructive and aesthetic surgery. The goals and objectives of most plastic surgeries are to change the appearance of various parts of the body to improve aesthetic perception, both by the patient and others. The reasons can be of a restorative nature, resulting from injuries, the appearance of sutures from previous surgeries and the psychological kind, which are most often caused by the moral state of the patient, who is dissatisfied with his appearance, as a rule, due to subjective conclusions.

Operation types

A plastic procedure on the patient's face, which provides for the creation of a rejuvenation effect by removing wrinkles, nasolabial folds, by lifting. Manipulations are carried out under general anesthesia. The face is marked, after which the necessary incisions are made from the scalp in the temple area, along the ear and up to hairline behind the ear, excess skin is excised, after which a suture is applied. The recovery period takes about a month.

Front lift (eyebrow and forehead lift). It is performed by open or endoscopic method.

The essence of these methods is to remove excess fat, redistribute the skin and change the muscle tissue in the supraorbital and frontal region.

This operation can be performed both under local and general anesthesia.

This is a surgical method that allows you to change the geometry of the eyelids and eye incision. Distinguish between blepharoplasty of the upper and lower eyelids, eliminating their overhanging or saccular swelling under the eyes. It is performed by creating an incision in the crease of the eyelid and removing excess skin, fat cells and correcting muscles. Operations on the lower eyelid can be performed using an incision on inside century. It is possible to perform circular blepharoplasty, affecting both eyelids at the same time. Rehabilitation takes 2-3 weeks.

Allows changes in acquired or congenital curvature or geometry replacement. There are many surgical approaches for performing the operation. Closed plasty is more common, in which certain cartilage or bone tissues are removed, and, if necessary, they are increased. The open type of operation is indicated for massive defective phenomena, in this case, in addition to the tissue of the nostrils, the vertical septum separating the nostrils is also cut. In some situations, secondary plastic surgery is indicated. Full recovery depends on the methods of the operation and takes at least 3 weeks. Septoplasty, unlike rhinoplasty, it involves restoring the shape of the nasal septum, on the recommendation of an ENT specialist. The goal is to restore nasal breathing. This type of operation refers to reconstructive plastic surgery.

Otoplasty (plastic surgery of the ears). The most common indication is deafness.

The procedure is performed under general or local anesthesia.

The method involves determining the appropriate cartilage shape, after which an incision is made behind the shell and the cartilage is shaped to fit the ear to the head.

It is performed by the method of injections or implants.

For injections, preparations based on collagens or synthetic substances are used.

Implants are used in the form of synthetic plates, implanted in the lips. Sometimes, together with injections, lip contouring is performed.

Hair for transplantation is taken only from the patient who undergoes this operation.

The technique is that a graft (a small area of ​​skin with hair) is cut out and transplanted into place of the same cut area on the bald part.

The number of transferred grafts determines the future frequency of hairline.

Mentoplasty (genioplasty, mandibuloplasty, chin plasty). The procedure is divided into two types: reducing or increasing the chin. It can be performed externally, through an incision in the skin fold under the chin, or through an internal incision in the area of ​​the lower lip. The increase is performed using the installed implant. The reduction is carried out by cutting the bone and cartilage tissue. This type operations are classified as traumatic with a long rehabilitation period of three months.

Malyarplasty (plastic of the cheekbones). The techniques of the operation are similar to mentoplasty, the shape of the cheekbones is changed by the introduction of special implants (bone, synthetic, silicone). Synthetic materials tend to cause allergic reactions, and bone dissolve over time, in connection with this, the use of solid silicone prostheses is currently practiced. If a reduction in the size of the lower jaw is required, excess bone tissue is removed for this. Manipulation is carried out under general anesthesia, the rehabilitation period takes at least three months.

Cervicoplasty (plasty of the neck and subchin area) is a surgical operation, the purpose of which is to remove excess skin on the neck and under the chin. The technique consists in incision of the skin in the area of ​​the chin and ears. Excess covers are removed, if necessary, fatty tissues are cut off. After that, the incision is sutured with skin tension, which leads to the tightening of the integument. Since the human neck contains vital great vessels and the thyroid gland, such an intervention requires the highest qualification of the surgeon. The rehabilitation period is short, usually it is equal to the time for tightening the formed sutures. In some cases, this type of correction is combined with platysmaplasty.

one of the frequently performed procedures in the field of plastic surgery, is performed in order to achieve the aesthetics (shape) of the mammary glands or change their size. Often, patients need to correct the shape and increase (decrease) the size of the breast at the same time. The operation is carried out by implanting special prostheses, which are selected individually according to the wishes of the patient. They differ in the material of their shell, filler, tear resistance. Typically, such prostheses can be in a woman's chest for a long time (about 15 years), after which they need to be replaced. The choice of dislocation of the incision is negotiated with the patient. The implant is placed depending on the situation and may be located between the breast muscle and the gland or under it. To reduce the breast, liposuction is used, which does not leave sutures or the T-shaped incision method, which drastically reduces the tissue volume of the breast.

have a general direction based on the removal of excess skin and fat. So, classic abdominoplasty involves the total removal of excess fat and excess skin by creating an incision near the navel and on the bikini projection. This removes fatty tissue from the abdominal wall and excess skin. This operation involves the installation of a drain to drain the exudate. Postoperative suture postoperative suture in the suprapubic area. Liposuction involves the removal of fatty tissue by suction through a special tube inserted into areas with excess fat cells through small incisions. When it is carried out, it is required to observe the symmetry of the removal of fat, to prevent the formation of dents. The postoperative period takes 3-4 weeks.

Gluteoplasty (buttock correction procedure). It is based on the implantation of prostheses under the gluteal muscle.

The operation is performed under general anesthesia, an incision is made in the sacral region, after which an implant is inserted under the buttock muscle and the incision is sutured.

Recovery takes about a week.

Brachioplasty (hand plastic) is a tightening of the skin on the hands, usually in the upper part.

The method consists in creating an incision from the armpit to the elbow and removing excess skin and fat. Then the suture is applied.

Sometimes this method is combined with liposuction. The postoperative period takes 1-2 months.

Cruroplasty and femoroplasty (plasty of the lower legs and inner thigh). Thus, cruroplasty is based on the implantation of a prosthesis in the subcalf muscle or its fascia. To do this, the popliteal fossa is cut into 3-5 cm. Femoroplasty is designed to remove excess and sagging skin on the inner thighs. It is carried out by creating an incision in the groin area and removing excess skin and fat. The length of the incision depends on the individual characteristics of the patient.

Labiaplasty (plasty of small and large labia). Sometimes the indications are postpartum trauma. There are plastics of small and large labia. Operations on the labia minora are carried out by excising excess tissues, achieving the desired reduction in them. On large lips, plastic surgery is performed in order to increase or decrease the size. To increase, either a special gel or adipose tissue is injected into the body of the lips. They are reduced by removing excess or by liposuction. The rehabilitation period takes about a month.

Hymenoplasty (plasty of the hymen). Distinguish between short-term and long-term results of the operation.

In the first case, sections of the hymen are sutured, which gives a temporary result due to incomplete healing, in the second case, the hymen is restored from the tissues lining the entrance to the vaginal area.

The procedure is performed under general anesthesia.

Vaginoplasty (Vaginoplasty) involves the restoration of muscle tone lost due to labor or structural features of the vagina in individual cases. The reason for going to the surgeon is the desire to increase sexual sensations during intimacy with a partner. In some cases, this operation is indicated purely for medical reasons, for example, when the uterus is prolapsed. There are several technical approaches. Classical techniques are based on excision of the tissue and suturing the edges of the incision, which leads to a narrowing of the vagina. The method of implantation consists in the introduction of a special fastening mesh, which over time is covered with connective tissue and increases muscle tone.

Phalloplasty (penile plastic surgery) one of the technically complex operations is performed to correct or artificially form the penis. Such operations are indicated for many reasons, not only aesthetic, but also medical. The aesthetic factor is due to an increase in the length of the penis, medical reasons include penile injury, the consequences of malignant tumors, developmental anomalies. The complexity of the intervention is exacerbated by the task of restoring the urethra. The technique consists in moving the cavernous bodies, replanting the skin in the form of cut flaps and providing innervation that allows you to get full sensations during sexual activity. At the same time, vascular surgery is performed, for a full blood supply to the tissues of the penis. Skin flaps are taken from the scrotum, back or forearm. The rehabilitation period is 2-3 months.

Platysmaplasty (neck plastic surgery) involves lifting (tightening of skin and muscle tissue) on the neck. Often performed in conjunction with chin plastic surgery. The task of this operation is to get rid of sagging formations and sagging. Unlike cervicoplasty, manipulations are performed on the subcutaneous muscle (platysma). Plastic surgery is carried out by removing fat cells, creating incisions in the behind-the-ear region and tightening the platysma. In case of divergence of its edges, medial plasty is performed. The operation is performed under general anesthesia, complete healing and resorption of the sutures occurs after 1-1.5 months.

Panniculectomy (skin tightening after weight loss). In some cases, it is carried out in parallel with liposuction or abdominoplasty. Panniculectomy does not affect the manipulation of muscles and involves only the removal of excess skin. The skin-fat apron is removed as follows: an incision is made from the sternum to the area of ​​the pubic joint and a transverse horizontal incision along the pubic region itself. Excess skin and fat is removed and the incisions are sutured. For some time, drainage is carried out through the inserted tube. Rehabilitation may take 2 months.

Torsoplasty (combined plastic surgery) This is an operation involving the removal of excess skin on two or three areas at the same time. Refers to complex and lengthy surgical interventions. Performed as a result of significant weight loss. Removal of excess stretched skin is carried out in the back, on the sides, in the abdomen. The peculiarity of this technique is the simultaneous (on the same day of operation) disposal of excess skin-fat structure. Technically, it is performed by excision of excess tissue on the back and sides, and then, according to the principle of abdominoplasty, an excision is performed in the abdomen. The rehabilitation period takes about a month, the final result can be seen no earlier than six months later, since it takes a long time to reduce and lose the color of postoperative scars.

Reconstructive plastic surgery for massive external lesions is a specific type of surgical operations, differs from classical plastic surgery in that the patient in this case is forced to resort to certain manipulations that can restore the natural appearance of body parts to him. So, various injuries, burns, the consequences of certain diseases or classic radical effects can lead to irreversible consequences of a change in appearance. Sometimes a massive impact on a person of adverse factors leads to total disfigurement. Reconstructive plastic surgery of the face is able to restore the natural appearance of a person after burns, serious injuries. It can be combined with rhinoplasty if there is a need to restore the nose. Reconstructive breast surgery makes it possible to restore the organ in case of its removal due to malignant tumors. Reconstruction includes a part of phalloplasty operations. Abdominoplasty and reconstruction on the extremities allow you to remove sutures from previous abdominal operations or restore limbs, including vascular and nerve microsurgery.

Trends in world plastic surgery and the most popular types of interventions performed

Conducted research in this area shows that the number of surgical procedures of this type is steadily increasing. If we consider the trends in the increase in the number of these operations since the beginning of the 21st century, we can see that the annual increase in interventions is about 10%, that is, in each subsequent year, the number of patients undergoing plastic surgery of any body parts increases.

There are certain types of operations that are most popular in the world, and in different countries their rating may change, but at the same time, according to their classification, they remain the most frequently performed.

List of the most popular interventions according to world statistics:

• mammoplasty (corrective breast surgery);
• liposuction (removal of fatty deposits);
• blepharoplasty (eyelid correction);
• abdominoplasty (correction in the abdomen and waist area);
• rhinoplasty (surgery to change the shape of the nose).

Frequency of performed plastic procedures in Russia:

• rhinoplasty;
• liposuction;
• blepharoplasty;
• mammoplasty;
• abdominoplasty.

That is, there are approximately the same types of polarity operations with different ratings.

Features of psychological moments

By carrying out plastic surgery of various directions, it is possible to achieve two positive moments at once. The first is to recreate the required aesthetic component, the second moment has a direct impact on the psycho-emotional state of the patient. A successful procedure helps a person get rid of a set of certain complexes associated with an unsatisfactory (even in his subjective opinion) state of any parts of the body. On a global level, aesthetic surgery has a beneficial effect on the mental component of the patient.

Surgical defloration (medical dissection of the hymen) is a plastic surgery on the external female genital organs, which is performed both at the request of the patient herself and for medical reasons. When is it necessary to perform surgical defloration Virgin ...

Vaginoplasty (intimate plastic surgery of the vagina, colpoplasty) is a plastic surgery that involves the elimination of damage and sprains, the restoration of lost muscle tone, the natural anatomical structure of the vagina. The operation is carried out both for aesthetic reasons, and to eliminate diseases of the female organs, ...