Plastic surgery (cosmetology) is a field of medicine dealing with the elimination of deformities and defects, restoration and improvement of the form and functions of any organ, tissue or human body. This type surgical intervention is aimed at returning the patient to the usefulness of his own body, psychological comfort, restoring the quality of life and a sense of beauty.

Plastic cosmetology aims at full or partial return of lost functions to the human body. For example, breast reconstruction after a mastectomy, rhinoplasty to solve breathing problems, transplantation skin after burns or elimination of scars and scars. However, operations are also aimed at purely aesthetic purposes - breast and buttock augmentation, removal of the hump on the nose, correction of the shape of the eyes, etc.

Reconstructive and aesthetic plastic surgery

All plastic surgeries can be conditionally divided into reconstructive and aesthetic (cosmetic).

Reconstructive surgeries are precisely those that correct body deformities and tissue defects that interfere with normal human life. In this case, surgical intervention is not just a whim, but a vital necessity. Reconstructive plastic surgery, carried out successfully, can change the quality of life of a person in better side helping to restore his sense of completeness.

Aesthetic surgery is the use of cosmetic surgery methods to improve the appearance. Such operations help not only to prolong youth and beauty, improve your body, but also get rid of many psychological complexes about the imperfection of your face, any organ or body as a whole. In this way, aesthetic surgery also significantly improves a person's quality of life.

Types of cosmetic surgery

Most often, plastic surgeons are treated with a desire to look younger. For some, this means big breasts and plump lips, while for others it means removing wrinkles on the face, for others it means getting rid of sagging skin. There are a lot of types of aesthetic plastic surgery, but we will list the most common among them:

• Plastic surgery of the eyelids, nose, ears
• Breast and lip augmentation
• Facial rejuvenation
• Hair transplantation
• Enlargement of the male genital organ and vagina
• Forehead and brow lift
• Plastic surgery of the cheekbones and chin
• Skin tightening after weight loss
• Plastic surgery of the arms, buttocks and abdomen
• Hymenoplasty (hymen restoration)
• Plastic surgery of large and small labia.

Another popular surgical procedure is liposuction - the removal of excess fat in the various zones body.

Read more about all types of plastic surgery in this section. Good luck!

Facial plastic surgery
(face, nose, ears, lips, neck, eyelids)

Modern facial plastic surgery has in its arsenal a lot of techniques for correcting completely different appearance flaws. With the help of blepharoplasty, lipofilling and facelift, unnecessary signs of aging and fatigue are removed, the look becomes more open and expressive, and the face is young. The most narrowly focused plastic surgeries - rhinoplasty (nose correction), cheiloplasty (lip plastic surgery), otoplasty (ear plastic surgery), mentoplasty (chin plastic surgery) - are performed on separate parts of the face, but significantly change the entire appearance of the patient. Plastic surgery to remove Bish's lumps allows you to get rid of problems with jowls and gives your face a more sophisticated look.

(implants, areolas, nipples)

Mammoplasty is a whole range of plastic surgeries aimed at correcting the appearance of the mammary glands. This includes:

• increase or decrease in breast size
• breast lift (mastopexy)
• elimination of asymmetry of glands
• nipple and areola reshaping
• breast reconstruction
• repeated mammoplasty

Modern used implants are made of high quality materials and have a lifetime manufacturer's warranty.

(belly, navel, waist, back)

Every person wants to have a beautiful toned body, but, unfortunately, nature has not awarded everyone with such an advantage. But thanks modern technologies in the arsenal of surgeons there are such plastic surgeries as liposuction, lipomodeling and abdominoplasty. With their help, you can remove excess body fat in any, even hard-to-reach, places, correct parts of the body that lack their own fat and tighten the tummy.

(ass, clitoris, vagina, lips)

Such types of plastics are gaining more and more popularity in recent years. Gluteoplasty, or buttock plastic surgery, allows you to tighten your ass and increase it in volume.

The whole range of plastic surgeries of the intimate zone is aimed at removing defects and giving the genitals an attractive appearance:

• laboplasty (correction of small and large labia)
• vaginoplasty
• clitoroplasty
• hymenoplasty (hymen reconstruction)
• G-spot injections (to enhance a woman's sexual sensations)

The appearance of a person has a significant impact on the moral state of a person, and sometimes even determines his fate. That is why for many it is extremely important how they look. Some people are extremely critical of themselves, so they are ready to do anything in order to have plastic surgery and get closer to the ideal. They are ready to endure dozens of surgical interventions, take on credit the amount missing for plastic surgery, and go through a long and far from always pleasant rehabilitation period. As a result, many manage to start life from scratch and become a successful and happy person.

What are plastic surgeries

Modern aesthetic medicine solves almost any problem associated with external imperfections. All operations are divided into two main groups: reconstruction and plastic surgery.

Reconstruction is usually performed for medical reasons and its main purpose is to restore the function of a particular part of the body. Such interventions are relevant for patients after serious injuries, unsuccessful operations, and those with congenital malformations. Plastic surgery is purely aesthetic. Its purpose is to make the patient more attractive.

The same intervention can be both aesthetic and reconstructive. An example is rhinoplasty. If the patient has a deviated nasal septum that causes respiratory failure, the intervention will be reconstructive, if the person simply does not like the shape of his nose, this is an aesthetic operation.

Today there are many types of plastic surgery. Here are the most popular destinations:

• mammoplasty;
• liposuction and lipofilling;
• rhinoplasty;
• lifting;
• cheiloplasty;
• abdominoplasty.

Undoubtedly, the most popular area is mammoplasty. Many women want to enlarge their breasts or change their shape, because they believe that the bust is the first thing that attracts the attention of men. There are many ways to do this, from implants to breast modeling using your own adipose tissue. There are also those who want to reduce their breasts. Nothing is impossible for aesthetic surgeons.

No less topical issue is the preservation of youth. Wrinkles and blurry facial contours do not adorn anyone, so most women make every effort to get rid of these manifestations. Russian and foreign stars are especially eager to save their face. They are ready to do dozens of braces, lifts, Botox injections to look attractive.

Liposuction closes the top three most popular procedures. Slenderness is considered a sign of youth and beauty, therefore plump women constantly struggling with extra pounds. The fastest and most reliable way to lose weight is liposuction. The technique not only eliminates overweight, but also to model the figure.

Today, sensual, voluminous lips are in trend. And it does not matter if nature has not made such a gift. The possibilities of plastic surgery allow you to adjust the shape and volume of each lip, create a bright, attractive image.

Eyes, cheeks, jaws, neck, chin, ears are also often subject to correction. Thanks to plastic surgeons, you can create almost any image and get closer to your own ideal.

To do or not to do plastic

There can be no single answer to this question, as they say: to each his own. If a person has congenital or acquired anomalies, here the answer is unambiguous: of course, do it. But why do those who are quite naturally pretty come to plastic surgeons?

The fact is that each person sees himself in a specific image, wants to occupy a certain position in society. The appearance given by nature often does not correspond to these ideas, which sometimes causes moral discomfort and serious mental disorders. It is plastic surgery that helps such people restore inner balance, gain self-confidence. In this case, it is worth deciding on plastic surgery, but you need to know the measure and realize what kind of result is needed and whether it is possible. We must not forget that there are many people for whom plastic surgery has become an obsession. This encourages them to perform one operation after another, in the end not improving their appearance, but disfiguring it.

If you are thinking about plastic, evaluate your own health. You need to understand that this is a surgical operation, and only a healthy, strong body can tolerate it well and recover quickly. A sick heart, diabetes mellitus, reduced immunity and many other diseases are also contraindications for plastic surgery. If you have serious problems, then you should not take risks, because health is more expensive than a beautiful appearance.

An obstacle for many is the cost of plastic surgery. It is worth noting that beauty is not cheap. But if there is an irresistible desire, it is possible to find the right amount of money. Many people invest in their appearance, and for good reason. Original appearance helped them become famous and make a solid profit.

Undoubtedly, the best way- perceive ourselves as we are, love our appearance, and consider shortcomings as a sign of individuality. But not everyone succeeds. If the desire to transform does not leave you, why not take the chance that plastic surgeons give us!

The possibilities of modern plastic surgery are truly endless. With the help of an experienced professional's scalpel, it is easy to achieve an ideal appearance or, at least, correct aesthetic flaws and change forms. We will consider the range of proposed types of facial plastic surgeries according to the demand rating in this review, showing before and after photos.

Facial plastic surgery - types of operations

Facelift - lose five or even ten years

With age, natural changes on the face appear in the form of deep wrinkles, the appearance of excess fat, and fading of the skin.

The essence of facelift is to strengthen the muscles, remove excess skin and form a new fresh contour. Facial plastic surgery can eliminate visible signs of aging, restore the former oval of the face, skin elasticity, tighten muscles, smooth out unwanted wrinkles and folds. But with all this, a facelift does not affect the structure of the skin and the process of age-related changes.

Facelift - lifting not only the skin: the operation also affects the superficial muscles, which gives a more pronounced and lasting rejuvenating effect.

The operation itself lasts about three hours, is performed under general anesthesia and requires a two-week postoperative period. The cost of a facelift depends directly on the amount of correction and is 300,000-350,000 rubles.

Forehead and eyebrow plastic surgery - stop hiding wrinkles under bangs

All the variety of emotions is expressed mainly by the upper third of the face. Rich facial expressions over the years are manifested by deep transverse wrinkles in the forehead, the formation of a crease on the bridge of the nose, excess skin in the area of ​​the upper eyelid, and drooping of the outer region of the eyebrow.

Modern plastic surgery is able to restore the former smoothness of the skin by performing forehead and eyebrow plastic surgery.

The duration of the operation, performed under general anesthesia, is one to two hours. The rehabilitation period lasts up to one week, after which you can use makeup and lead a normal life. The price of forehead and eyebrow plastic surgery is about 110,000 rubles.

Blepharoplasty - a small genius of a big transformation

A rich pattern of wrinkles in the eye area gives out age first, the so-called "crow's feet" appear already after thirty-five.

The possibilities of modern plastic surgery allow you to restore elasticity to the thin skin of the eyelids, get rid of fine wrinkles without a trace, remove dark circles and “bags” under the eyes, remove excess skin hanging over the eyes, thereby returning a young, fresh and happy look.

The duration of blepharoplasty is from forty minutes to one and a half hours. The operation itself does not require general anesthesia, local anesthesia is sufficient for its implementation. The rehabilitation period lasts about one to two weeks. And the cost depends on the level of correction and ranges from 30,000 to 100,000 rubles.

Rhinoplasty - ideal proportions

The reasons for rhinoplasty can be both aesthetic and functional. Correction of the shape and size of the nose is the most common operation for both men and women.

Rhinoplasty is an opportunity to improve breathing ability in case of difficulty, to make the nose perfectly shaped in the presence of an aesthetic discrepancy.

What can be corrected with rhinoplasty:

• tip of the nose
• "Asian" form
• nose length
• nose width
• snub nose
• remove the hump

The operation itself takes one to two hours under general anesthesia. The rehabilitation period is quite long. After seven to ten days, you can remove the plaster cast, up to ten to fourteen days, bruises under the eyes remain, and about three to four months, a slight swelling of the tissues in the nose area is noticeable. The cost of rhinoplasty ranges from 100,000 to 250,000 rubles.

Lip plastic - add charm and sexuality

Wrinkles at the corners of the mouth, nasolabial folds, too thin lips or their irregular shape are a real problem for those who want to always remain young and attractive.

Today's possibilities of plastic surgeons make it possible to correct all defects without a complex traumatic operation. Fillers (gels), which have appeared recently, make it possible to radically rejuvenate a smile in a short time (the procedure lasts ten to twenty minutes), while the rehabilitation period is minimal. The duration of the effect, as well as the cost of the procedure (15,000-60,000 rubles), depends on the drug used and the amount of correction.

Mentoplasty - perfect facial contours

A small or sloping chin violates the proportions of the entire face, and a heavy and large chin brings disharmony to the appearance.

Thanks to the modern possibilities of plastic surgery, today it is possible to change almost any aesthetic defect. Plastic surgery of the chin (increasing, reducing, changing its shape) allows you to make the appearance harmonious and achieve the desired result in a short time.

The operation usually lasts no more than half an hour, is performed under local anesthesia and requires a rehabilitation period of up to two weeks. The cost of mentoplasty varies from 20,000 to 50,000 rubles, depending on the amount of intervention required.

Facial contouring - the illusion of rejuvenation

Revolutionary in the field of rejuvenation has become an alternative to plastic surgery - facial contouring.

The ability to restore the lost freshness to the skin, smooth wrinkles and unwanted folds, restore the oval of the face, replenish the lost turgor, correct the shape of the lips - all this can be achieved by a non-surgical technique, contour plastic.

This procedure is carried out by subcutaneous injection of special biological products, the so-called, which perfectly eliminate the signs of aging.

The price range for facial contouring is quite wide and depends mainly on the volume of manipulations performed.

Change, transform, regain lost youth, but most importantly - do not lose your individuality.

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

Razor or 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 proper. 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.

pectoralis tendon, apply various options 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.