Search

In the article provides an analysis of own of clinical experience peculiarities of carrying out of anesthesia, when performing 466 various tracheo-bronhoplastiс of operations for the period from 1979 to 2014 the year a one team of surgeons. Preoperative preparation, anesthesia and postoperative management of patients are key to improving treatment outcomes. Full arsenal of modern methods of ventilation lets you choose for each stage of surgery is most convenient for the surgeon and patient-safe way to maintain gas exchange. Presented in this paper our anestiology experience allows you to discuss and elect the proposed management of patients through the selection and optimization of the method that best meets modern requirements.

Unlabelled: Predictable and stable functional and aesthetic result is the aim of priority for the neurosurgeon dealing with the reconstruction of large cranial bone defects and complex-formed skull defects involving cranio-orbital region., Aim: the paper presents the experience with САD/САМ titanium and polyetheretherketone (PEEK) implants for complex-formed and large skull bone defects reconstruction., Material and Methods: Between 2005 and 2013 nine patients (5 females and 4 males) underwent cranioplasty and cranio-facial reconstruction with insertion of the customized САD/САМ titanium and PEEK implants. Computer-assisted preoperative planning was undertaken by the surgeon and the engineer together in 3 cases to provide accurate implant design. Eight patients had complex-formed and large posttraumatic defects of fronto-orbital (7 cases) and parietal (one case) regions. In two of these cases one-step reconstruction surgery for posttraumatic fronto-orbital defects combined with adjacent orbital roof (one case) and orbito-zygomatic (one case) deformities was performed. One patient underwent one-step primary cranioplasty after cranio-orbital fibrous dysplasia focus resection. Titanium implants were used in 4 cases while PEEK implants - in 5 ones. The follow-up period ranged from 6 months till 8,5 years (median 4,4 years)., Results: The accuracy of the implant intraoperative fit was perfect in all cases. Postoperative wounds healed primary and there were no any complications in the series presented. Post-op clinical assessment and CT data testified to high implants precision, good functional and aesthetic outcomes in all patients., Conclusion: САD/САМ titanium and PEEK implants application should allow for optimal reconstruction in the challenging patients with complex-formed and large skull bone defects providing predictable good functional and aesthetic result together with surgery morbidity and duration reduction. Computer-assisted preoperative planning should be undertaken for САD/САМ implants creation in the cases of posttraumatic defects combined with adjacent bone structures deformities and benign bone tumors of cranio-orbital region, thus enabling one-step reconstructive surgery resulted in essential symmetry attained.

This paper reports an observation illustrating the possibility of the successful surgical treatment of otosclerosis in a HIV-infected patient presenting with acquired immunodeficiency syndrome (AIDS) and positive response in the test for hepatitis C. The authors used the results of multispiral computed tomography (MSCT) of the temporal bones as a basis for the prediction of the outcome of the surgical intervention taking into consideration specific primary manifestations of HIV infection as well as immunological and virlogical responses to anti-retroviral therapy.

This paper describes for the first time the combined treatment of the patients who underwent plastic surgery for the correction of cosmetic defects in the form of grade II and III senile atrophy of the skin in conjunction with complicated neuropathies of the facial nerve. The essence of the proposed combined treatment consists in using lymphatic drainage massage, medicinal electrophoresis of a nivalin solution, multichannel electrostimulation, and microcurrent therapy with bipolar pulsed currents. The method made it possible to significantly improve the properties of the skin in the facial region, neuro-muscular conductivity, general microcirculation and cerebral circulation in the treated patients.

Results of the surgical treatment of 28 patients presenting with grade II microtia are presented. Otoplasty with the use of a free dermocartilaginous graft harvested from the normal auricle by the method of G.V. Kuchinsky was performed in 3 cases, correction of grade II plical folding of the pinna as described by A.T. Gruzdeva in 14 cases, and correction of grade III plical folding of the pinna as proposed by J. Diffenbach in 11 cases. Six cases of grade II microtia were treated by the original otoplastic technique. The results of the surgical treatment presented in this paper are discussed with special reference to differential modalities for the correction of auricular deformities considered in the present study.

Background: The problem of closure of skull base defects after resection of craniofacial tumors remains one of the most challenging in neurosurgery. Local pedicled grafts are preferred material for plasty. In this study authors present original technique of using a pedicled buccal fat pad (BFP) graft. Anatomy and functions of BFP are discussed in details., Materials and Methods: Since 2004 till 2009 159 patients with anterior skull base mass lesions were operated in Moscow Burdenko Neurosurgical Institute using the discussed technique (male:female = 53:106, mean age was 47 years (10-72))., Results: In 93% of cases pedicle BFP flap was applied, in 7%--free. Follow-up period ranged between 1 and 6 years. No postoperative CSF leak or other severe complication was observed in the series., Conclusion: BFP is characterized by absolute advantages--proximity of donor site and defect, simplicity of surgical technique, minimal postoperative discomfort and very low risk of benign complications. This paper is the first description of the suggested technique.

Implant materials for orbital surgery are mainly used during orbital traumatic deformity-eliminating operations, postenucleation stump plasty, evisceration, and anophthalmic syndrome correction. There are currently a lot of biological and artificial implant materials, but there is no universal material to correct all types of defects and this makes surgeons use a great quantity of reparative procedures and techniques and scientists continue to search for more suitable implant materials. This paper reviews the currently available materials used in orbital surgery in Russia and foreign countries.

The outcomes of keratitis in lagophthalmos occurring due to various causes despite therapeutic measures are generally poor. The influence of factors, such as drying of the cornea, impairment of its trophism, and infection, leads to the development of rough leukomas, and occasionally to eye death due to occurring endophthalmitis. The paper describes a clinical case of deep trophic central corneal ulcer on the single seeing eye with lagophthalmos, as well as ulcer treatment by the authors' procedure, by simultaneously affecting both elements of the pathology (lagophthalmos and trophic ulcerative keratitis of central localization) and creating an artificial pupil. This allows one to increase visual acuity, to cure keratitis, and to close a palpebral fissure.

The surgical treatment of postoperative ventral hernias (PVH) in patients with high operative-anesthesiologic risk (OAR) still remains a problem. The results of PVH treatment in 150 patients with different degrees of OAR are analyzed in the paper. Autoplastic operations and explantation of synthetic prostheses were performed. The second method demonstrated a range of advantages. The necessity of widening the indications for the planned surgery for PVH is proved, especially in patients with the increased OAR. This will permit avoiding complications of the hernia itself and decrease the frequency of urgent PVH surgery, very undesirable in such patients. The algorithm of the choice of reconstruction and anesthetic management is worked out.

The paper lays down the basic principles of ophthalmoplastic treatment on the basis of an analysis of the results of treatment and follow-ups of 2300 patients aged 6 months to 18 years who have abnormalities of the orbit and appendages of the eye. Emphasis is laid on the preference of methods for plastic repair, using local tissues, and free autologous grafting of the skin and mucosa. A soft material that is to be easy grown through, such as Carbotextim-carbonic felt, is recommended when contour plastic repair of the orbit is required. For hanging, a mersilene mesh should be employed in case of blepharoptosis. To achieve the better cosmetic results, it is better to operate at the age of more than 4 years; however, treatment should be initiated at the age of 1 year when there are available functional indications (symblepharon, ablepharia, or cryptophthalmus).

The paper analyzes complications due to 500 orbital plastic repairs for traumatic deformities. Biomaterials (cadaveric cartilage/bone, allograft for orbital wall plastic repair, or xenopericardium) were applied in all cases. The lost orbital volume was also compensated for by Carbotextim-M. Damage to the inferior oblique muscle was the severest intraoperative complication. The bulk of complications in the early postoperative period were transient and implant displacement in the late periods required its position correction only in 4% of cases. The implant displacement-associated risk factors were as follows: male sex, childhood, application of a solid material (cartilage, bone), and its attachment failure. Purulent processes were local and encountered in 2% of cases. The low incidence of severe complications, as well as permanently high functional and cosmetic outcomes (during as long as 98.2 months) suggest that biografting of the lower orbital wall is effective.

The paper presents an analysis of traumas of the orbit combined with craniocerebral trauma in children made according to data obtained at the eye microsurgery department, Morozov's Pediatric City Clinical Hospital. Fractures of the lower orbit wall account for around 70% of all orbit fractures; clinical signs of fractures of the lower orbit wall are defined; computer tomography is shown to be the most informative diagnostic tool. The paper contains indications for plasty of the lower orbit wall. Materials used in orbitoplasty are comparatively analyzed. The use of demineralized osseous implants is preferential.

The paper describes a clinical observation of closure of sphenoidal sinus defect and plastic repair of dura mater by using orbital tissues after removal of a tumor from the medial portions of the middle cranial fossa, which spread into the orbit and sphenoidal sinus, in complete irreversible loss of visual function, ophthalmoplegia and ptosis in a patient with skull soft tissue hypotrophy due to multiple operations and radiation therapy and hence unsuitable for displacement and closure. This observation shows it possible to use orbital soft tissue for repair of the base of the skull, in cases when integumentary cranial tissues are impossible to use as a plastic material due to their hypotrophicity. At the same time severe dysfunctions, such as blindness and ophthalmoplegia enable orbital tissues to be employed without significantly deteriorating any functional and cosmetic effect.