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Immediately after silicone implants were described, the technique of prepectoral implant placement dominated in breast reconstructive surgery. However, this plane soon had to be abandoned due to the high frequency of complications, such as infection, capsular contracture, explantation. For these reasons, surgeons soon had to switch to the subpectoral plane. Several decades later, thanks to the discovery of synthetic and biological meshes, surgeons returned to the prepectoral plane, but at a technically new level.The purpose of this review was to analyze the role of biological and synthetic matrices as factors influencing the choice of the implant plane in one-stage breast reconstruction.

Purpose of the study. Evaluation of the antioxidant status and DNA damage in tissues of subcutaneous xenografts of non-small cell lung cancer and in peritumoral tissues created using the A549 and H1299 cell cultures.Materials and methods. The study included 35 intact male Balb/c Nude immunodeficient mice. Cell lines A549 and H1299 were used as transplantable tumor biomaterial. A CDX model was created in accordance with the protocol for supratentorial injections (Ozawa T., James C. D., 2010) adapted for this experiment. Growth rates were controlled and intracranial xenografts were visualized using a high-resolution micro-CT system. The activity of catalase and superoxide dismutase was determined with non-denaturing electrophoresis in 8 % and 12 % polyacrylamide gel. The concentrations of sulfhydryl groups were determined according to Ellman. The DNA damage in lymphocytes was determined by the comet assay.Results. The experiment resulted in the creation of models of brain tumors characterized by intracranial growth pattern in 100 %. The activity of catalase in the studied lysates of intracranial xenografts, peritumoral tissue and healthy tissues of tumor-bearing animals in all experimental groups increased statistically significantly relative to the healthy tissue of intact animals, and the greatest differences from the control were recorded in the group of animals with implanted H1299 culture at a concentration of 1 × 106 . Superoxide dismutase activity in the studied lysates of intracranial xenografts and peritumoral tissues statistically significantly increased compared to the control sample in all experimental groups. The highest increase in the SOD activity was observed in the tissues of intracranial xenografts with the highest tumor load, which amounted to 28.8 % and 32.9 % of the changes relative to the control sample. A statistically significant increase in the concentration of SH-groups relative to the control sample in tumor tissue lysates was revealed in all experimental groups, and the highest concentration (36.2 ± 0.47) was observed in the group of experimental animals with the highest tumor load. Percentage change in tail moment (DNA damage indicator) in groups O1, O2, O3 and O4 increased statistically significantly compared to the control sample by 55.8 %, 111.8 %, 97.3 % and 170 %, respectively.Conclusions. The observed increase in the activity of the antioxidant defense system, accumulation of oxidative modifications of proteins, and an increase in DNA double-strand breaks in the tissues of intracranial xenografts of non-small cell lung cancer in vivo suggest that the created models reflect processes similar to those in tumors of human non-small cell lung cancer.

Background. Breast cancer is one of the most common malignancies and one of the leading causes of cancer deaths among women in the Russian Federation. The prognosis of the disease is largely determined by thebiological subtype of the tumor. Her2-positive breast cancer is characterized by an aggressive course and unfavorable prognosis. The use of pertuzumab, a recombinant humanized monoclonal antibody to the human epidermal growth factor receptor 2, significantly improved immediate and long-term treatment outcomes. The aim of the study was to evaluate treatment outcomes in patients with Her2-positive molecular subtype of breast cancer receiving chemotherapy combined with a dual anti-Her2 blockade, and to assess the intensityand incidence of side effects. Material and methods. Between 2015 and 2018, 37 patients with Her2-positive breast cancer received chemotherapy combined with a dual anti-HER2 blockade (docetaxel 75 mg/m2 i/v on day 1 + trastuzumab 6 mg/kg (loading dose 8 mg/kg) i/v on day 1 + pertuzumab 420 mg (loading dose 840 mg) i/v on day 1 once every 3 weeks). The mean age of the patients was 45.6 ± 11.6 years. Results. Neoadjuvant pertuzumab in combination with trastuzumab and docetaxel resulted in pathological complete response in 12 % of patients and pathological partial response in 36 % of patients. Among patients who received the above neoadjuvant therapy regimen, disease progression was observed in 4 % of patients. The most common side effects were weakness and fatigue (5.4 % of cases) and grade I–II leukopenia (5.4 %).Conclusion. The study demonstrated the efficacy of antitumor therapy with pertuzumab in combination with trastuzumab and docetaxel as well as the absence of severe side effects associated with this treatment regimen in patients with Her2-positive breast cancer.

Purpose of the study. Improving the results of surgical treatment of melanoma of the skin of the extremities by using skin-fascial flaps on perforating vessels.Patients and methods. In 42 patients with limb skin melanoma T1–3N0M0, the closure of a skin defect was performed by islet flaps on perforating vessels. Perforating vessels of the donor zone were detected with an assessment of the blood supply of the flaps in the pre- and postoperative period using ultrasound and marking of perforants with adjustment of the preliminary marking of the flaps.Results. Permanent perforating vessels with a diameter of more than 1 mm were used. After excision of the tumor, on the opposite sides of the wound defect, taking into account the location of the perforating vessels, flaps were taken, with further mobilization by excision of the fiber and muscle fascia, they were separated from the underlying tissues while maintaining the integrity of the supply vessels. The circulatory state of the selected flaps was determined by skin color and capillary response to digital pressure. The flaps were displaced to the center, covered the area of the defect and sutured with single sutures, the edges of the donor wound were mobilized, sutured with single sutures until light tension appeared and sutured into the remaining wound defect. In the postoperative period, the determination of the parameters of the blood flow of perforating vessels showed the absence of hemodynamically significant violations of the blood flow during the movement of the flap. Transient ischemia of one of the oncoming flaps after surgery developed in 11.9%, marginal necrosis of the distal flap — in 7.1% of cases. A normotrophic scar was formed, with a width of not more than 0.3 cm, which aesthetically satisfied 92.8% of patients. Assessment of two-year relapse-free survival showed a complete absence of local relapses.Conclusion. The flaps vascularized by perforating vessels have high viability, are identical in color and texture to the skin of the recipient area, and the close proximity to the receiving area contributes to minimal deformation of the donor area, which increases the radicality of the operation, reduces the incidence of postoperative complications and improves аesthetic and functional results.