Browsing by Author "Makarov, Vitaliy"
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Item Features of the use of ladder myoplasty of a gunshot wound to the laryngopharynx: Case report(2023-10-01) Lurin, I.; Makarov, Vitaliy; Khoroshun, Eduard; Nehoduiko, Volodymyr; Shypilov, Sergiy; Smolianyk, KostiantynIntroduction and importance: The laryngopharynx wound is considered to be one of the most severe wounds of neck both in war and in peace, as it may cause life threatening changes in the whole body (asphyxia, bleeding, shock). Important aspects of surgical treatment are to ensure full breathing, acceptable ways of feeding, and the use of reliable wound closure techniques aimed to prevent digestive tract failure and to maintain the framework and aerostasis of the laryngotracheal region. Case presentation: A case of unilateral multiple wounds of the laryngopharynx was described in the article. The features of diagnostics, surgical treatment and conservative therapy in the postoperative period with this injury were presented. The wounded man was urgently operated. During surgery the pharynx was mobilized. The metal fragment was removed. The wound of the pharynx was sutured with a two-row suture. The next stage of the surgical treatment was myoplasty. In the case of the patient, the purpose of myoplasty was additional sealing of the pharyngeal suture and myoplasty of the thyroid cartilage injury zone for the purpose of aerostasis. Because of the size of the wounds and their anatomical localization, we used the mobilized lower edge of the Musculus sternocleidomastoideus for myoplasty and proposed the method of ladder myoplasty developed by us. Clinical discussion: In myoplasty method the following criteria must be followed: the muscle flap must be of sufficient length and width, so as not to cause excessive tension in the myoplasty area; the flap must be thick enough to avoid necrosis that may cause subsequent infectious complications; when taking the flap, the most sparing operative access should be used to avoid functional and anatomical disorders; the volume of the taken muscle flap must not lead to functional and anatomical disorders. Conclusion: The proposed method of ladder myoplasty using Musculus sternocleidomastoideus is unique, and proves its high efficiency in unilateral multiple laryngopharyngeal injuries, and can be recommended for wide clinical implementation in such clinical situations.Item Quantitative morphometry of compensated liver cirrhosis can aid to predict the outcomes of surgical treatment(2024) Petiunin, Oleksii; Makarov, Vitaliy; Feskov, Volodymyr; Smolianyk, Kostiantyn; Shpytalna, Y.Objective — to define quantitative morphometric characteristics of hepatic parenchyma lesions at compensated liver cirrhosis (CLC), which will allow more accurately to assess its functional reserves and predict the outcomes of surgical treatment. Materials and methods. Intraoperative marginal liver biopsy was performed for 74 patients with CLC, who underwent surgical treatment. Morphological examinations with quantitative morphometry of intraoperative liver biopsies were done with the use of cytological analyzer with software «Integral-2MT» produced by the association «Kvant» (Kyiv). The connective tissue area (CTA), unchanged hepatocytes area (UHA), stromal-parenchymatous ratio (SPR), the volume of hepatocytes in the state of necrosis and/or necrobiosis (VHSNN), the volume of hepatocytes in the state of division (VHSD) were determined. The statistical analysis was performed by use of Statistica 12 software package. Results. Three types of morphological pattern of CLC were isolated. Type I (type A) portal cirrhosis with weakly pronounced signs of parenchymatous and stromal reaction (mono-multilobular type, portal cirrhosis). The CTA was 66.73 ± 1.71 m2, SPR was 0.285 ± 0.019, UHA was 234.13 ± 11.5 m2, VHSNN was 11.21 ± 0.74 %, VHSD was 10.23 ± 0.57 %. Type II cirrhosis (type B) — cirrhosis of mono-multilobular type with moderately expressed signs of parenchymatous and stromal reaction. The CTA was 126.69 ± 12.5 m2, SPR was 0.617 ± 0.031, UHA was 205.34 ± 13.8 m2, VHSNN was 17.32 ± 0.63 %, VHSD was 15.43 ± 0.48 %. Type III cirrhosis (type C) — cirrhosis with pronounced signs of parenchymatous and stromal reaction, more often of multilobular type. The CTA was 240.16 ± 13.4 m2, SPR was 1.344 ± 0.089, UHA was 178.69 ± 18.7 m2, VHSNN was 23.97 ± 0.75 %, VHSD was 11.07 ± 0.58 %. Analysis of immediate results of surgical treatment demonstrated, that no one patient with A-type CLC died, while 9.5 % of patients with B-type and 25.0 % of patients with C-type CLC died in the early postoperative period. Conclusions. Quantitative morphometry demonstrated that pathological changes in the liver at CLC are heterogeneous and can be categorized in to 3 types (A, B, C). Three types of morphological pattern at CLC, which were isolated, are characterized by significant differences in CTA, UHA, SPR, VHSNN, VHSD parameters. At transition of A-type cirrhosis into C-type, volume of hepatic parenchyma becomes to be decreased, while volume of connective tissue becomes to be increased. This is accompanied by decrease in UHA, increase in CTA, SPR and VHSNN. Surgical intervention in patients with type C morphological pattern of cirrhosis is associated with a high risk (25 %) of poor outcome, which indicates the need to limitations for indications to elective surgical operations in this category of patients. Thus, quantitative morphometry of liver biopsies in CLC patients can aid to predict the outcomes of surgical treatment.Item Telemedicine support aids lower limb reconstruction after combat injury in Ukraine(2023-05-18) Khomenko, I.; Lurin, I.; Gumeniuk, K.; McKnigh, G.; Makarov, Vitaliy; Nehoduykо, Volodymyr; Khoroshun, Eduard; Tertyshnyi, S.Since the destructive and illegal full-scale invasion of Ukraine in February 2022, caring for the victims of war trauma has been an essential function of Ukrainian clinicians [1, 2]. The authors present a case where using novel dynamic digital thermography (DDT), combined with international telemedicine support, contributed to saving the lower limb of an injured Ukrainian soldier. A male soldier in his 30s presented with a ‘through and through’ fragmentation wound to the right thigh from an artillery shell exploding nearby. After initial haemorrhage control and resuscitation, the patient was transferred to a tertiary hospital. Using telemedicine support, reconstructive surgery was planned and performed successfully using a perforating f lap technique. DDT was used pre-operatively to identify a perforating vessel and post-operatively to ensure perfusion of the f lap. The patient made a good recovery and was discharged 14 d post-operativelyItem Termination transformation of the fragmentary capsule after a gunshot(2023) Lurin, I.; Makarov, Vitaliy; Nehoduiko, Volodymyr; Tertyshnyi, S.; Vastyanov, R.; Chobey, R.; Korol, S.By the method of Mikel Calvo in the modification of Davydenko S.I. by staining the carboxyl and basic groups of proteins, it was proven that the perversion of the synthesis and maturation of the connective tissue of the periosteal capsule is due to the presence of metal fragments, soot, chemicals and elements. In the capsule around the fragment located in the dermis, in the period from 4 months to 6 years, due to contact with large and small metal fragments, disorganization of collagen occurs with a decrease in the relative number of basic amino groups of proteins and an increase in the relative number of acidic proteins due to carboxyl and hydroxyl groups. Endless destruction of maturing connective tissue fibers by carboxyl groups of proteins and their predominance over basic groups contributes to tissue acidosis and enhances metabolic proteolysis processes, destroying surrounding tissues, preventing tissue healing and leading to final fibrosis and removal.Item Videothoracoscopic removal of a foreign body (arrow-shaped element) of gunshot origin from the vertebral body, using radiation and magnetic technologies(2022) Lurin, I.; Khoroshun, Eduard; Makarov, Vitaliy; Nehoduiko, Volodymyr; Bunin, Yu.; Salyutin, R.; Tertyshnyi, S.Gunshot wounds to the chest have always occupied a special place among the entire set of gunshot wounds on the human body. Today, the one of the important challenges before the Navy of the Armed Forces of Ukraine, – not only to restore the damaged anatomical structures of the chest, but also to create optimal conditions for the restoration of the functional component. This will make possible to reduce the treatment period of a wounded serviceman and return him to the formation (or to the occupied position) as soon as possible. The use of minimally invasive methods (videothoracoscopy, radiation control and magnetic technologies) during the treatment of a wounded person with a penetrating gunshot wound of the chest is the key in the surgeon’s hands whose task is to save life and eliminate the defect (formed as a result of the wound). This approach is not only an example of highly specialised surgical care for the wounded in the navy, but also demonstrates the high quality of the proposed care scheme. Purpose – practically implement new organisational, tactical and professional approaches to the treatment of gunshot wounds to the thorax using a clinical case study. It is presented the clinical case of wounded man Sh., 35 years old, with a gunshot fragmentation blind wound of the posterior surface of the thorax, gunshot fracture of the Th7 vertebral body on the background of a foreign body (metal arrowhead). In the current world literature, there are many options for surgical tactics for the treatment of wounded patients with penetrating gunshot wounds to the chest. However, our clinical case draws attention to the high relevance of applying and combining minimally invasive techniques (video-othoracoscopy, radiation control and magnetic technology). This makes it possible to reduce the time (or duration) of surgical intervention, perform an «extended» revision of the pleural cavity, examine and assess the condition of the wound canal, remove a foreign body (shrapnel, bullets, arrowhead component), compensate for respiratory failure phenomena as quickly as possible and restore the integrity and function of the thoracic cells.