Lecture Lecture №№ 1 1

The subject of the problem of The subject of the problem of topographic anatomy and operative topographic anatomy and operative

surgerysurgeryprimary treatment of woundsprimary treatment of wounds

Closure of skin defectsClosure of skin defects

• Topographic anatomy - the study of Topographic anatomy - the study of the morphological structure of the the morphological structure of the different regions of the human body.different regions of the human body.

• TOPOS - the place and the GRAPH - TOPOS - the place and the GRAPH - I write. Hence - topographic, ie I write. Hence - topographic, ie Regional (regional) anatomy.Regional (regional) anatomy.

1) Layered topography - ie successive layers 1) Layered topography - ie successive layers outcrop area, from the skin.outcrop area, from the skin.2) Golotopiya - position of authority in relation to 2) Golotopiya - position of authority in relation to the human body. The liver, for example, is the human body. The liver, for example, is golotopicheski at right hypochondrium and golotopicheski at right hypochondrium and epigastric abdominal cavity and the heart - in the epigastric abdominal cavity and the heart - in the anterior mediastinum and thoracic cavity, etc.anterior mediastinum and thoracic cavity, etc.3) syntopy - the ratio of the body to the surrounding 3) syntopy - the ratio of the body to the surrounding organs and tissues. Thus, behind the stomach organs and tissues. Thus, behind the stomach adherent pancreas, bottom - adherent pancreas, bottom - poperechnoobodochnaya intestine, stomach in front poperechnoobodochnaya intestine, stomach in front of the front abdominal wall, etc. Relationships are of the front abdominal wall, etc. Relationships are described and with n t o p u and body.described and with n t o p u and body.4) Skeletopiya body, its relation to the level of the 4) Skeletopiya body, its relation to the level of the skeleton. Thus, renal pedicle skeletotopicheski skeleton. Thus, renal pedicle skeletotopicheski located at the level II of the lumbar vertebrae, located at the level II of the lumbar vertebrae, pylorus - XII breast etc.pylorus - XII breast etc.5) A typical anatomy, design a school professor. 5) A typical anatomy, design a school professor. V.N.Shevkunenko studying the variants of the V.N.Shevkunenko studying the variants of the structure of organs and their extreme structure of organs and their extreme morphological types in connection with a wide morphological types in connection with a wide variety of shapes and positions.variety of shapes and positions.

• 6) Age anatomy - the process of 6) Age anatomy - the process of identifying age differences in the identifying age differences in the location of bodies.location of bodies.7) Xirurgicheskaya studying 7) Xirurgicheskaya studying anatomy and morphology of the body anatomy and morphology of the body surrounding anatomical structures surrounding anatomical structures in pathological conditions.in pathological conditions.

Method for studying Method for studying topographic anatomytopographic anatomy

• Dissection - allocation body, followed Dissection - allocation body, followed by a study.by a study.Method cuts Pirogov ("Pirogov Method cuts Pirogov ("Pirogov slices") to the frozen corpse.slices") to the frozen corpse.The method of "ice sculpture" Pirogov The method of "ice sculpture" Pirogov is the design on the frozen corpse of a is the design on the frozen corpse of a separate body, by removing all excess separate body, by removing all excess tissue using chisel and hammer.tissue using chisel and hammer.Method injections or cordials vessels.Method injections or cordials vessels.

SUBJECT of SurgerySUBJECT of Surgery

• Operative Surgery - is the study of Operative Surgery - is the study of surgical operations, addressed the surgical operations, addressed the development and study of development and study of techniques and good practice techniques and good practice surgery.surgery.

In surgery distinguish In surgery distinguish two main points: on-line two main points: on-line access and operational access and operational

techniques.techniques. • 0perativnym access is the part of the 0perativnym access is the part of the

operation, the surgeon ensures operation, the surgeon ensures outcrop body.outcrop body.The operative technique is called the The operative technique is called the main part of the operation on the main part of the operation on the organ.organ.

ANESTEZIYAANESTEZIYA

• 1) local anesthesia,1) local anesthesia,2) nerve block,2) nerve block,3) spinal anesthesia,3) spinal anesthesia,4) epidural anesthesia.4) epidural anesthesia.

Surgical instruments:Surgical instruments: Divided into 5 groupsDivided into 5 groups

• to disconnect the tissues - scalpels, knives, scissors, saws, to disconnect the tissues - scalpels, knives, scissors, saws, chisels, osteotomes, pliers, etc.chisels, osteotomes, pliers, etc.

• to stop the bleeding - hemostat? Kocher, Billroth, to stop the bleeding - hemostat? Kocher, Billroth, Halstead, Mikulic, etc. and ligature needles Cooper and Halstead, Mikulic, etc. and ligature needles Cooper and Deschamps.Deschamps.

• fixation tools (enhance and support)? tweezers fixation tools (enhance and support)? tweezers anatomical, surgical, web-footed, blunt and sharp hooks, anatomical, surgical, web-footed, blunt and sharp hooks, probes, and large extensions (mirrors), bone fixation probes, and large extensions (mirrors), bone fixation forceps.forceps.

• for tissue - needle holders with sharps needles, for tissue - needle holders with sharps needles, instruments for bone joint.instruments for bone joint.

• special tools used for ophthalmology, ENT, neurosurgery, special tools used for ophthalmology, ENT, neurosurgery, cardiology, pulmonology, gynecology and urology.cardiology, pulmonology, gynecology and urology.

Classification of Classification of transactionstransactions

• radicalradical

• palliativepalliative

By due dateBy due dateEmergencyEmergencyurgenturgentroutineroutine

healinghealingdiagnosticdiagnostic

PRIMARY TREATMENT OF PRIMARY TREATMENT OF WOUNDSWOUNDS

• I) wide incision woundsI) wide incision wounds2) deprived of food and excision of 2) deprived of food and excision of contaminated sitescontaminated sites3) stop the bleeding,3) stop the bleeding,4) removal of free-lying foreign bodies 4) removal of free-lying foreign bodies and bone fragments devoid of and bone fragments devoid of periosteum,periosteum,5) wide drainage of the wound,5) wide drainage of the wound,6) immobilization of the affected limb.6) immobilization of the affected limb.

Types of surgical suturesTypes of surgical sutures

• Primary - Where the operation menee Primary - Where the operation menee than 6-12 hours after the injury, and if it than 6-12 hours after the injury, and if it was possible to excise the wound;was possible to excise the wound;Initially delayed - in the case of late Initially delayed - in the case of late avivement - 24 hours after the injury - avivement - 24 hours after the injury - the wound is recommended to flash, but the wound is recommended to flash, but do not leave seams tied, sutures tied in do not leave seams tied, sutures tied in 4-5 days if there are no signs of 4-5 days if there are no signs of inflammation in the wound;inflammation in the wound;Secondary - after days, the wound is Secondary - after days, the wound is festering like after treatment stitches.festering like after treatment stitches.

Distinguish 5 types of Distinguish 5 types of plastic surgery on the plastic surgery on the

skinskin • Plastic local tissues,Plastic local tissues,

plastic skin graft to pedicle,plastic skin graft to pedicle,Free transplantation of skin grafts.Free transplantation of skin grafts.the use of cultured allofibroblastov.the use of cultured allofibroblastov.temporary closure of a biological temporary closure of a biological defect.defect.

Виды кожной пластики Виды кожной пластики местными тканями.местными тканями.

I и II— по Ю. К. Шимановскому; III — по А. А. I и II— по Ю. К. Шимановскому; III — по А. А. Лимбергу; IV — индийский метод; V — итальянский Лимбергу; IV — индийский метод; V — итальянский

метод (вариант метода).метод (вариант метода).

Способы выкраивания Способы выкраивания кожного стебля по В. П. кожного стебля по В. П.

Филатову.Филатову.

Пластика мигрирующим Пластика мигрирующим стеблем по В. П. стеблем по В. П.

ФилатовуФилатову

Разновидности кожной Разновидности кожной пластики итальянским пластики итальянским

методомметодом

Взятие расщепленного Взятие расщепленного лоскута кожилоскута кожи

Некоторые виды Некоторые виды пластики местными пластики местными

тканямитканями

1 — применение послабляющих разрезов; 2 1 — применение послабляющих разрезов; 2 — перемещение прямоугольных лоскутов; — перемещение прямоугольных лоскутов;

3 — пластика встречными 3 — пластика встречными треугольникамитреугольниками

Этапы создания стебля по Этапы создания стебля по Л. Р. Балону. Л. Р. Балону.

THANK YOU FOR YOUR THANK YOU FOR YOUR ATTENTIONATTENTION