[PELVIC FLOOR RECONSTRUCTION AFTER PELVIC EVISCERATION USING GRACILIS MUSCULOCUTANEOUS FLAP].

Evisceration of the pelvic organs (EPO) is a fairly uncommon surgical treatment that removes all organs from a patient's pelvic cavity. We use gracilis musculocutaneous flap to repair pelvic floor after EPO. Over the period from November 2013 to December 2014 we carried out EPO with reconstructive repair of the pelvic floor with gracilis musculocutaneous flap in 10 patients with locally advanced pelvic tumors. We describe the surgical procedure and surgical outcomes in these patients. Mean age of the patients was 55 years. Mean duration of EPO with the pelvic floor repair was 285 min., mean blood loss--595 mL and the average length of hospital stay--19 days. Gracilis musculocutaneous flap has a sufficient arterial supply and mobility for pelvic floor reconstruction. Necrosis of flap's distal edge occurred in one of the 10 clinical cases, while the remaining flaps were fully preserved. Complete healing of wounds with no signs of weakening of the pelvic floor muscles was observed in all cases. Pelvic floor reconstruction is an essential procedure in order to reduce complications associated with the evisceration of the pelvic organs. The Gracilis musculocutaneous flap is the logical alternative to repair pelvic floor defect. It does not contribute to complications like functional deficiency of the lower limbs, complications of stoma formation or weakening of the muscles of the anterior abdominal wall.

[Reconstructive operations in combined burn strictures of the esophagus and stomach]. / Vosstanovitel'nye operatsii pri sochetannykh ozhogovykh strikturakh pishchevoda i zheludka.

Variants of surgical repair for patency of the esophagogastroduodenal tract, used in the treatment of 64 patients with combined burn strictures of the stomach and esophagus are presented. The scope of reconstructive operations depended on the patientsT baseline status, the severity of concomitant diseases, the pattern of anatomical disorders of burned organs. In short distal burn strictures of the esophagus and stomach, esophagogastrostomy and gastroduodenostomy were performed (2). If the burn stricture was in the pyloric area, pyloroplasty was performed (9). In patients with antral and pyloric stenoses, gastroduodenal anastomosis was formed (3). If burn damage to the stomach could not be clearly differentiated, gastroenterostomy was made. If there were scars in the stomach, it was respected by one of BillrotTs methods (30). Only in 8 of the 64 patients reconstructive operation on the stomach could be combined with esophagoplasty and in 4 cases stepwise esophagoplasty was performed by transpositing a small intestinal graft to the neck. Esophagoplasty was made with a fragment of the ileocolon in 32 patients, with that of the left half of the colon in 23, one and 6 patients underwent intrapleural and small intestinal esophagoplasty, respectively. Esophagoplasty with local tissues was performed in 2 patients. Postoperative mortality was 6.25%.

[Total esophagoplasty in esophageal strictures]. / Total'naia plastika pishchevoda pri ego strikturakh.

An analysis of immediate and long-term results of surgical treatment of 170 patients with esophageal obstruction is presented. Esophagoplasty with different fragments of the gastrointestinal tract was used (87--ileocolon, 16--small intestine, 23--left half of the colon, 44--a stalk from the greater curvature of the stomach). The greater amount of complications due to incompetence of the esophageal anastomosis sutures was noted in patients after esophagoplasty with a fragment of the small (50%) and right half of the large (59.7%) intestine, more rarely-after plasty with a gastric stalk (15.9%) and left half of the colon (26.1%). There was no necrosis of the transplant from the left half of the colon. Severe ischemic lesions made their appearance in the fundal portion of the gastric stalk (2.2%), necrosis of the small intestine part of ileocolon developed in 16.1% of the patients. In the patients with less amount of postoperative complications one-stage esophagoplasty was performed. Reconstructive operations on the artificial esophagus were necessary in 43.6% of the patients. The main indication for it was mechanical dysphagia.

[A comparative evaluation of different methods of esophagoplasty]. / Sravnitel'naia otsenka razlichnykh sposobov ézofagoplastiki.

Intraoperative comparative oxyhemo- and thermometry of fragments of the gastrointestinal tract used for creation of the artificial esophagus were performed in 41 patients. The relationship of the degree of ischemic alterations in the transplant tissues and the development of postoperative complications was determined.