PECULIARITIES OF USING A NEUROVASCULARIZED FLAP ON THE SURAL ARTERY IN PLASTIC SURGERY OF GUNSHOT DEFECTS ON THE FOOT AND LOWER LEG.

The results of treatment of 36 patients with extensive gunshot defects on the foot and lower leg with the use of a neurovascularized flap on the sural artery have been analyzed. Goal - to investigate the effect of catheterization of the small saphenous vein, which is included in the flap, on the frequency of development of its ischemic complications. The 1st group (n=14) included the wounded, who underwent complex treatment of an extensive gunshot defect followed by its plasticity with a "sural flap" with temporary catheterization of the small subcutaneous vein included in its composition. The 2nd group (n=23) included patients who, after complex treatment of an extensive gunshot defect, underwent plastic surgery with a "sural flap" without catheterization of the vessels included in it. In case of using a flap without catheterization of the small saphenous vein, necrosis of the "sural" flap was observed in 5 (22%) cases. During catheterization of the small saphenous vein, the number of flap necrosis was 2 (15%) cases. Catheterization of the small saphenous vein of the "sural" flap allows to reduce the frequency of complications related to blood supply disorders by 7%.

EVALUATION OF THE EFFECTIVENESS OF PHYSIOTHERAPEUTIC INTERVENTIONS IN THE TREATMENT OF THORACIC PAІN IN PATIENTS WITH THORACIC OSTEOCHONDROSIS.

The purpose of the study is to improve the results of complex restorative treatment of patients with pain syndrome in osteochondrosis of the thoracic spine. The study was conducted on the basis of the Rehabilitation Department of the State Institution "ITO NAMSU" in Kiev (from 2020 to 2022). The study involved 150 patients with pain in the thoracic spine, who were treated in the rehabilitation department. The mean age of the patients was 44.7±1.5 years. The average duration of the disease was 10.2±0.3 years, treatment - 13.5±1.0 days. Evaluation of treatment results using the Visual Analogue Scale of pain (Visual Analogue Scale) and electromyography on DIGITAL M - TEST was carried out 14 days after the program of physiotherapy interventions. The developed program of rehabilitation interventions included the use of myofascial release of the thoracic spine, physical exercises, breathing exercises during the myofascial release of the thoracic spine. The analysis of the obtained results showed that after the rehabilitation measures with the use of myofascial release, there was a statistically significant decrease in the level of pain in the group of examined patients (before PT - 4.87±0.47 cm, after PT - 1.17±0.26*) * (x±S), (p<0.01), which allows us to conclude that the program of physiotherapy interventions is effective. The use of myofascial release in the complex of physiotherapeutic interventions improves the quality of life and saves patients from thoracic paіn caused by degenerative changes in the spine in the short term.

STRATEGY OF RECONSTRUCTIVE AND RESTORATIVE INTERVENTIONS FOR HAND TISSUE DEFECTS.

The article is devoted to the development of a strategy for reconstructive interventions in wounded after gunshot injuries of the hand with tissue defects, which will improve the anatomical and functional results. During the period from 2019 to 2020, 42 plasty of soft tissue defects of the hand (39 patients) with the use of rotary flaps on perforating and axial vessels were performed in the trauma department of the injury clinic of the National Military Medical Clinical Center «Main Military Clinical Hospital¼ for plasty of soft tissue defects of the hand, a radial flap was used in 15 (36%), a rotational dorsal forearm flap in 15 (36%), and an insular neurovascular flap in 12 (28%). Evaluation of the immediate (3 places after surgery) and long-term (1 year after surgery) results of treatment of patients with soft tissue defects of the hand who underwent flap transposition, according to the Disability of the arm, shoulder, and hand outcome measure scale (DASH) showed an average value of 32,0 (after 3 months) and 29,4 (after 1 year), which corresponds to good functional results of treatment. The main principle of successful treatment of gunshot wounds is the implementation of primary, repeated surgical treatments followed by early closure of defects. The main factors that determine the surgical tactics are localization, area, and volume of the wound defect.

[OUR EXPERIENCE WITH THE USE OF BIPORTAL ENDOSCOPIC SURGERY IN THE TREATMENT OF HERNIATED DISCS OF THE LUMBAR SPINE].

Open microdiscectomy is the standard surgical treatment for herniated discs at the lumbar level. However, with open operations on the spine, the risk of developing postoperative instability of the spine and the occurrence of chronic back pain is quite high. Biportal endoscopic spinal surgery is a new method in minimally invasive spinal surgery, which has several advantages over open surgery. The aim of the study was to analyze the results of treatment of patients with hernias of the intervertebral discs who underwent biportal endoscopic discectomy and compare them with the results of treatment with open microdiscectomy. The analysis of the results of treatment of 155 patients who underwent a diskectomy operation from March 2019 to October 2019 was performed: 67 patients were operated by biportal endoscopy in the spine surgery clinic of the Institute of Traumatology and Orthopedics of the National Academy of Medical Sciences of Ukraine, while 88 - The first patient was operated on by open microdiscectomy in the Ivano-Frankivsk Regional Clinical Hospital. Pain intensity was assessed using a visual analogue pain scale (VAS), patient satisfaction and quality of life were assessed using a modified MacNab scale and the Oswestry Disability Index (ODI), respectively, 1 week, 3 months and 6 months after surgery. Perioperative data were also evaluated (duration of surgery and length of stay in the hospital, blood loss and complications). X-ray results were evaluated using pre- and postoperative MRI (6-8 weeks after surgery). One week after surgery, the level of VAS back pain in the biportaldiskectomy group showed more significant improvements than in the group after open microdiscectomy. However, the comparative results after a 3-month and 6-month period for VAS (back and leg), ODI questionnaires, a modified MacNab scale, did not significantly differ between the two groups. In the biportaldiskectomy group, the level of blood loss (32.82±15.9) was lower, and the length of hospital stay (2.8±1.6) was shorter than in the group of patients after open microdisectomy (141.1±56.5) and (6.6±1.3), respectively. However, the duration of the operation (71.3±21.9) was longer in the biportal discectomy group than in the group after open microdisectomy (62.2±14.6), the difference was statistically significant. Biportal endoscopic spinal surgery is an effective method for the treatment of hernias of the intervertebral intervertebral discs of the lumbar region, which has several advantages over open surgery, namely: less tissue trauma, less blood loss, faster back pain regression after surgery, higher patient satisfaction with the result of treatment, and reduced hospital stay.

Interethnic marriages in the USSR in the mid-1930s.

"The present article will attempt to determine the extent of interethnic marriage in the Soviet Union in the mid-1930s, utilizing materials from the Central Statistical Administration of the USSR." Interethnic marriage is analyzed according to Union Republic, rural or urban area, and socioeconomic and cultural development.