[Soft tissue emphysema in spontaneous pneumothorax. Features of medical approaches]. / Massivnaya emfizema myagkikh tkanei pri spontannom pnevmotorakse. Osobennosti lechebnoi taktiki.

Soft tissue emphysema (including subcutaneous emphysema) is common in pneumothorax. In most cases, this condition is of little clinical significance and regresses under standard medical procedures. However, progressive soft tissue emphysema poses a threat to the patient's life in case of compression of the upper respiratory tract in some cases. The world literature describes various approaches to the treatment of these patients. Standard medical care for progressive soft tissue emphysema following pneumothorax is pleural drainage with active aspiration. Despite unequivocal treatment tactics, this may not be enough in case of massive air release. Surgical treatment may be accompanied by surgical and anesthetic difficulties including difficult intubation. The authors present persistent tension pneumothorax and soft tissue emphysema, features of surgical and anesthetic management, as well as current treatment options.

[Chest wall morphological changes after sternal reconstruction with titanium mesh implant in patients with sternum instability]. / Strukturnye izmeneniya perednei grudnoi stenki posle alloplastiki grudiny titanovym setchatym endoprotezom u patsientov s nestabil'nost'yu grudiny.

Sternal instability is the one of the unresolved problems in open cardiac surgery (1-8%). The risk of recurrence after repeated osteosynthesis is up to 20% in these patients. Repeated osteosynthesis is impossible in some cases, and this complicates anterior chest wall reconstruction. Among various methods of sternal reconstruction, there are options for repair with own tissues and various fixing devices. Mesh prostheses from titanium and its alloys are modern materials for chest defect closure. There are literature data on soft tissue structural changes after hernia repair with titanium mesh implants, but biological compatibility and advantages of titanium alloys for chest wall instability are unclear. We present 2 patients after sternal reconstruction with titanium mesh implant and subsequent partial removal of prosthesis for various reasons with morphological examination.

[Surgical approach for destructive pneumonia associated with COVID-19]. / Taktika khirurgicheskogo lecheniya destruktivnoi pnevmonii, assotsiirovannoi s infektsiei COVID-19.

There were over 400 million people with COVID-19 pneumonia worldwide and over 12 million in the Russian Federation after 2020. Complicated course of pneumonia with abscesses and gangrene of lungs was observed in 4% of cases. Mortality ranges from 8 to 30%. We report 4 patients with destructive pneumonia following SARS-CoV-2 infection. In one patient, bilateral lung abscesses regressed under conservative treatment. Three patients with bronchopleural fistula underwent staged surgical treatment. Reconstructive surgery included thoracoplasty with muscle flaps. There were no postoperative complications that required redo surgical treatment. We observed no recurrences of purulent-septic process and mortality.

[Intercostal nerve cryoablation in correction of pectus excavatum in adults]. / Krioablyatsiya mezhrebernykh nervov pri korrektsii voronkoobraznoi deformatsii grudnoi kletki u vzroslykh. Pervyi opyt v Rossii.

OBJECTIVE: To evaluate an effectiveness of cryoanalgesia in older patients with pectus excavatum and to determine feasibility of further research. MATERIAL AND METHODS: We have developed an original technique of intercostal nerve cryoablation for correction of pectus excavatum in adults. The results of intercostal nerve cryoablation during correction of pectus excavatum in 10 older patients were analyzed. RESULTS: Postoperative outcomes were followed-up over a period of 4 - 12 months. There were no perioperative surgical complications. In 1 case, moderate pain syndrome persisted for 3 months after surgery (mean VAS score 2±1.3). In 9 months, mean VAS score was 0.6±0.6 in a month after surgery. CONCLUSION: Intercostal nerve cryoablation in correction of pectus excavatum in adults may be an alternative to the current methods of regional analgesia. Further research is requried to achieve objective information.

[Benign metastasizing uterine leiomyoma with lung metastasis: problems of diagnosis and treatment]. / Dobrokachestvennaya metastaziruyushchaya leiomioma matki s porazheniem legkikh: problemy diagnostiki i lecheniya.

Uterine leiomyoma (LM) is a smooth muscle tumor occurring in 30% of women of reproductive age. This neoplasm is the most common benign tumor of female genitals. Uterus is the most frequent localization of tumor. However, LM can be detected in external genitalia, ovaries, bladder and urethra. Despite the benign nature, LM is characterized by metastasizing as one of the main properties of malignant neoplasms. For the first time, Steiner described this case in 1939. The author found similar histological structure of pulmonary and uterine neoplasms. LM metastases in bone tissue, skin, mediastinum, muscles, lymph nodes, omentum and retroperitoneal space are rarer. In this manuscript, we report complex treatment of benign metastasizing uterine leiomyoma followed by lung metastasis.

[Musculocutaneous grafting in the treatment of irradiation-induced chest osteomyelitis]. / Kozhno-myshechnaya plastika v lechenii postluchevogo osteomielita kostei grudnoi kletki.

OBJECTIVE: To report our own experience of one-stage surgical treatment of irradiation-induced osteomyelitis as a complication of radiotherapy for breast cancer (BC). MATERIAL AND METHODS: The study included 25 patients with irradiation-induced chest osteomyelitis after previous radiotherapy for breast cancer. All patients were examined according to the same protocol. One-stage surgery with full-thickness resection of affected tissues and plastic closure of the wound was performed depending on localization of lesion and availability of plastic material. RESULTS: Follow-up period ranged from 18 to 110 months (median 48 (19; 52) months). Complications were assessed according to Clavien-Dindo classification. Complications followed by antibacterial therapy and/or local treatment were observed in 8 (32%) out of 25 patients (95% CI 11.5-43.4). Marginal necrosis of musculoskeletal flap was registered in 4 (16%) patients. One (4%) patient required redo thoracomyoplasty after excision of necrotic tissues of musculocutaneous flap due to extensive tissue defect. Total necrosis of musculocutaneous flap was not noted. There were no fatal outcomes. Mean length of hospital-stay was 13 (10; 27) days in the group of musculocutaneous flap from latissimus dorsi muscle and 11 days (7; 24) in the group of rectus abdominis muscle. Good and satisfactory treatment outcomes after one-stage surgical treatment were achieved in 24 (96%) out of 25 patients (95% CI: 75-97.8). CONCLUSION: Irradiation-induced chest osteomyelitis is still actual problem despite an improvement of modern medical equipment and accumulation of experience in radiotherapy. Surgery is preferable method of treatment. Comprehensive examination including contrast-enhanced chest CT with 3D reconstruction and Doppler ultrasound of vascular pedicle is valuable to determine type of resection and plastic technique. Simultaneous approach with resection and plastic closure of the wound is preferred for irradiation-induced chest osteomyelitis if sufficient amount of plastic material is available and contraindications for reconstructive surgery are absent.

[Transsternal occlusion of the main bronchus stump in bronchopleural fistula and non-specific pleural empyema]. / Transsternal'naia okkliuziia kul'ti glavnogo bronkha pri bronkhoplevral'nom svishche i nespetsificheskoi émpieme plevry.

OBJECTIVE: To present our experience in the treatment of patients with bronchopleural fistula and chronic non-specific pleural empyema after pneumonectomy. MATERIAL AND METHODS: There were 25 patients with chronic pleural empyema following bronchopleural fistula after pneumonectomy. All patients were examined in standard fashion and divided into two groups depending on length of bronchial stump: more or equal to 20 mm and less than 20 mm. Transsternal occlusion of bronchial stump was performed in the 1st group. Pedicled muscle or omental flap was applied for bronchial stump repair in the 2nd group. RESULTS: Follow-up period ranged from 18 to 110 months (median 48 (19; 52) months). Complications were grade daccording to Clavien-Dindo classification. Infectious complications not associated with bronchial stump insufficiency and required antibiotic therapy and/or topical treatment were registered in 6 (24%) out of 25 patients (95% CI 11.5-43.4): suppurative tracheobronchitis, pneumonia, postoperative wound suppuration in 1 (4%), 2 (8%) and 3 (12%) patients, respectively. Overall mortality rate was 2 (8%) out of 25 patients. There were no recurrences after transsternal occlusion of bronchial stump. In the control group, recurrent bronchopleural fistula was noted in 2 (12.5%) out of 16 patients (95% CI 3.5-36). Mean hospital-stay was 13 (13; 16) and 20 (11; 35) days in both groups, respectively (p<0.05). A good and satisfactory result after transsternal occlusion of bronchial stump was achieved in 23 (92%) out of 25 patients (95% CI 75-97.8). CONCLUSION: Transsternal occlusion of bronchial stump is more advisable than tissue flap transposition in patients with chronic pleural empyema followed by BPF and bronchial stump length over 20 mm due to less trauma and good reproducibility.