Features of the use of ladder myoplasty of a gunshot wound to the laryngopharynx: Case report.

INTRODUCTION 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.

[Comparison of surgical treatment efficacy in patients with complex extrasphincteric rectal fistulas using principal operative methods].

We have analyzed results of treatment of 211 patients with complex extrasphincteric rectal fistulas. We have used the different methods of treatment, in particular, method of Ryzhih, method of "integrated" block and method of "packing" rectal fistulas using autothrombin glue. Estimation of results was based on two main criteria: the postoperative relapses rate and postoperative incontinence rate. The method of "integrated" block and the method of "packing" of rectal fistulas using autothrombin glue give less postoperative relapses rate and the incontinence rate en immediate and remote period after intervention.

[Results of application of a new operative procedure in treatment of patients with nonspecific complete extrasphincteric rectal fistula].

In 2003-2005 yrs in the division of proctology there were operated 52 patients for nonspecific complete extrasphincteric rectal fistula using an original method. There were analyzed immediate results of intervention of the method proposed and conventional procedure according to Ryzhikh (the closest analogue). It was established that application of a new operative method is highly effective, essentially influences the general results of treatment, promotes the lowering of the postoperative complications, recurrences and incontinence rate.

[Method of the surgical treatment of nonspeciphic extrasphincteric rectal fistula].

The method of treatment of nonspeciphic extrasphincteric rectal fistula was proposed, which consists of the fistula channel excision en bloc with external and internal (the anal sinus, which bears the fistula) apertures on perineum, subsequent layer by layer restoration of the rectal wall, as well as the sphincters and the anal levators muscles integrity (if necessary) and the formed cavity drainage. The operation was performed in 25 patients. Its performance have guaranteed the recurrences rate lowering as well as the postoperative incontinence occurrence.