Topographic anatomy definition, methods of study, basic provisions. Anatomy. Study of a corpse in topography

The word "topographic" comes from two Greek words: "topos" - place and "grapho" - write. Topographic anatomy studies the relative position of tissues and organs by region and their anatomical connections with other organs and tissues and with the central nervous system. A number of methods are used to solve these problems. Particularly important is the method of layer-by-layer study of tissues in conditionally limited areas. The use of this method is dictated by practical necessity, firstly, to give the doctor the opportunity to accurately determine the localization of certain pathological changes and, secondly, to provide accurate guidelines for surgical interventions in which tissues have to be cut from the surface to the depth strictly layer by layer.

The tasks of the practical study of topographic anatomy consist primarily in giving a layer-by-layer description of the areas. Regions in topographic anatomy are parts of the body delimited from each other by natural or artificially drawn (conditional) lines (for example, the lateral region of the face, the anterior region of the thigh). Natural boundaries are skin folds (eg, groin), bony prominences (eg, iliac crest, clavicle).

From all of the above, the difference between topographic anatomy and the so-called normal (or descriptive) anatomy is clear. The latter describes organs by system (for example, the musculoskeletal system, the circulatory system), while topographic anatomy describes the relative arrangement of organs by region. Topographic anatomy synthesizes anatomical knowledge, while normal anatomy is a predominantly analytical science, dealing with the study of individual systems and the internal structure of individual organs.

Shown in Fig. 1 and 2, the division of the human body into regions is conditional. At this time, Soviet scientists are developing a unified scheme for dividing the body into regions. Therefore, this manual presents the boundaries of the regions in the form in which they are now (with certain minor deviations) described when teaching topographic anatomy in medical universities.

The position of the internal organs is entirely determined by their relationship: 1) to the body and its regions - holotopy, 2) to - skeletopy, 3) to neighboring organs - syntopy. For example, holotopically lies in the left hypochondrium, skeletotopically - within the IX-XI ribs, syntopically outside the diaphragm, inside and in front - to the stomach, inside and behind - to the left kidney and left adrenal gland, inside and below - to the tail of the pancreas and splenic curvature of the colon.

In scientific research, there is often a need to establish a relationship between the shape and position of organs, on the one hand, and the shape of the body, on the other.

The school of V.N. Shevkunenko distinguishes two extreme forms of physique: dolichomorphic (narrow, long) and brachymorphic (short, wide). The main feature that determines this division is the relative length of the body. The length of the body is expressed by the distance from the sternal notch to the anterior-superior edge of the symphysis and is called distantia jugulopubica. The relative length of the body is determined by the formula: distantia jugulopubica x100/ standing.

In order to navigate in a particular area, you need to know and be able to palpate the main bone formations available for this (bone landmarks). Often you can also feel the muscles and (muscle and tendon landmarks), and in certain positions of the body parts, the tendons and muscles are visible to the eye; Thus, with the hands bent and clenched into a fist, the flexor tendons of the hand and fingers are clearly visible in the lower third. The same applies to superficial veins, which are usually clearly visible in many areas of the body, especially on the extremities. After moving to the proximal parts of the extremities, the veins of the distal parts are revealed even more clearly.

It is important to feel the pulse of the arteries, and to access the vessels and nerves it is necessary to know their projections, that is, lines drawn on the surface of the body that correspond to the position and course of the vessels and nerves in depth. By projecting the contours of an organ onto the surface of the body, we get an idea of its boundaries (borders of the heart, liver, etc.).

Pathologically altered organs may become accessible for examination by palpation, for example, the spleen, lymph nodes.

Lymphatic vessels and nodes, as well as interfascial spaces containing loose tissue, can serve as pathways for the spread of the inflammatory purulent process. Therefore, in topographic anatomy, special attention is paid to the course of the fascial plates, the location of the cellular spaces between them, the position of the lymph nodes and the connections between the regional nodes. The study of lymphatic connections is also important from the point of view of the question of how malignant tumors spread. also play an important role in the spread of infection and malignant tumors. This implies the need to study arterial and venous connections. This is also necessary to determine the ways of development of collateral (roundabout) blood circulation (in case of bleeding, disturbances of venous outflow, etc.).

Everything discussed in this chapter is the subject of topographic anatomy. Thus, topographic anatomy provides a number of information important for the clinic and for the practical activities of a doctor of any specialty, primarily a surgeon and therapist. Therefore, topographic anatomy is also called applied or clinical anatomy.

By the term “surgical anatomy” N.I. Pirogov understood the totality of data characterizing the position of individual organs in accordance with the needs of surgical practice. In “Surgical anatomy of the arterial trunks” he implemented this principle in this way. Having given individual chapters of his work such titles as “Position of the brachial artery”, “Position of the femoral artery in the upper third of the thigh” (instead of “Shoulder region”, “Anterior region of the thigh”), Pirogov focused on the position of the arterial trunks and those related to them fascial sheets. He described the layers covering a particular artery as they appear to the surgeon when the vessel is exposed during surgery.

When Pirogov compiled his atlas of cuts, calling it “Anatome topographica,” he presented in drawings and sorted out by region not only the relationships of organs that were not pathologically changed, but also showed the shape and position of organs in the presence of pathological changes in them or in surrounding tissues. Pirogov widely covered the collected material in his explanations for the atlas, including issues such as the mechanism of dislocations in joints, the technique of performing certain clinical techniques (for example, catheterization of the Eustachian tube), (for example, perineal stone section), and other issues of practical importance. Connection with practice is the main direction along which the development of topographic anatomy has taken place in our country since the time of Pirogov.

Thus, in the modern understanding, topographic anatomy is an applied science that examines the relationships and connections of organs in normal and pathological conditions and systematizes data on these relationships and connections by area. Therefore, the subject of topographic anatomy also includes such issues as the anatomy of the limbs during dislocations and fractures (displacement of fragments, changes in the relationships between bones, muscles, vessels and fascial spaces), the ways of spreading hematomas and purulent ones, the development of collateral circulation after ligation of blood vessels, etc.

The most important position of I. P. Pavlov on the leading role of the nervous system in the life of the body was the impetus for the development of various types of influence on the central and peripheral nervous system. A significant place in this is occupied, for example, by the novocaine nerve block developed by A.V. Vishnevsky, which is a common method of “pathogenetic therapy”. It is quite natural that the technique of many effects on the central and peripheral nervous system (in particular, the technique of various types of local anesthesia) cannot be justified without accurate topographical and anatomical knowledge. That is why topographic anatomy acquires special significance as a science about the organ as a whole, that is, its relationships and connections with other organs and with the entire body, as a science that substantiates the differential diagnosis of diseases and a system of many therapeutic measures.

It is also justified to study changes in the topography of organs that occur under the influence of impulses from the central nervous system. Thus, F.I. Bulatnikov (1915) suggested that the topography of blood vessels can change depending on the contraction of individual muscle groups. Considering the question of the topography of the external carotid artery and its relationship to the tonsil, he shows that with contraction of the posterior belly of the digastric muscle and the stylohyoid muscle located next to it, the arc formed in the region of these muscles by the external carotid artery can approach the tonsil. In the presence of an inflammatory focus in the circumference of the tonsil, for example, a peritonsillar abscess, irritation of the branches innervating the tonsil area and reflex transmission of this irritation to the motor part of the trigeminal nerve, which innervates the anterior belly of the digastric muscle, is possible. F.I. Bulatnikov associates the resulting contracture of the entire digastric muscle with irritation of the center of the trigeminal nerve and provides a diagram explaining the possible arc of such a reflex (Fig. 3). In the light of the teachings of I.P. Pavlov, this interpretation is quite acceptable, and the possibility of changing the topography of organs under the influence of various impulses from the central nervous system should certainly be taken into account and studied.

INTRODUCTION

The study of the Earth's surface began in ancient times. Almost all human activity and life are concentrated on the surface of the Earth. Therefore, it is no coincidence that the Earth sciences - geodesy, topography, cartography, geography - were born many centuries ago. They are closely related, and each of them is very important.
The course “Topography with the basics of geodesy” is one of the components of the training of specialists and masters of geography. The course program is compiled in relation to the curriculum of natural geography faculties, taking into account the school curriculum in geography and the program of the school elective course on the basics of topography and cartography. The objectives of the course include: reading topographic maps, plans, aerial photographs, their use in studying the area; terrain orientation; disclosure of the properties and features of topographic maps, study of ways and methods of their use; acquiring the skills of topographical surveys on the ground.
Students, working with topographic maps, develop skills that can be applied in their future work activities. For a geography teacher, a map is a means of his work.
The course program “Topography with the basics of geodesy” includes the amount of knowledge that must be obtained by students in lectures, laboratory classes, field practice and as a result of independent work.
Control over the assimilation of the material covered will be carried out during laboratory classes, tests, exams, as well as during computer testing.
To perform laboratory work, you must have a separate notebook with a volume of at least 48 pages. After completing each laboratory work, students are required to hand over their notebooks to the teacher for checking.

1.1.1. Subject of topography and geodesy

Topography - a scientific discipline that studies the earth’s surface (i.e., the elements of its physical surface and the objects of human activity located on it) in geometric terms.
The purpose of this study is to create topographic maps - a detailed image of the terrain (i.e., sections of the earth's surface) on a plane.
The main scientific and practical problems solved by topography include the development and improvement of methods for creating topographic maps, methods of depicting the earth's surface on them, methods and rules for using maps in solving scientific and practical problems.

Geodesy (from geo.. and Greek daio - I divide), a system of sciences about determining the shape and size of the Earth and about measurements on the earth's surface to display it on plans and maps.
It is divided into astronomical geodesy (higher geodesy), which studies the figure and gravitational field of the Earth, as well as the theory and methods of constructing a geodetic reference network, topography, applied geodesy, etc.

Measurements on the earth's surface are necessary to observe movements and deformations of the earth's crust, changes in the coastline of oceans and seas, to establish the height of sea levels and their differences, to study the movement of the earth's poles, as well as to solve various engineering problems of civil, industrial, agricultural, transport construction, etc.

The main method of studying the earth's surface- topographic survey, which includes a complex of measuring, computational and graphic works.
Coordinate systems used to indicate the relative position of elements (points) of the earth's surface make it possible to determine their plan (i.e. location on any surface) and altitude (i.e. location above the original surface) position.

1.1.2. Relationship between topography and geodesy and other sciences.
Their role in the development of the national economy

Topography and geodesy are closely related to cartography - the science of displaying and studying natural and social phenomena (their location, properties, relationships and changes over time) through cartographic images. Such images also include topographic maps. Cartography develops general issues of depicting reality on maps.
Topography and geodesy have close connections with geography, geology, and soil science. Data from these sciences contribute to a deeper understanding of the properties of the physical surface of the Earth and their correct depiction on maps.
Advances in aviation and photographic technology have made it possible to develop such directions in topography as: aerial phototopography and ground phototopography. The widespread use of photographs has determined the connection between topography and photogrammetry, which solves the problem of measuring objects on the earth's surface and determining their coordinates from photographic images.
Space exploration led to the emergence of satellite geodesy, which studies the shape and size of the Earth using artificial satellites, space rockets, ships and stations. With the development of methods for obtaining information about the earth's surface from space images, space topography began to develop.
Methods for solving scientific and practical problems of geodesy and topography are based on the laws of mathematics and physics. With the help of mathematics, a relationship is established between the results of measurements on the ground and the quantities necessary to create maps, the accuracy of the work being carried out is justified and controlled. Information from physics, especially such branches as optics, radiophysics, electronics, is necessary in the development of the latest geodetic instruments and tools. The achievements of cybernetics and modern computer technology are the basis for automating the creation of topographic maps.
The importance of topography and geodesy for science and practice is difficult to overestimate. Topographic maps make it possible to study the Earth's surface from the point of view of conditions for human life, the degree of development of specific territories and the possibilities for further development of this process. Topographic maps are the basis for displaying the results of scientific research and practical activities in geography, geology and other earth sciences. They are needed in the exploration and exploitation of natural resources, in the planning and deployment of the country's productive forces, in the design of engineering structures, in the development and implementation of strategic, tactical, military engineering and many other tasks. Geodetic measurements are widely used in surveys, design and construction of plants and factories, hydraulic engineering and land reclamation structures, nuclear power plants, road networks, etc.

1.2. CONCEPT OF THE SHAPE AND SIZE OF THE EARTH

Land makes up approximately one third of the Earth's total surface. It rises above sea level by an average of 900 - 950 m. Compared to the radius of the Earth (R = 6371 km), this is a very small value. Since most of the Earth's surface is occupied by seas and oceans, the shape of the Earth can be taken to be a level surface that coincides with the undisturbed surface of the World Ocean and is mentally continued under the continents. At the suggestion of the German scientist Listing, this figure was called geoid .
A figure bounded by a level surface coinciding with the surface of the water of the World Ocean in a calm state, mentally continued under the continents, is called geoid .
The World Ocean refers to the surfaces of seas and oceans connected to each other.
The surface of the geoid is perpendicular to the plumb line at all points.
The shape of the geoid depends on the distribution of masses and densities in the Earth's body. It does not have an exact mathematical expression and is practically indeterminable, and therefore in geodetic measurements, instead of the geoid, its approximation - a quasi-geoid - is used. Quasigeoid, unlike the geoid, is uniquely determined from the results of measurements, coincides with the geoid on the territory of the World Ocean and is very close to the geoid on land, deviating only a few centimeters on flat terrain and no more than 2 meters in high mountains.
To study the figure of our planet, first determine the shape and dimensions of a certain model, the surface of which is relatively well studied geometrically and most fully characterizes the shape and dimensions of the Earth. Then, taking this conditional figure as the original one, the heights of the points are determined relative to it. To solve many geodesy problems, the Earth model is taken Ellipsoid of revolution (spheroid).

The direction of the plumb line and the direction of the normal (perpendicular) to the surface of the ellipsoid at points on the earth's surface do not coincide and form an angle ε , called deviation of the plumb line . This phenomenon is due to the fact that the density of masses in the Earth’s body is not the same and the plumb line deviates towards denser masses. On average, its value is 3 - 4", and in places of anomalies it reaches tens of seconds. The actual sea level in different regions of the Earth will deviate by more than 100 meters from the ideal ellipsoid.

Rice. 1.3. The relationship between the surfaces of the geoid and the earth's ellipsoid.
1) the world ocean; 2) earth's ellipsoid; 3) plumb lines; 4) the body of the Earth; 5) geoid

To determine the size of the earth's ellipsoid on land, special degree measurements were taken (the distance along a meridian arc of 1º was determined). Over the course of a century and a half (from 1800 to 1940), various sizes of the earth's ellipsoid were obtained (ellipsoids of Delembert (d'Alembert), Bessel, Hayford, Clark, Krasovsky, etc.).
Delembert's ellipsoid has only historical significance as the basis for establishing the metric system of measures (on the surface of Delembert's ellipsoid, a distance of 1 meter is equal to one ten-millionth of the distance from the pole to the equator).
The Clark ellipsoid is used in the USA, Latin America, Central America and other countries. In Europe, the Hayford ellipsoid is used. It was also recommended as an international one, but the parameters of this ellipsoid were obtained from measurements made only in the United States, and, moreover, contain large errors.
Until 1942, the Bessel ellipsoid was used in our country. In 1946, the dimensions of Krasovsky’s earth ellipsoid were approved for geodetic work on the territory of the Soviet Union and are still in effect on the territory of Ukraine.
The ellipsoid, which is used by a given state, or a separate group of states, to carry out geodetic work and project points on the physical surface of the Earth onto its surface is called reference ellipsoid. The reference ellipsoid serves as an auxiliary mathematical surface to which the results of geodetic measurements on the earth's surface are led. The most successful mathematical model of the Earth for our territory in the form of a reference ellipsoid was proposed by prof. F. N. Krasovsky. The geodetic coordinate system Pulkovo-1942 (SK-42), which was used in Ukraine to create topographic maps from 1946 to 2007, is based on this ellipsoid.

Dimensions of the earth's ellipsoid according to Krasovsky

Semi-minor axis (polar radius)
Semimajor axis (equatorial radius)
Average radius of the Earth taken as a sphere
Polar compression (ratio of semi-axis difference to semi-major axis)
Earth's surface area	510083058 km²
Meridian length
Equator length
Arc length 1° along the meridian at latitude 0°
Arc length 1° along the meridian at latitude 45°
Arc length 1° along the meridian at latitude 90°

When introducing the Pulkovo coordinate system and the Baltic height system, the Council of Ministers of the USSR entrusted the General Staff of the Armed Forces of the USSR and the Main Directorate of Geodesy and Cartography under the Council of Ministers of the USSR with recalculating the triangulation and leveling network into a single system of coordinates and heights, completed before 1946, and obliged them to complete this work within a 5-year period. Control over the reissue of topographic maps was entrusted to the General Staff of the Armed Forces of the USSR, and nautical maps to the Main Headquarters of the Naval Forces.
On January 1, 2007, a USK-2000 - Ukrainian coordinate system instead of SK-42. The practical value of the new coordinate system is the ability to effectively use global navigation satellite systems in topographic and geodetic production, which have a number of advantages compared to traditional methods.
The author of this textbook has no information that in Ukraine the coordinates of SK-42 were recalculated into USK-2000 and new topographic maps were published. On educational topographic maps published in 2010 by the State Research and Production Enterprise “Cartography”, the inscription “Coordinate system 1942” still remains in the upper left corner.
The 1963 coordinate system (SK-63) was a derivative of the previous state coordinate system of 1942 and had certain connection parameters with it. To ensure secrecy, real data was artificially distorted in SK-63. With the advent of powerful computer technology for high-precision determination of communication parameters between different coordinate systems, this coordinate system lost its meaning in the early 80s. It should be noted that SK-63 was canceled by a decision of the USSR Council of Ministers in March 1989. But subsequently, given the large volumes of accumulated geospatial data and cartographic materials (including the results of land management work during the USSR), the period of its use was extended until all data was transferred to the current state coordinate system.
For satellite navigation, the three-dimensional coordinate system WGS 84 (World Geodetic System 1984) is used. Unlike local systems, it is a single system for the entire planet. WGS 84 determines coordinates relative to the Earth's center of mass, the error is less than 2 cm. In WGS 84, the prime meridian is considered to be the IERS Reference Meridian. It is located 5.31″ east of the Greenwich meridian. The basis is a spheroid with a larger radius - 6,378,137 m (equatorial) and a smaller one - 6,356,752.3142 m (polar). Differs from the geoid by less than 200 m.
The structural features of the Earth's figure are fully taken into account in the mathematical processing of high-precision geodetic measurements and the creation of state geodetic reference networks. Due to the smallness of the compression (the ratio of the difference between the major and equatorial semi-axis ( A) of the earth's ellipsoid and the polar semi-minor axis ( b) to the semi-major axis [ a-b]/b) ≈ 1:300) when solving many problems, the figure of the Earth can be taken with sufficient accuracy for practical purposes sphere , equal in volume to the earth's ellipsoid . The radius of such a sphere for the Krasovsky ellipsoid is R = 6371.1 km.

1.3. BASIC LINES AND PLANES OF THE EARTH'S ELLIPSOID

When determining the position of points on the surface of the Earth and on the surface of the Earth's ellipsoid, certain lines and planes are used.
It is known that the points of intersection of the axis of rotation of the earth's ellipsoid with its surface are poles, one of which is called the North Rs, and the other - South Ryu(Fig. 1.4).

Rice. 1.4. The main lines and planes of the earth's ellipsoid

Sections of the earth's ellipsoid by planes perpendicular to its minor axis form a trace in the form of circles, which are called parallels. Parallels have radii of different sizes. The closer the parallels are to the center of the ellipsoid, the larger their radii. The parallel with the largest radius equal to the semi-major axis of the earth's ellipsoid is called equator . The plane of the equator passes through the center of the earth's ellipsoid and divides it into two equal parts: the Northern and Southern Hemispheres.
The curvature of the ellipsoid's surface is an important characteristic. It is characterized by the radii of curvature of the meridian section and the section of the first vertical, which are called the main sections
Sections of the surface of the earth's ellipsoid by planes passing through its minor axis (axis of rotation) form a trace in the form of ellipses, which are called meridian sections .
In Fig. 1.4 straight CO", perpendicular to the tangent plane QC" at the point of contact WITH, called normal to the surface of the ellipsoid at this point. Each normal to the surface of the ellipsoid always lies in the meridian plane, and therefore intersects the axis of rotation of the ellipsoid. Normals to points lying on the same parallel intersect the minor axis (axis of rotation) at the same point. Normals to points located on different parallels intersect with the axis of rotation at different points. The normal to a point located on the equator lies in the equatorial plane, and the normal at the pole point coincides with the axis of rotation of the ellipsoid.
The plane passing through the normal is called normal plane , and the trace from the section of the ellipsoid by this plane is normal cross section . An infinite number of normal sections can be drawn through any point on the surface of an ellipsoid. The meridian and the equator are special cases of normal sections at a given point of the ellipsoid.
Normal plane perpendicular to the meridian plane at a given point WITH, called plane of the first vertical , and the trace along which it intersects the surface of the ellipsoid is a section of the first vertical (Fig. 1.4).
The relative position of the meridian and any normal section passing through the point WITH(Fig. 1.5) on a given meridian, is determined on the surface of the ellipsoid by the angle A, formed by the meridian of a given point WITH and normal section.

Rice. 1.5. Normal section

This angle is called geodetic azimuth normal section. It is measured from the northern direction of the meridian clockwise from 0 to 360°.
If we take the Earth to be a ball, then the normal to any point on the surface of the ball will pass through the center of the ball, and any normal plane forms a trace on the surface of the ball in the form of a circle, which is called a great circle.

2.3. METHODS FOR DETERMINING THE FIGURE AND DIMENSIONS OF THE EARTH

The following methods were used to determine the shape and size of the Earth:

Astronomical - geodetic method
Determining the shape and size of the Earth is based on the use of degree measurements, the essence of which boils down to determining the linear value of one degree of the arc of the meridian and parallel at different latitudes. However, direct linear measurements of a significant extent on the earth's surface are difficult; its unevenness significantly reduces the accuracy of the work.

Triangulation method
It consists in the geodetic construction of a system of points on the ground that form triangles, in which all the angles and lengths of some basic (base) sides are measured.
High accuracy in measuring long distances is ensured by the use of the triangulation method, developed in the 17th century. Dutch scientist W. Snellius (1580 - 1626).
Triangulation work to determine the arcs of meridians and parallels was carried out by scientists from different countries. Back in the 18th century. it was found that one degree of arc of the meridian at the pole is longer than at the equator. Such parameters are typical for an ellipsoid compressed at the poles. This confirmed I. Newton's hypothesis that the Earth, in accordance with the laws of hydrodynamics, should have the shape of an ellipsoid of rotation, flattened at the poles.

Geophysical (gravimetric) method
It is based on the measurement of quantities characterizing the earth's gravity field and their distribution on the earth's surface. The advantage of this method is that it can be used in the waters of seas and oceans, i.e. where the capabilities of the astronomical-geodetic method are limited. Data from measurements of the gravity potential made on the surface of the planet make it possible to calculate the compression of the Earth with greater accuracy than using the astronomical-geodetic method.
Gravimetric observations began in 1743 by the French scientist A. Clairaut (1713 - 1765). He assumed that the surface of the Earth has the form of a spheroid, that is, the figure that the Earth would take if it were in a state of hydrostatic equilibrium under the influence only of the forces of mutual gravity of its particles and the centrifugal force of rotation about a constant axis. A. Clairaut also suggested that the body of the Earth consists of spheroidal layers with a common center, the density of which increases towards the center.

Space method
The development of the space method and the study of the Earth is associated with the exploration of outer space, which began with the launch of the Soviet artificial Earth satellite (AES) in October 1957. Geodesy was faced with new tasks related to the rapid development of astronautics. These include monitoring satellites in orbit and determining their spatial coordinates at a given point in time. The identified deviations of real satellite orbits from the precalculated ones, caused by the uneven distribution of masses in the earth's crust, make it possible to clarify the idea of the Earth's gravitational field and, as a result, its figure.

Questions and tasks for self-control

Give definitions: “Topography”, “Geodesy”, “Topographic map”.
What sciences is topography related to? Explain this connection with examples.

For what purposes are data on the shape and size of the Earth used?

By what signs did ancient people determine that the Earth has a spherical shape?

What figure is called the geoid?

What shape is called an ellipsoid?

What figure is called the reference ellipsoid?

What are the elements and dimensions of Krasovsky's ellipsoid?

Name the main lines and planes of the earth's ellipsoid.

What methods are used to determine the shape and size of the Earth?

Give a brief description of each method.

No. 6 Topography of the temporal region. Scheme of cranial topography. Projection of the middle meningeal artery. Osteoplastic and decompressive craniotomy.

The temporal region is delimited from the orbit by the zygomatic process of the frontal and the frontal process of the zygomatic bones, and from the lateral region of the face by the zygomatic arch. The upper border is determined by the contour of the upper edge of the temporal muscle. Leather thinner than in the fronto-parietal-occipital region; the hairline remains in the posterior part of the region, less firmly fused with the superficial fascia, especially in the anterioinferior part.

Blood supply: The frontal branch of the superficial temporal artery anastomoses with the supraorbital artery. The parietal branch of the superficial temporal artery anastomoses with the occipital artery. In addition, the branches of the left and right superficial temporal arteries anastomose with each other.

Innervation: Sensitive innervation - n. auriculotemporais, n. zygomaticotemporalis, r. frontalis, r. Zygomaticus - branch of the facial nerve. In the tissue between the plates of the superficial fascia pass the trunks of the superficial temporal vessels and the branches of the auriculotemporal nerve, n. auriculotemporalis, as well as the motor branches of the facial nerve, rr. frontalis et zygomaticus. The fascia of the temporal region has the appearance of an aponeurosis. Attaching to the bones at the borders of the region, the fascia closes the temporal fossa on the outside. Between the superficial and deep layers of the temporal fascia lies interaponeurotic fatty tissue. Under the temporal aponeurosis - the temporal muscle, blood vessels, nerves and fatty tissue, in between

the anterior edge of the temporal muscle and the outer wall of the orbit is the temporal process of the fatty body of the cheek. Anterior and posterior temporal vessels and nerves, a., v. et n. temporales profundi anteriores et posteriores. The deep temporal arteries arise from the maxillary artery, the nerves arise from n. mandibularis. Lymph flows into the nodes in the thickness of the parotid salivary gland - nodi lymphatici parotideae profundi. On the inner surface of thinned bones (temporal squama and large wing of the sphenoid bones) a. meningea media. Under the dura mater are the frontal, parietal and temporal lobes of the brain, separated by the central (Rolandic) and lateral (Sylvian) fissures.

Scheme of cranial topography . The diagram makes it possible to project onto the surface of the cranial vault the main grooves and convolutions of the cerebral hemispheres, as well as the course of the trunk and branches of a. Meningea media. A midsagittal line of the head is drawn connecting the glabella, glabella, with the protuberantia occipitalis externa. A main-lower-horizontal line is drawn, running through the lower orbital margin and the upper edge of the external auditory canal. An upper horizontal line is drawn parallel to the lower one - through the supraorbital margin. Three perpendiculars are restored to the horizontal lines: the anterior one - to the middle of the zygomatic arch, the middle one - to the middle of the articular process of the lower part and the posterior one - to the posterior border of the base of the mastoid process. The projection of the central (Rolandic) groove is a line drawn from the point of intersection of the posterior vertical of the median sagittal line to the intersection of the anterior vertical of the upper horizontal line. The lateral (Sylvian) fissure, sulcus lateralis, is projected onto the bisector of the angle formed by the projection of the central (Rolandic) fissure, sulcus centralis, and the upper horizontal. Barrel a. meningea media is projected to the point of intersection of the anterior vertical with the lower horizontal (at the upper edge of the zygomatic arch at 2.0-2.5

cm posterior to the frontal process of the zygomatic bone). Frontal branch a. Meningea media - to the point of intersection of the anterior vertical with the upper horizontal, and the parietal branch - to the place of intersection of this horizontal with the posterior vertical.

Decompressive trepanation . Produced when intracranial pressure increases in cases of inoperable brain tumors, with progressive cerebral edema developing as a result of injury. The patient is on the left side, the leg on this side is slightly bent at the knee and hip joints. A horseshoe-shaped incision of the skin and subcutaneous tissue in the right temporal region, corresponding to the line of attachment of the temporal muscle. The flap is separated and turned to the base at the level of the zygomatic arch. The temporal aponeurosis, interaponeurotic fatty tissue and temporal muscle are dissected in the vertical direction to the periosteum. The latter is dissected and separated with a rasp on an area of 6 cm2. Having opened the wound with hooks, a milling hole is made in the center of the area freed from the periosteum with a large cutter and then it is expanded with forceps-nippers. The expansion of this hole in the antero-inferior direction is dangerous due to the possibility of damage to the trunk a. meningea media. Before opening the dura mater, a lumbar puncture is performed. Cerebrospinal fluid is removed in small portions (10-30 ml) to prevent wedging of the brain stem into the foramen magnum. The dura mater is opened with a cruciform incision and additional radial incisions. The surgical incision is sutured layer by layer, with the exception of the dura mater; it remains unsutured.

Osteoplastic craniotomy . Indications: for the purpose of access for surgery on its contents during strokes, to stop bleeding from damaged a. meningea media, removal of intracranial hematoma and inflammatory focus or brain tumor. A Krenlein diagram is applied to the operated area. A horseshoe-shaped incision with the base of the flap at the zygomatic arch is made so that the trunk and posterior branch of a can be ligated in the burr hole. meningea media. According to the lines outlined in Krenlein's diagram, the skin, subcutaneous tissue and temporal aponeurosis are dissected, and in the lower parts of the anterior and posterior parts of the incision, the temporal muscle is divided along its bundles. The length of the base of the flap is at least 6-7 cm, its edges are 1 cm from the edge of the orbit and the tragus of the ear. After stopping the bleeding, the musculocutaneous aponeurotic flap is turned down onto gauze napkins and covered on top with gauze moistened with a 3% hydrogen peroxide solution. Cutting out the osteoperiosteal flap begins with an arcuate dissection of the periosteum, departing 1 cm from the edges of the skin incision. The periosteum is peeled off from the incision in both directions to a width equal to the diameter of the cutter, which is then applied 5-7

holes. The areas between the cutter holes are cut with a Gigli saw or Dahlgren pliers.

I period: 1764–1835 1764 – opening of the medical faculty of Moscow University. Mukhin is the head of the department of anatomy, surgery and midwifery. Buyalsky - published anatomical and surgical tables - director of the medical instrument plant (Buyalsky's spatula). Pirogov– founder of operative surgery and topographic anatomy. Years of life: 1810–1881. At the age of 14 he entered Moscow University. Then he studied in Dorpat with Moyer (the topic of his doctoral dissertation was “Ligation of the abdominal aorta for inguinal aneurysms” - defended at the age of 22). In 1837 - the atlas “Surgical anatomy of the arterial trunks” and received the Demidov Prize. 1836 – Pirogov – professor of surgery at the University of Dorpat. 1841 - Pirogov returned to St. Petersburg to the Medical-Surgical Academy at the Department of Hospital Surgery. Founded 1 anatomical institute. New techniques invented Pirogov:

Layer-by-layer preparation of a corpse

Cross-cut method, frozen cuts

Ice sculpture method.

The cuts were made taking into account the function: joints - in a bent and unbent state.

Pirogov is the creator of the “Complete Course of Applied Anatomy”. 1851 – atlas of 900 pages.

II period: 1835–1863 There are independent departments of surgery and topographic anatomy. III period: 1863-present: Bobrov, Salishchev, Shevkunenko (typical anatomy), Spasokukotsky and Razumovsky - founders of the department of topographic anatomy; Klopov, Lopukhin.

3 Methods for studying topographic anatomy. On the corpse:

Layer-by-layer preparation

Cross frozen cuts

"ice sculpture"

Injection method

Corrosion method.

Live:

Palpation

Percussion

Auscultation

Radiography

CT scan.

4. Pirogov. Works that brought world fame:

“Surgical anatomy of arterial trunks and fascia” - the basis of topographic anatomy as a science

“A complete course of applied anatomy of the human body with drawings. Descriptive-physiological and surgical anatomy"

"Topographic anatomy illustrated by sections drawn through the human body in 3 directions." The basic rule is observed: preservation of organs in their natural position.

Using the cutting method to study not only the morphology, but also the function of organs, as well as differences in their topography associated with changes in the position of certain parts of the body and the condition of neighboring organs

Used the cutting method to develop the question of the most appropriate access to various organs and rational surgical techniques

Osteoplastic amputation of the lower leg

Animal experiments (abdominal aortic ligation)

Study of the effect of ether vapor

For the first time he taught topographic anatomy of operative surgery.

Operative surgery

Operative surgery (the science of surgical operations) studies the technique of surgical interventions. Topographic (surgical) anatomy is the science of the relationships between organs and tissues in various areas of the human body, studies their projection on the surface of the human body; the relationship of these organs to non-displaceable bone formations; changes in the shape, position and size of organs depending on body type, age, gender, disease; vascularization and innervation of organs, lymphatic drainage from them. Based on modern advances in anatomy and physiology, operative surgery develops methods for rationally exposing organs and performing certain effects on them. Topographic anatomy describes the layer-by-layer arrangement and relationship of organs by region, which allows you to determine the affected organ and choose the most rational surgical access and technique.

The first work on operative and topographic anatomy was written by the Italian surgeon and anatomist B. Jeng in 1672. The founder of topographic anatomy as a science is the brilliant Russian scientist, anatomist and surgeon N. I. Pirogov. For the first time, the department of operative surgery and topographic anatomy appeared on his initiative at the St. Petersburg Military Academy in 1867, the first head of the department was Professor E. I. Bogdanovsky. Topographic anatomy and operative surgery were especially developed in our country in the works of V. N. Shevkunenko, V. V. Kovanov, A. V. Melnikov, A. V. Vishnevsky and others.

According to N. N. Burdenko, when performing an operation, a surgeon must be guided by three main principles: anatomical accessibility, technical feasibility and physiological permissibility. This involves knowledge of topographic anatomy to make an anatomically sound incision with minimal damage to blood vessels and nerves; operative surgery to select the most rational intervention on the affected organ, physiology to anticipate possible functional disorders during and after surgery.

One of the main methods for studying operative surgery and clinical anatomy is independent work on a corpse, which allows one to examine the relationships of organs and tissues, and also teaches one to recognize anatomical objects by specific local features (depth of location, direction of muscle fibers, relative position of organs, structure of fascia, etc.). d.). But working on a corpse does not provide mastery of the necessary condition - stopping bleeding from damaged vessels, and therefore it is necessary to carry out surgical interventions on living animals, performed in compliance with all anesthetic requirements. Working on live animals makes it possible to master the skills and techniques of stopping bleeding, the ability to handle living tissue, and assess the condition of the animal after surgery.

In recent years, thanks to the development of computer graphics, it has become possible to simulate three-dimensional images of complex anatomical areas, to reproduce them from different angles, at different stages of surgical intervention.

Any operation consists of two main stages: surgical access and surgical reception.

Online access

Surgical access represents those actions of the surgeon that provide exposure of the organ affected by the pathological process or damaged. Operational access must meet certain requirements, which can be divided into qualitative and quantitative. The criteria for qualitative assessment of surgical access are: latitude; the shortest distance to the object of the operation; correspondence to the direction of the main vessels and nerves; good blood supply to the edges of the surgical wound (which promotes rapid healing); distance from infected foci.

Width of access is necessary to ensure freedom of action for the surgeon. It depends on a number of factors: the degree of development of fatty tissue in the patient (both subcutaneous and intermuscular); the depth of the organ’s location, the need to audit other organs; the nature and degree of complexity of the proposed operation. When performing a minimal approach, surgical trauma is reduced and the cosmetic effect is better achieved. But in case of severe complications and a high probability of death of the patient, they resort to large accesses, since with a small access the surgeon will not establish an accurate diagnosis, since he will not be able to examine neighboring organs, will not completely remove effusion from the chest or abdominal cavities, etc. Attempts to mechanically expand the surgical access due to tissue elasticity can lead to tissue damage, compression of blood vessels and worsen the results of wound healing. But too large accesses are not only traumatic and unsightly, but also lead to the formation of postoperative hematomas, wound suppuration, and eventration. To obtain a good overview with a small access, it is necessary to ensure the optimal position of the patient on the operating table. With the help of the design of a modern operating table, it is possible, by giving the patient’s body an appropriate position or using a system of rollers, to bring the organ being operated closer, which is necessary not only for better surgical intervention, but also to reduce tissue tension and, accordingly, the cutting of sutures when closing the wound. To reduce the cutting of sutures, it is necessary to operate on the patient under anesthesia with good relaxation; dissect the aponeurosis slightly longer than the length of the skin incision, since the tendon practically does not stretch; use speculums, retractors and retractors. Rack or screw wound retractors, which evenly stretch the wound, are applicable if the object of surgical intervention is located in the center of the wound, but if the object of operation is shifted to the corner of the wound, the wound should be opened using hooks or mirrors, visually controlling the degree of visibility of the wound.

It must be taken into account that access should pass through the least number of layers, along the shortest distance to the organ. To achieve this goal, it is necessary that the incision is located in the projection area of the organ. In addition, the surgeon must take into account that the tissues forming the access edges must fuse well after the operation, i.e. they must be well supplied with blood. Due to poor blood supply, the edges of the wound take a long time to heal. Therefore, in order to avoid wound dehiscence and prolapse of viscera, such approaches are not advisable for use in the elderly, cancer patients and patients with severe chronic pathology.

Access should not be located near infected (contaminated) areas of the body. Failure to comply with this requirement can lead to purulent complications in the postoperative period.

The quantitative assessment of surgical approaches is based on criteria developed by A. Yu. Sozon-Yaroshevich. The criteria that objectively evaluate surgical access are the following.

Operational axis. This refers to the line connecting the surgeon's eye to the deepest point of the surgical wound (or the most important surgical target). Most often, the axis of the surgical action runs along the axis of the cone of the surgical wound or is the bisector of the angle between the side walls of the wound cavity. A prerequisite for using this criterion is that the surgeon examines the object of the operation in a certain position, without losing the most important object of the operation from the control of the organ of vision. The direction of the axis of the surgical action is determined in relation to the frontal, sagittal and horizontal planes. Accordingly, the analysis of the direction of the axis of the surgical action is carried out both qualitatively, using the appropriate terms (top-bottom, front-to-back, lateral-medial), and in degrees relative to the plane of the wound aperture. The use of the stereotactic method of performing operations (for example, on brain structures) is a classic example of quantitative assessment of the direction of the axis of the surgical action in degrees. The stereotactic method is a set of techniques and calculations that make it possible to insert a cannula (electrode) into a predetermined, deep-lying structure of the brain with great precision. To do this, it is necessary to have a stereotactic device that compares the conventional coordinate points (systems) of the brain with the coordinate system of the apparatus, an accurate anatomical determination of intracerebral landmarks and stereotactic atlases of the brain.

It makes no sense to study the axis of surgical action in superficial wounds or wounds in which the organ is removed to the surface. However, in narrow surgical wounds, when the operated organ remains at a considerable depth, the role of this criterion is great. The value of the direction of the axis of the surgical action determines the angle from which the surgeon will see the object of the operation and the layers that he must sequentially cut, revealing the object of the operation.

Angle of inclination of the operating action axis. This term refers to the angle formed by the axis of the surgical action and the surface of the patient’s body within the operating zone (the plane of the wound aperture). The angle of inclination of the axis of the surgical action determines the angle of view from which the surgeon views the object of the operation. The best conditions for the operation are created if the angle is 90° and the surgeon looks directly at the object of the operation. Practice shows that when this angle is less than 25°, it is difficult to operate, and it is better to make a new approach that combines the projection of the surgical object with the wound aperture.

Operating angle. This angle is formed by the walls of the cone of the surgical wound; it determines the freedom of movement of the surgeon’s fingers and instruments in the wound. That is, the larger this angle, the easier it is to operate. When the operating angle is more than 90°, the operation is performed easily, as if the organ was lying on the surface. When the angle is from 89° to 26°, manipulations in the wound do not cause any particular difficulties. At an angle of 15–25°, manipulation is difficult. If the angle is less than 15°, the operation is practically impossible. It is necessary to take into account that if the edges of the surgical wound are formed by soft tissues, then with the help of hooks and retractors its geometric characteristics can be significantly improved. One way to improve the characteristics of a wound is to mobilize the corresponding part of the organ. If the edges of the wound are formed by rigid elements (bones of the calvarium, ribs, sternum, etc.), then the possibilities for improving the parameters of the angle of surgical action are limited.

Depth of the wound. This term refers to the distance between the planes of the upper and lower apertures of the wound. The depth of the wound is determined by the axis of the cone, which is also the axis of the surgical action, or by the bisector of the angle of the surgical action. This is a segment of the axis of the surgical action from the plane of the wound aperture to the object of intervention. The depth of the wound determines the ease of action of the surgeon's fingers and instruments. When working with conventional instruments, the depth of the wound should not exceed 150–200 mm. To characterize the depth of the wound, you can use the wound depth index, defined as the ratio of the depth of the wound to the size of the upper aperture, multiplied by 100.

The accessibility zone in the classical sense is the area of the bottom of the surgical wound. Measured in absolute values, it is not very informative. At the same time, the ratio of the values of the upper aperture and the bottom of the wound is indicative. If the ratio of values is approximately 1: 1, then this indicates the shape of the wound in the form of a cylinder or well and indicates the rationality of access. The indicated ratio must be adjusted to the depth of the wound. If the area of the upper aperture of the wound is many times greater than the area of the lower aperture, this indicates an unreasonably long incision length with a relatively superficial location of the intervention object.

Modern technologies (video endosurgical equipment) make it possible, after a minimal incision in the abdominal or chest wall, to introduce a miniature television lens and a powerful light source for inspection or intervention on almost all organs of the abdominal and thoracic cavities.

In these cases, the viewing area will be many times greater than the area of the wound aperture (puncture holes). This ratio indicates the low traumatic nature of the surgical approach.

The choice of operational access should take into account the following conditions.

1. Physique (constitution) of the patient. The degree of development of fatty tissue plays a significant role.

2. Features of the operation being performed.

3. Risk of surgical intervention.

4. The patient has a large scar after a previous operation. On the one hand, making access with excision of the existing scar is more profitable both in terms of preventing new scars and from a cosmetic point of view. However, when excising a scar, the vessels or internal organs involved in the scar may be damaged. In addition, if there is a tendency to form a keloid scar, excision can lead to even greater growth of connective tissue.

5. Possibility of wound infection. The presence of an infected wound in a patient or the fear that a colostomy, tracheostomy, or bladder fistula may serve as a source of infection after surgery forces one to seek surgical access as far away from them as possible.

6. Cosmetic considerations. To achieve the best effect, you should pay attention to the amplitude and direction of muscle movements (make the incision so that it is perpendicular to the direction of these movements throughout); the direction of Langer's lines (i.e. the course of collagen and elastic fibers, the incision is made parallel to these lines); the course and direction of skin folds and wrinkles; topographic and anatomical features of the operation area.

7. Compliance with the rules of ablastics. To comply with ablastics, they use an approach to the tumor from the periphery, isolation of dissected healthy tissues, and use an electric knife, laser or plasma scalpel.

8. Presence of pregnancy. The uterus should be kept away from surgical access to avoid its premature stimulation; access should be made taking into account the displacement of organs by the uterus depending on the duration of pregnancy.

Operational reception

Surgical technique is direct actions at the site of surgical intervention aimed at removing a modified organ or pathological focus. Performing a surgical procedure involves a sequence of actions when removing an organ or part of it, restoring the patency of the gastrointestinal tract, restoring blood flow or lymph flow through the corresponding vessel, etc. Certain requirements are imposed on the surgical procedure; it must be radical, minimally traumatic, and, if possible, bloodless ; minimally disrupt the body’s vital functions, ensuring the best elimination of the cause of the disease.

By radical surgery we mean the most complete removal of the source of the disease, often not only along with the affected organ, but, for example, in the case of malignant tumors, with regional lymph nodes or even part of neighboring organs.

The bloodlessness of the surgical intervention is ensured by careful sequential stopping of bleeding as the manipulations are carried out. In some cases, it is recommended to perform preliminary ligation of large arterial and venous trunks involved in the blood supply to a given region. This is done during complex operations in the head and face, performing preliminary ligation of the external carotid artery, the branches of which supply the maxillofacial area and the cranial vault.

It is important to preserve (or restore) the function of the organ after the operation. It provides for the mandatory inclusion in the operation plan of the restoration of a particular organ and its function after the operation.

The requirements for surgical access and reception are very contradictory; compliance with all of them is almost impossible. As a rule, one surgical approach corresponds to one surgical technique. Sometimes two approaches correspond to one surgical technique. Of interest are situations when several approaches are performed from one access or the patient undergoes several approaches and surgical techniques during the operation.

There are several types of operational benefits.

Emergency (emergency, urgent) - performed immediately according to vital indications.

Planned - performed after examining the patient, establishing an accurate diagnosis, and lengthy preparation. Elective operations pose less danger to the patient and less risk to the surgeon than emergency operations.

Radical – completely eliminate the cause of the disease (pathological focus).

Palliative operations do not eliminate the cause of the disease, but provide only temporary relief to the patient.

The operation of choice is the best operation that can be performed for a given disease and which gives the best treatment result at the current level of medical science.

Operations of necessity are the best option possible in a given situation; depends on the qualifications of the surgeon, the equipment of the operating room, the condition of the patient, etc.

Also, operations can be one-stage, two-stage or multi-stage (one-, two- or multi-stage). Simultaneous operations are operations in which, during one stage, all necessary measures are performed to eliminate the cause of the disease. Two-stage operations are performed in cases where the patient’s health condition or the risk of complications do not allow the surgical intervention to be completed in one stage, or if it is necessary to prepare the patient for long-term dysfunction of any organ after surgery. Multi-stage operations are widely practiced in plastic and reconstructive surgery, and in oncology.

In recent years, due to increasing life expectancy, there has been a tendency towards an increase in the number of patients suffering from several surgical diseases. Improved diagnostics, improved surgical techniques and advances in the field of anesthesiology and resuscitation have contributed to the expansion of indications for combined (simultaneous) surgical interventions. Combined (or simultaneous) operations are performed during one surgical intervention on two or more organs for various diseases. Extended surgery is characterized by an increase in the volume of surgical procedures for a disease of one organ due to the characteristics or stage of the pathological process. A combined operation is associated with the need to increase the scope of surgical procedures for one disease that affects neighboring organs.

Assessment of surgical operations. The assessment is based on the results of the operation. They are divided into immediate and remote. Immediate outcomes are determined by mortality on the operating table and in the immediate days and weeks after surgery. The quality of the immediate results largely depends on the surgeon himself. Long-term results are determined by the patient’s condition months and years after surgery.

The operation includes a number of successive stages: dissection of tissues, their dilution, fixation, surgical technique, stopping bleeding, connecting tissues, which are ensured by various surgical instruments.

1. Tissue separation. The operation begins with the separation of tissues with one smooth movement of the scalpel. The amount of access must be sufficient to carry out this operation. The access corresponds to the projection of the organ or is away from its projection. The skin and subcutaneous tissue are dissected with one movement of the scalpel. Further, to dissect fiber, fascia, aponeurosis and other soft tissues, not only scalpels, knives, scissors, but also an electric knife, laser scalpel, ultrasonic device and others can be used.

2. Stop bleeding. During surgery, definitive methods of stopping bleeding are mainly used:

ligation of a vessel captured by a hemostatic clamp with a ligature;

ultrasound or laser;

stitching tissue in the area of the bleeding vessel;

applying a vascular suture;

the use of muscles, omentum, adipose tissue, hemostatic and semi-biological sponges;

using a physical method to stop bleeding - applying napkins moistened with hot saline solution;

3. Fixation of tissues. The edges of the wound are separated and the organs are fixed for better visibility and freedom of movement for the surgeon in the depths of the wound.

4. The main stage of the operation. Special sets of instruments and various surgical techniques are used.

5. Connection of tissues. Various methods of joining fabrics are used: to join fabrics, various stitching devices have been created that connect fabrics using metal staples.

Devices are used for stitching tissues and organs in case of damage, vascular disease, atrium, lungs, gastrointestinal tract, bladder, ureters, skin.

The use of ultrasound and laser to cut and connect tissue.

Cold in the form of liquid nitrogen and a laser were used to separate tissues and remove the pathological focus.

Soft fabrics are sewn with various threads: silk, catgut, nylon, lavsan, tantalum clips. Various metal plates, wires, staples, and pins can be used. Medical glue is also used to join tissues.

Surgical instruments are divided into: general instruments and special purpose instruments.

The manual introduces the technique of performing basic operations and examines the relative position of organs and tissues in various parts of the body. For students of higher medical educational institutions.

LECTURE 1. INTRODUCTION TO TOPOGRAPHIC ANATOMY

Topographic anatomy (“local regional anatomy”) - studies the structure of the body by region, - the relative arrangement of organs and tissues in different areas of the body.

1. Tasks of topographic anatomy:

holotopia– areas where nerves, blood vessels, etc. are located.

layered structure of the region

skeletopia– the relationship of organs, nerves, blood vessels to the bones of the skeleton.

siletopia– the relationship of blood vessels and nerves, muscles and bones, organs.

Typical anatomy– characteristic of a certain body type. Index relative length of the body is equal to the length of the body (distantia jugulopubica) divided by height and multiplied by 100%:

31.5 and more – brachymorphic body type.

28.5 and less – dolichomorphic body type.

28.5 -31.5 – mesomorphic type of build.

Age anatomy– the bodies of children and elderly people differ from those of mature age – all organs decline with age. Clinical anatomy. Any operation consists of two parts:

Online access

Operational techniques.

Online access– the method of exposing a pathologically altered organ depends on the patient’s physique, his condition, and the stage of the pathological process.

Criteria for assessing operational access (according to Shevkunenko-Sazon-Yaroshevich).

Alpha – operating angle (must be neither large nor small)

Accessibility area S (cm 2)

The axis of surgical action (AS) is a line drawn from the surgeon’s eye to the pathological organ

Beta - the angle of inclination of the operating action axis - the closer beta is to 90 degrees, the better

OS – depth of the wound. The relative depth of the wound is equal to OS divided by AB - the smaller, the better the cut.

ABOUT operative technique– depends on the stage of the process and the patient’s condition. Surgical techniques are divided into radical and palliative. Radical surgery– eliminates the cause of the disease (appendectomy). Palliative operation– eliminates some symptoms of the disease (metastases in the liver due to cancer of the pyloric part of the stomach – a new outlet from the stomach is created – gastroenteroscopy). Operations differ in terms of completion. Emergency indications:

Bleeding, injury to the heart, large vessels, hollow organs;

Perforated stomach ulcer;

Strangulated hernia;

Appendicitis progressing to peritonitis.

Urgent– after 3-4 hours of observation in dynamics – acute appendicitis. Planned – Single-stage, multi-stage - for prostate adenoma and urinary retention - stage 1 - cystostomy, and after 2 weeks - removal of prostate adenoma.

2. History of the development of topographic anatomy.

I period: 1764–1835 1764 – opening of the medical faculty of Moscow University. Mukhin is the head of the department of anatomy, surgery and midwifery. Buyalsky - published anatomical and surgical tables - director of the medical instrument plant (Buyalsky's spatula). Pirogov– founder of operative surgery and topographic anatomy. Years of life: 1810–1881. At the age of 14 he entered Moscow University. Then he studied in Dorpat with Moyer (the topic of his doctoral dissertation was “Ligation of the abdominal aorta for inguinal aneurysms” - defended at the age of 22). In 1837 - the atlas “Surgical anatomy of the arterial trunks” and ... received the Demidov Prize. 1836 – Pirogov – professor of surgery at the University of Dorpat. 1841 - Pirogov returned to St. Petersburg to the Medical-Surgical Academy at the Department of Hospital Surgery. Founded 1 anatomical institute. New techniques invented Pirogov: