Reconstructive surgery: what it is and where it is used

Reconstructive surgery originates from ancient centuries. Still in excavations Ancient Egypt, Peru and Urartu, skulls with devices for osteosynthesis of bones were discovered. Modern reconstructive facial surgery is a relatively young field that deals with the restoration and treatment of damaged tissues of the human body after severe injuries, burns, oncological operations, and for correction congenital pathology development. After many congenital and acquired pathologies, a person experiences serious disorders vital functions: swallowing, nasal breathing, chewing. As a rule, such violations are accompanied by a violation of facial aesthetics, which clearly leads to loss vital activity human and mental disorders.

Recovery operations V maxillofacial surgery are carried out to eliminate defects by recreating lost (partially or completely) organs or tissues of the face and neck with the subsequent restoration of their function and integrity. Why is the technology of moving one’s own tissues used or microsurgical technique for transplanting a large complex of tissues?

Reconstructive surgery is aimed at eliminating deformations caused by trauma or post-traumatic process.

Indications for use reconstructive operations - these are congenital and acquired defects and deformations:

soft tissues and bones of the face (jaw, eye sockets, frontal bone, oral cavity, nasal and zygomatic areas, nasal cartilage);
violation of facial aesthetics and facial expressions;
chewing dysfunction;
difficulty or inability to speak;
difficulty breathing;
complete or partial absence of the bones of the facial skeleton and adjacent soft tissues (eyeballs, ears, eyelids, etc.);
damage to tissue and bones as a result of operations for tumors and radiation therapy.

Contraindications restorative and reconstructive operations include mental disorders, infectious diseases, skin pyoderma, ulcerative stomatitis, inflammatory processes in lymph nodes, sinuses, pharynx, general malaise and age of the patient.

In the Federal State Budgetary Institution Scientific Center of Otorhinolaryngology, Federal Medical and Biological Agency of Russia, reconstructive recovery operations are carried out by qualified specialists of the scientific and clinical department of maxillofacial surgery under the guidance of Doctor of Medical Sciences, Professor A.S. Karayan.

Operations performed on the face, oral cavity, neck, and limbs are complex jewelry art that requires not only the special professional skills of the surgeon, but also special tools, special suture material, surgical equipment, operating rooms. Our Center has the most modern clinical facilities for performing such complex operations, including diagnostic equipment and its own laboratory (the only laboratory in Russia) for the production of ectoprostheses necessary for patients. All employees of the department have scientific degrees and extensive practical experience in maxillofacial surgery, actively use not only the best domestic and foreign techniques, but also apply their own developments and methods in their work. All this allows us to comprehensively examine the patient, carry out the necessary treatment and provide highly qualified assistance.

To carry out restorative and reconstructive operations, the Center’s specialists conduct a thorough study of the nature of the injury, associated pathological changes using radiography, CT or MRI. The patient undergoes examination and consultation with doctors of related specialties - a neurosurgeon, an otolaryngologist and an ophthalmologist.

Patients undergo a detailed examination and study of the features bone tissue in the defect area using 3D modeling, which is necessary for the production of an individual stereolithographic model when modeling the graft. In the non-profit organization of maxillofacial surgery, developed and implemented clinical practice some unique techniques for the restoration and reconstruction of the face and neck in patients who have suffered complex oncological diseases, injuries, burns, gunshot wounds.

Only A complex approach assessment of all positions makes it possible to accurately determine the size of damage, identify the boundaries of preservation of areas of bones and soft tissues, and develop tactics for further treatment and recovery of the patient.

Post-traumatic deformities of the zygomatico-orbital complex– the most common in the practice of maxillofacial surgeons. Fractures of the walls of the orbit can be isolated and in combination with fractures of the zygomatic, maxillary, frontal, temporal bones, and often with the bone base of the nose. Considering that the above bones partially or completely form the walls of the orbit, their fracture involves an orbital fracture. Therefore, a displaced fracture of the zygomatic bone is always a zygomaticoorbital fracture.

As for isolated fractures of the bones of the orbit, in this case its bottom and medial wall, which are “ weak points", limiting the orbit from the paranasal sinuses, and having the thinnest bone wall; Such fractures are called “blowout” or “blowout” fractures. The cause of such fractures is most often a blow to the eyeball with a blunt object. According to the laws of physics, an impact causes elastic deformation of the eyeball due to a short-term change in hydraulic pressure in it. In turn, the resulting elastic deformation causes mechanical stress in the surrounding soft tissues, which causes destruction of the orbital walls. With this type of fracture, the edges of the orbit remain intact, and the soft tissue component can displace and penetrate into the paranasal sinuses. Isolated orbital fractures occur in 16.1% of cases of fractures involving the orbit.

Zygomatic-orbital fractures occur quite often (in 64% of patients with injuries to the upper and middle zones of the face) as a result of motor vehicle injuries, impacts and falls from a height, while the zygomatic bone breaks more often along the zygomatic-maxillary, zygomatic-frontal, zygomatic-temporal buttresses and shifts, involving a fracture of the lower, less often the medial, walls of the orbit.

Since orbital trauma is combined with neurotrauma in 30% of cases, the diagnosis and treatment of orbital fractures are often relegated to the background when monitoring patients in neurosurgical departments. Untimely access to a specialized medical institution can also be the cause of the formation of post-traumatic deformities.

Within 2–3 weeks after injury, in the absence of treatment, bone and fibrous adhesions occur between bone fragments. From this period, the process of resorption of displaced bone fragments of the walls of the orbit begins, and in their place, rough scar tissue is formed, which is not capable of performing the function of a bone frame. By the end of the third month, the deformity that arose after an injury in the absence of treatment is considered to be formed, that is pathological processes in the affected area fully manifested themselves with the appearance of persistent aesthetic and functional disorders.

Defects in the walls of the orbit can arise as a result of resorption of displaced fragments of the lower and medial walls of the orbit, sometimes having a thickness of no more than a paper plate, and involving changes in the soft tissue contents, leading to its atrophy, scar changes or prolapse in the sinus cavity. The resulting enophthalmos and/or hypophthalmos leads, in turn, to aesthetic and functional disorders. Restoration of atrophied soft tissue contents surrounding eyeball, especially behind the orbital cellular space, is still very complex and actual problem reconstructive surgery, which does not have a unified concept optimal treatment. We came to the conclusion that to eliminate post-traumatic volume deficit of the soft tissues of the orbit, the optimal material is a prepared mixture of bone chips and platelet-rich autoplasma (PRP).

Any bone reconstruction requires repositioning of displaced bone fragments, their fixation to intact bones, to each other, and replacement of bone tissue defects. Restoring the lower and inner walls of the orbit requires a special approach. Small bone fragments that form during fractures cannot be compared and consolidated; moreover, over time they resolve, forming a defect.

When repositioning incorrectly fused bone fragments zygomatico-orbital complex, the intraoperative occurrence of a bone tissue defect is, as a rule, inevitable. Therefore in practice we're talking about about replacing the lost bone base with grafts or implants. A variety of materials have been and are still used in this capacity: titanium meshes, plates, silicone implants, auto-, allografts, etc. Since the walls of the orbit directly border the paranasal sinuses, the use of synthetic material has a certain risk due to infection of the latter with the development of inflammatory complications; In addition, as practice shows, over time, scarring of the tissues surrounding the implant may occur. Optimal material in in this case may be a bone graft. The outer plate of the parietal bone and the wing crest are used as donor material. ilium or rib. A bone autograft is required as a donor material, with the help of which it is possible to obtain thin bone plates that make it possible to recreate the lost orbital wall, while the bone material should be minimally susceptible to resorption, convenient for collection and relatively painless for the patient in the postoperative period.

Bone autografts are classified according to their structure: cortical - the cranial vault, chin and body of the lower jaw; spongy – tibia and iliac crest; cortical-spongy or mixed - iliac crest. By embryonic origin: intramembranous type - mesenchymal origin: skull bones and enchondral type - ectomesenchymal origin: iliac crest and tibia. Cortical grafts of membranous origin are characterized by high mechanical strength and resistance to resorption. We have successful experience in using cortical parietal autografts for reconstruction of defects of the medial and inferior walls of the orbit in isolated fractures.

Our experts came to the conclusion that for reconstruction of the floor or medial wall of the orbit, with isolated fractures that caused a defect in one wall, in cases where the patient, for one reason or another (religious considerations, concomitant alopecia, etc.) refuses coronary access, with enophthalmos ≤ 3.5 mm, it is possible to do without coronary access, using cortical autografts taken from the branch of the mandible, which are similar in their properties and origin to the parietal ones, as a donor material for the reconstruction of defects in the orbital walls.

It is very important to understand that a bicoronal or, in other words, coronal incision is necessary when it comes to eliminating the reconstruction of the zygomatic-orbital complex, zygomatic arch, frontal bone, since the incision simultaneously serves as an access that allows you to get to the desired areas without damaging the neurovascular bundles and the site of collection of donor material. The coronal incision does not leave visible scars as it passes through the scalp.

Features of membranous mandibular cortical autografts

Like parietal cortical bone grafts, chin and ramus grafts are of intramembranous origin and therefore are less resorbed than those of an enchondral nature. This feature is explained by osteologists by rapid revascularization and slow resorption of bones of intramembranous origin.

Compared to other methods of bone reconstruction, when using autografts from the lower jaw, the quality of bone tissue in the area of grafting improves and the healing time is reduced. The body of the mandible embryologically develops as rectangular membranous bone, while the condylar processes develop from an enchondral bone precursor. Experiments have shown that autografts from membranous bone undergo less resorption than bones of endochondral origin (from hyaline cartilage). Although cancellous blocks revascularize faster than cortical ones, cortical membranous autografts revascularize faster than autografts of endochondral origin, even with a more pronounced cancellous layer. It is the early revascularization of the bone block of membranous origin that is most likely the reason for the preservation of the volume of the autograft. This explains why bone autografts of the lower jaw, which are mainly a cortical plate and contain a small number of osteogenic cells, lose little volume and quickly take root in the recipient bed. There is another hypothesis that states that bones of ectomesenchymal origin (eg, the mandible) have better engraftment potential in the maxillofacial region due to the biochemical similarity between the protolagen of the donor site and the recipient site.

Some researchers have suggested that better engraftment of membranous autografts is associated with a preferred three-dimensional structure. Marx pointed out that autografts of the calvarial bones, for example, have a developed vascular system spongy substance and a large number of Haversian canals and Volkmann canals, which contribute to rapid and complete revascularization. In addition, autografts of membranous origin have a more pronounced cortical layer, due to which they resolve much more slowly. The advantages also include: the absence of aesthetic disturbances due to intraoral access for sampling, minor postoperative pain and, most importantly, it is always easy to obtain the patient’s consent for this manipulation.

Operation scheme

To access the lower and medial walls of the orbit, we often use the subciliary approach. To do this, the incision is made 1.5-2 mm below the ciliary edge. The preparation plane is either superficially above m. orbicularis oculi - with the creation of a skin flap, or deeper under the muscle - with the formation of a musculocutaneous flap. When forming a musculocutaneous flap, variations are possible: the muscle can be cut at a level 1 mm lower than the skin incision. The orbicularis muscle is incised and the periosteum in the area of the lower orbital margin is dissected. The approach allows visualization of the medial and inferior walls of the orbit.

Next, a graft taken from the ramus of the mandible or the parietal region is installed in the area of the defect in the lower orbital wall (or medial orbital wall). Also, the bone graft is crushed in a bone mill, the resulting shavings are mixed with platelet-rich autoplasma (PRP) and placed in the retroocular tissue space to eliminate the deficit in soft tissue volume with hypercorrection in the form of exophthalmos in a relatively healthy eye.

Example 1

Before surgery

CT scan before surgery

After operation

Example 2

Purpose plastic surgery is to give body parts aesthetic appeal. However, in case of severe damage - trauma, burns, the task becomes more ambitious: it is necessary to recreate the original shape of the body and restore its functionality. This is what reconstructive plastic surgery does.

Features

Reconstructive surgery is a subtype of plastic surgery. It is distinguished by 3 main features:

nature of the operation– it is necessary to eliminate a defect that is not just disfiguring, but interfering normal operation organs. This category includes not only birth defects like “ cleft lip“, but also the consequences of burns, injuries, and serious illnesses. During surgery, sutures and scar tissue are not simply removed, but microsurgery of nerves and blood vessels is also performed in order to ensure the functionality of the restored area;
causes– traumatic effects and birth defects leading to partial or complete loss of ability to work. Massive damage to any tissue - muscle, skin - inevitably leads to dysfunction of the lungs, cardiovascular system, and kidneys. In this case, plastic surgery not only restores the natural appearance, but also prevents the appearance of internal pathologies;
Another difference between reconstructive plastic surgery is active participation of specialists from various fields: dentists, otolaryngologists, ophthalmologists, gynecologists, orthopedists. This is due to the fact that with conventional rhinoplasty, for example, the surgeon does not need to restore the nasal septum, but when performing reconstructive operations it is necessary, first of all, to restore functionality.

Indications

Indications for operations are as follows:

birth defects;
deep burns – chemical, thermal, electrical, and frostbite – stage 3–4;
malignant diseases;
mechanical injuries - wounds, crushing of tissues, separation of body fragments - fingers, limbs, ears;
consequences of operations - this includes the elimination of scars;
the consequences of certain diseases - infectious and inflammatory, leading to the appearance of defects in organs and tissues;
numerous benign formations on the skin - warts are classified as reconstructive plastic surgery;
complications after childbirth or age-related changes leading to deformation of the uterus and perineum. For men, this category includes phalloplasty operations - restoration of the shape and length of the penis;
sex reassignment surgery - and.

As a rule, reconstruction is carried out in several stages, since it affects too much bone and soft tissue. During the rehabilitation period, the patient remains under observation: before each next step, it is important to achieve complete recovery.

Unlike general plastic surgery, reconstructive plastic surgery in some cases is carried out free of charge.

Types of operations

By direction of impact

Reconstructive plastic surgery involves working not only with skin and muscle tissue, but also with mucous membranes, tendons, and bone tissue. Based on this feature, the following types of RP are distinguished:

correction of skin defects– used to eliminate rough scars, extensive scars after chemical and thermal burns, postoperative sutures. This also includes the removal of benign formations, “ spider veins", deep pigmentation and the like. As a rule, skin grafting is required to eliminate defects. It is preferable to use tissue from the patient himself: fragments are taken from an area that is invisible under clothing - the abdomen, buttocks, thighs;
tendon reconstruction– carried out to restore completely or partially lost mobility: congenital underdevelopment of the tendon, contracture, traumatic impact. In case of severe damage, the tendon is replaced with artificial material;
correction of muscle defects– restoration of tissue in case of underdevelopment or loss as a result of injury. This also includes innervation muscle tissue and elimination of disturbances in the blood supply - in fact, microsurgery of blood vessels. The lack of tissue can be partially compensated by implants or;
restoration of completely or partially lost organs– ears, fingers, chest, nose, as well as operations to eliminate unsuccessful plastic corrections and removal of stretch marks. Reconstruction requires donor tissue;
correction of birth defects– asymmetry of hands and feet, fused fingers, cleft palate, cleft lip, missing ears, etc. This type of intervention is considered the most complex and requires a number of operations.

By localization

Another well-known classification is related to the area of work. In many ways, it coincides with the types of conventional plastic surgery, but always involves the participation of specialists in the functionality of the organ being operated on:

– change in the ocular shape and geometry of the eyelids. During reconstruction, a partially or completely lost eyelid is restored, and an uneven edge that leads to incomplete closure is corrected;
– and, more precisely, that is, a correction in which the nasal septum is restored or corrected. The operation is carried out under the supervision of an ENT doctor;
– the position of the cartilage is corrected and increased Auricle. If the ear is completely absent, an implant is used;
jaw correction– combines plastic surgery of the chin, lips, neck, and implies active cooperation with dentists. This category most often includes the correction of birth defects, such as cleft palate;
– restoration of partially or completely lost mammary glands as a result of injury or surgery. Implants are almost always used;
– removal of scars, postoperative sutures, burns and stretch marks in the abdominal area. Combined with excision of excess skin and fat;
– correction of the walls of the vagina, uterus, plastic surgery of the labia majora and minora, etc.;
– correction or restoration of the penis after surgery, injury or to eliminate birth defects. Includes restoration of the urethra, if necessary, vascular surgery;
– a complex operation aimed at restoring the biomechanical axis of the limb. Includes bone tissue augmentation, muscle implantation if necessary, and tendon replacement in case of irreversible damage. It is carried out in several stages and requires long-term resuscitation.

The video below will tell you about reconstructive plastic surgery:

What you need to know before RP

Reconstructive plastic surgery is used when there is no other solution to the problem. The possibilities in this area are not limitless, but in many cases, surgical intervention allows you to get rid of disability and return to a full life.

Contraindications

In general, reconstructive plastic surgery is not a life-saving operation. However, most types of correction - restoration of joints, cartilage and bone tissue, prevent various pathologies internal organs, therefore, there are noticeably fewer restrictions in this area than with conventional plastic surgery.

These include:

severe cardiovascular failure;
oncological diseases;
disorders of blood clotting - unfortunately, exclude surgical intervention;
severe diabetes mellitus;
autoimmune diseases - exceptions are possible, but require careful preliminary examination and consultation with specialists;
severe damage to the liver and kidneys - operations are prohibited in cases where reconstructive plastic surgery is not aimed at correcting a negative operating factor;
pregnancy and lactation – the need for surgery is determined by the benefit or risk to the fetus. Thus, correction of the nasal septum, if this causes hypoxia, is also resorted to during pregnancy.

Material for reconstruction

To restore body parts and organs, both artificial material and donor tissue from the patient are used. The second method is preferable as it minimizes the risk of rejection. However, in some cases it cannot be used.

Replenishment of missing muscle tissue, restoration of the cartilage and bone structure of the nose, angles of the jaw, and cheekbones are made from neutral organic materials. The most popular are silicone, medpora - polyethylene, and porous polytetrafluoroethylene. These materials do not cause allergies and are extremely rarely rejected.

As implants from donor tissue are used:

muscle tissue fragments- enough rare view operations;
adipose tissue– used for mammoplasty, as well as for correcting curvature of the legs, replenishing missing muscle tissue during facial plastic surgery;
bone and cartilage material– most often the source is the ribs, cartilage of the auricle;
skin tissue– skin flaps are taken from areas hidden by clothing.

Features of the operation and rehabilitation

Reconstruction surgery is always more complex and difficult than conventional correction of body parts. Accordingly, preparation for it takes longer, and recovery is long and difficult.

The general reconstruction scheme is as follows:

preliminary examination, laboratory examination, consultation with specialists - reconstruction is always associated with structural changes that affect the functionality of organs;
extraction biological material– bone tissue, cartilage, skin on the vascular pedicle. If a decision is made to use artificial implants, a suitable material is selected or the implant is made to order;
surgery with transplantation of skin, cartilage, bones, implants;
the period of adaptation of the transplanted tissue is a stage more important than the operation itself. The result of the reconstruction depends entirely on how well the tissue has taken root;
rehabilitation – complete or partial restoration functions of the damaged organ or body part.

In the vast majority of cases, reconstruction involves not one, but a whole series of operations. After each procedure, it is necessary to ensure tissue engraftment and fully restore function at this stage. Only then, in the absence of complications, is the next correction prescribed.

Reconstructive plastic surgery is a field of plastic surgery aimed not only at correcting an aesthetic defect, but also at restoring organs and body parts.

In recent years, one of the important areas of medical rehabilitation of disabled people has become reconstructive surgery. It allows through complex surgical operations restore the structure and function of organs, preventing or reducing the consequences of congenital or acquired defects, thereby reducing life limitations. Such operations include reconstructions for congenital anomalies of the limbs, spine, internal organs, blood vessels, transplantation of organs and tissues - kidneys, bone marrow, skin, cornea, etc., which are becoming increasingly common. A significant number of reconstructive operations relate to endoprosthetics, i.e. integration into the structure of organs of internal prostheses that combine biological compatibility with tissues and adequate mechanical behavior, i.e. practically implants. Many reconstructive surgeries use microsurgical technologies. In order to improve the technical equipment of reconstructive surgery institutions and increase the accessibility of complex organ restoration operations for people with disabilities, the Government decree Russian Federation The Federal Target Program “High-Tech Medicine” was adopted.

The organizational and legal basis for medical rehabilitation through reconstructive surgery is the order of the Russian Ministry of Health “On organizing the provision of high-tech (expensive) types of medical care in healthcare institutions of federal subordination." According to this order, planned volumes of high-tech types of operations and quotas for subjects of the Russian Federation in medical institutions of federal subordination are developed annually. The referral of sick and disabled people within the framework of quotas is carried out by the health authorities of the constituent entities of the federation; in addition to the quotas, disabled people can be referred at the expense of the constituent entities of the Russian Federation, their own or sponsorship funds. The List of high-tech types of medical care financed from the federal budget includes a number of reconstructive operations indicated for people with disabilities to overcome limitations in their ability to live:

Reconstructive plastic surgery after burns and complex
ny combined injuries of the hand;

X-ray endovascular valvuloplasty, coronary plastic surgery;

Arterial replacement lower limbs;

Reconstructive operations for cicatricial tracheal stenosis;
-reconstructive plastic surgery for injuries and burns
organ of vision;

Reconstructive plastic surgery for severe forms
swing perinatal pathology eyes in children;

Reconstructive plastic surgery for congenital, acquired defects and deformations of the maxillofacial system;

Endoprosthetics of large joints;

Replantation of large limb segments with autotransplantation
plantation of tissue complexes;

Replantation of fingers;

Treatment of severe spinal deformities in children using
the use of biological transplants and metal structures;

Staged reconstructive operations combined with hardware correction of the length and shape of the limbs for systemic diseases, bone defects and malformations of the limbs in children;

Reconstructive surgery on the hip joints in children;

Reconstructive plastic surgery for malignancy
tumors;

Kidney, liver, heart, bone marrow transplantation;

Reconstructive surgeries for cicatricial stenoses of the larynx
and trachea in children;

Cochlear implantation;

Surgical intervention for ophthalmic pathology
logy using alloplant.

The greatest effectiveness of reconstructive surgery has been observed during operations on children with congenital heart defects. Among disabled children, 5% are children whose disability is associated with this pathology, since progressive heart failure leads to severe limitations in life. Prevalence of congenital heart defects among children for 1998 - 2002. increased by 35%. A peculiarity of reconstructive operations for this disease in children is the need to carry them out during the neonatal period or during the first year of life. In 2002, the number of reconstructive surgical interventions for congenital heart defects in children under 1 year of age increased by 32 %. Currently, such operations are carried out in 29 federal institutions. However, these operations are clearly not enough; the need for them is satisfied only by 11.3 - 69.9%, depending on the shape of congenital heart defects. Pediatric reconstructive surgery is very poorly developed at the regional level. This leads to the fact that 40-80% of children in need of cardiac surgery do not receive it and become disabled.

Disabled people with acquired defects also need organ restoration operations on the heart. A research institute for acquired heart defects has been created, in which technologies for complex reconstructive operations are developed, tested and implemented, including for multivalve and combined lesions. In recent years, the technology of reconstruction of valves and pericardium with the help of bioprostheses, specially processed and turned into non-rejectable xenoprostheses, has been used. The Center for Reconstructive Surgery of Heart Diseases of the Institute of Transplantology and Artificial Organs, the Russian Cardiology Research and Production Complex also develop and perform heart surgeries under artificial circulation, and perform bioprosthetics of the heart and blood vessels. Similar reconstructive operations are being implemented at the Kemerovo Cardiac Surgery Center and the Krasnoyarsk Regional Clinical Hospital.

The Moscow Center for Pediatric Maxillofacial Surgery performs all reconstructive operations known in foreign and domestic practice in the maxillofacial and craniofacial areas: reconstruction of the lower jaw using bone grafts, plastic surgery after facial burns, distraction and reconstructive osteosynthesis after injuries, reconstructive microsurgical operations for birth defects face and hands, etc.

Research Institute of Eye Diseases named after. Helmholtz, Center for Laser Eye Microsurgery of the Central Clinical Hospital, All-Russian Center for Eye and Plastic Surgery in Ufa, MNTK "Eye Microsurgery" conduct

optical reconstructive operations using intraocular correction and biological implants and artificial lenses, not only in the head center, but also in branches located in the constituent entities of the Russian Federation.

Unique reconstructive operations for congenital and acquired limb defects, plastic surgeries using microsurgical techniques are carried out in Central Research Institute traumatology and orthopedics named after. N. I. Pirogov, Russian scientific center Restorative Traumatology and Orthopedics named after. G.A. Ilizarov, Institute of Surgery named after. A.V. Vishnevsky, which are under the jurisdiction of the Ministry of Health of Russia, as well as in the St. Petersburg Scientific and Practical Center for Medical and Social Expertise, Prosthetics and Rehabilitation of the Disabled named after. G.N.Albrecht, Federal and Novokuznetsk scientific and practical centers for medical and social examination and rehabilitation of disabled people, administered by the Ministry of Labor of Russia.

Reconstructive surgery is a very promising area of medical rehabilitation, but it is still underdeveloped in Russia.

One of the most important types of medical rehabilitation is prosthetics. It is aimed at replenishing lost or congenitally absent organs and their functions using artificial analogues. Limb prosthetics have been performed in Russia for many years. Currently, issues of prosthetics of limbs, mammary glands, orthoses of the musculoskeletal system are under the jurisdiction of the Ministry of Labor of Russia, issues of eye and ear prosthetics are under the joint jurisdiction of the Ministry of Labor of Russia, the Ministry of Health of Russia, and authorities social protection and healthcare of the constituent entities of the Russian Federation.

According to 2000 data, in Russia the number of citizens in need of various types of prosthetic and orthopedic care amounted to more than 1 million people, of which 724.3 thousand were disabled.

In the process of prosthetics, several stages can be distinguished: production of a prosthetic product, selection and adaptation of the product to the individual characteristics of a disabled person, training in the use of a prosthesis.

The production of prosthetic limbs is currently carried out by 68 federal unitary enterprises, two factories produce orthopedic shoes, and three enterprises produce breast prostheses, corrective devices and semi-finished products for other orthopedic products. In addition, in a market economy, dozens of enterprises of various organizational, legal forms and forms of ownership have appeared that operate in the field of prosthetics, which creates a competitive environment and helps improve the quality of prosthetics.

The quality of manufacturing of prosthetic and orthopedic products largely determines their ability to replace lost functions and reduce life limitations, which, in turn, determines the quality of life of people with disabilities. Therefore, by decision of the USSR Government (1989), the Energia rocket and space complex, as part of its conversion activities, was entrusted with the creation of modern prosthetics for disabled people with damage to the musculoskeletal system.

Currently, the production of a large number of different modern modules, assemblies and parts for prostheses based on new materials has been launched. Particularly progressive has been the creation of a system of new prosthetic and orthopedic products based on a modular principle, when a specialist can assemble an individual prosthesis for a specific disabled person from individual modules. The modular principle of prosthetics has become widespread in recent years. RSC Energia operates an experimental center where new models of prosthetics are tested and prepared for serial production. Created on the basis of the sanatorium “Fortress” in Kislovodsk rehabilitation center, where prosthetics are carried out in combination with sanatorium treatment.

Over the past few years, the Russian Ministry of Labor has been carrying out a lot of work on the technical re-equipment of prosthetic enterprises. It is carried out within the framework of the federal target programs approved by resolutions of the Government of the Russian Federation “Development and production of prosthetics, construction, reconstruction and technical re-equipment of prosthetic and orthopedic enterprises” (1995) and “Social support for people with disabilities for 2000 - 2005” (2000). As a result of the implementation of the programs, a basic range of modules for lower limb prostheses has been mastered, almost completely corresponding to the nomenclature required for prosthetics for most medical indications. In terms of functional and performance characteristics, these prostheses are significantly superior to those manufactured previously and generally meet the needs of disabled people. Currently, almost all prosthetic and orthopedic enterprises have begun to provide prosthetics for disabled people with damage to the lower extremities, using modern modular semi-finished products. In 2002, the use of modern prosthetics for disabled people averaged 38-39%.

Due to insufficient funding for federal target programs, there is some lag in the development of modules and assemblies for prostheses upper limbs, orthotics and new models of orthopedic shoes.

Selection and adaptation of prosthetic and orthopedic products to the characteristics of the anatomical structure, functional

studies of the musculoskeletal system and lifestyle of a disabled person at prosthetic enterprises are carried out in special departments and offices. To provide prosthetics for disabled people living in remote areas, teams of prosthetic specialists travel to try on and adjust prostheses, as well as to train disabled people in how to use them. In 1994, mobile prosthetic workshops were produced based on PAZ-3205 buses. Prosthetics in complex and atypical situations are carried out in complex prosthetics hospitals, which are available at 45 prosthetic and orthopedic enterprises. Perhaps all types of primary limb prosthetics will have to be carried out in these hospitals. Working disabled people are issued a certificate of temporary incapacity for work during the period of prosthetics in a hospital and travel to the place of prosthetics and back.

The provision of prosthetic and orthopedic care to disabled people is carried out in accordance with the instructions “On the procedure for providing the population with prosthetic and orthopedic products, mobility aids and means that make the lives of disabled people easier” (1991). Prosthetic limbs for disabled people are provided free of charge, and provision of orthopedic shoes - depending on the disability group and complexity of the product - is free or at a discount.

The Decree of the Government of the Russian Federation “On the sale of prosthetic and orthopedic products” (1995) extended the validity of this instruction in relation to free prosthetics disabled people and children, and also approved standards for the sale of prosthetic and orthopedic products, in addition to those issued free of charge, with a 70% discount. For enterprises producing prosthetic and orthopedic products, a maximum profitability level of 35% of the cost has been established. The authorities of the constituent entities of the Russian Federation are recommended to introduce additional benefits in the field of prosthetics for disabled people.

In recent years, to improve the quality of prosthetics of the lower extremities, the one developed at the St. Petersburg Research Institute of Prosthetics named after. G.N. Albrecht hardware and software complex “DiaSled”, which records and processes information about the dynamics of pressure distribution between the foot and the supporting surface. He helps the orthopedic doctor develop adequate requirements for the design of the prosthesis, evaluate its effectiveness, adjust the prosthesis individually for each disabled person, and teach him how to walk correctly.

The Federal Scientific and Practical Center for Medical and Social Expertise and Rehabilitation also develops and introduces new types of prosthetic products and prosthetic technologies, provides organizational and methodological assistance in the field of prosthetics.

limbs to specialized institutions in the country. For subjects of the Russian Federation Siberian and Far Eastern federal districts This function is performed by the Novokuznetsk Scientific and Practical Center for Medical and Social Expertise and Rehabilitation of Disabled People.

Ear and eye prosthetics are mainly the responsibility of the health authorities of the constituent entities of the Russian Federation. Eye prostheses and hearing aids are manufactured by medical industry enterprises; prosthetics for disabled people are carried out in medical institutions. These types of prosthetics are financed from budgets of all levels and are provided for in the formation of these territorial programs, as well as in a special list of expensive types of medical care approved by the health authority of the constituent entity of the Russian Federation.

For hearing aids, pocket, behind-the-ear, in-ear, and intra-canal hearing aids are used. Hearing aids and earmolds are selected individually. Usually, people with disabilities are provided free of charge with the simplest domestically produced devices with standard ear plugs.

Modern hearing aid is an individual device; The digital device independently adjusts to play sounds depending on the situation. The latest achievement of science is cochlear implantation, which is electronic prosthetics of the cochlea.

Individual production of eye prostheses - from glass and plastic - is carried out by the Eye Prosthetics Center.

the federal law“On Social Insurance of Citizens of the Russian Federation” (1998) provides for prosthetics for disabled people due to industrial accidents at the expense of social insurance funds. Rehabilitation program for victims of an industrial accident and occupational disease, approved by decree of the Russian Ministry of Labor (2001), also provides for prosthetics.

Questions for self-control

1. What achievements can be noted in the development of reconstructive

surgery?

2. What is the social and rehabilitation significance of the prosthesis?
roving?

3. What rights and benefits do disabled people enjoy with prosthetics?
Vania?

Literature

1. Amputation, prosthetics, rehabilitation: present and future: Proceedings of the Moscow Scientific and Practical Conference. - M., 2001.

2. Epikhina T. P.Medical and social examination and rehabilitation pain
after reconstructive operations for atherosclerosis of lower vessels
of their limbs // Medical and social examination and rehabilitation. -
1998. - № 2.

3. Amendment S. I., Sergeev V. A. Methodological approaches to organization
rehabilitation of military personnel with amputation defects, of course
stay // Military-methodological journal. - 2000. - No. 1.

Multidisciplinary medical Center ViTerra in Belyaevo has been working for you since 2011. Heads the clinic Mostovoy Ilya Alexandrovich, urologist-andrologist, reflexologist, doctor ultrasound diagnostics, full member of the Professional Association of Andrologists of Russia, member of the European Association of Urology (EAU) and a number of other well-known medical societies.

The ViTerra Clinic in Belyaevo provides high-quality and affordable medical services to patients from Moscow, regions, near and far abroad. We cooperate with leading Russian and European educational institutions and are the clinical base of a number of departments medical institute RUDN University

Our employees include doctors of all specialties, professors, doctors and candidates of medical sciences, doctors of the highest qualification category, consultants from leading clinics in Moscow. Here you are treated by specialized and general practitioners working on the most modern equipment. In addition, all our employees are simply caring people who are ready to help each of their patients.

Most services at the ViTerra medical center in Belyaevo are performed using disposable instruments. At the same time, the processing regime for equipment and tools fully complies with European standards, which eliminates even the slightest possibility of transmitting any infection. We provide medical services absolutely safe for every patient concerned about their health.

We carry out highly accurate diagnostics and carry out any types of analyzes in the shortest possible time. ViTerra surgeons perform minimally invasive operations and manipulations on endoscopic equipment using safe anesthesia.

As supporters of an individual approach to each patient, we guarantee high-quality and extremely attentive treatment of any problem that worries you. This means that by contacting the ViTerra clinic in Belyaevo, you are guaranteed to receive qualified advice from our specialists, your problem will be thoroughly studied, an accurate diagnosis will be made and all information will be given. necessary recommendations or effective and efficient treatment is prescribed.

Comfort for you, our patients, is one of the foundations of the philosophy of the ViTerra clinic in Belyaevo. Our medical center has free colorful shoe covers, a neat dressing room, coolers with cool drinking water own production, free coffee, sweets and chocolate. Spacious corridors with comfortable sofas and light music will allow you to relax and relieve stress before your appointment or while waiting for test results. And if you are caught in the rain at the clinic, you can use free umbrellas. In the toilet rooms, any visitor will always find everything they need for personal hygiene: hand cream, refreshing wipes and even perfume!

Getting to the ViTerra clinic is not only fast, but also very convenient: by car, metro or even on foot. And even in those cases when you don’t want to go to the doctor at all! :-) You can easily see this for yourself.

At the ViTerra clinic in Belyaevo you will always receive a warm and hospitable welcome. For our beloved patients there are always pleasant gifts, surprises and promotions. We also launched our own line for the production of high-quality artesian water - now you can feel our careful care for you even outside the walls of the clinic, just by using the convenient home delivery service of clean and healthy drinking water produced under the brand ViTerra.

Come to our multidisciplinary medical center for excellent health, strength and energy. Our doors are always open for you!

Reconstructive operation (o. reconstructica) O., restoring the anatomical relationships, shape or function of an organ (body part).

Big medical dictionary . 2000 .

See what “reconstructive surgery” is in other dictionaries:

Reconstructive surgery on the outer and (or) middle ear, performed to improve sound transmission... Large medical dictionary

- (A. M. Landa, 1894 1964, Soviet traumatologist) reconstructive surgery for a complete rupture cruciate ligaments knee joint, which consists in restoring the functions of the joint by strengthening it with a tendon-aponeurotic flap from... ... Large medical dictionary

I Heart The heart (Latin cor, Greek cardia) is a hollow fibromuscular organ that, functioning as a pump, ensures the movement of blood in the circulatory system. Anatomy The heart is located in anterior mediastinum(Mediastinum) in the Pericardium between... ... Medical encyclopedia

Surgical (operatio; lat. “work”, “action”; syn. Surgical intervention) therapeutic or diagnostic event associated with injury to the patient’s tissues and organs. Obstetric operation (o. obstetrica) O. on a woman’s genitals… Medical encyclopedia

MAMMARY CANCER- honey The incidence of breast cancer has increased significantly over the past 10 years, affecting 1 in 9 women. The most common location is the upper outer quadrant. Genetic aspects Only in 20% of cases there is a corresponding... ... Directory of diseases

Illustration of the amputation process from a surgery textbook (1537) Amputation (lat. amputatio) truncation of the distal part ... Wikipedia

ACUTE ARTERY OCCLUSIONS- honey Acute arterial occlusions acute disorder blood circulation distal to the site of occlusion of the artery by an embolus or thrombus. The condition is considered urgent. Proximal and distal to the occlusion site, normal blood flow is disrupted, which leads to... ... Directory of diseases

I Surgery (chirurgia; Greek cheirurgia, from cheir + ergon work, action) area clinical medicine, studying diseases and injuries for the treatment of which surgical methods are used, developing these methods and regulating their conditions... ... Medical encyclopedia

Plastic surgery is a branch of surgery that deals with surgical interventions aimed at eliminating deformations and defects of any organ, tissue or surface. human body. The following are most often performed... ... Wikipedia

- (facial hemispasm, facial hemispasm) a disease manifested by painless involuntary unilateral tonic or clonic contractions of the facial muscles innervated by the ipsilateral facial nerve.… … Wikipedia