Distinguish the following types transplantation:

• autogenous (autotransplants);
• allogeneic (homogeneous);
• syngeneic (isogenic);
• xenogeneic (xenotransplants);
• explantation (implantation) is a type of plastic surgery in which synthetic materials foreign to the body are used.

Autogenous transplants This is a type of transplantation that is performed within one organism. These are the most successful transplants, since the transplanted fresh organs with an intact structure are characterized by a complete antigenic match with the recipient’s tissues, age and gender characteristics. Autologous tissues can be transplanted with complete separation of the graft from the maternal bed. For example, during coronary artery bypass surgery at coronary disease heart cut large saphenous vein sewn between the ascending aorta and the coronary artery of the heart or its branches, bypassing the site of occlusion. Autogenous veins are similarly used to replace large arterial defects or resected arteries damaged pathological process.

In free skin grafting, areas of skin are completely isolated and placed in a new location. Transplants, which include epithelium, “stick” to the bottom of the wound and use tissue fluid for nutrition. Thick skin grafts with layers of dermis partially restore nutrition due to the entry of tissue fluid into the vessels. Therefore, to use a free graft, it is necessary to take into account its tendency to primary shrinkage. Restoration of innervation of the transplanted skin occurs after 3-8 months. Tactile sensitivity appears first, then pain, and lastly temperature.

Based on thickness, full and split flaps are distinguished. Full has all layers of skin without subcutaneous fat. Its thickness makes it possible to transplant only on a wound that has good blood supply, in the complete absence of risk of infection. A full flap is cut out using a scalpel, treating the skin in such a way that no subcutaneous fat remains on it. The flap is transplanted onto the wound, sutured, then secured with a bandage. The site from which the graft was cut is sutured or closed by moving the mobilized skin.

The split skin flap consists of the epidermis and part of the dermis. Such flaps are cut using manual or electric dermatomes, which are used to cut a flap of the required thickness and width on the anterior or lateral surface of the thigh, in the gluteal region. To do this, the skin is covered thin layer Vaseline and straighten by stretching, apply dermatome to it. set to a certain depth and width, and, pressing slightly, move forward. After cutting out the flap, the area on the skin is covered with sterile gauze pads with an antiseptic, over which a compressive bandage is applied. Epithelization of the donor surface occurs due to the epithelium of the excretory ducts of the sweat glands and hair follicles over 2 weeks.

The graft is placed on the surface of the wound, straightened and sutured to the edges of the defect, after which it is covered with a gauze bandage soaked in ointment. Change the bandage after 8-10 days.

To close large granulating wounds, it is advisable to use mesh autodermal grafts. To do this, small through incisions are made in a checkerboard pattern using a special apparatus on a split skin flap cut with a dermatome. As a result of stretching the mesh graft, it is possible to increase its area by 3-5 times.

During mobilization of the stem flap, one side of it is not cut off, but is left as a pedicle through which the blood supply occurs. The site where the flap is taken is sutured or covered with a split graft, and the flap is placed on the surface of the defect and secured with sutures. Plastic grafting with a stem flap is advisable to use to cover skin defects on the extremities. The advantage of the method is that the largest defects can be closed in a short time - up to 5 weeks. The disadvantage is that to ensure reliable engraftment, the limbs must be brought together and fixed with a plaster cast.

For skin grafting, bridge-like skin grafts are used, which have a blood supply on both sides. Flaps with narrow pedicles are also used if the pedicle contains an artery of sufficient diameter.

A round stem flap is formed from a flap of skin with subcutaneous fat according to V.P. Filatov. This makes it possible to bring a significant amount of plastic material to the defect and carry out various simulations. The disadvantage of this method is the multi-stage nature and significant duration of plastic surgery (sometimes for several months). The stem flap is formed using two parallel incisions of the skin and subcutaneous fat down to the fascia. Then the flap is prepared, its edges, starting from the inside, and the edges of the defect under the flap are sutured. After the wounds have healed, they move on to training the stem. To do this, the vessels entering the flap are clamped on the side intended for transplantation. The pinching lasts for a few minutes at first, and then for about 2 hours. After 4 weeks, the stem can be transplanted to a new location.

In reconstructive surgery, autogenous bone grafting and plastic peripheral nerves And internal organs. An example of the latter is the widely used plastic surgery of the esophagus with a piece of the stomach, small or large intestine, preserving the mesentery and the vessels located in it (Ru, P. O. Herzen, S.S. Yudin, A.G. Savinykh, B.V. Petrovsky, M. I. Kolomiychenko, I.M. Matyashin).

Allogeneic (homogeneous) transplants This is a type of transplantation that is carried out within one biological species (from person to person, in an experiment, between animals of the same species). These include isogenic (donor and recipient are monozygotic, identical twins sharing the same genetic code) and syngeneic types of transplantation (donor and recipient are first-degree relatives, most often mother and child).

Material for isogenic transplantation is taken from living donors ( we're talking about about paired organs). Thus, D. Murray in 1954 was the first to successfully transplant a kidney from identical twins, since their tissues are absolutely identical and do not cause an immune conflict. However, with this type of transplantation one has to overcome the ethical barrier associated with organ removal from healthy person. These types of transplantation are the most effective, but the problem of a shortage of organs arises, since it is impossible to organize their banks.

For allogeneic transplantations, cadaveric organs are usually used. In this case, it is possible to organize banks of large organs and, finally, it is possible to use “recycled” tissue, that is, take specially prepared tissue from a removed organ that has been injured or affected by a pathological process. For example, you can use individual parts of bones after the entire limb.

At xenogeneic (heterogeneous) types of transplantation donor and recipient belong to different biological species. This is an interspecies transplant. Typically, for clinical purposes, transplants are taken from animals (zoogenic material).

As the French surgeon Jean-Paul Binet established, the closest immunological characteristics to humans are pigs, calves, and monkeys. However, with such transplants the rejection reaction is most pronounced.

Currently, xenogeneic tissues are widely used for plastic surgery of heart valves, blood vessels and bones. To reduce the rejection reaction, the animals from which the transplant is taken are injected with human tissue antigens. Such animals are called chimera donors. Thus, a pig's liver is temporarily connected to the human body, which suffers from liver failure(most often in case of poisoning with inedible mushrooms, dichloroethane).

In the experiment, right ventricular-pulmonary and apicoaortic bypass was developed. For stenosis of the pulmonary trunk or aorta, a shunt made of bovine (calf) pericardium or synthetic material with a sewn-in valve (such shunts are called conduits) is placed between the right ventricle and the pulmonary trunk or the left ventricle and the aorta, bypassing the stenosis.

Explantation This is a type of transplantation that involves replacing biological tissue with synthetic material. Thus, vascular prostheses woven or knitted from Dacron, Teflon, and fluoro-lonlavsan are widely used. Valves made of Teflon (Golikov prosthesis) or biological tissue (standard valve-containing prostheses, for example, a Dacron vascular prosthesis with a porcine valve) are often sewn into them. Ball heart valves are also widely used and are installed in the mitral and aortic positions. Created artificial joints(hip, knee), heart.

There may still be transplants orthotopic And heterotopic. Orthotopic transplants are carried out in the same place where the affected organ was (it is usually removed) (orthotopic heart, liver transplant). A heterotopic type of transplantation is the transplantation of an organ into another, unusual topographic anatomy place, by connecting the vessels of the organ with the vessels of the recipient located nearby. An example of a heterotopic transplant is a kidney transplant into iliac region, pancreas - in abdominal cavity. Heterotopic liver transplantation is possible in left hypochondrium after removal of the spleen.

The article was prepared and edited by: surgeon

The problem of organ shortage for transplantation is urgent for all humanity as a whole. About 18 people die every day due to the lack of organ and soft tissue donors without waiting their turn. Organ transplantation in modern world for the most part, it is produced from deceased people who, during their lifetime, signed the appropriate documents indicating their consent to donation after death.

What is transplantation

Organ transplantation involves removing organs or soft tissue from a donor and transferring them to a recipient. The main direction of transplantology is organ transplantation - that is, those organs without which existence is impossible. These organs include the heart, kidneys, and lungs. While other organs, such as the pancreas, can be replaced replacement therapy. To date high hopes Organ transplantation helps prolong a person's life. Transplantation is already being successfully practiced. These are the kidneys, liver, thyroid gland, cornea, spleen, lungs, blood vessels, skin, cartilage and bones to create a framework so that new tissues can form in the future. For the first time, a kidney transplant operation to eliminate acute renal failure The patient was performed in 1954, the donor was an identical twin. Organ transplantation in Russia was first performed by Academician B. V. Petrovsky in 1965.

What types of transplantation are there?

There are a huge number of terminally ill people all over the world who need internal organ and soft tissue transplants because traditional ways Treatments for the liver, kidneys, lungs, and heart provide only temporary relief, but do not fundamentally change the patient’s condition. There are four types of organ transplantation. The first of them - allotransplantation - occurs when the donor and recipient belong to the same species, and the second type includes xenotransplantation - both subjects belong to different types. In the case when tissue or organ transplantation is performed in or animals raised as a result of consanguineous crossing, the operation is called isotransplantation. In the first two cases, the recipient may experience tissue rejection, which is caused by the body's immune defense against foreign cells. And in related individuals, tissues usually take root better. The fourth type includes autotransplantation - transplantation of tissues and organs within one organism.

Indications

As practice shows, the success of the operations is largely due to timely diagnosis and precise definition the presence of contraindications, as well as how timely the organ transplant was performed. Transplantation must be predicted taking into account the patient's condition both before and after surgery. The main indication for surgery is the presence of incurable defects, diseases and pathologies that cannot be treated with therapeutic and surgical methods, and also threaten the patient’s life. When performing transplantation in children the most important aspect is to determine the optimal moment for the operation. As experts from such an institution as the Institute of Transplantology testify, the operation should not be postponed unreasonably. long term, because developmental delay young body may become irreversible. Transplantation is indicated in case of a positive life prognosis after surgery, depending on the form of the pathology.

Organ and tissue transplantation

In transplantology, autotransplantation is most widespread, as it eliminates tissue incompatibility and rejection. Most often, operations are performed on fatty and muscle tissue, cartilage, bone fragments, nerves, and pericardium. Vein and vascular transplantation is widespread. This became possible thanks to the development of modern microsurgery and equipment for these purposes. A great achievement in transplantology is the transplantation of fingers from the foot to the hand. Autotransplantation also includes transfusion of one's own blood in case of large blood losses during surgical interventions. During allotransplantation, bone marrow and blood vessels are most often transplanted. This group includes blood transfusions from relatives. It is much rare to carry out operations on this because so far this operation faces great difficulties, however, in animals, transplantation of individual segments is successfully practiced. A pancreas transplant can stop the development of such a serious disease as diabetes. IN recent years 7-8 out of 10 operations performed are successful. In this case, not the entire organ is transplanted, but only part of it - islet cells that produce insulin.

Law on organ transplantation in the Russian Federation

On the territory of our country, the transplantology industry is regulated by the Law of the Russian Federation of December 22, 1992 “On Transplantation of Human Organs and (or) Tissues.” In Russia, kidney transplantation is most often performed, and less often heart and liver transplantation. The law on organ transplantation considers this aspect as a way to preserve the life and health of a citizen. At the same time, the legislation considers the preservation of the life of the donor to be a priority in relation to the health of the recipient. According to the Federal Law on organ transplantation, objects can be the heart, lung, kidney, liver and other internal organs and tissues. Organ removal can be carried out both from a living person and from a deceased person. Organ transplantation is carried out only with the written consent of the recipient. Donors can only be legally capable persons who have passed medical examination. Organ transplantation in Russia is carried out free of charge, since the sale of organs is prohibited by law.

Donors for transplantation

According to the Institute of Transplantology, every person can become a donor for organ transplantation. For persons under eighteen years of age, parental consent is required for the operation. When you sign a consent to donate organs after death, a diagnosis and medical examination is carried out to determine which organs can be transplanted. Carriers of HIV, diabetes mellitus, cancer, kidney disease, heart disease and other serious pathologies are excluded from the list of donors for organ and tissue transplantation. Related transplantation is carried out, as a rule, for paired organs - kidneys, lungs, as well as unpaired organs - liver, intestines, pancreas.

Contraindications for transplantation

Organ transplantation has a number of contraindications due to the presence of diseases that can be aggravated as a result of the operation and pose a threat to the patient’s life, including leading to fatal outcome. All contraindications are divided into two groups: absolute and relative. The absolute ones include:

• infectious diseases in other organs on a par with those that are planned to be replaced, including the presence of tuberculosis and AIDS;
• disruption of the functioning of vital organs, damage to the central nervous system;
• cancerous tumors;
• the presence of developmental defects and birth defects, incompatible with life.

However, during the period of preparation for surgery, thanks to treatment and elimination of symptoms, many absolute contraindications become relative.

Kidney transplant

Kidney transplantation is of particular importance in medicine. Since this paired organ, when it is removed, the donor does not experience any disturbances in the functioning of the body that threaten his life. Due to the peculiarities of the blood supply, the transplanted kidney takes root well in the recipients. The first experiments on kidney transplantation were carried out in animals in 1902 by researcher E. Ullman. During transplantation, the recipient, even in the absence of supportive procedures to prevent rejection of the foreign organ, lived for just over six months. Initially, the kidney was transplanted onto the thigh, but later, with the development of surgery, operations began to transplant it into the pelvic area, a technique that is still practiced today. The first kidney transplant was performed in 1954 between identical twins. Then in 1959, an experiment was carried out on kidney transplantation of fraternal twins, which used a technique to counteract graft rejection, and it proved its effectiveness in practice. New agents have been identified that can block the body's natural mechanisms, including the discovery of azathioprine, which suppresses immune protection body. Since then, immunosuppressants have been widely used in transplantology.

Organ preservation

Any vital organ that is intended for transplantation is subject to irreversible changes without blood supply and oxygen, after which it is considered unsuitable for transplantation. For all organs, this period is calculated differently - for the heart, time is measured in a matter of minutes, for the kidney - several hours. Therefore, the main task of transplantology is to preserve organs and maintain their functionality until transplantation into another organism. To solve this problem, canning is used, which consists of supplying the organ with oxygen and cooling. The kidney can be preserved in this way for several days. Preservation of an organ allows you to increase the time for its examination and selection of recipients.

Each of the organs, after receiving it, must be preserved; for this, it is placed in a container with sterile ice, after which preservation is carried out special solution at a temperature of plus 40 degrees Celsius. Most often, a solution called Custodiol is used for these purposes. Perfusion is considered complete if a clean preservative solution without blood admixtures emerges from the mouths of the graft veins. After this, the organ is placed in a preservative solution, where it is left until the operation.

Graft rejection

When a transplant is transplanted into the recipient's body, it becomes the object of the body's immunological response. As a result defensive reaction the recipient's immune system undergoes a number of processes cellular level which lead to rejection of the transplanted organ. These processes are explained by the production of donor-specific antibodies, as well as antigens of the recipient's immune system. There are two types of rejection - humoral and hyperacute. At acute forms Both mechanisms of rejection develop.

Rehabilitation and immunosuppressive treatment

To prevent this side effect, immunosuppressive treatment is prescribed depending on the type of surgery performed, blood type, donor-recipient compatibility, and the patient's condition. The least rejection is observed with related transplantation of organs and tissues, since in this case, as a rule, 3-4 antigens out of 6 coincide. Therefore, a lower dose of immunosuppressive drugs is required. The best survival rate is demonstrated by liver transplantation. Practice shows that the organ demonstrates more than ten years of survival after surgery in 70% of patients. With prolonged interaction between the recipient and the graft, microchimerism occurs, which allows the dose of immunosuppressants to be gradually reduced over time until they are completely abandoned.

Transplantation is the transfer of tissue or an entire organ from one organism to another in order to cure a serious disease. Transplantation and replacement of tissues within one organism is possible.

Such an important medical field as transplantation of human organs and tissues has begun to actively develop thanks to the study and understanding of the ongoing immunological processes in the body and their mechanisms. It is carried out in cases where it is impossible to save the life of a sick or injured person in any other way.

The possibility of organ transplantation has been influenced by the active development vascular surgery, as well as the discovery of histocompatibility antigen. Transplantation of organs and tissues became possible thanks to immunosuppressive therapy, namely, the process of inhibiting the body's production of antibodies and immune cells.

Types of transplantation

Currently modern medicine practices several types of this technique, namely:

Autotransplantation. In which tissue transplantation is performed within one individual.
- Homotransplantation. Transplantation is carried out from one organism to another, but within individuals of the same species.
- Heterotransplantation. An organ or tissue is transplanted from a donor to a recipient when they belong to different species but the same genus.
- Xenotransplantation. A transplant operation where the donor and recipient are from different genera, families, and sometimes orders.

Transplanted tissues, organs

In clinical transplantology, autotransplantation is more often practiced. This is a type of transplantation in which there is no tissue incompatibility. The most common transplants are skin, fat tissue, connective tissue muscles (fascia). Transplantation of cartilage, pericardium, as well as bone fragments and nerves is also often performed.

Speaking from reconstructive surgery, vein transplantation is often practiced here. For example, when transplanting the great saphenous vein of the thigh, resected arteries are used, namely the internal iliac and deep femoral artery.

With the development of microsurgical practice, with the advent of the possibility of using modern medical devices and technology, the importance of autotransplantation has become even greater. Transplantations are actively carried out on the vascular, and often nerve, connections of the skin. Skin and musculocutaneous flaps are transplanted. Musculoskeletal fragments and individual muscles are transplanted.

Modern clinical transplantology actively practices toe to hand transplants. Surgeons perform transplants greater omentum to the lower leg area, intestinal segments are transferred when performing esophageal plastic surgery.

If we talk about organ autotransplantation, the most common operation is kidney transplantation. Indications include extensive ureteral stenosis, as well as extracorporeal reconstruction of the renal hilum vessels.

Tissue allotransplantation operations are increasingly being carried out: cornea transplantation, bone marrow and bones.

Transplantation of b-cells located in the pancreas is performed less frequently. This operation may be indicated when diabetes mellitus. Also, hepatocyte transplantation is not very often performed when treating acute liver failure.

Transplant problems

This very important, necessary medical direction, saving the lives of almost hopeless patients, has a number of important issues. These include:

Immunological donor selection. The wrong choice can cause future rejection by the body, immune system organ transplant recipient. To prevent this, the patient must take immunosuppressive drugs for the rest of his life. However, these drugs always have contraindications, side effects which sometimes lead to the death of the patient.

Ethical and legal problems. There is much debate about the ethics of transplanting any vital organ. The issue of removing any organs from living people or corpses is very hotly discussed.

Transplantation still poses a great risk to life. Therefore, many species are still very important, necessary operations belong to the category of medical experiments and cannot enter into clinical practice.

Risk groups, contraindications

The main contraindication to organ transplantation is the serious genetic differences between the donor and the recipient. There are contraindications for kidney transplantation. For example, it cannot be performed on patients with acute infectious or inflammatory diseases. It should not be done during exacerbation of chronic diseases.

The risk group includes patients with oncological diseases, which have malignant neoplasms with a short period of time elapsed after the procedure radical treatment. For the vast majority of malignant tumors, after treatment, at least two years must pass before transplant surgery.

Those patients who have undergone transplant surgery must strictly adhere to a certain regimen and follow medical instructions throughout their lives.

Organ transplantation embodies the age-old desire of people to learn to “repair” human body. And if skin transplants, kidney transplants and even heart transplants are becoming commonplace, liver transplant operations are still considered one of the most difficult. Unfortunately, other than cartilage, which is not often needed, no other tissue or organ that we would like to transplant has this advantage. To prevent the destruction and rejection of transplanted kidneys, hearts, lungs, livers, etc., it is necessary to intervene normal work immune system.

Many Russian scientists worked on the problem of organ transplantation and tissue transplantation, achieving great results and becoming famous throughout the world for their achievements in the field of tissue and organ transplantation. This is N.I. Pirogov (the first to use ether anesthesia), N. Strauch, N. Feigin (established the possibility of corneal transplantation), V. Antonevich (tooth transplantation work), K.M. Sapezhko (work on mucous membrane transplantation), Yu. Voronoi (the world's first kidney transplantation), V. Shumakov (heart transplantation operations), G. Falkovsky A. Pokrovsky (research on methods of organ preservation), S. Voronov (transplantation of animal testes to humans ), S. Bryukhonenko (creation of the world's first apparatus cardiopulmonary bypass), V. Demikhov (brain transplant operations) and so on.

Currently, Ernst Muldashev (the world's first eye transplant operation), Leo Bockeria, K. Shatalov (development of an artificial heart model) and many others are working in this direction.

In our country, only one clinic, the Russian Scientific Center of Surgery of the Russian Academy of Medical Sciences, actually deals with the problem of organ transplantation. It is located in Moscow, at the address Abrikosovsky lane, building 2. The director of this scientific center Konstantinov Boris Alekseevich, full member of the Russian Academy of Medical Sciences. There, in the clinic of reconstructive surgery, there is an organ transplantation department, headed by S.V. Gautier. The department includes: a hemodialysis laboratory, a liver transplantation department and a kidney transplantation department, the heads of which are, respectively, V.A. Maksimenko, S.V. Gauthier, as well as M.M. Kaabak.

The purpose of my essay is to study the features of tissue transplantation and organ transplantation in humans.

reveal the difficulties surgeons face during surgery;

tell how doctors fight the recipient’s immune system after surgery;

tell how donors are selected;

find out what tissue typing is and how it is carried out;

describe in detail the transplantation of each organ (heart, liver, kidneys, etc.);

talk about the first steps in this direction.

The choice of this particular topic is justified by the relevance of the problem at the present time and my interest in it.

Organs and tissues can be transplanted, or "transplanted," from one person to another, or from one place to another within one person. Figure 1 shows the internal organs of a person.

Fig.1. Human internal organs.

Table 1 lists the transplanted tissues and transplanted organs.

Table No. 1

The first successful and repeatable tissue exchange between two people was a cornea transplant. What's most interesting is that many successful corneal transplants were done before the principles of immunology were understood. The reason is simple: to remain transparent, the cornea does not have blood vessels, so although the transplanted corneal disc is a foreign tissue that must be rejected by the body, the cells and antibodies that cause rejection cannot reach the donor tissue, as they travel only through the circulatory system.

Back in the 19th century, surgeons learned to transplant individual tissues, the reason for which was the improvement of the surgical technique necessary for this. After research by N.I. Pirogov and Yu.K. Shimakovsky, the development of transplantology in Russia was associated with the works of N. Strauch (1840), N. Feigin (1867), who established the possibility of corneal transplantation, V. Antonevich - on tooth transplantation (1865), K.M. Sapezhko - on mucosal transplantation (1892) and many others. In 1858, the French scientist L. Ollier developed a method of bone transplantation, and in 1869, the Parisian surgeon J. Reverdin conducted research on skin transplantation.

Significant progress in skin grafting techniques was achieved after the experiments of Emil Holman, which he began in 1923-24, while still a young novice surgeon. Some allografts (allograft - transplantation between two individuals of the same species) - organs or tissues - can be divided into small parts or pieces and freely transplanted into a new body, in an area rich in blood vessels. Already in a new place, these cells find sources of supply, that is, new routes for blood flow. Using this method, pieces of the pituitary gland, adrenal gland, parathyroid and thyroid glands are transplanted.

Today it is hard to believe that for many years the connection of blood vessels was considered an incomprehensible surgical mystery. Finally, at the turn of the 20th and 19th centuries, doctors learned to do this very simply, with the help of a needle and thread. This possibility was opened up by the work of the French (who worked in America for many years) surgeon and researcher Alexis Carrel, who was the first to develop the technique of suturing blood vessels. This method has a number of advantages, for example, it is equally suitable for both arteries and veins, for vessels of large and small diameter, it is not complicated in execution, but requires maximum accuracy and thoroughness when working, in addition, when using it there is no the integrity of the vascular endothelium (cells) is impaired inner surface blood vessel), and the main connection is completely impenetrable and does not cause vasoconstriction.

None of the methods used has all these advantages. This superiority is due to the use of extremely fine needles and special welcome, allowing the vessel to expand at the time of its suturing, which prevents its narrowing later.

Around 1950, the Soviet Union developed a device that fastens the walls of blood vessels with tiny metal staples. Sewing vessels with its help had well-known advantages over the Carrel method, but had the disadvantage that a rather cumbersome mechanism had to be inserted into a small incision.

Thus, modern surgical technology uses both manual stitching and the use of devices, the prototype of which was the device of 1950.

TO epithelial tissues include: skin, glands, internal organs, nails, hair, etc. We will take a detailed look at how skin grafting is performed.

Donor skin may be useful as temporary cover for large areas of burned or damaged skin, but is not a long-term replacement. Therefore, the patient's skin is transplanted from a healthy part of the body to the damaged part. If the bare area is not covered, it will overgrow over time, but this will be accompanied by the formation of ugly and functionally unsatisfactory scar tissue. Wide areas of scar tissue tend to stretch and shrink; it can cause disability, especially if it is near a joint. General indications Skin grafts can be used for: extensive burns, wide ulcers and skin cancer transfer operations, when safety considerations require removal of the affected area of ​​skin around the swelling.

Skin grafting is divided into two types, partial and full-thickness; when the area of ​​the affected area is small, such a graft requires suturing.

Coverage of a wide area is usually provided by what is called a split flap, cut from a suitable part of the body, such as the front or side of the thigh, using a very sharp knife with a long blade called a dermatome.

“Cutting out split flaps of skin is akin to an art. With the help of an assistant who pulls the donor skin taut with two flat wooden boards, the surgeon presses a well-lubricated knife with the flat side into the skin and cuts off a thin, almost transparent sheet with a sawing motion, being careful not to make a hole in it.” The thickness of the layer should not exceed one millimeter. Some surgeons prefer to use an electric dermatome with a rotating blade, which works in the same way.

The donor area is covered with a sterile, non-stick bandage for a couple of days to protect against infection. At first a lot of serum is released, but soon the flow stops and the area can be freed from the bandage to dry and heal.

Sometimes the need for skin is so great and the healthy area is so limited that the same donor area has to be used over and over again.

Thyroid tumors

Benign tumors(follicular adenomas)

Clinical picture and diagnostics. On physical examination, the node has a round shape, clear contours, flat, smooth surface, elastic or densely elastic consistency, shifts when swallowing.

On ultrasound, the shape of the node in most cases is round, the rim around the adenoma indicates a well-defined capsule; the internal structure is homogeneous (fine-grained), hyper- or isoechoic is characteristic, and a cavity (cystadenoma) may occur in the node. When differentiating a cyst from a cystadenoma, it is necessary to perform a fine-needle aspiration biopsy under ultrasound guidance (after aspiration of the fluid, in the presence of a cystadenoma, a nodular formation will remain). Radionuclide scanning usually reveals a “cold” node. Levels of T3, T4 and TSH are normal. In diagnostics important have the results of ultrasound with fine-needle polypositional aspiration biopsy.

Treatment surgical. Due to the difficulty of differential diagnosis with follicular adenocarcinoma in urgent histological examination Many authors consider hemithyroidectomy to be justified.

Malignant tumors. See oncology

Concept of various types transplantation. Basic scientific discoveries, underlying the development of organ and tissue transplantation. Ethical, legal, religious, immunological aspects of transplantation. Donation problem. The state of the problem of organ transplantation. Prospects and directions for the development of transplantology.

Autogenous transplantation- donor and recipient are the same person;

Isogenic transplantation - donor and recipient are identical twins;

Syngeneic transplantation - donor and recipient are first degree relatives;

Allogeneic transplantation - the donor and recipient are of the same species (for example, human-to-human transplant);

Xenogeneic transplantation - the donor and recipient are from different species (eg, monkey-to-human transplant).

To denote the transplantation of an organ to its usual place, the term orthotopic transplantation. When an organ is transplanted to any other anatomical site, they speak of heterotopic transplantation.

If a severed organ or severed body part is re-implanted into the host's body, then such an operation is called replantation.

Alloplastic transplantation- replacement of an organ or tissue with synthetic materials.

In January 1902, E. Ullmann (Austria) presented to the council of the Royal Society of Surgeons a goat with a dog kidney transplanted onto its neck. The operation was successful, but three weeks later the organ was rejected for reasons unknown at that time.

A. Carrel in 1910-1912 in New York during the independent scientific research by application vascular sutures performed a series of brilliant kidney transplant operations on animals and proved the possibility of suturing blood vessels and completely restoring blood circulation in the sutured organ; he was awarded the Nobel Prize.

The first successful kidney transplant in clinical terms from a twin to his brother was performed by D. Murray (USA) in 1954. The recipient lived after the operation for twenty years, maintaining social activity.

Immunosuppression initially consisted of radiation and large doses 6-mercaptopurine and cortisone. In 1963, azathioprine, less toxic than 6-mercaptopurine, was introduced at the first transplantology congress. Over the next 10 years, patients were prescribed a combination of azathioprine and prednisolone.

In 1972, J. F. Borrell in Basel (Switzerland) discovered the selective immunosuppressant cyclosporine A, which made it possible to carry out effective and relatively safe prevention of transplant rejection.

The first attempt at clinical liver transplantation was made on March 1, 1963 by a group of American surgeons led by Thomas Starles. A three-year-old child with biliary atresia received a liver from a five-year-old child with a brain tumor; The operation was technically successful, but the child died 5 hours later as a result of coagulopathy.

At the Congress of American Surgeons in 1968, three children with engrafted functioning livers were presented. Thomas Starles, who is rightfully considered the founder of world transplantation, performed 170 liver transplants until 1980. Since the early eighties, liver transplantation has become a routine procedure for many diseases.

In Europe, the first successful liver transplant was performed at the University of Cambridge in 1967. For 35 years, new technologies have been continuously developed, such as transplantation of reduced livers in children, transplantation of the left lobe of the liver from a living related donor, a technique for maintaining blood flow in the lower lobe of the liver during the non-hepatic period, the use of vascular conduits in pathologies of liver vessels. The possibility of xenotransplantation from chimpanzees and baboons was studied.

Removing part of the liver for transplantation into patients is safe for the donor. American scientists have found that within two weeks after this procedure regeneration and full recovery liver functions.

November 5, 1968 in Leningrad at the base Military Medical Academy A. A. Vishnevsky, with the participation of the institute’s staff, performed the first human heart transplant operation in the USSR. In March 1987, at the height of perestroika, a message appeared about the first successful heart transplant operation in the USSR, performed by surgeon Valery Shumakov.

LIST of human organs and (or) tissues subject to transplantation (Resolution of the Ministry of Health of the Republic of Belarus dated May 31, 2007 No. 53)

2. Liver and its parts.

3. Heart.

4. Heart-lung complex.

5. Bone marrow.

6. The pancreas alone or in combination with other organs.

7. Bone fragments with a cortical layer.

8. Sclera.

9. Lens capsule.

10. Conjunctiva.

11. Cartilage tissue.

12. Intestinal fragments.

13. Multivisceral complexes (liver–kidney, liver–kidney–adrenal glands–pancreas–regions gastrointestinal tract, kidney-pancreas).

15. Allogenic tissues (pancreas, thyroid gland, parathyroid, pituitary gland and other endocrine tissues).

16. Hematopoietic stem cells.

Living donor must be an adult, fully conscious, capable of making a decision voluntarily, without outside pressure. The donor must be physically and mentally completely healthy, capable of undergoing surgery to remove the organ without significant risk to health. In a number of countries, kidney transplants or 2-3 liver segments from living donors are performed quite often (40-60% of total number transplantations of these organs).

If immunosuppressive therapy continues to improve and the survival rate of transplanted organs increases, only the shortage of cadaveric organs may justify the use of organs from living donors. In our country, taking an organ from a living donor who is not a close relative is prohibited for ethical and legal reasons.

Dead donor. There are donors who died from cardiac arrest (biological death), and donors with brain death but with a beating heart.

In donors with biological death It is necessary to carry out cold preservation of organs as soon as possible after cardiac arrest in order to reduce the time of warm ischemia, which causes dystrophic changes in organs and sharply reduces the possibility of restoring normal function after organ transplantation.

Brain death established by a commission consisting of an anesthesiologist, surgeon (neurosurgeon), neurologist, psychiatrist and attending physician, according to established neurological criteria, after a double examination in a hospital with an interval of 6 to 12 hours. Loss of brain function is determined:

1) by lack of response to external painful stimuli, the presence of deep coma, muscle atony;

2) by the absence of spontaneous breathing and cough reflex (including when the position of the endotracheal tube changes or the absence of irritation of the mucous membrane of the trachea and bronchi during sputum suction), spontaneous breathing movements within 3 minutes after turning off the device artificial respiration;

3) by the absence of eye movements, corneal reflexes, reaction of the pupils to light, the presence of wide pupils, isoelectric EEG (lack of brain activity);

4) by a steady decrease in body temperature. Gradually developing hypothermia with a body temperature below 32 °C can be considered a reliable criterion for brain death;

5) by decrease blood pressure, despite the ongoing resuscitation measures (transfusion of solutions and administration medicines for many hours).

9. Complications and difficulties in biliary tract surgery. The concept of PCES, classification, tactics. Basic principles of biliary tract surgery. Errors and dangers in surgery of the biliary system, their causes, prevention and methods for correcting complications.