PIROGOV’S "ICE ANATOMY" IN SURGICAL ANATOMY INJURIES RESEARCH OF MINE AND BLAST OF LIMBS

Аннотация

Полный текст

Of the many methods that N. I. Pirogov perfected in creating the atlas «Topographic anatomy of cuts of a frozen human body» (1853-1859), namely: sawing in 3 mutually perpendicular planes, layerwise cleavage of frozen tissue or selectively thawing them in the necessary areas, the formation of windows with the abandonment of the most important anatomical landmarks, etc., undoubtedly, the most informative was the way of layer cuts. The technology of sawing developed by the great surgeon and anatomist with the subsequent accurate transfer of two-dimensional information from preparations to paper and then to lithographic stones became the prototype of modern methods of radiation visualization of anatomical structures by CT and MRI methods with software digital reconstruction of images in 2-4 D measurements. Pirogov’s technology was brilliantly used by A. N. Maksimenkov during the Great Patriotic War to study the surgical anatomy of wound canals in gunshot wounds of extremities. This technology was further developed in the works of E. A. Dyskin, L. N. Aleksandrova, L. B. Ozeretskovsky when studying the problems of terminal wound ballistics of bullet and fragmentation wounds. Over the past 30 years, we have successfully used the method of sawing a frozen body in the study of amputated limb segments in the wounded that have been blown up on anti-personnel mines, and also after modeling of mine-blast injuries on anatomical objects and experimental animals. Due to the complex research performed, it was found out that the case architectonics of the limb segments for the distribution of reversible and irreversible disorders in tissues plays no less important role than the distance from the center of the explosion. The most severe and extended injuries are concentrated in the deep muscles along the bones, fascial septa and the interosseous membrane, as well as loose paravasal and paraneural tissues. The data obtained make it possible to develop a program for a full-fledged audit of injured tissues in the affected, to justify the tasks of surgical treatment of wounds, and, if necessary, the level and method of limb amputation.