Purpose: To introduce a wide range of specialists with the technique of reconstructive plastic surgery, which was first used in local radiation injury (LRI). Material and methods: clinical analysis of the case histories of the severe LRI of the hand. The report describes the results of the first autotransplantation of the II toe in the position of the right hand III finger for the restoration of grip function in LRI. Results: Patient L., 38 years old, was admitted to the A.I. Burnazyan Federal Medical Biophysical Center in 2010 for the treatment of late consequences of severe LRI of the right hand resulting from contact with a gamma radiation source (Ir 192) in 2008. In the period from 2010 to 2018, the patient underwent repeated surgical operations, including reconstructive plastic surgery, which made it possible to achieve healing of constantly recurring late radiation ulcers. However, multiple necrectomies, exarticulations, finger amputations and resections of the phalanges led to the formation of a functionally defective hand and persistent disability of the patient. In 2018, the patient was admitted to the clinic for reconstructive surgery to restore the function of hand grip - microsurgical transplantation of the II toe into the position of the III finger of the hand. As a result of the treatment, the function of grabbing objects with the right hand was restored, and the patient’s ability to work was largely restored. Conclusions: The obtained long-term functional and aesthetic results allow us to consider the applied method of fingerless hand reconstruction by autotransplantation of the toe with the imposition of microvascular anastomoses optimal. It is advisable to use this type of surgical treatment more widely for the rehabilitation of patients with severe and extremely severe hand LRI.

Introduction . Primary Cutaneous Diffuse Large B-Cell Lymphoma, Leg Type it is a rare variant of skin lymphoma that has an aggressive course and a high risk of extracutaneous manifestations. The purpose of this work is to familiarize a wide range of specialists with the clinical manifestations of a rare disease — primary cutaneous diffuse large B-cell lymphoma. Materials and methods . An interesting clinical case is presented and the medical history of a patient with B-cell lymphoma from the skin is analyzed. Results . A differential diagnosis of the disease was made. Based on the study of histological material, the final clinical diagnosis was established and further treatment tactics were determined. Discussion . The patient had spots and plaques on the lower extremities, the sole visible signs of the disease. These symptoms may suggest a positive prognosis and a gradual progression. Diagnostic measures should include gathering medical history, assessing the local condition, and carrying out an excision biopsy early in the examination process for an accurate and prompt diagnosis Conclusion . Due to the rarity of this subtype of lymphoma and the limited number of domestic publications on the topic, a more detailed study and description of individual clinical cases can lead to a better understanding of the characteristics of the symptoms and the processes of pathological changes in cells, tissues, and organs. This could potentially lead to the development of more efficient methods for early diagnosis and timely treatment of the condition.

Purpose: To study the effect of the phenomenon of mutual aggravation on the early diagnosis of the severity of acute radiation bone marrow syndrome (ARBMS), which develops within the framework of combined radiation-mechanical injury (CRMI). Material and methods: According to the general blood test data, the dynamics of the relative and absolute number of lymphocytes in 36 patients was studied during the first 10 days after receiving polytrauma. There are 35 men and one woman among them. The average age of the victims at the time of injury was 40.24 ± 4.07 years. The number of studied blood tests in one patient varied from one to 16 during the specified follow–up period (on average, 6). The dynamics of the absolute number of lymphocytes at the same time was also studied in 11 patients (men, average age – 30.00 ± 2.01 years) diagnosed with acute radiation syndrome (ARS) I and in 15 men diagnosed with ARS II (average age – 28.47 ± 2.03 years). Statistical processing of the material was performed using the IBM SPSS Statistics software package.23 using the Kraskal–Wallis criteria and the Mann–Whitney U-test for independent samples. The differences between the obtained results were considered statistically significant at p < 0.05. Results: Relative lymphopenia was detected in 25 (69.4 %) patients diagnosed with polytrauma. A combination of absolute and relative lymphopenia was found in 15 (41.7 %) patients. Only transient relative lymphopenia was detected in 10 patients. The depth of absolute lymphopenia detected in polytrauma was compared with a similar indicator at the same time in ARS I and ARS II. The depth of absolute lymphopenia in trauma without exposure to ionizing radiation at the time when it is usually studied to determine the severity of ARBMS reached the indicators characteristic of ARS I and ARS II (up to 0.3–0.5 × 109/L.). At the same time, the nature of the dynamics of the absolute number of lymphocytes in trauma is radically different from that in acute radiation exposure. Conclusion: The data obtained allow us to consider the possible deepening of absolute lymphopenia in CRMI in 42 % of cases as one of the manifestations of the phenomenon of mutual aggravation, which can lead to an early aggravation of the predicted severity of the developing ARBMS. The data obtained indicate that this weighting may be + 1, in rare cases +2 degrees of severity of ARS to the true degree of severity corresponding to the absorbed dose of radiation exposure.

Силиконовая лимфаденопатия — это развитие гранулематозного воспаления в лимфоузлах, ассоциированного с наличием имплантированных в организм силиконовых эндопротезов, — редкая патология. Механизм развития этой патологии до конца не изучен, считается, что силиконовые частицы попадают в лимфоузлы по средствам транспортировки макрофагами с последующим развитием гранулематозного воспаления. В статье описан клинический случай развития двусторонней силиконовой лимфаденопатии в подмышечных, подключичных, надключичных, парастернальных лимфоузлах, ассоциированной с разрывом силиконовых имплантатов молочных желез. Силиконовая лимфаденопатия должна быть включена в дифференциальный диагноз при обнаружении увеличенных лимфатических узлов у пациентов, ранее перенесших пластические или онкопластические операции с использованием силиконовых эндопротезов.

Introduction. Sarcomas refer to a group of heterogeneous non-epithelial malignant tumors originating from connective tissue. These tumors are characterized by extremely aggressive local growth, relatively low incidence of lymphogenic metastases, predominant and early hematogenic generalization. These tumors most oft en metastasize to the lungs.Materials and methods. The paper describes a case of successful surgical treatment for a giant retroperitoneal fibrosarcoma metastasis to the lung.Results. Successful treatment for sarcoma depends primarily on a global understanding by oncologists of the complex pathogenesis, histological forms and principles of comprehensive treatment for this complex, polymorphic group of malignant pathologies. The earlier the primary site is diagnosed, the sooner and more definitely the surgical treatment is performed, and the more correctly the drug therapy is carried out, the better the result of the complex treatment approach. Similarly, sarcoma secondary sites should be treated proactively – without waiting until their size and local spread contraindicate surgical treatment. Conclusion. Neglected sarcoma cases indicate the need for combined and extended surgical interventions, one successful example of which is described in this paper.

Silicone lymphadenopathy is a rare complication in breast implant patients caused by the presence of silicone particles in the lymph nodes with the development of specific granulomatous inflammation. Most often, it occurs against the background of a violation of the integrity of the silicone implant capsule and the spread of silicone into the surrounding tissues. Due to the rarity of this pathology, there are no statistical data on the prevalence of this disease. The literature review presents the data of foreign authors on the clinical picture, diagnosis and treatment of this pathology. Silicon lymphadenopathy is a diagnosis of exclusion, primarily of malignant neoplasms of the breast, since the clinical picture is similar. Silicone lymphadenopathy should be included in the differential diagnosis in patients with enlarged lymph nodes who have previously undergone plastic or oncoplastic surgery using silicone endoprostheses.

Your attention is given to the clinical observation of a patient with recurrent liposarcoma of the left upper limb. According to vital indications with palliative purpose, the patient underwent surgery in the Oncology Department of surgical methods of treatment of FSBI SSC FMBC named after A.I. Burnazyan, FMBA of Russia. The operation was carried out in the amount of interscapularthoracic amputation on the left with resection of the left clavicle, plasty of the defect of rotary musclefat flap on a vascular pedicle after previous surgical treatment previous year in the amount of assertional the left upper extremity with the plastic of the wound defect myofascial flap on a vascular pedicle. Attempts to palliative embolization of blood vessels supplying the tumor node were unsuccessful, and the only option to provide medical care at this stage was surgical treatment. It should also be noted that the patient has a history of cancer of the left breast, in connection with which she was treated about 10 years ago. Currently, the patient is under our dynamic control and is undergoing adjuvant radiotherapy. The postoperative period was uneventful.

As a result of some deviations in the installation of the X-ray inspection plant 'Extravolt-225/1600' two workers of an X-ray inspection laboratory were exposed to the radiation in a dose enough to cause an acute local radiolesions (LRs). The first patient was diagnosed with an acute LR of the hands of severe and extremely severe degree. The second patient was diagnosed with a mild LR of her right hand. The first patient received a surgical treatment followed by subcutaneous introduction of the autologous mesenchymal stem cells. The second patient received only conservative treatment. The complete epithelization of the traumatic surface was achieved. Modeling the incident with the following EPR analysis of the compact substance of the ablated bone structures made it possible to specify the spatial-temporal properties of the exposure.