1<?xml version="1.0" encoding="UTF-8"?> 2<!DOCTYPE html> 3<html prefix="og: http://ogp.me/ns#" xmlns="http://www.w3.org/1999/xhtml" lang="en" xml:lang="en"> 4<head> 5 <title>Experimental validation of the original technique for plastic surgery of extensive posttraumatic diaphragm defects - Korobka - Journal of Experimental and Clinical Surgery</title> 6 <meta http-equiv="Content-Type" content="text/html; charset=utf-8" /> 7 <meta name="viewport" content="width=device-width, initial-scale=1"> 8 9 <meta name="title" xml:lang="en" lang="en" content="Experimental validation of the original technique for plastic surgery of extensive posttraumatic diaphragm defects"/> 10 <meta name="description" xml:lang="en" lang="en" content="Experimental validation of the original technique for plastic surgery of extensive posttraumatic diaphragm defects"/> 11 <meta name="title" xml:lang="ru" lang="ru" content="ÐкÑпеÑименÑалÑное обоÑнование оÑигиналÑной меÑодики плаÑÑики обÑиÑнÑÑ Ð¿Ð¾ÑÑÑÑавмаÑиÑеÑÐºÐ¸Ñ Ð´ÐµÑекÑов диаÑÑагмÑ"/> 12 <meta name="description" xml:lang="ru" lang="ru" content="ÐкÑпеÑименÑалÑное обоÑнование оÑигиналÑной меÑодики плаÑÑики обÑиÑнÑÑ Ð¿Ð¾ÑÑÑÑавмаÑиÑеÑÐºÐ¸Ñ Ð´ÐµÑекÑов диаÑÑагмÑ"/> 13 <meta name="abstract" xml:lang="en" lang="en" content=" Background. According to modern research studies, including those using polypropylene mesh, the recurrence rate after diaphragm plastic surgery for traumatic, congenital, and postoperative defects varies widely, ranging from 2% to 30% or more. 14 Aim. To evaluate the morphological and biomechanical features of the diaphragm musculo-aponeurotic structures regarding the application of an original surgical technique for treating patients with extensive post-traumatic diaphragmatic defects. 15 Materials and methods. An anatomical, morphological, and biomechanical study was conducted on 36 cadavers of both sexes from three age groups (young, middle-aged, and elderly) and various somatotypes. The shape and dimensions of the diaphragm and central tendon, as well as the parameters of hemomicrocirculatory network, the tensile strength, and the modulus of elasticity, were evaluated using the ISS-500 testing device. Additionally, 12 diaphragm specimens were examined after simulating an extensive defect and performing plastic surgery using an original technique. Statistical data were analysed using Statistica 10 (StatSoft, USA). 16 Results. Somatotype-associated variants in the shape of the diaphragm dome and central tendon were identified, gender-related differences in its dimensions (in men, the values of the sagittal and frontal dimensions were generally larger, with the maximum dimensions observed in brachymorphic and mesomorphic types). In the middle-aged and the elderly, there was a decreased density of the vascular network of the hemimicrocirculatory bed and a tendency towards the decreased tissue strength and elasticity. In the experiment, the original tension-free fixation of the mesh endoprosthesis with reinforcement of the U-shaped suture line using a frame thread resulted in a 71.95% increase in the tensile strength and a 70.41% increase in the modulus of elasticity compared to native diaphragm specimens (p&lt; 0.05), regardless of the patients' somatotype and age. 17 Conclusion. Age-related and anatomical features of the diaphragm should be considered when planning reconstruction; the proposed technique strengthens the fixation line of the polypropylene mesh and improves the biomechanical reliability of plastic surgery in extensive post-traumatic defects. "/> 18 <meta name="abstract" xml:lang="ru" lang="ru" content=" ÐкÑÑалÑноÑÑÑ. Ðо даннÑм ÑовÑеменнÑÑ Ð¸ÑÑледований, в Ñом ÑиÑле пÑи пÑименении полипÑопиленовой ÑеÑки, ÑаÑÑоÑа ÑеÑидивов поÑле плаÑÑики диаÑÑÐ°Ð³Ð¼Ñ Ð¿Ñи ÑÑавмаÑиÑеÑÐºÐ¸Ñ , вÑождÑннÑÑ Ð¸ поÑлеопеÑаÑионнÑÑ Ð´ÐµÑекÑÐ°Ñ ÑиÑоко ваÑÑиÑÑÐµÑ â Ð¾Ñ 2% до 30% и более. 19 ЦелÑ. ÐÑенка моÑÑологиÑеÑÐºÐ¸Ñ Ð¸ Ð±Ð¸Ð¾Ð¼ÐµÑ Ð°Ð½Ð¸ÑеÑÐºÐ¸Ñ Ñ Ð°ÑакÑеÑиÑÑик мÑÑеÑно-апоневÑоÑиÑеÑÐºÐ¸Ñ ÑÑÑÑкÑÑÑ Ð´Ð¸Ð°ÑÑÐ°Ð³Ð¼Ñ Ð² аÑпекÑе пÑÐ¸Ð¼ÐµÐ½ÐµÐ½Ð¸Ñ Ð¾ÑигиналÑной Ñ Ð¸ÑÑÑгиÑеÑкой меÑодики леÑÐµÐ½Ð¸Ñ Ð¿Ð°ÑиенÑов Ñ Ð¾Ð±ÑиÑнÑми поÑÑÑÑавмаÑиÑеÑкими деÑекÑами диаÑÑагмÑ. 20 ÐеÑодÑ. ÐÑоведено анаÑомо-моÑÑологиÑеÑкое и Ð±Ð¸Ð¾Ð¼ÐµÑ Ð°Ð½Ð¸ÑеÑкое иÑÑледование 36 ÑÑÑпов лÑдей обоего пола ÑÑÐµÑ Ð²Ð¾Ð·ÑаÑÑнÑÑ Ð³ÑÑпп (молодого, ÑÑеднего, пÑеклонного возÑаÑÑов) и ÑазлиÑнÑÑ ÑомаÑоÑипов. Ðа иÑпÑÑаÑелÑном ÑÑенде ÐСС-500 оÑенивали ÑоÑÐ¼Ñ Ð¸ ÑазмеÑÑ Ð´Ð¸Ð°ÑÑÐ°Ð³Ð¼Ñ Ð¸ ÑÑÑ Ð¾Ð¶Ð¸Ð»Ñного ÑенÑÑа, паÑамеÑÑÑ ÑеÑи гемомикÑоÑиÑкÑлÑÑоÑного ÑÑÑла, а Ñакже пÑедел пÑоÑноÑÑи и модÑÐ»Ñ ÑпÑÑгоÑÑи. ÐÑделÑно иÑÑÐ»ÐµÐ´Ð¾Ð²Ð°Ð½Ñ 12 пÑепаÑаÑов диаÑÑÐ°Ð³Ð¼Ñ Ð¿Ð¾Ñле моделиÑÐ¾Ð²Ð°Ð½Ð¸Ñ Ð¾Ð±ÑиÑного деÑекÑа и его плаÑÑики по оÑигиналÑной меÑодике. СÑаÑиÑÑиÑеÑкий анализ даннÑÑ Ð¿Ñоводили Ñ Ð¸ÑполÑзованием пÑогÑÐ°Ð¼Ð¼Ñ Statistica 10 (StatSoft, СШÐ). 21 РезÑлÑÑаÑÑ. ÐÑÑÐ²Ð»ÐµÐ½Ñ ÑомаÑоÑип-аÑÑоÑииÑованнÑе ваÑианÑÑ ÑоÑÐ¼Ñ ÐºÑпола и ÑÑÑ Ð¾Ð¶Ð¸Ð»Ñного ÑенÑÑа диаÑÑагмÑ, а Ñакже половÑе ÑазлиÑÐ¸Ñ ÐµÑ ÑазмеÑов (Ñ Ð¼ÑжÑин знаÑÐµÐ½Ð¸Ñ ÑагиÑÑалÑного и ÑÑонÑалÑного ÑазмеÑов в Ñелом болÑÑе, макÑималÑнÑе - пÑи бÑÐ°Ñ Ð¸Ð¼Ð¾ÑÑном и мезомоÑÑном ÑÐ¸Ð¿Ð°Ñ ). Ð ÑÑеднем и пÑеклонном возÑаÑÑе оÑмеÑено Ñнижение плоÑноÑÑи Ð¸Ñ ÑоÑÑдиÑÑой ÑеÑи гемомикÑоÑиÑкÑлÑÑоÑного ÑÑÑла и ÑенденÑÐ¸Ñ Ðº ÑменÑÑÐµÐ½Ð¸Ñ Ð¿ÑоÑноÑÑно-ÑпÑÑÐ³Ð¸Ñ Ñ Ð°ÑакÑеÑиÑÑик Ñканей. Ð ÑкÑпеÑименÑе оÑигиналÑÐ½Ð°Ñ Ð½ÐµÐ½Ð°ÑÑÐ¶Ð½Ð°Ñ ÑикÑаÑÐ¸Ñ ÑеÑÑаÑого ÑндопÑоÑеза Ñ ÑкÑеплением лиÐ
21½Ð¸Ð¸ Ð-обÑазнÑÑ Ñвов каÑкаÑной ниÑÑÑ Ð¾Ð±ÐµÑпеÑила ÑвелиÑение пÑедела пÑоÑноÑÑи на 71,95% и модÑÐ»Ñ ÑпÑÑгоÑÑи на 70,41% по ÑÑÐ°Ð²Ð½ÐµÐ½Ð¸Ñ Ñ Ð½Ð°ÑивнÑми пÑепаÑаÑами диаÑÑÐ°Ð³Ð¼Ñ (p&lt; 0,05), незавиÑимо Ð¾Ñ ÑомаÑоÑипа и возÑаÑÑа паÑиенÑов. 22 ÐаклÑÑение. ÐозÑаÑÑнÑе и анаÑомиÑеÑкие оÑобенноÑÑи диаÑÑÐ°Ð³Ð¼Ñ ÑледÑÐµÑ ÑÑиÑÑваÑÑ Ð¿Ñи планиÑовании ÑеконÑÑÑÑкÑии; пÑÐµÐ´Ð»Ð¾Ð¶ÐµÐ½Ð½Ð°Ñ Ð¼ÐµÑодика ÑÑÐ¸Ð»Ð¸Ð²Ð°ÐµÑ Ð»Ð¸Ð½Ð¸Ñ ÑикÑаÑии полипÑопиленовой ÑеÑки и повÑÑÐ°ÐµÑ Ð±Ð¸Ð¾Ð¼ÐµÑ Ð°Ð½Ð¸ÑеÑкÑÑ Ð½Ð°Ð´ÐµÐ¶Ð½Ð¾ÑÑÑ Ð¿Ð»Ð°ÑÑики обÑиÑнÑÑ Ð¿Ð¾ÑÑÑÑавмаÑиÑеÑÐºÐ¸Ñ Ð´ÐµÑекÑов. "/> 23 24 <meta name="keywords" xml:lang="en" lang="en" content="diaphragm; muscular-fascial structures; post-traumatic diaphragmatic hernia; diaphragm defect"/> 25 <meta name="keywords" xml:lang="ru" lang="ru" content="диаÑÑагма; мÑÑеÑно-ÑаÑÑиалÑнÑе ÑÑÑÑкÑÑÑÑ; поÑÑÑÑавмаÑиÑеÑÐºÐ°Ñ Ð´Ð¸Ð°ÑÑагмалÑÐ½Ð°Ñ Ð³ÑÑжа; деÑÐµÐºÑ Ð´Ð¸Ð°ÑÑагмÑ"/> 26 27 28 <meta property="og:title" content="Experimental validation of the original technique for plastic surgery of extensive posttraumatic diaphragm defects" /> 29<meta property="og:type" content="article" /> 30 <meta property="og:url" content="https://doi.org/10.18499/2070-478X-2026-19-2-61-68" /> 31<meta property="og:description" content="Journal of Experimental and Clinical Surgery Vol 19, No 2 (2026)" /> 32<meta property="og:site_name" content="Journal of Experimental and Clinical Surgery" /> 33 <meta property="og:image" content="https://vestnik-surgery.com/files/journals/1/articles/1937/supp/1937-7252-1-SP.jpg" /> 34 <meta property="og:image" content="https://vestnik-surgery.com/public/journals/1/cover_issue_81_en_US.png" /> 35 <meta property="og:image" content="https://vestnik-surgery.com/public/journals/1/homepageImage_en_US.jpg" /> 36 <meta property="og:locale" content="en_US" /> 37 <link rel="schema.DC" href="http://purl.org/dc/elements/1.1/" /> 38 39 40 <meta name="DC.Creator.PersonalName" xml:lang="en" lang="en" content="Roman V. Korobka"/> 41 <meta name="DC.Creator.PersonalName" xml:lang="ru" lang="ru" content="ÐоÑобка Роман ÐÑÑеÑлавовиÑ"/> 42 <meta name="DC.Creator.PersonalName" xml:lang="en" lang="en" content="Ivan S. Klets"/> 43 <meta name="DC.Creator.PersonalName" xml:lang="ru" lang="ru" content="ÐÐ»ÐµÑ Ðван СеÑгеевиÑ"/> 44 <meta name="DC.Creator.PersonalName" xml:lang="en" lang="en" content="Vyacheslav L. Korobka"/> 45 <meta name="DC.Creator.PersonalName" xml:lang="ru" lang="ru" content="ÐоÑобка ÐÑÑеÑлав ÐеонидовиÑ"/> 46 <meta name="DC.Creator.PersonalName" xml:lang="en" lang="en" content="Vladimir K. Tatyanchenko"/> 47 <meta name="DC.Creator.PersonalName" xml:lang="ru" lang="ru" content="ТаÑÑÑнÑенко ÐÐ»Ð°Ð´Ð¸Ð¼Ð¸Ñ ÐонÑÑанÑиновиÑ"/> 48 <meta name="DC.Creator.PersonalName" xml:lang="en" lang="en" content="Arkady B. Lageza"/> 49 <meta name="DC.Creator.PersonalName" xml:lang="ru" lang="ru" content="Ðагеза ÐÑкадий ÐоÑиÑовиÑ"/> 50 <meta name="DC.Creator.PersonalName" xml:lang="en" lang="en" content="Mikhail V. Gonchar"/> 51 <meta name="DC.Creator.PersonalName" xml:lang="ru" lang="ru" content="ÐонÑÐ°Ñ ÐÐ¸Ñ Ð°Ð¸Ð» ÐикÑоÑовиÑ"/> 52 <meta name="DC.Creator.PersonalName" xml:lang="en" lang="en" content="Sergey I. Dudarev"/> 53 <meta name="DC.Creator.PersonalName" xml:lang="ru" lang="ru" content="ÐÑдаÑев СеÑгей ÐгоÑевиÑ"/> 54 55 <meta name="DC.Date.available" scheme="ISO8601" content="2029-07-01"/> 56 <meta name="DC.Date.created" scheme="ISO8601" content="2026-06-26"/> 57 <meta name="DC.Date.dateSubmitted" scheme="ISO8601" content="2026-03-12"/> 58 <meta name="DC.Date.issued" scheme="ISO8601" content="2026-06-26"/> 59 <meta name="DC.Date.modified" scheme="ISO8601" content="2026-07-01"/> 60 <meta name="DC.Description" xml:lang="en" lang="en" content=" Backgroun
60d. According to modern research studies, including those using polypropylene mesh, the recurrence rate after diaphragm plastic surgery for traumatic, congenital, and postoperative defects varies widely, ranging from 2% to 30% or more. 61 Aim. To evaluate the morphological and biomechanical features of the diaphragm musculo-aponeurotic structures regarding the application of an original surgical technique for treating patients with extensive post-traumatic diaphragmatic defects. 62 Materials and methods. An anatomical, morphological, and biomechanical study was conducted on 36 cadavers of both sexes from three age groups (young, middle-aged, and elderly) and various somatotypes. The shape and dimensions of the diaphragm and central tendon, as well as the parameters of hemomicrocirculatory network, the tensile strength, and the modulus of elasticity, were evaluated using the ISS-500 testing device. Additionally, 12 diaphragm specimens were examined after simulating an extensive defect and performing plastic surgery using an original technique. Statistical data were analysed using Statistica 10 (StatSoft, USA). 63 Results. Somatotype-associated variants in the shape of the diaphragm dome and central tendon were identified, gender-related differences in its dimensions (in men, the values of the sagittal and frontal dimensions were generally larger, with the maximum dimensions observed in brachymorphic and mesomorphic types). In the middle-aged and the elderly, there was a decreased density of the vascular network of the hemimicrocirculatory bed and a tendency towards the decreased tissue strength and elasticity. In the experiment, the original tension-free fixation of the mesh endoprosthesis with reinforcement of the U-shaped suture line using a frame thread resulted in a 71.95% increase in the tensile strength and a 70.41% increase in the modulus of elasticity compared to native diaphragm specimens (p&lt; 0.05), regardless of the patients' somatotype and age. 64 Conclusion. Age-related and anatomical features of the diaphragm should be considered when planning reconstruction; the proposed technique strengthens the fixation line of the polypropylene mesh and improves the biomechanical reliability of plastic surgery in extensive post-traumatic defects. "/> 65 <meta name="DC.Abstract" xml:lang="en" lang="en" content=" Background. According to modern research studies, including those using polypropylene mesh, the recurrence rate after diaphragm plastic surgery for traumatic, congenital, and postoperative defects varies widely, ranging from 2% to 30% or more. 66 Aim. To evaluate the morphological and biomechanical features of the diaphragm musculo-aponeurotic structures regarding the application of an original surgical technique for treating patients with extensive post-traumatic diaphragmatic defects. 67 Materials and methods. An anatomical, morphological, and biomechanical study was conducted on 36 cadavers of both sexes from three age groups (young, middle-aged, and elderly) and various somatotypes. The shape and dimensions of the diaphragm and central tendon, as well as the parameters of hemomicrocirculatory network, the tensile strength, and the modulus of elasticity, were evaluated using the ISS-500 testing device. Additionally, 12 diaphragm specimens were examined after simulating an extensive defect and performing plastic surgery using an original technique. Statistical data were analysed using Statistica 10 (StatSoft, USA). 68 Results. Somatotype-associated variants in the shape of the diaphragm dome and central tendon were identified, gender-related differences in its dimensions (in men, the values of the sagittal and frontal dimensions were generally larger, with the maximum dimensions observed in brachymorphic and mesomorphic types). In the middle-aged and the elderly, there was a decreased density of the vascular network of the hemimicrocirculatory bed and a tendency towards the decreased tissue strength and elasticity. In the experiment, the original tension-free fixation of the mesh endoprosthesis with reinforcement of the U-shaped suture line using a frame thread resulted in a 71.95% increase in the tensile strength and a 70.41% increase in the modulus of elasticity compared to native diaphragm specimens (p&lt; 0.05), regardless of the patients' somatotype and age. 69 Conclusion. Age-related and anatomical features of the diaphragm should be considered when planning reconstruction; the proposed technique strengthens the fixation line of the polypropylene mesh and improves the biomechanical reliability of plastic surgery in extensive post-traumatic defects. "/> 70 <meta name="DC.Description" xml:lang="ru" lang="ru" content=" ÐкÑÑалÑноÑÑÑ. Ðо даннÑм ÑовÑеменнÑÑ Ð¸ÑÑледований, в Ñом ÑиÑле пÑи пÑименении полипÑопиленовой ÑеÑки, ÑаÑÑоÑа ÑеÑидивов поÑле плаÑÑики диаÑÑÐ°Ð³Ð¼Ñ Ð¿Ñи ÑÑавмаÑиÑеÑÐºÐ¸Ñ , вÑождÑннÑÑ Ð¸ поÑлеопеÑаÑионнÑÑ Ð´ÐµÑекÑÐ°Ñ ÑиÑоко ваÑÑиÑÑÐµÑ â Ð¾Ñ 2% до 30% и более. 71 ЦелÑ. ÐÑенка моÑÑологиÑеÑÐºÐ¸Ñ Ð¸ Ð±Ð¸Ð¾Ð¼ÐµÑ Ð°Ð½Ð¸ÑеÑÐºÐ¸Ñ Ñ Ð°ÑакÑеÑиÑÑик мÑÑеÑно-апоневÑоÑиÑеÑÐºÐ¸Ñ ÑÑÑÑкÑÑÑ Ð´Ð¸Ð°ÑÑÐ°Ð³Ð¼Ñ Ð² аÑпекÑе пÑÐ¸Ð¼ÐµÐ½ÐµÐ½Ð¸Ñ Ð¾ÑигиналÑной Ñ Ð¸ÑÑÑгиÑеÑкой меÑодики леÑÐµÐ½Ð¸Ñ Ð¿Ð°ÑиенÑов Ñ Ð¾Ð±ÑиÑнÑми поÑÑÑÑавмаÑиÑеÑкими деÑекÑами диаÑÑагмÑ. 72 ÐеÑодÑ. ÐÑоведено анаÑомо-моÑÑологиÑеÑкое и Ð±Ð¸Ð¾Ð¼ÐµÑ Ð°Ð½Ð¸ÑеÑкое иÑÑледование 36 ÑÑÑпов лÑдей обоего пола ÑÑÐµÑ Ð²Ð¾Ð·ÑаÑÑнÑÑ Ð³ÑÑпп (молодого, ÑÑеднего, пÑеклонного возÑаÑÑов) и ÑазлиÑнÑÑ ÑомаÑоÑипов. Ðа иÑпÑÑаÑелÑном ÑÑенде ÐСС-500 оÑенивали ÑоÑÐ¼Ñ Ð¸ ÑазмеÑÑ Ð´Ð¸Ð°ÑÑÐ°Ð³Ð¼Ñ Ð¸ ÑÑÑ Ð¾Ð¶Ð¸Ð»Ñного ÑенÑÑа, паÑамеÑÑÑ ÑеÑи гемомикÑоÑиÑкÑлÑÑоÑного ÑÑÑла, а Ñакже пÑедел пÑоÑноÑÑи и модÑÐ»Ñ ÑпÑÑгоÑÑи. ÐÑделÑно иÑÑÐ»ÐµÐ´Ð¾Ð²Ð°Ð½Ñ 12 пÑепаÑаÑов диаÑÑÐ°Ð³Ð¼Ñ Ð¿Ð¾Ñле моделиÑÐ¾Ð²Ð°Ð½Ð¸Ñ Ð¾Ð±ÑиÑного деÑекÑа и его плаÑÑики по оÑигиналÑной меÑодике. СÑаÑиÑÑиÑеÑкий анализ даннÑÑ Ð¿Ñоводили Ñ Ð¸ÑполÑзованием пÑогÑÐ°Ð¼Ð¼Ñ Statistica 10 (StatSoft, СШÐ). 73 РезÑлÑÑаÑÑ. ÐÑÑÐ²Ð»ÐµÐ½Ñ ÑомаÑоÑип-аÑÑоÑииÑованнÑе ваÑианÑÑ ÑоÑÐ¼Ñ ÐºÑпола и ÑÑÑ Ð¾Ð¶Ð¸Ð»Ñного ÑенÑÑа диаÑÑагмÑ, а Ñакже половÑе ÑазлиÑÐ¸Ñ ÐµÑ ÑазмеÑов (Ñ Ð¼ÑжÑин знаÑÐµÐ½Ð¸Ñ ÑагиÑÑалÑного и ÑÑонÑалÑного ÑазмеÑов в Ñелом болÑÑе, макÑималÑнÑе - пÑи бÑÐ°Ñ Ð¸Ð¼Ð¾ÑÑном и мезомоÑÑном ÑÐ¸Ð¿Ð°Ñ ). Ð ÑÑеднем и пÑеклонном возÑаÑÑе оÑмеÑено Ñнижение плоÑноÑÑи Ð¸Ñ ÑоÑÑдиÑÑой ÑеÑи гемомикÑоÑиÑкÑлÑÑоÑного ÑÑÑла и ÑенденÑÐ¸Ñ Ðº ÑменÑÑÐµÐ½Ð¸Ñ Ð¿ÑоÑноÑÑно-ÑпÑÑÐ³Ð¸Ñ Ñ Ð°ÑакÑеÑиÑÑик Ñканей. Ð ÑкÑпеÑименÑе оÑигиналÑÐ½Ð°Ñ Ð½ÐµÐ½Ð°ÑÑÐ¶Ð½Ð°Ñ ÑикÑаÑÐ¸Ñ ÑеÑÑаÑого ÑндопÑоÑеза Ñ ÑкÑеплением лиÐ
73½Ð¸Ð¸ Ð-обÑазнÑÑ Ñвов каÑкаÑной ниÑÑÑ Ð¾Ð±ÐµÑпеÑила ÑвелиÑение пÑедела пÑоÑноÑÑи на 71,95% и модÑÐ»Ñ ÑпÑÑгоÑÑи на 70,41% по ÑÑÐ°Ð²Ð½ÐµÐ½Ð¸Ñ Ñ Ð½Ð°ÑивнÑми пÑепаÑаÑами диаÑÑÐ°Ð³Ð¼Ñ (p&lt; 0,05), незавиÑимо Ð¾Ñ ÑомаÑоÑипа и возÑаÑÑа паÑиенÑов. 74 ÐаклÑÑение. ÐозÑаÑÑнÑе и анаÑомиÑеÑкие оÑобенноÑÑи диаÑÑÐ°Ð³Ð¼Ñ ÑледÑÐµÑ ÑÑиÑÑваÑÑ Ð¿Ñи планиÑовании ÑеконÑÑÑÑкÑии; пÑÐµÐ´Ð»Ð¾Ð¶ÐµÐ½Ð½Ð°Ñ Ð¼ÐµÑодика ÑÑÐ¸Ð»Ð¸Ð²Ð°ÐµÑ Ð»Ð¸Ð½Ð¸Ñ ÑикÑаÑии полипÑопиленовой ÑеÑки и повÑÑÐ°ÐµÑ Ð±Ð¸Ð¾Ð¼ÐµÑ Ð°Ð½Ð¸ÑеÑкÑÑ Ð½Ð°Ð´ÐµÐ¶Ð½Ð¾ÑÑÑ Ð¿Ð»Ð°ÑÑики обÑиÑнÑÑ Ð¿Ð¾ÑÑÑÑавмаÑиÑеÑÐºÐ¸Ñ Ð´ÐµÑекÑов. "/> 75 <meta name="DC.Abstract" xml:lang="ru" lang="ru" content=" ÐкÑÑалÑноÑÑÑ. Ðо даннÑм ÑовÑеменнÑÑ Ð¸ÑÑледований, в Ñом ÑиÑле пÑи пÑименении полипÑопиленовой ÑеÑки, ÑаÑÑоÑа ÑеÑидивов поÑле плаÑÑики диаÑÑÐ°Ð³Ð¼Ñ Ð¿Ñи ÑÑавмаÑиÑеÑÐºÐ¸Ñ , вÑождÑннÑÑ Ð¸ поÑлеопеÑаÑионнÑÑ Ð´ÐµÑекÑÐ°Ñ ÑиÑоко ваÑÑиÑÑÐµÑ â Ð¾Ñ 2% до 30% и более. 76 ЦелÑ. ÐÑенка моÑÑологиÑеÑÐºÐ¸Ñ Ð¸ Ð±Ð¸Ð¾Ð¼ÐµÑ Ð°Ð½Ð¸ÑеÑÐºÐ¸Ñ Ñ Ð°ÑакÑеÑиÑÑик мÑÑеÑно-апоневÑоÑиÑеÑÐºÐ¸Ñ ÑÑÑÑкÑÑÑ Ð´Ð¸Ð°ÑÑÐ°Ð³Ð¼Ñ Ð² аÑпекÑе пÑÐ¸Ð¼ÐµÐ½ÐµÐ½Ð¸Ñ Ð¾ÑигиналÑной Ñ Ð¸ÑÑÑгиÑеÑкой меÑодики леÑÐµÐ½Ð¸Ñ Ð¿Ð°ÑиенÑов Ñ Ð¾Ð±ÑиÑнÑми поÑÑÑÑавмаÑиÑеÑкими деÑекÑами диаÑÑагмÑ. 77 ÐеÑодÑ. ÐÑоведено анаÑомо-моÑÑологиÑеÑкое и Ð±Ð¸Ð¾Ð¼ÐµÑ Ð°Ð½Ð¸ÑеÑкое иÑÑледование 36 ÑÑÑпов лÑдей обоего пола ÑÑÐµÑ Ð²Ð¾Ð·ÑаÑÑнÑÑ Ð³ÑÑпп (молодого, ÑÑеднего, пÑеклонного возÑаÑÑов) и ÑазлиÑнÑÑ ÑомаÑоÑипов. Ðа иÑпÑÑаÑелÑном ÑÑенде ÐСС-500 оÑенивали ÑоÑÐ¼Ñ Ð¸ ÑазмеÑÑ Ð´Ð¸Ð°ÑÑÐ°Ð³Ð¼Ñ Ð¸ ÑÑÑ Ð¾Ð¶Ð¸Ð»Ñного ÑенÑÑа, паÑамеÑÑÑ ÑеÑи гемомикÑоÑиÑкÑлÑÑоÑного ÑÑÑла, а Ñакже пÑедел пÑоÑноÑÑи и модÑÐ»Ñ ÑпÑÑгоÑÑи. ÐÑделÑно иÑÑÐ»ÐµÐ´Ð¾Ð²Ð°Ð½Ñ 12 пÑепаÑаÑов диаÑÑÐ°Ð³Ð¼Ñ Ð¿Ð¾Ñле моделиÑÐ¾Ð²Ð°Ð½Ð¸Ñ Ð¾Ð±ÑиÑного деÑекÑа и его плаÑÑики по оÑигиналÑной меÑодике. СÑаÑиÑÑиÑеÑкий анализ даннÑÑ Ð¿Ñоводили Ñ Ð¸ÑполÑзованием пÑогÑÐ°Ð¼Ð¼Ñ Statistica 10 (StatSoft, СШÐ). 78 РезÑлÑÑаÑÑ. ÐÑÑÐ²Ð»ÐµÐ½Ñ ÑомаÑоÑип-аÑÑоÑииÑованнÑе ваÑианÑÑ ÑоÑÐ¼Ñ ÐºÑпола и ÑÑÑ Ð¾Ð¶Ð¸Ð»Ñного ÑенÑÑа диаÑÑагмÑ, а Ñакже половÑе ÑазлиÑÐ¸Ñ ÐµÑ ÑазмеÑов (Ñ Ð¼ÑжÑин знаÑÐµÐ½Ð¸Ñ ÑагиÑÑалÑного и ÑÑонÑалÑного ÑазмеÑов в Ñелом болÑÑе, макÑималÑнÑе - пÑи бÑÐ°Ñ Ð¸Ð¼Ð¾ÑÑном и мезомоÑÑном ÑÐ¸Ð¿Ð°Ñ ). Ð ÑÑеднем и пÑеклонном возÑаÑÑе оÑмеÑено Ñнижение плоÑноÑÑи Ð¸Ñ ÑоÑÑдиÑÑой ÑеÑи гемомикÑоÑиÑкÑлÑÑоÑного ÑÑÑла и ÑенденÑÐ¸Ñ Ðº ÑменÑÑÐµÐ½Ð¸Ñ Ð¿ÑоÑноÑÑно-ÑпÑÑÐ³Ð¸Ñ Ñ Ð°ÑакÑеÑиÑÑик Ñканей. Ð ÑкÑпеÑименÑе оÑигиналÑÐ½Ð°Ñ Ð½ÐµÐ½Ð°ÑÑÐ¶Ð½Ð°Ñ ÑикÑаÑÐ¸Ñ ÑеÑÑаÑого ÑндопÑоÑеза Ñ ÑкÑеплением линии Ð-обÑазнÑÑ Ñвов каÑкаÑной ниÑÑÑ Ð¾Ð±ÐµÑпеÑила ÑвелиÑение пÑедела пÑоÑноÑÑи на 71,95% и модÑÐ»Ñ ÑпÑÑгоÑÑи на 70,41% по ÑÑÐ°Ð²Ð½ÐµÐ½Ð¸Ñ Ñ Ð½Ð°ÑивнÑми пÑепаÑаÑами диаÑÑÐ°Ð³Ð¼Ñ (p&lt; 0,05), незавиÑимо Ð¾Ñ ÑомаÑоÑипа и возÑаÑÑа паÑиенÑов. 79 ÐаклÑÑение. ÐозÑаÑÑнÑе и анаÑомиÑеÑкие оÑобенноÑÑи диаÑÑÐ°Ð³Ð¼Ñ ÑледÑÐµÑ ÑÑиÑÑваÑÑ Ð¿Ñи планиÑовании ÑеконÑÑÑÑкÑии; пÑÐµÐ´Ð»Ð¾Ð¶ÐµÐ½Ð½Ð°Ñ Ð¼ÐµÑодика ÑÑÐ¸Ð»Ð¸Ð²Ð°ÐµÑ Ð»Ð¸Ð½Ð¸Ñ ÑикÑаÑии полипÑопиленовой ÑеÑки и повÑÑÐ°ÐµÑ Ð±Ð¸Ð¾Ð¼ÐµÑ Ð°Ð½Ð¸ÑеÑкÑÑ Ð½Ð°Ð´ÐµÐ¶Ð½Ð¾ÑÑÑ Ð¿Ð»Ð°ÑÑики обÑиÑнÑÑ Ð¿Ð¾ÑÑÑÑавмаÑиÑеÑÐºÐ¸Ñ Ð´ÐµÑекÑов. "/> 80 <meta name="DC.Format" scheme="IMT" content="application/pdf"/> 81 <meta name="DC.Format" scheme="IMT" content="application/pdf"/> 82 83 <meta name="DC.Identifier" content="1937"/> 84 <meta name="DC.Identifier.pageNumber" content="61-68"/> 85 <meta name="DC.Identifier.DOI" content="10.18499/2070-478X-2026-19-2-61-68"/>
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824 <a class="icon button" href="javascript:openRTWindow('https://vestnik-surgery.com/journal/rt/captureCite/1937/0');">Cite item</a> 825 </div> 826 827 <div class="rightBlock"> 828 <div class="downloadPDF"> 829 <h2 class="label">Full Text</h2> 830 <div style="padding-bottom: 5px;"> 831 <img src="https://vestnik-surgery.com/lib/pkp/templates/images/icons/text_open.png" alt="Open Access" /> 832 Open Access<br> 833 <img src="https://vestnik-surgery.com/lib/pkp/templates/images/icons/text_unlock.png" alt="Restricted Access" /> 834 Access granted<br> 835 <img src="https://vestnik-surgery.com/lib/pkp/templates/images/icons/text_lock.png" alt="Restricted Access" /> 836 Subscription or Fee Access 837 </div> 838 <div id="topBar"> 839 <div id="articleFullText"> 840 <a href="https://vestnik-surgery.com/journal/article/view/1937/1376" class="file" target="_parent"> 841 <div style="position: relative;"> 842 <div class="galleyLabel"><img src="/img/labels/pdf.png" alt="PDF"><span class="galleyLanguageLabel">(Russian)</span></div> 843 <img class="accessLogo" src="https://vestnik-surgery.com/lib/pkp/templates/images/icons/text_lock.png" alt="Restricted Access" /> 844 </div> 845 </a> 846 <a href="https://vestnik-surgery.com/journal/article/view/1937/1382" class="file" target="_parent"> 847 <div style="position: relative;"> 848 <div class="galleyLabel"><img src="/img/labels/pdf.png" alt="PDF"><span class="galleyLanguageLabel">(English)</span></div> 849 <img class="accessLogo" src="https://vestnik-surgery.com/lib/pkp/templates/images/icons/text_lock.png" alt="Restricted Access" /> 850 </div> 851 </a> 852 </div> 853 </div> 854 </div> 855 </div> 856 </div> 857 858 859 <div id="tabs"> 860 <ul> 861 <li><a href="#tabs-1">Abstract</a></li> 862 <li id="fullTextLabel"><a href="#tabs-2">Full Text</a></li> 863 <li><a href="#tabs-3">About the authors</a></li> 864 <li><a href="#tabs-4">References</a></li> 865 <li><a href="#tabs-5">Supplementary files</a></li> <li><a href="#tabs-6">Statistics</a></li> 866 </ul> 867 <div id="tabs-1"> 868 <div id="articleAbstract"> 869 <h2 class="label">Abstract</h2> 870 <div><p><strong>Background.</strong> According to modern research studies, including those using polypropylene mesh, the recurrence rate after diaphragm plastic surgery for traumatic, congenital, and postoperative defects varies widely, ranging from 2% to 30% or more.</p><p><strong>Aim.<em> </em></strong>To evaluate the morphological and biomechanical features of the diaphragm musculo-aponeurotic structures regarding the application of an original surgical technique for treating patients with extensive post-traumatic diaphragmatic defects.</p><p><strong>Materials and methods. </strong>An anatomical, morphological, and biomechanical study was conducted on 36 cadavers of both sexes from three age groups (young, middle-aged, and elderly) and various somatotypes. The shape and dimensions of the diaphragm and central tendon, as well as the parameters of hemomicrocirculatory network, the tensile strength, and the modulus of elasticity, were evaluated using the ISS-500 testing device. Additionally, 12 diaphragm specimens were examined after simulating an extensive defect and performing plastic surgery using an original technique. Statistical data were analysed using Statistica 10 (StatSoft, USA).</p><p><strong>Results.<em> </em></strong>Somatotype-associated variants in the shape of the diaphragm dome and central tendon were identified, gender-related differences in its dimensions (in men, the values of the sagittal and frontal dimensions were generally larger, with the maximum dimensions observed in brachymorphic and mesomorphic types). In the middle-aged and the elderly, there was a decreased density of the vascular network of the hemimicrocirculatory bed and a tendency towards the decreased tissue strength and elasticity. In the experiment, the original tension-free fixation of the mesh endoprosthesis with reinforcement of the U-shaped suture line using a frame thread resulted in a 71.95% increase in the tensile strength and a 70.41% increase in the modulus of elasticity compared to native diaphragm specimens (p< 0.05), regardless of the patients' somatotype and age.</p><p><strong>Conclusion.<em> </em></strong>Age-related and anatomical features of the diaphragm should be considered when planning reconstruction; the proposed technique strengthens the fixation line of the polypropylene mesh and improves the biomechanical reliability of plastic surgery in extensive post-traumatic defects.</p></div> 871 </div> 872 873 <div id="articleSubject"> 874 <h2>Keywords</h2> 875 <div> 876 <a href="https://vestnik-surgery.com/journal/search?subject=diaphragm">diaphragm</a>, <a href="https://vestnik-surgery.com/journal/search?subject=muscular-fascial%20structures">muscular-fascial structures</a>, <a href="https://vestnik-surgery.com/journal/search?subject=post-traumatic%20diaphragmatic%20hernia">post-traumatic diaphragmatic hernia</a>, <a href="https://vestnik-surgery.com/journal/search?subject=diaphragm%20defect">diaphragm defect</a> </div> 877 </div> 878 879 </div> 880 <div id="tabs-2"> 881 <h2 class="label">Full Text</h2> 882 <img src="https://vestnik-surgery.com/lib/pkp/templates/images/icons/text_lock.png" alt="Restricted Access" /> 883 884 </div> 885 <div id="tabs-3"> 886 <h2 class="label">About the authors</h2> 887 <h3><a target="_blank" href="https://vestnik-surgery.com/journal/search/authors/view?firstName=Roman%20&middleName=V.&lastName=Korobka">Roman V. Korobka</a></h3> 888 Rostov State Medical University; Rostov Regional Clinical Hospital <p style="padding-top: 10px;"> 889 <strong>Author for correspondence.</strong><br> Email: <a href="mailto:[email protected]">[email protected]</a><br> <p>M.D., Associate Professor of the Department of Reconstructive, Cardiovascular, Thoracic, Maxillofacial Surgery and Transplantology</p> Russian Federation, Rostov-on-Don; Rostov-on-Don </p> 890 <h3><a target="_blank" href="https://vestnik-surgery.com/journal/search/authors/view?firstName=Ivan%20&middleName=S.&lastName=Klets">Ivan S. Klets</a></h3> 891 Rostov State Medical University; Rostov Regional Clinical Hospital <p style="padding-top: 10px;"> 892 Email: <a href="mailto:[email protected]">[email protected]</a><br> <p>Assistant Professor of the Department of Reconstructive, Cardiovascular, Thoracic, Maxillofacial Surgery and Transplantology</p> Russian Federation, Rostov-on-Don; Rostov-on-Don </p> 893 <h3><a target="_blank" href="https://vestnik-surgery.com/journal/search/authors/view?firstName=Vyacheslav%20&middleName=L.&lastName=Korobka">Vyacheslav L. Korobka</a></h3> 894 Rostov State Medical University; Rostov Regional Clinical Hospital <p style="padding-top: 10px;"> 895 Email: <a href="mailto:[email protected]">[email protected]</a><br> <p>M.D., Professor, Head of the Department of Reconstructive, Cardiovascular, Thoracic, Maxillofacial Surgery and Transplantology</p> Russian Federation, Rostov-on-Don; Rostov-on-Don </p> 896 <h3><a target="_blank" href="https://vestnik-surgery.com/journal/search/authors/view?firstName=Vladimir%20&middleName=K.&lastName=Tatyanchenko">Vladimir K. Tatyanchenko</a></h3> 897 Rostov State Medical University <p style="padding-top: 10px;"> 898 Email: <a href="mailto:[email protected]">[email protected]</a><br> <p>
898M.D., Professor, Department of Surgery No. 4</p> Russian Federation, Rostov-on-Don </p> 899 <h3><a target="_blank" href="https://vestnik-surgery.com/journal/search/authors/view?firstName=Arkady&middleName=B.&lastName=Lageza">Arkady B. Lageza</a></h3> 900 Rostov State Medical University; Rostov Regional Clinical Hospital <p style="padding-top: 10px;"> 901 Email: <a href="mailto:[email protected]">[email protected]</a><br> <p>Ph.D., Associate Professor of the Department of Reconstructive, Cardiovascular, Thoracic, Maxillofacial Surgery and Transplantology</p> Russian Federation, Rostov-on-Don; Rostov-on-Don </p> 902 <h3><a target="_blank" href="https://vestnik-surgery.com/journal/search/authors/view?firstName=Mikhail&middleName=V.&lastName=Gonchar">Mikhail V. Gonchar</a></h3> 903 Rostov State Medical University; Rostov Regional Clinical Hospital <p style="padding-top: 10px;"> 904 Email: <a href="mailto:[email protected]">[email protected]</a><br> <p>Assistant Professor of the Department of Reconstructive, Cardiovascular, Thoracic, Maxillofacial Surgery and Transplantology</p> Russian Federation, Rostov-on-Don; Rostov-on-Don </p> 905 <h3><a target="_blank" href="https://vestnik-surgery.com/journal/search/authors/view?firstName=Sergey%20&middleName=I.&lastName=Dudarev">Sergey I. Dudarev</a></h3> 906 Rostov State Medical University; Rostov Regional Clinical Hospital <p style="padding-top: 10px;"> 907 Email: <a href="mailto:[email protected]">[email protected]</a><br> <p>Ph.D., Assistant Professor of the Department of Reconstructive, Cardiovascular, Thoracic, Maxillofacial Surgery and Transplantology</p> Russian Federation, Rostov-on-Don; Rostov-on-Don </p> 908 </div> 909 <div id="tabs-4"> 910 <h2 class="label">References</h2> 911 <div id="articleCitations" class="articleCitationsHeader"> 912 <div> 913 <ol> 914 <li>Solli P, Bertolaccini L, Brandolini J, Pardolesi A. Reconstructive techniques after diaphragm resection and use of the diaphragmatic flap in thoracic surgery. Shanghai Chest. 2017; 1(4): 21.1-21.9. doi: <a href='https://doi.org/10.21037/shc.2017.08.04' target='_blank'>10.21037/shc.2017.08.04</a>.</li> 915 <li>Plekhanov AN. Epidemiology, diagnostics, and treatment of traumatic diaphragmatic hernias (literature review). Acta Biomedica Scientifica. 2011; 1-2: 237-242. (in Russ.)</li> 916 <li>Davydov MI, Aliev MD, Sobolevsky VA, Ilyushin AL. Surgical treatment of malignant tumors of the chest wall. Vestnik RONTs im. N. N. Blokhina RAMN. 2008; 1: 35-40. (in Russ.)</li> 917 <li>Parshin VD, Khetagurov MA. Diaphragmatic hernias in planned thoracic surgery. Khirurgiya. Zhurnal im. N.I. Pirogova. 2018; 8: 36-45. (in Russ.)</li> 918 <li>Abakumov MM, Shcherbatenko MK, Vladimirova ES, Ermolova IV, Kartavenko VI, Pogodina AN, Kazantsev SV, Abakumov AM, Sharifullin FA. Diagnostics and treatment of diaphragmatic ruptures. Surgery. 2000; 7: 1: 28-33. (in Russ.)</li> 919 <li>Karamustafaoglu YA, Kuzucuoglu Ð, Tarladacalisir Т, Yoruk Y. Transabdominal subcostal approach in surgical management of Morgagni hernia. European journal of cardio-thoracic surgery. 2011; 39: 6: 1009-1011.</li> 920 <li>Hanna WC, Ferri LE, Fata P, Razek T, Spicer J. Diaphragmatic hernia repair: what should we expect? Canadian Journal of Surgery. 2016; 59(2): 78-79.</li> 921 <li>Bhatt NR, McMonagle M. Recurrence in a Laparoscopically Repaired Traumatic Diaphragmatic Hernia: Case Report and Literature Review. Trauma Monthly. 2016; 21: e20421.</li> 922 <li>Postanovlenie Pravitel'stva RF ot 21.07.2012 â 750 «Ob utverzhdenii Pravil peredachi nevostrebovannogo tela, organov i tkanei umershego cheloveka dlya ispol'zovaniya v meditsinskikh, nauchnykh i uchebnykh tselyakh, a takzhe ispol'zovaniya nevostrebovannogo tela, organov i tkanei umershego cheloveka v ukazannykh tselyakh» (red. ot 17.12.2016). Ofitsial'nyi internet-portal pravovoi informatsii. Moskva, 2012. URL: <a href='http://www.pravo.gov.ru' target='_blank'>http://www.pravo.gov.ru</a> (data obrashcheniya: 21.05.2026). (in Russ.)</li> 923 <li>Tat'yanchenko VK, Sarkisyan VA, Andreev EV, Chubaryan KA, Sposob issledovaniya fastsii i kletchatochnykh prostranstv. Patent RF â2271740. 2006; 8. (in Russ.)</li> 924 <li>Stepanov VS, Tat'yanchenko VK, Ovsyannikov AV. Kontrastnoe sredstvo dlya zalivki sosudov. Avtorskoe svidetel'stvo â1144703 SSSR. 1985; 6. (in Russ.)</li> 925 <li>Korobka VL, Klets IS, Lageza AB, Korobka RV. Sposob khirurgicheskogo lecheniya obshirnykh posttravmaticheskikh defektov diafragmy. Patent RF â2846270. 2025; 16. (in Russ.)</li> 926 </ol> 927 </div> 928 </div> 929 </div> 930 <div id="tabs-5"> 931 <h2 class="label">Supplementary files</h2> 932 <div id="suppFilesBlock" class="info listing" width="100%"> 933 934<div id="heading" class="heading">Supplementary Files</div> 935<div id="headingActions" class="heading" style="text-align: center;">Action</div> 936 937<div valign="top" class="dark suppFileBlock"> 938 <span>1.</span> 939 <span class="galleyLanguageLabel">JATS XML</span> 940</div> 941<div class="dark action download"> 942 <span><a target="_blank" href="https://vestnik-surgery.com/journal/article/xml/1937" target="_blank">Download</a></span> 943</div> 944<div class="dark action"> 945</div> 946 947 <div valign="top" class="light suppFileBlock"> 948 <span>2.</span> 949 <span>Fig. 1. Test device for studying the biomechanical parameters of tissues: a â general view of the device: б â measuring sensor.</span> 950 <span class="preview"> 951 <div class='preview fancybox' style='text-align: center'><a rel='simplebox' href='/files/journals/1/articles/1937/supp/1937-7252-1-SP.jpg' title='Fig. 1. Test device for studying the biomechanical parameters of tissues: a â general view of the device: б â measuring sensor.'><img style='max-height: 100px; max-width: 100px;' src='/files/journals/1/articles/1937/supp/1937-7252-1-SP.jpg'></a><br></div> 952 </span> 953 </div> 954 955 <div class="light action download"> 956 <span><a target="_blank" href="https://vestnik-surgery.com/journal/article/downloadSuppFile/1937/1525">Download</a> (89KB)</span> 957 </div> 958 959 <div class="light action"> 960 <span><a href="javascript:openRTWindow('https://vestnik-surgery.com/journal/rt/suppFileMetadata/1937/0/1525');">Indexing metadata</a></span> 961 </div> 962 <div valign="top" class="dark suppFileBlock"> 963 <span>
9633.</span> 964 <span>Fig. 2. Diaphragm shape variants in the frontal plane: a â in the form of two domes; b â the domes are not pronounced; c â in the form of one dome.</span> 965 <span class="preview"> 966 <div class='preview fancybox' style='text-align: center'><a rel='simplebox' href='/files/journals/1/articles/1937/supp/1937-7253-1-SP.jpg' title='Fig. 2. Diaphragm shape variants in the frontal plane: a â in the form of two domes; b â the domes are not pronounced; c â in the form of one dome.'><img style='max-height: 100px; max-width: 100px;' src='/files/journals/1/articles/1937/supp/1937-7253-1-SP.jpg'></a><br></div> 967 </span> 968 </div> 969 970 <div class="dark action download"> 971 <span><a target="_blank" href="https://vestnik-surgery.com/journal/article/downloadSuppFile/1937/1526">Download</a> (272KB)</span> 972 </div> 973 974 <div class="dark action"> 975 <span><a href="javascript:openRTWindow('https://vestnik-surgery.com/journal/rt/suppFileMetadata/1937/0/1526');">Indexing metadata</a></span> 976 </div> 977 <div valign="top" class="light suppFileBlock"> 978 <span>4.</span> 979 <span>Fig. 3. Types of anatomical structure of the central tendon.</span> 980 <span class="preview"> 981 <div class='preview fancybox' style='text-align: center'><a rel='simplebox' href='/files/journals/1/articles/1937/supp/1937-7254-1-SP.jpg' title='Fig. 3. Types of anatomical structure of the central tendon.'><img style='max-height: 100px; max-width: 100px;' src='/files/journals/1/articles/1937/supp/1937-7254-1-SP.jpg'></a><br></div> 982 </span> 983 </div> 984 985 <div class="light action download"> 986 <span><a target="_blank" href="https://vestnik-surgery.com/journal/article/downloadSuppFile/1937/1527">Download</a> (155KB)</span> 987 </div> 988 989 <div class="light action"> 990 <span><a href="javascript:openRTWindow('https://vestnik-surgery.com/journal/rt/suppFileMetadata/1937/0/1527');">Indexing metadata</a></span> 991 </div> 992 <div valign="top" class="dark suppFileBlock"> 993 <span>5.</span> 994 <span>Fig. 4. X-ray angiogram of the human diaphragm in the first mature age period of the mesomorphic body type (contrasting according to V.K. Tatyanchenko's method (author's certificate â1144703 [11]), 1 - lower diaphragmatic arteries.</span> 995 <span class="preview"> 996 <div class='preview fancybox' style='text-align: center'><a rel='simplebox' href='/files/journals/1/articles/1937/supp/1937-7255-1-SP.jpg' title='Fig. 4. X-ray angiogram of the human diaphragm in the first mature age period of the mesomorphic body type (contrasting according to V.K. Tatyanchenko's method (author's certificate â1144703 [11]), 1 - lower diaphragmatic arteries.'><img style='max-height: 100px; max-width: 100px;' src='/files/journals/1/articles/1937/supp/1937-7255-1-SP.jpg'></a><br></div> 997 </span> 998 </div> 999 1000 <div class="dark action download"> 1001 <span><a target="_blank" href="https://vestnik-surgery.com/journal/article/downloadSuppFile/1937/1528">Download</a> (107KB)</span> 1002 </div> 1003 1004 <div class="dark action"> 1005 <span><a href="javascript:openRTWindow('https://vestnik-surgery.com/journal/rt/suppFileMetadata/1937/0/1528');">Indexing metadata</a></span> 1006 </div> 1007 <div valign="top" class="light suppFileBlock"> 1008 <span>6.</span> 1009 <span>Fig 5. Superior midline laparotomy, creating a defect in the muscular part of the diaphragm dome measuring 15x10 cm. 1 â diaphragm defect.</span> 1010 <span class="preview"> 1011 <div class='preview fancybox' style='text-align: center'><a rel='simplebox' href='/files/journals/1/articles/1937/supp/1937-7256-1-SP.jpg' title='Fig 5. Superior midline laparotomy, creating a defect in the muscular part of the diaphragm dome measuring 15x10 cm. 1 â diaphragm defect.'><img style='max-height: 100px; max-width: 100px;' src='/files/journals/1/articles/1937/supp/1937-7256-1-SP.jpg'></a><br></div> 1012 </span> 1013 </div> 1014 1015 <div class="light action download"> 1016 <span><a target="_blank" href="https://vestnik-surgery.com/journal/article/downloadSuppFile/1937/1529">Download</a> (134KB)</span> 1017 </div> 1018 1019 <div class="light action"> 1020 <span><a href="javascript:openRTWindow('https://vestnik-surgery.com/journal/rt/suppFileMetadata/1937/0/1529');">Indexing metadata</a></span> 1021 </div> 1022 <div valign="top" class="dark suppFileBlock"> 1023 <span>7.</span> 1024 <span>Fig. 6. Applying U-shaped sutures along the entire perimeter of the diaphragm defect, capturing the frame thread. 1 â diaphragm defect; 2 â U-shaped sutures; 3 â frame thread.</span> 1025 <span class="preview"> 1026 <div class='preview fancybox' style='text-align: center'><a rel='simplebox' href='/files/journals/1/articles/1937/supp/1937-7257-1-SP.jpg' title='Fig. 6. Applying U-shaped sutures along the entire perimeter of the diaphragm defect, capturing the frame thread. 1 â diaphragm defect; 2 â U-shaped sutures; 3 â frame thread.'><img style='max-height: 100px; max-width: 100px;' src='/files/journals/1/articles/1937/supp/1937-7257-1-SP.jpg'></a><br></div> 1027 </span> 1028 </div> 1029 1030 <div class="dark action download"> 1031 <span><a target="_blank" href="https://vestnik-surgery.com/journal/article/downloadSuppFile/1937/1530">Download</a> (130KB)</span> 1032 </div> 1033 1034 <div class="dark action"> 1035 <span><a href="javascript:openRTWindow('https://vestnik-surgery.com/journal/rt/suppFileMetadata/1937/0/1530');">Indexing metadata</a></span> 1036 </div> 1037 <div valign="top" class="light suppFileBlock"> 1038 <span>8.</span> 1039 <span>Fig. 7. The mesh endoprosthesis is stitched with the ends of the U-shaped sutures. 1 â diaphragm defect; 2 â U-shaped sutures; 3 â frame thread; 4 â mesh endoprosthesis.</span> 1040 <span class="preview"> 1041 <div class='preview fancybox' style='text-align: center'><a rel='simplebox' href='/files/journals/1/articles/1937/supp/1937-7258-1-SP.jpg' title='Fig. 7. The mesh endoprosthesis is stitched with the ends of the U-shaped sutures. 1 â diaphragm defect; 2 â U-shaped sutures; 3 â frame thread; 4 â mesh endoprosthesis.'><img style='max-height: 100px; max-width: 100px;' src='/files/journals/1/articles/1937/supp/1937-7258-1-SP.jpg'></a><br></div> 1042 </span> 1043 </div> 1044 1045 <div class="light action download"> 1046 <span><a target="_blank" href="https://vestnik-surgery.com/journal/article/downloadSuppFile/1937/1531">Download</a> (176KB)</span> 1047 </div> 1048 1049 <div class="light action"> 1050 <span><a href="javascript:openRTWindow('https://vestnik-surgery.com/journal/rt/suppFileMetadata/1937/0/1531');">Indexing metadata</a></span> 1051 </div> 1052 <div valign="top" class="dark suppFileBlock"> 1053 <span>9.</span> 1054 <span>Fig. 8. The final stage of the operation. Fixation of the endoprosthesis to the diaphragm defect from the abdominal cavity using a frame thread and U-shaped sutures. 2 â U-shaped sutures; 3 â frame thread, 4 â mesh endoprosthesis, 5 â fixed endoprosthesis using U-shaped sutures and a frame thread.</span> 1055 <span class="preview"> 1056 <div class='preview fancybox' style='text-align: center'><a rel='simplebox' href='/files/journals/1/articles/1937/supp/1937-7259-1-SP.jpg' title='Fig. 8. The final stage of the operation. Fixation of the endoprosthesis to the diaphragm defect from the abdominal cavity using a frame thread and U-shaped sutures. 2 â U-shaped sutures; 3 â frame thread, 4 â mesh endoprosthesis, 5 â fixed endoprosthesis using U-shaped sutures and a frame thread.'><img style='max-height: 100px; max-width: 100px;' src='/files/journals/1/articles/1937/supp/1937-7259-1-SP.jpg'></a><br></div> 1057 </span> 1058 </div> 1059 1060 <div class="dark action download"> 1061 <span><a target="_blank" href="https://vestnik-surgery.com/journal/article/downloadSuppFile/1937/1532">Download</a> (276KB)</span> 1062 </div> 1063 1064 <div class="dark action"> 1065 <span><a href="javascript:openRTWindow('https://vestnik-surgery.com/journal/rt/suppFileMetadata/1937/0/1532');">Indexing metadata</a></span> 1066 </div> 1067 </div>
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