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5	<title>Experimental validation of the original technique for plastic surgery of extensive posttraumatic diaphragm defects - Korobka - Journal of Experimental and Clinical Surgery</title>
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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="Экспериментальное обоснование оригинальной методики пластики обширных посттравматических дефектов диафрагмы"/>
12		<meta name="description" xml:lang="ru" lang="ru" content="Экспериментальное обоснование оригинальной методики пластики обширных посттравматических дефектов диафрагмы"/>
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&amp;lt; 0.05), regardless of the patients&#039; 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="  Актуальность.    По данным современных исследований, в том числе при применении полипропиленовой сетки, частота рецидивов после пластики диафрагмы при травматических, врождённых и послеоперационных дефектах широко варьирует — от 2% до 30% и более. 
19  Цель.    Оценка морфологических и биомеханических характеристик мышечно-апоневротических структур диафрагмы в аспекте применения оригинальной хирургической методики лечения пациентов с обширными посттравматическими дефектами диафрагмы. 
20  Методы.    Проведено анатомо-морфологическое и биомеханическое исследование 36 трупов людей обоего пола трех возрастных групп (молодого, среднего, преклонного возрастов) и различных соматотипов. На испытательном стенде ИСС-500 оценивали форму и размеры диафрагмы и сухожильного центра, параметры сети гемомикроциркуляторного русла, а также предел прочности и модуль упругости. Отдельно исследованы 12 препаратов диафрагмы после моделирования обширного дефекта и его пластики по оригинальной методике. Статистический анализ данных проводили с использованием программы Statistica 10 (StatSoft, США). 
21  Результаты.    Выявлены соматотип-ассоциированные варианты формы купола и сухожильного центра диафрагмы, а также половые различия её размеров (у мужчин значения сагиттального и фронтального размеров в целом больше, максимальные - при брахиморфном и мезоморфном типах). В среднем и преклонном возрасте отмечено снижение плотности их сосудистой сети гемомикроциркуляторного русла и тенденция к уменьшению прочностно-упругих характеристик тканей. В эксперименте оригинальная ненатяжная фиксация сетчатого эндопротеза с укреплением лиÐ
21½Ð¸Ð¸ П-образных швов каркасной нитью обеспечила увеличение предела прочности на 71,95% и модуля упругости на 70,41% по сравнению с нативными препаратами диафрагмы (p&amp;lt; 0,05), независимо от соматотипа и возраста пациентов. 
22  Заключение.    Возрастные и анатомические особенности диафрагмы следует учитывать при планировании реконструкции; предложенная методика усиливает линию фиксации полипропиленовой сетки и повышает биомеханическую надежность пластики обширных посттравматических дефектов. "/>
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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="диафрагма; мышечно-фасциальные структуры; посттравматическая диафрагмальная грыжа; дефект диафрагмы"/>
26	
27	
28	<meta property="og:title" content="Experimental validation of the original technique for plastic surgery of extensive posttraumatic diaphragm defects" />
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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" />
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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="Коробка Роман Вячеславович"/>
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="Клец Иван Сергеевич"/>
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="Коробка Вячеслав Леонидович"/>
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="Татьянченко Владимир Константинович"/>
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="Лагеза Аркадий Борисович"/>
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="Гончар Михаил Викторович"/>
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="Дударев Сергей Игоревич"/>
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&amp;lt; 0.05), regardless of the patients&#039; 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&amp;lt; 0.05), regardless of the patients&#039; 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="  Актуальность.    По данным современных исследований, в том числе при применении полипропиленовой сетки, частота рецидивов после пластики диафрагмы при травматических, врождённых и послеоперационных дефектах широко варьирует — от 2% до 30% и более. 
71  Цель.    Оценка морфологических и биомеханических характеристик мышечно-апоневротических структур диафрагмы в аспекте применения оригинальной хирургической методики лечения пациентов с обширными посттравматическими дефектами диафрагмы. 
72  Методы.    Проведено анатомо-морфологическое и биомеханическое исследование 36 трупов людей обоего пола трех возрастных групп (молодого, среднего, преклонного возрастов) и различных соматотипов. На испытательном стенде ИСС-500 оценивали форму и размеры диафрагмы и сухожильного центра, параметры сети гемомикроциркуляторного русла, а также предел прочности и модуль упругости. Отдельно исследованы 12 препаратов диафрагмы после моделирования обширного дефекта и его пластики по оригинальной методике. Статистический анализ данных проводили с использованием программы Statistica 10 (StatSoft, США). 
73  Результаты.    Выявлены соматотип-ассоциированные варианты формы купола и сухожильного центра диафрагмы, а также половые различия её размеров (у мужчин значения сагиттального и фронтального размеров в целом больше, максимальные - при брахиморфном и мезоморфном типах). В среднем и преклонном возрасте отмечено снижение плотности их сосудистой сети гемомикроциркуляторного русла и тенденция к уменьшению прочностно-упругих характеристик тканей. В эксперименте оригинальная ненатяжная фиксация сетчатого эндопротеза с укреплением лиÐ
73½Ð¸Ð¸ П-образных швов каркасной нитью обеспечила увеличение предела прочности на 71,95% и модуля упругости на 70,41% по сравнению с нативными препаратами диафрагмы (p&amp;lt; 0,05), независимо от соматотипа и возраста пациентов. 
74  Заключение.    Возрастные и анатомические особенности диафрагмы следует учитывать при планировании реконструкции; предложенная методика усиливает линию фиксации полипропиленовой сетки и повышает биомеханическую надежность пластики обширных посттравматических дефектов. "/>
75		<meta name="DC.Abstract" xml:lang="ru" lang="ru" content="  Актуальность.    По данным современных исследований, в том числе при применении полипропиленовой сетки, частота рецидивов после пластики диафрагмы при травматических, врождённых и послеоперационных дефектах широко варьирует — от 2% до 30% и более. 
76  Цель.    Оценка морфологических и биомеханических характеристик мышечно-апоневротических структур диафрагмы в аспекте применения оригинальной хирургической методики лечения пациентов с обширными посттравматическими дефектами диафрагмы. 
77  Методы.    Проведено анатомо-морфологическое и биомеханическое исследование 36 трупов людей обоего пола трех возрастных групп (молодого, среднего, преклонного возрастов) и различных соматотипов. На испытательном стенде ИСС-500 оценивали форму и размеры диафрагмы и сухожильного центра, параметры сети гемомикроциркуляторного русла, а также предел прочности и модуль упругости. Отдельно исследованы 12 препаратов диафрагмы после моделирования обширного дефекта и его пластики по оригинальной методике. Статистический анализ данных проводили с использованием программы Statistica 10 (StatSoft, США). 
78  Результаты.    Выявлены соматотип-ассоциированные варианты формы купола и сухожильного центра диафрагмы, а также половые различия её размеров (у мужчин значения сагиттального и фронтального размеров в целом больше, максимальные - при брахиморфном и мезоморфном типах). В среднем и преклонном возрасте отмечено снижение плотности их сосудистой сети гемомикроциркуляторного русла и тенденция к уменьшению прочностно-упругих характеристик тканей. В эксперименте оригинальная ненатяжная фиксация сетчатого эндопротеза с укреплением линии П-образных швов каркасной нитью обеспечила увеличение предела прочности на 71,95% и модуля упругости на 70,41% по сравнению с нативными препаратами диафрагмы (p&amp;lt; 0,05), независимо от соматотипа и возраста пациентов. 
79  Заключение.    Возрастные и анатомические особенности диафрагмы следует учитывать при планировании реконструкции; предложенная методика усиливает линию фиксации полипропиленовой сетки и повышает биомеханическую надежность пластики обширных посттравматических дефектов. "/>
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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"/>
86	<meta name="DC.Identifier.URI" content="https://vestnik-surgery.com/journal/article/view/1937"/>
87	<meta name="DC.Language" scheme="ISO639-1" content="en"/>
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89			<meta name="DC.Rights" content="Voronezh N.N. Burdenko State Medical University, 2026" xml:lang="en" lang="en" copyrightHolder="Voronezh N.N. Burdenko State Medical University" copyrightYear="2026" />
90				<meta name="DC.Rights" content="ФГБОУ ВО ВГМУ им. Н.Н. Бурденко Минздрава России, 2026" xml:lang="ru" lang="ru" copyrightHolder="ФГБОУ ВО ВГМУ им. Н.Н. Бурденко Минздрава России" copyrightYear="2026" />
91		<meta name="DC.Rights" content="https://vestnik-surgery.com/journal/about/editorialPolicies"/>
92			<meta name="DC.Source" xml:lang="en" lang="en" content="Journal of Experimental and Clinical Surgery"/>
93				<meta name="DC.Source" xml:lang="ru" lang="ru" content="Вестник экспериментальной и клинической хирургии"/>
94			<meta name="DC.Source.ISSN" content="2409-143X"/>
95	<meta name="DC.Source.URI" content="https://vestnik-surgery.com/journal"/>
96	<meta name="DC.Source.Issue" content="2"/>
97	<meta name="DC.Source.Volume" content="19"/>
98
99			<meta name="DC.Subject" xml:lang="en" lang="en" content="diaphragm"/>
100				<meta name="DC.Subject" xml:lang="en" lang="en" content="muscular-fascial structures"/>
101				<meta name="DC.Subject" xml:lang="en" lang="en" content="post-traumatic diaphragmatic hernia"/>
102				<meta name="DC.Subject" xml:lang="en" lang="en" content="diaphragm defect"/>
103				<meta name="DC.Subject" xml:lang="ru" lang="ru" content="диафрагма"/>
104				<meta name="DC.Subject" xml:lang="ru" lang="ru" content="мышечно-фасциальные структуры"/>
105				<meta name="DC.Subject" xml:lang="ru" lang="ru" content="посттравматическая диафрагмальная грыжа"/>
106				<meta name="DC.Subject" xml:lang="ru" lang="ru" content="дефект диафрагмы"/>
107	
108			<meta name="DC.Title" xml:lang="en" lang="en" content="Experimental validation of the original technique for plastic surgery of extensive posttraumatic diaphragm defects"/>
109		<meta name="DC.Title.Alternative" xml:lang="en" lang="en" content="Experimental validation of the original technique for plastic surgery of extensive posttraumatic diaphragm defects"/>
110				<meta name="DC.Title" xml:lang="ru" lang="ru" content="Экспериментальное обоснование оригинальной методики пластики обширных посттравматических дефектов диафрагмы"/>
111		<meta name="DC.Title.Alternative" xml:lang="ru" lang="ru" content="Экспериментальное обоснование оригинальной методики пластики обширных посттравматических дефектов диафрагмы"/>
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118			<meta name="citation_journal_title" xml:lang="en" lang="en" content="Journal of Experimental and Clinical Surgery"/>
119				<meta name="citation_journal_title" xml:lang="ru" lang="ru" content="Вестник экспериментальной и клинической хирургии"/>
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121		<meta name="citation_issn" content="2409-143X"/>
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123																					<meta name="citation_author" xml:lang="en" lang="en" content="Roman  V. Korobka"/>
124									
125															<meta name="citation_author_institution" xml:lang="en" lang="en" content="Rostov State Medical University; Rostov Regional Clinical Hospital"/>
126																											<meta name="citation_author" xml:lang="ru" lang="ru" content="Коробка Роман Вячеславович"/>
127									
128															<meta name="citation_author_institution" xml:lang="ru" lang="ru" content="Ростовский государственный медицинский университет; Ростовская областная клиническая больница"/>
129																																			<meta name="citation_author" xml:lang="en" lang="en" content="Ivan  S. Klets"/>
130									
131															<meta name="citation_author_institution" xml:lang="en" lang="en" content="Rostov State Medical University; Rostov Regional Clinical Hospital "/>
132																											<meta name="citation_author" xml:lang="ru" lang="ru" content="Клец Иван Сергеевич"/>
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790        <a href="https://vestnik-surgery.com/journal/issue/view/81" target="_parent">Vol 19, No 2 (2026)</a> &gt;                                <a href="https://vestnik-surgery.com/journal/article/view/1937" class="current" target="_parent">Experimental validation of the original technique for plastic surgery of extensive posttraumatic diaphragm defects</a>
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794<div id="content">
795
796	
797                                
798                <article class="article">
799                    <h1>Experimental validation of the original technique for plastic surgery of extensive posttraumatic diaphragm defects</h1>
800                    <div class="topBlock">
801                        <div class="preview fancybox">
802									<a rel="simplebox" href="https://vestnik-surgery.com/public/journals/1//cover_issue_81_en_US.png" title="Vol 19, No 2 (2026)"><img src="https://vestnik-surgery.com/public/journals/1//thumbnail_cover_issue_81_en_US.webp" alt="Cover Page"/></a>				                        </div>
803			<div class="titleAuthors">
804                        <ul>
805									<li><b>Authors: </b>
806												<a target="_blank" href="https://vestnik-surgery.com/journal/search/authors/view?firstName=Roman%20&amp;middleName=V.&amp;lastName=Korobka">Korobka R.V.</a><sup>1</sup><sup>,2</sup>, <a target="_blank" href="https://vestnik-surgery.com/journal/search/authors/view?firstName=Ivan%20&amp;middleName=S.&amp;lastName=Klets">Klets I.S.</a><sup>1</sup><sup>,2</sup>, <a target="_blank" href="https://vestnik-surgery.com/journal/search/authors/view?firstName=Vyacheslav%20&amp;middleName=L.&amp;lastName=Korobka">Korobka V.L.</a><sup>1</sup><sup>,2</sup>, <a target="_blank" href="https://vestnik-surgery.com/journal/search/authors/view?firstName=Vladimir%20&amp;middleName=K.&amp;lastName=Tatyanchenko">Tatyanchenko V.K.</a><sup>1</sup>, <a target="_blank" href="https://vestnik-surgery.com/journal/search/authors/view?firstName=Arkady&amp;middleName=B.&amp;lastName=Lageza">Lageza A.B.</a><sup>1</sup><sup>,2</sup>, <a target="_blank" href="https://vestnik-surgery.com/journal/search/authors/view?firstName=Mikhail&amp;middleName=V.&amp;lastName=Gonchar">Gonchar M.V.</a><sup>1</sup><sup>,2</sup>, <a target="_blank" href="https://vestnik-surgery.com/journal/search/authors/view?firstName=Sergey%20&amp;middleName=I.&amp;lastName=Dudarev">Dudarev S.I.</a><sup>1</sup><sup>,2</sup>					</li>
807											<li>
808							<b>Affiliations: </b>
809							<ol>
810																	<li style="list-style-image: none;">Rostov State Medical University</li>
811																	<li style="list-style-image: none;">Rostov Regional Clinical Hospital</li>
812															</ol>
813						</li>
814													<li><b>Issue: </b>Vol 19, No 2 (2026)</li>				<li><b>Pages: </b>61-68</li>				<li><b>Section: </b>
815											<a href="https://vestnik-surgery.com/journal/browseSearch/sections/view?sectionId=6">Original articles</a>
816										</li>
817																	                        <li><b>URL:</b> <a href="https://vestnik-surgery.com/journal/article/view/1937">https://vestnik-surgery.com/journal/article/view/1937</a></li>
818								        				                				        				        						<li><b>DOI:</b> <a id="pub-id::doi" href="https://doi.org/10.18499/2070-478X-2026-19-2-61-68">https://doi.org/10.18499/2070-478X-2026-19-2-61-68</a></li>
819													        				                				        				        								<li><b>ID:</b> 1937</li>
820							</ul>
821
822																																																				
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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&amp;middleName=V.&amp;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:&nbsp;<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&amp;middleName=S.&amp;lastName=Klets">Ivan  S. Klets</a></h3>
891												Rostov State Medical University; Rostov Regional Clinical Hospital 						<p style="padding-top: 10px;">
892														Email:&nbsp;<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&amp;middleName=L.&amp;lastName=Korobka">Vyacheslav  L. Korobka</a></h3>
894												Rostov State Medical University; Rostov Regional Clinical Hospital						<p style="padding-top: 10px;">
895														Email:&nbsp;<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&amp;middleName=K.&amp;lastName=Tatyanchenko">Vladimir  K. Tatyanchenko</a></h3>
897												Rostov State Medical University						<p style="padding-top: 10px;">
898														Email:&nbsp;<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&amp;middleName=B.&amp;lastName=Lageza">Arkady B. Lageza</a></h3>
900												Rostov State Medical University; Rostov Regional Clinical Hospital						<p style="padding-top: 10px;">
901														Email:&nbsp;<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&amp;middleName=V.&amp;lastName=Gonchar">Mikhail V. Gonchar</a></h3>
903												Rostov State Medical University; Rostov Regional Clinical Hospital						<p style="padding-top: 10px;">
904														Email:&nbsp;<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&amp;middleName=I.&amp;lastName=Dudarev">Sergey  I. Dudarev</a></h3>
906												Rostov State Medical University; Rostov Regional Clinical Hospital						<p style="padding-top: 10px;">
907														Email:&nbsp;<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 М, 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 № 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 №2271740. 2006; 8. (in Russ.)</li>
924																			<li>Stepanov VS, Tat'yanchenko VK, Ovsyannikov AV. Kontrastnoe sredstvo dlya zalivki sosudov. Avtorskoe svidetel'stvo №1144703 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 №2846270. 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&nbsp;XML</span>
940</div>
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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 – general view of the device: б – 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 – general view of the device: б – 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>
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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 – in the form of two domes; b – the domes are not pronounced; c – 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 – in the form of two domes; b – the domes are not pronounced; c – 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>
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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
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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 №1144703 [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&#039;s method (author&#039;s certificate №1144703 [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
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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 – 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 – 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>
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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 – diaphragm defect; 2 – U-shaped sutures; 3 – 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 – diaphragm defect; 2 – U-shaped sutures; 3 – 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
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1032		</div>
1033
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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 – diaphragm defect; 2 – U-shaped sutures; 3 – frame thread; 4 – 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 – diaphragm defect; 2 – U-shaped sutures; 3 – frame thread; 4 – 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
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1046			<span><a target="_blank" href="https://vestnik-surgery.com/journal/article/downloadSuppFile/1937/1531">Download</a>&nbsp;(176KB)</span>
1047		</div>
1048
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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 – U-shaped sutures; 3 – frame thread, 4 – mesh endoprosthesis, 5 – 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 – U-shaped sutures; 3 – frame thread, 4 – mesh endoprosthesis, 5 – 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>
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1063
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1079		Copyright (c) 2026 Voronezh N.N. Burdenko State Medical University
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