Introduction. Small intestine atresia is one of the most common causes of low bowel obstruction in newborns. Mortality in this pathology ranges from 5 to 60%, depending on the country. Modern views about surgical correction are rather contradictory. Purpose. To analyze the surgical treatment of small intestine atresia in the surgical department of the City Children’s Hospital No. 1 ССH) (Chernivtsi, Ukraine) and the surgical department Saint Damien Pediatric Hospital NPH (SDH) (Port-o-Prence, Haiti). To determine the best methods of surgery. Materials and methods. The surgical treatment of 15 children under the conditions of SDH (Haiti) and 12 children under conditions of the city children’s clinical hospital (CCH, Chernivtsi) with atresia of the small intestine was analyzed. Determined the effectiveness of closed (oblique «end-to-end» anastomosis, taping with «end-to-end» anastomosis, Denis-Brown and Louw anastomoses), discharging (U- and T-shaped, taping with anostomosing and suspended proximal enterostoma), anastomoses and stomas (end, double, according to Mikulich). Mortality with limited parenteral nutrition was 40% (SDH), with the presence of parenteral nutrition – 33.33% (ССH, Chernivtsi). Results. According to the analyzed data, we believe that the use of the method of surgical treatment should correspond to the type of atresia, the distance of the blind proximal end from the Treitz ligament, the difference in the diameters of the adducting and abducting sections, the possibility of parenteral nutrition, and the threat of short bowel syndrome (SCS). Conclusions. Y-shaped discharging anastomosis «side-to-side» with the removal of the proximal area in the form of a stoma, can be the method of choice in case of significant difference between the intestinal diameters. It provides a wide area of the small bowel junction, chyme abduction until the fistula heals, and can be used for different types of small bowel atresia. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of participating institution. The informed consent of the patient was obtained for conducting the studies. Keywords: small intestine atresia, surgical treatment, children.

Introduction. Diseases that are accompanied by significant cutaneous-subcutaneous-fascial defects during surgery in children include: pilonidal cyst (PC), spinal hernia (SH), Fournier’s gangrene and wounds. Various methods of surgical treatment of PC consist of the stages: removal of the cyst and covering the wound surface with suturing or leaving the wound surface open. The existing methods of covering a defect in SH in children cannot satisfy surgeons, because they are accompanied by significant tissue tension, which causes complications. Fournier’s gangrene in children is a rare disease with a large area of soft tissue damage. Initial surgical debridement of wounds in childhood requires an individual approach with the choice of the correct method to close the defect. Purpose. To study the possibilities of using the rotation of vascularized cutaneous-subcutaneous-fascial flap (CSFF) for the surgical treatment of superficial defects in children. Materials and methods. The surgical treatment of superficial defects in 73 children in a City Children’s Hospital (Chernivtsi) with PC (29 children), SH (20 children), wounds of the face, limbs and trunk (23 children), Fournier gangrene (1 child) was analyzed. We compared the performing of traditional methods of treatment and rotational methods of using CSFF. Recovery time and postoperative complications were analyzed. Results. By using traditional methods of treating PC, complications were observed in 50%, when using the proposed plastic surgery with rotational CSFF in 6.67%; in case of SH – in 44.44% and 18.18%, with wounds – in 27.27% and 8.33%, respectively. Plastic reconstruction in Fournier’s gangrene recovered on the 40th day of the postoperative period. Conclusion. The use of cutaneous-subcutaneous-fascial rotational flap with perforating vessels surgery allows to reduce the amount of complications after operations for PC, SH, initial surgical debridement of wounds, Fournier’s gangrene. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of participating institution. The informed consent of the patient was obtained for conducting the studies. Key words: cutaneous-subcutaneous-fascial flaps, superficial defects, children.

152Клінічна анатомія та оперативна хірургія -Т.

клінічний випадок тяжкої полтравми, що ускладнений спайковою хворобою у дитини з діагнозом: проникаюче поранення органів черевної порожнини. Пошкодження тонкого та товстого кишок. Відрив бокової поверхні таза та стегна зліва, травматична ампутація лівої клубової кістки та лівої стегнової кістки. Перелом лобкової та сідничної кісток справа. Перелом тіл S5-L1 хребців. Геморрагічний шок ІІІ ступеня. Гіповолемічний шок ІІІ ступеня. Травматичний шок. Післяопераційний період ускладнився: гнійно-некротичною раною бокової поверхні черевної стінки та сформованої культі; некротичним фасціоцелюлітом та міозитом; раневим сепсисом; септикопіємією; порушенням всмоктування та синдромом короткої петлі. Обгрунтовані основні принципи хірургічного лікування пацієнта. Виявлена трьохетапність надання допомоги: І етап-збереження життя; ІІ-корекція ускладнень політравми та спайкової хвороби; ІІІ-відновлення функції ушкоджених органів. Ключові слова: спайкова хвороба, політравма, хірургічне лікування, діти.

No abstract