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Video: We Actually Perform The Function Of Military Surgeons - To Return The Wounded To The Ranks
We actually perform the function of military surgeons - to return the wounded to the ranks
Treatment of cancer patients with the participation of a plastic surgeon ceases to be exclusive today. The director of the Cluster Oncology Clinic of the First Moscow State Medical University named after N.I. THEM. Sechenov, Academician of the Russian Academy of Sciences Igor Reshetov.
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Today, when oncologists have learned to save the lives of patients, more and more efforts are directed to preserving its quality, and operations with the participation of a plastic surgeon are no longer exclusive. The director of the Cluster Oncology Clinic, head of the Department of Oncology, Radiotherapy and Plastic Surgery of the First Moscow State Medical University named after M.V. THEM. Sechenov, Academician of the Russian Academy of Sciences Igor Reshetov.
Igor Vladimirovich, you are the head of the Department of Oncology, Radiotherapy and Plastic Surgery. For an uninitiated person who associates plastic surgery with a desire to improve their appearance or stop aging, this combination seems strange
- Today, the effectiveness of treatment is understood as an increase in life expectancy and its quality. And for most tumors, this quality is associated with the process of reconstructive plastic surgery. Even a special term has been formed - oncoplasty. It is truly unusual for our ear, but it has a profound implication for a synergistic approach to treatment and recovery. This is the imperative of the times, thanks to new trends, our patients return to full life. We actually perform the function of military surgeons - to return the wounded to the ranks. And, of course, this is not an easy multifactorial task that requires, among other things, a personalized approach.
Personalized medicine, as pleasant as it sounds for patients, is a very difficult task for doctors. Especially today, when medicine is more and more standardized. Is it possible to combine such a forcedly creative approach and standardization, are there no contradictions here?
- I think there are no contradictions, because the more standards there are, the wider the choice for doctors will be for doctors. But this is if we talk about the level of municipal or specialized medical care. And in federal research centers, such as our university, there is a statutory right to conduct additional developmental research. That is, we can provide help to people according to the newest, so-called, research protocols. And this is where the creative approach is realized to the greatest extent and the possibility of a personalized approach increases many times over.
This spring, you were awarded the RF Government Science and Technology Prize for your work "Scientific substantiation, development and implementation into clinical practice of modern, effective and efficient methods of rehabilitation of patients with socially significant dental diseases." In particular, they talked about the rehabilitation of patients with severe injuries and deformities in the maxillofacial region and impaired appearance.
- Fortunately, now Russia is not conducting large-scale hostilities, so there are few patients with avulsion wounds, but, unfortunately, there are many cancer patients. And the main group of patients, in which we demonstrated these technologies, just became patients after treatment of oncological diseases.
Our team of authors includes representatives of various institutions. Each of us is a bearer of certain knowledge and technologies, when combined, the technological circle is formed, which allows us to achieve a high level of patient rehabilitation. So, our university has a prototyping machine that allows us to create models of the highest degree of fit. The team that works at the Dental University. Evdokimova, realizes these models with the highest accuracy into real objects, for example, in the form of casting. In addition to doctors, our multidisciplinary team includes physicists, mathematicians, specialists in IT technologies, as well as in materials science - the most complex science that allows us to achieve biocompatibility of the implant material with human tissues.
We have worked out the issues of restoring the jaws, creating a good appearance, and the next stage is their orthopedic rehabilitation. Indeed, I had to follow new paths, because this is already a changed surgical anatomy - completely different ratios of sizes, proportions of bones. To restore the full symmetrical oval of the lower jaw, it was necessary to come up with unusual forms of dental implantation, devices and apparatus for augmentation and correction of bones.
What are these apparatus and devices?
- We are talking about individual development of the same implants using additive technologies of individual selection of casting, 3D printing. They are needed in order to achieve the so-called symmetrical positions of the bases of the prostheses for loading them with the already dentition. In addition, this is the selection of variations of polymer materials, in fact, the transition to composite materials. Today, using composite materials, not only aircraft or missiles are built, but also people. Such materials make it possible to achieve biosimilarity or similarity to the natural state. And our technologies allow you to achieve complete biointegration of the transplanted part.
Metals, polymers, silicones, and high-quality caloric materials are used, thanks to which the transitions between living and non-living tissue in the case of complex orthopedic structures become absolutely invisible. All this is based on high quality sustainable plastics. First of all, on transplanted autologous bones, which create the basis for subsequent rehabilitation and virtually complete recovery of a person, right up to the return to work. The most important thing in this case is the comfortable state of a person who feels that he is not flawed, can smile with a full smile, can eat with everyone, and no one will even guess what difficult trials in life he had to go through.
Are your own fabrics still the main restoration material?
- Yes. Today, plastic is beginning to replace prostheses. The logic of going forward is that the patient should not depend on consumables. A hand-made construction made of its own fabric is more reliable, it is always with the patient and does not require replacement. With it, there will be no graft versus host reaction. So, we found a surgical solution that makes expensive voice prostheses unnecessary - we managed to make a sound-conducting tube from the patient's own tissue. Or take the mammary gland, for example. If the patient's constitution allows removing excess tissue from one place (for example, the anterior abdominal wall, lateral thighs, buttocks) and at the same time reconstructing the volume and shape of the lost gland, then we get two in one: contour plasty and the acquisition of a new organ. Its own fabric - it is its own,it really creates maximum comfort both in sensations and in reaction to cold or heat. And this is possible only if you have your own tissue regulated by hormones and blood circulation.
And, perhaps, living tissue is especially important in rehabilitation after mutilation operations in the head and neck area? A unique operation to reconstruct the oral cavity with a free flap was broadcast at the master class held as part of the last week of Oncology at Pirogovka
- This is one of the most important parts of recovery, because if the oral cavity of a person is not closed, and he can neither eat nor talk, then ultimately this will lead to the fact that he will become asocial. Therefore, it is so important to select a good bioplastic material to restore the state of the norm. If it is necessary, for example, to restore the entire tongue, a free flap is taken from the reinnervated muscle. If we are talking about the palate or about the cheek, then it can be the skin of the shoulder, forearm, outer or inner thigh with a section of the sensitive nerve.
We call such transplants functional, since we restore in them not only blood circulation, but also innervation, so that a person does not have “dumb zones” in the future. That is, so that he adequately perceives the temperature and density of food, does not burn himself, does not prick himself with a fork. We have not yet managed to achieve taste sensitivity, but we restore all other types of sensitivity, the oral cavity begins to act as an organ, and people become very comfortable.
The Cluster Oncology Clinic deals with the treatment of malignant neoplasms in the most complex and large-scale nosologies and has become the basis for training and retraining of specialists. In the fall, during a discussion of the professional standard for the profession, you supported an increase in the period of study in a plastic surgery residency
- Regardless of the specific medical specialty, a person becomes a full-fledged specialist somewhere by the fifth year of study. Previously, it looked like an internship followed by a graduate school. But graduate school was not convenient for everyone, because more work on a dissertation was required. And the graduates of the residency became purely professional artisans. Therefore, willy-nilly, we came to the conclusion that the period of residency should be longer than two years. Today, at the transitional stage, we have reached a three-year cycle. And a number of professions, for example, neurosurgery, plastic surgery, are trying to immediately switch to a five-year cycle.
Maybe, then, it is worthwhile to divide plastic surgery into aesthetic and reconstructive, and make the residency different in duration?
- You can, of course, release a surgeon from the residency only for appendicitis or only for autoplasty, but this is wrong. We must train fully qualified specialists. And after receiving their diploma, they will choose what they like.
The problem here is different: today a resident, as a student, has no right to work according to his profile and receive a salary for it. And it is impossible to live in our country for five years on a scholarship. Now there is a proposal to make the residency in two stages. So that after completing the first stage of training in a year or two, the resident received the opportunity to get a job in his specialty (as a doctor's assistant, on duty) and could afford to continue his studies.
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