Contents
Chapter I.
GENERAL PROBLEMS OF TOPOGRAPHICAL ANATOMY AND OPERATIVE SURGERY ............................................................................................................................... 8
Medical and Anatomical Terminology ..................................................................................... 9
Directional Terms ................................................................................................................. 10
Classification of Operations................................................................................................. 12
Stages of Surgical Operation............................................................................................... 13
Surgical Instruments and Rules of Their Use ........................................................................ 16
General Principles of Pediatric Anatomy:............................................................................. 24
Types of Suture Material ...................................................................................................... 24
Suturing Apparatus .............................................................................................................. 25
Anesthesia .......................................................................................................................... 25
The use of Laser, Ultrasound and Adhesive Agents in Applied Medicine ............................ 28
Methods of Temporal and Definitive Haemostasis .............................................................. 29
The Principles of Primary Surgical Treatment of Wound (Initial dbridement, Initial Handling) 29
Questions for Self-Control .................................................................................................... 30
Chapter 2
HEAD .................................................................................................................................. 31
Cerebral Part of the Head (the Skull) ................................................................................... 31
Temporal Region ................................................................................................................. 36
Mastoid Region ................................................................................................................... 36
Meninges of the Brain .......................................................................................................... 37
The Brain ............................................................................................................................. 40
Base of the Skull .................................................................................................................. 43
Operations on the Head....................................................................................................... 47
Primary Surgical Treatment of cranial wounds ..................................................................... 47
Trepanation of the Skull (Craniotomy) .................................................................................. 47
Antrotomy (Mastoid Process Trepanation)........................................................................... 49
Suboccipital Puncture .......................................................................................................... 49
Gamma Knife Radiosurgery ................................................................................................ 49
Facial Part of the Head ........................................................................................................ 49
Buccal Region ..................................................................................................................... 49
Parotidomasseter Region.................................................................................................... 52
The Parotid Gland................................................................................................................ 53
Profound Facial Region ....................................................................................................... 54
Operative Surgery of the Facial Region ............................................................................... 55
The Features of Facial Wounds ........................................................................................... 55
Soft Tissue Injuries ............................................................................................................... 56
Questions for Self-Control .................................................................................................... 56
Chapter 3
NECK.................................................................................................................................. 57
Areas of the Neck ................................................................................................................ 57
Fascias of the Neck ............................................................................................................. 58
Spaces of the Neck ............................................................................................................. 59
Sternocleidomastoid Region ............................................................................................... 60
Triangles of the Neck ........................................................................................................... 61
Lymphatics and the Right and Left Thoracic Lymphatic Ducts .............................................. 63
Lymphatic Structures of the Neck ......................................................................................... 65
Tonsils.................................................................................................................................. 65
Pharynx ................................................................................................................................ 66
Larynx .................................................................................................................................. 70
Trachea ............................................................................................................................... 75
Thyroid Gland ...................................................................................................................... 75
Parathyroid Glands .............................................................................................................. 78
Cervical Esophagus ............................................................................................................ 78
Operative Surgery of the Neck ............................................................................................. 79
Incisions in the Neck ............................................................................................................ 79
Cricothyroidotomy................................................................................................................ 81
Tracheostomy ...................................................................................................................... 82
Subtotal Subcapsular Resection of theThyroid Gland (Strumectomy) according to Nikolayev 86
Primary Surgical Treatment of the Short Wounds of the Neck ............................................. 86
Opening of Phlegmons of the Neck...................................................................................... 87
The Vago-Sympathetic Block by Vishnevskyi ...................................................................... 87
Cervical Plexus Block .......................................................................................................... 87
Brachial Plexus Block .......................................................................................................... 87
Ligation of the Common and External Carotid Arteries ........................................................ 87
Ligation of the Lingual Artery................................................................................................ 88
Questions for Self-Control .................................................................................................... 88
Chapter 4
THORAX............................................................................................................................. 89
Structure of the Thoracic Wall............................................................................................... 89
The Regions of the Thorax ................................................................................................... 93
Layers of the Thoracic Wall .................................................................................................. 93
Superficial Layer of the Thoracic Wall ................................................................................. 93
Mammary Gland .................................................................................................................. 93
Medium Layer of the Thoracic Wall ...................................................................................... 96
Deep Layer of the Thorax .................................................................................................... 96
Diaphragm ........................................................................................................................ 101
The Thoracic Cavity ........................................................................................................... 103
Mediastinum ...................................................................................................................... 103
Pleurae .............................................................................................................................. 103
Trachea ............................................................................................................................. 104
Principal Bronchi ............................................................................................................... 105
Lungs ................................................................................................................................. 105
Pericardium ....................................................................................................................... 108
Heart.................................................................................................................................. 109
Esophagus ........................................................................................................................ 117
Thymus .............................................................................................................................. 118
Large Arteries of the Thorax............................................................................................... 118
Lymph Nodes and Vessels of the Thorax ........................................................................... 120
Nerves of the Thorax .......................................................................................................... 121
Operative Surgery of Thorax .............................................................................................. 124
Operations on the Thoracic Wall ........................................................................................ 124
Chest Wound ..................................................................................................................... 124
Types of Pneumothorax and Techniques of their Treatment ................................................ 124
Primary Surgical Treatment of the Penetrating Wound of the Thoracic Wall ....................... 124
Thoracostomy .................................................................................................................... 125
Thoracotomy ...................................................................................................................... 125
Posterolateral Thoracotomy Incision .................................................................................. 125
Rib excision ....................................................................................................................... 129
Orerations on the Mammary Gland .................................................................................... 129
Operations on the Lungs .................................................................................................... 130
Operations on the Heart..................................................................................................... 131
Suturing of the Heart Wounds ............................................................................................ 131
Intercostal Nerve block ....................................................................................................... 131
Sternum and Marrow Biopsy.............................................................................................. 132
Questions for Self-Control .................................................................................................. 132
Chapter 5
ABDOMEN ....................................................................................................................... 133
 Abdominal Wall ................................................................................................................. 133
Surface Anatomy and Anatomical Landmark of the Abdominal Wall................................... 134
Regions of the Abdomen ................................................................................................... 134
Layer-by-layer Structure of the Anterolateral Abdominal Wall ............................................. 135
Inguinal Region .................................................................................................................. 142
Inguinal Canal .................................................................................................................... 142
Surgical Anatomy of Abdominal Hernia .............................................................................. 146
Femoral Hernia.................................................................................................................. 149
Abdominal Viscera ............................................................................................................ 150
Esophagus (Abdominal Portion)........................................................................................ 150
Stomach ............................................................................................................................ 150
Small Intestine ................................................................................................................... 153
Large Intestine ................................................................................................................... 157
Liver .................................................................................................................................. 161
Bile Ducts .......................................................................................................................... 165
Gallbladder ........................................................................................................................ 166
Pancreas ........................................................................................................................... 166
Spleen ............................................................................................................................... 169
Retroperitoneal Space....................................................................................................... 169
Blood supply of the Gastrointestinal Tract .......................................................................... 169
Peritoneum and Peritoneal Cavity ..................................................................................... 173
Operative Surgery of the Abdomen .................................................................................... 176
Surgical Incisions in the Anterior Abdominal Wall ............................................................... 176
Pathogenesis of Groin Hernias and Principles of Their Repair .......................................... 184
Operative treatment of Indirect Inguinal hernia.................................................................... 186
Operative treatment of direct inguinal hernia ...................................................................... 198
Repair of Umbilical Hernia ................................................................................................. 203
Ventral Hernia .................................................................................................................... 207
Operative Surgery of the Stomach ..................................................................................... 211
Operative surgery of the Bowel .......................................................................................... 234
Operative surgery of the Large Intestine............................................................................. 241
Appendectomy .................................................................................................................. 245
Operative Surgery of the Liver ........................................................................................... 249
Surgery of the Biliary Tract ................................................................................................. 253
Surgery of the Pancreas .................................................................................................... 261
Splenectomy ...................................................................................................................... 261
Questions for Self-Control .................................................................................................. 266
Chapter 6
LUMBAR REGION ........................................................................................................... 267
Triangles of the Lumbar region .......................................................................................... 268
Retroperitoneal space ....................................................................................................... 270
Kidneys ............................................................................................................................. 271
Ureter ................................................................................................................................ 273
Suprarenal Glands ............................................................................................................. 274
The Abdominal Aorta ......................................................................................................... 275
The Inferior Vena Cava ...................................................................................................... 276
Retroperitoneal Lymphatics ............................................................................................... 277
Retroperitoneal Innervation ................................................................................................ 278
Operative surgery of the Lumbar region ............................................................................. 280
Incisions of the Posterior (Lumbar) Abdominal Wall ........................................................... 280
Operations on the Kidney and Ureter ................................................................................. 281
Paranephral Vagosympathetic Block by Vishnevsky .......................................................... 284
Questions for Self-Control .................................................................................................. 284
Chapter 7
PELVIC AND PERINEUM ................................................................................................ 285
True (Lesser or Minor) Pelvis ............................................................................................. 285
False Pelvis ....................................................................................................................... 285
Pelvic Viscera ................................................................................................................... 297
Gastrointestinal System ..................................................................................................... 297
The Urinary Organs ............................................................................................................ 303
Male Internal Genital Organs .............................................................................................. 310
The Female Internal Genital Organs ................................................................................... 313
Perineum ........................................................................................................................... 321
Operative Surgery of the pelvis and Perineum ................................................................... 329
Emergency (“Blind”) Suprapubic Cystostomy, Suprapubic Puncture (“SPP”) ..................... 330
Emergency Suprapubic Puncture (“SPP”) ......................................................................... 330
Open Suprapubic Cystostomy (Sectio Alta) ....................................................................... 330
Permanent Open Cystostomy ............................................................................................ 331
Surgical Approaches to the Prostate Gland ....................................................................... 331
Drainage of Ischiorectal Abscess ...................................................................................... 331
Excision of Fistula in Ano ................................................................................................... 332
Cesarean Section.............................................................................................................. 335
Salpingectomy ................................................................................................................... 337
Orchidopexy ...................................................................................................................... 337
Surgical Treatment of Phimosis (Circumcision) ................................................................. 340
Paraphimosis .................................................................................................................... 341
Surgical treatment of Hydrocele ......................................................................................... 341
Questions for Self-Control .................................................................................................. 342
Chapter 8
VERTEBRAL COLUMN AND SPINAL CORD................................................................ 343
Vertebral Column ............................................................................................................... 343
The Spinal Cord and Meninges ......................................................................................... 353
Structure of Spinal Nerves ................................................................................................. 354
Topography of Structures in the Vertebral Canal ................................................................ 357
Questions for Self-Control .................................................................................................. 360
Chapter 9
UPPER EXTREMITIES.................................................................................................... 361
Shoulder ............................................................................................................................ 361
Arm.................................................................................................................................... 376
Forearm............................................................................................................................. 386
Hand .................................................................................................................................. 397
Region of the Wrist ............................................................................................................ 400
Palm of the Hand ............................................................................................................... 402
The Dorsum of the Hand .................................................................................................... 411
Questions for Self-Control .................................................................................................. 412
Chapter 10
LOWER EXTREMITIES ................................................................................................... 413
The Gluteal Region ............................................................................................................ 413
Thigh.................................................................................................................................. 421
Leg .................................................................................................................................... 437
Region of the Ankle ............................................................................................................ 443
Foot ................................................................................................................................... 444
Sole of the Foot ................................................................................................................. 447
Dorsum of the Foot ............................................................................................................ 452
Operative Surgery of the Upper and Lower Extremities ..................................................... 458
Tying the Arteries ............................................................................................................... 458
Tying the External Carotid Artery ........................................................................................ 458
Tying the Third part of the Subclavian Artery ....................................................................... 458
Tying the Internal Iliac Artery ............................................................................................... 458
Tying the External Iliac Artery in the Groin ........................................................................... 459
Tying the Femoral Artery .................................................................................................... 459
Tying the Popliteal Artery.................................................................................................... 459
Incisions for Draining Pus .................................................................................................. 460
Principles of Amputation .................................................................................................... 461
Suture of Tendon ................................................................................................................ 463
Questions for Self-Control .................................................................................................. 466
Operative Surgery and Topographycal Anatomy Tests
HEAD AND NECK............................................................................................................ 467
Questions .......................................................................................................................... 467
Answers and Explanations................................................................................................. 476
THORAX........................................................................................................................... 480
Questions .......................................................................................................................... 480
Answers and Explanations................................................................................................. 485
ABDOMEN ....................................................................................................................... 487
Questions .......................................................................................................................... 487
Answers and Explanations................................................................................................. 493
PELVIS AND PERINEUM ................................................................................................ 496
Questions .......................................................................................................................... 496
Answers and Explanations................................................................................................. 502
VERTEBRAL COLUMN AND SPINAL CORD................................................................ 505
Questions .......................................................................................................................... 505
Answers and Explanations................................................................................................. 508
UPPER LIMB ................................................................................................................... 509
Questions .......................................................................................................................... 509
Answers and Explanations................................................................................................. 514
LOWER LIMB ................................................................................................................... 518
Questions .......................................................................................................................... 518
Answers and Explanations................................................................................................. 524
References ...................................................................................................................... 527