Topo Anatomy Lecture 1

Plan of the Lecture

• Overview of operative surgery and topographic anatomy

• Importance in medical training and education

• Historical context: St. Petersburg and Moscow schools of thought

• N. I. Pirogov: founder of anatomo-physiological approach in surgery

• Development of the Department of Operative Surgery and Topographic Anatomy at Russian State Medical University

• Concept of individual variability

Terminology

Normal Anatomy

• Defined as the study of the human organ systems

Clinical Anatomy

• Focuses on human structure from clinical perspectives

• Includes topographic and surgical anatomy

Topographic Anatomy

• Examines body structure within defined boundaries (regional anatomy)

• Surgical anatomy interprets this information specifically for surgical applications

Topographic Anatomy Fundamentals

• Established by N. I. Pirogov in 1845 as the first department of topographic anatomy and operative surgery

Key Components:

1. Border region: orientation of muscles and tissues

2. Layer-by-layer structure of the region

3. Blood vessel anatomy

4. Venous outflow pathways

5. Innervation specifics

6. Lymph drainage details

7. Holotape: projection of formations on the skin

8. Sellotape: correlation of organs to the skeleton

9. Syntopia: mutual location of organs and tissue structures

The Constitution of an Individual

• Defined as a biological passport representing human individuality

Key Concepts:

• Morphological and functional characteristics derived from:

  • Hereditary factors

  • Environmental influences

Law of Variability

• N. Shevkunenko's principle: Individual variability affects all human organs and systems

• Employs statistics to analyze the range and frequency of individual differences

• Anatomical differences result from ontogenesis, phylogenesis, and environmental interactions

V. N. Shevkunenko's Doctrine

Concept of Norm

• A varying set of morphological features with boundaries defining extreme variability

• Function of organs and systems is preserved within this range, maintaining organism vitality

Anomalies

• Result from disrupted developmental processes with preserved functions

Malformations

• Congenital anatomical disorders that can lead to dysfunctions

  • Examples: non-closed arterial duct, cleft lip, atresia

Contemporary Directions of Shevkunenko's Doctrine

• Developments in clinical and morphological, medical and biological, anatomical and surgical fields

• Age-related variability studies reveal differences in organ topography at various life stages

• Focus on improving surgical techniques and approaches

Operational Surgery

• Definition: Study of surgical operations including techniques and methods

Key Components:

1. Anatomical accessibility: ability to expose the surgical focus safely

2. Physiological permission: maintaining bodily functions post-surgery

3. Technical ability: mechanization of complex surgical steps

Components of Surgery

1. Operational Access (Phase One):

   • Actions to separate tissues for exposure

   • Methods: Macrotomiya, Minitomiya, Microtomiya (laparoscopic)

2. Operational Method (Second Stage):

   • Main stage involving surgical impact on the affected area

3. Completion of Operation (Stage Three):

   • Restoring anatomical relations post-access

Classification of Operations

Based on Goals:

1. Radical: Complete organ removal (e.g., appendectomy)

2. Palliative: Limited intervention to relieve symptoms

3. Therapeutic: Operations yielding therapeutic benefits

4. Diagnostic: Operations for clarifying diagnoses

5. Preventive: Operations to prevent complications

6. Repeated: Further operations due to complications

7. Simultaneous: Multiple operations performed together

Staging of Operations

• One-step: Simultaneous removal of affected organs

• Two-stage: Sequential operations for serious conditions

• Multi-stage: Common in reconstructive/plastic surgery

Timing of Surgery

Classification:

1. Emergency: Immediate intervention for critical conditions

2. Urgent: Short delay permissible for diagnostics/preparation

3. Planned: Scheduled after diagnosis and patient preparation

Wound Classification

By Mechanism:

• Cut, minced, chipped, torn, gunshot, explosive

By Damage Localization:

• Isolated, multiple, combined

Non-Surgical Wound Treatment

Indications

• Superficial wounds, small puncture wounds, minor bullet wounds

Treatment Elements

• Skin treatment, antibiotic administration, antiseptic lavage, drainage, aseptic dressings, immobilization

Surgical Wound Treatment

• Goals: remove non-viable tissues, prevent complications, promote healing

Types:

1. Primary Surgical Treatment (PSW):

   • Conducted early (within 24 hours), deferred (up to 48 hours), or late (after 72 hours)

Stages of PSW

1. Incision making with a scalpel for openings

2. Removal of foreign bodies and necrotic tissue

3. Wound drainage setup

4. Closure of the wound

Secondary Surgical Wound Treatment

• Aim: address complications post-surgery

Suturing Types:

1. Primary seam (within 24 hours)

2. Primary delayed suture (4-6 days for cleansing)

3. Early secondary suture (with granulation tissue)

4. Late secondary suture (for scar removal)

Conclusion

• Overview of the surgical processes, principles, and classifications related to operative surgery, emphasizing the importance of individual anatomical variability and the historical context provided by key figures in the field.