Karp S. Optimization of surgical treatment and prophylaxis of orostomas and pharyngostomas

The thesis is devoted to the problem of complex surgical treatment and prevention of the occurrence of orostomas and pharyngostomas , which appear as a surgical complication. During the work performance, we've analyzed main outcomes of treatment of 213 patients, which helped to optimize treatment and prophylaxis of this complication. By using the statistical method of logistic regression, we have identified the main risk factors that, when combined, have a significant effect on the formation of the stoma in the process of basic treatment. Using the calculated model, we developed the computer program which allows to simply calculate risk of stoma formation. Also we developed the conservative treatment method which included using of injectable skin implants based on nonstabilized 1% hyaluronic acid. This allowed to increase the effectiveness of conservative treatment process. We also developed an effective method of surgical treatment, using modified Filatov flap, which combined the simplicity and low-traumatism of local plastic and high efficiency of vascularized free tissue transplants. Due to the lack of a unified approach to stoma treatment we developed our own clinical algorithm that allowed to optimize the process of treating patients with stomas by building a therapeutic tactic, taking into account such indicators as the original area of stoma, the clinical type of stoma by the classification of Funk and it's dynamics. Finally, we evaluated the efficacy of preventive measures and identified optimal ones for using in clinical work.