Plan de studii

3. Topographical anatomy of the head (facial compartment). Cheek and mental regions. Methods af analgesia. Incisions and dreinage in purulences of sublingual space, paratonsilar and submaxilar spaces. Congenital anomalies and surgical treatment.

                                                                                                                Prof. B. Topor

4. Topographical anatomy of head (facial compartment). Surgical anatomy of lateral region of the face. Topography of parotidomasseteric region and deep regions of the face. Stratigraphy (layers). Rational incisions and dreinage in purulences.

                                                                                                                 Prof. B. Topor

5. Surgical anatomy of neck. Topographical divisions, triangles. Fascial sheats and celular spaces. Topography of triangles: medial and lateral triangles of the neck.

                                                                                                                 Prof. V. Nacu

6. Topography of sternocleidomastoid region. Scalenovertebral triangle. Ante- and interscalenic spaces. Nervous trunck block of the triangles on the neck. Inferior and superior traheotomy . Subclavian vein puncture. Incisions in the flegmonas and absceses on the neck.

                                                                                                                 Prof. V. Nacu

7. Surgical operations on vessels and nerves. Surgical peculiar properties in neck and head regions. Hemostasis. Types. Surgical aproaches and colateral blood supply for ligation of the vessels. Suturing and plasty of the vessels. Projectional lines of the vessels, neurolysis, neurotomy, suturing, plasty.

                                                                                                                 Prof. V. Nacu

8. Surgical operations on the bones and joints. Surgical peculiar properties in neck and head regions.

                                                                                                                 Prof. V. Nacu

Chief of medical studies

M.D., Ph.D., Professor                                                                              Suman S.

"APPROVED"

Head of Department __________

Dr.h., Prof. Catereniuc I.

THE SYLLABUS

of the practical lessons in Topographic Anatomy for Students of Medicine Faculty I and II, Year 2,

the autumn semester of 2021 – 2022 ( time 3 hours )

LESSON 1. Introduction. The topographic anatomy as the subject of medical instruction, its purpose, place and role in medical education, as well as principles and methods of studying this subject. Surgical instruments – classification. Basic surgical procedures: principles, phases of a surgical act. Methods and basic principles of incisions and sutures of different types of tissues. Hemostasis. Surgical knots.

LESSON 2. The shoulder (pectoral) girdle region: infraclavicular, deltoid, scapular and axillary regions.  Topographical anatomy of vessels and nerves. Spaces and spreading of phlegmons and hematomas. Incisions performed to evacuate collections of pus. Collateral blood circulation and argumentation of the level of ligation of the axillary artery (optimal and critical arterial segments). Projection lines, surgical approach, discover and ligation of the arteries on the extremities. Methods of hemostasis. Surgical approaches on joints, vessels (subclavicular artery, axillary artery) and nerves. Puncture of shoulder joint.

LESSON 3. Topographic anatomy of the arm, elbow and forearm regions: Boundaries, layers, fasciae and fascial sheaths, vessels and nerves. Ways of spreading of pus and hematomas, Positions of the bone segments in case of fractures on different levels of the humerus. Projection lines and surgical approaches to neurovascular bundles of arm, forearm and cubital region. Collateral blood circulation and argumentation of optimal ligation level of main arteries. Critical arterial segments. Incisions performed in case of purulent infections, technique and argumentation from anatomical point of view. Venesection, venipuncture. Vascular sutures.

LESSON 4. Topography of the hand  (carpus, metacarpus and fingers). Boundaries, layers, fasciae, sheaths and spaces, fibrous canals and synovial bursas. Ways of spreading of pus. Surgical access to vessels and nerves (critical arterial segments). Projection lines, finding and ligation of vessels of the hand. Incisions made on hand in case of phlegmons and panaritium, technique and argumentation from anatomical point of view. Exarticulation and amputation of phalanges. Sutures techniques of tendons(tenorrhaphy ) and nerves (neurorrhaphy and neurolysis ).

LESSON 5. Topography The anterior-medial region of the thigh. Subinguinal space, femoral canal, obturator canal, femoral triangle (Scarpa), Hunter canal. Surgical anatomy of femoral hernias. Topographic anatomy of gluteal region, posterior region of the thigh and hip joint. Positions of the bone segments in fractures on different levels of the femur. Ways of spreading of the phlegmons and hematomas. Vessels and nerves, projection lines. Collateral blood circulation and possible complications in case of ligation of femoral artery. Surgical approaches to femoral canal, femoral artery and vein. Herniotomy and hernioplasty of femoral hernias. Amputation and disarticulation: principles, types and surgical phases. Operations on vessels (saphenectomy).

LESSON 6. Surgical anatomy of the knee region (popliteal and Jobert fossae) and leg region. Fascial sheaths, canals, neurovascular bundles and spaces. Collateral blood circulation in case of lessions of arteries and possible complication in case of ligation of arteries. Argumentation of the pus spreading ways and surical approaches to purulent processes. Positions of the bone segments in fractures on different levels of the leg bones. Projection lines, surgical approaches, revealing and ligation of main arteries. Discovering and ligating the arteries in the wound and on the trajectory (at distance). Amputation and disarticulation: principles, types, surgical phases. Operations on vessels and nerves. (saphenectomy, nerve blockage). Operations on bones and articulations. Topographic anatomy of the talocrural (ankle) and foot regions. Osteo-fibrous canals, neurovascular bundles, collateral blood circulation, articulations and ligaments. Topographic anatomy of medial maleolar region, dorsal and plantar regions of the foot – boundaries, layers. Ways of pus spreading. Projection lines and surgical approaches to vessels, nerves and bones. Venesection and venipuncture. Collateral blood circulation in case of lessions of arteries. Amputation and disarticulation: principles, types (Lisfranc, Chopart). Surgical procedures on bones and articulations.

MID-TERM TEST 1 (theoretical and practical part).

LESSON 7. Topographic anatomy of the cerebral part of the head. Cranial vault. The boundaries and layers of the fronto-parieto-occipital region. Topography of the temporal region. Particularities of vascularization of the epicranial tissues. Surgical anatomy of the mastoid region. The meninges of the brain, intermeningeal spaces. Surgical treatment of the craniocerebral wounds. Methods of hemostasis. Trepanation of the skull (osteoplastic and decompresive). Cranioplasty. Mastoid antrotomy.  Ventriculopuncture and puncture of the superior sagital sinus. Surgical interventions in case of purulent infections of soft tissues of the head.

LESSON 8. Topographic anatomy of the facial part of the head. (the buccal (cheek), parotido-masseteric regions and deep region of the face). Layers, fascial spaces, celullar spaces, vessels and nerves. Topography of facial and trigeminal nerves. Surgical anatomy of parotid gland. Orbital, nasal and oral regions. Rational incisions in case of purulent infections of the face. Venous connections. Argumentation of the pus spreading ways. The blockage of trigeminal nerve branches. Ways of spreading of pus. Maxilar sinus puncture.

LESSON 9. Topographic anatomy of the neck: Division into regions, triangles.  Fascial layers and cellular spaces. Suprahioid region. Topographic anatomy of the medial triangle of the neck. The topography of thyroid and parathyroid glands, larynx, pharynx, neck portion of the trachea and esophagus. Surgical treatment of the wounds of the cervical region. Argumentation of the pus spreading ways in purulent processes. Surgical acces to organs of the neck, blood vessels and nerves. Puncture of the external and internal jugular veins. Tracheostomy and conicotomy. (complications), technical peculiarities in children. Topographic anatomy of the neck. Carotid triangle. Sternocleidomastoid region.  Lateral triangle of the neck (antescalene and interscalene spaces). Scalenovertebral triangle. Ways of spreading of pus and hematomas. Projection lines. Argumentation of the pus spreading ways in purulent processes. Surgical interventions on the neck. Argumentation of rational incisions made on the neck in case of superficial and deep phlegmons. Cervical plexus block.  Surgical access on neck. Puncture of the subclavian vein. Revealing and drainage of the thoracic duct on the neck.

LESSON 10. Topographic anatomy of the thorax. Layers and spaces of the chest wall. Vessels, nerves. Clinical anatomy of the mammary gland and intercostal spaces. Surgical anatomy of internal thoracic artery.  Sugical anatomy of the anterior and posterior mediastinum (heart,  pericard, thoracic aorta, esophagus, azygos and hemiazygos veins, splanchnic nerves, vagus nerves, phrenic nerves, recurent nerves, trachea, bronchi, thoracic duct, sympathetic trunk). Reflexogenous zones. Topographic anatomy of the diaphragm, pleura, lungs, lung roots (their projection on the thorax). Argumentation of pus spreading. Basic surgical operations on organs of the thoracic cavity. Rational surgical accesses on the toracic cavity organs. Incisions made in case of mastitis. Intercostals block. Thoracocentesis and pericardiocentesis. Surgical treatment of penetrating and non-penetrating thoracic wounds. Thoracotomy and subperiostal resection of the ribs. Puncture of subclavian vein. Emergency principles of surgical treatment on the chest wall – plasty (closing) of the  open pneumothorax. Surgical peculiarities in children. Notions of surgical interventions on the heart.

MID-TERM TEST 2 (theoretical and practical part).

LESSON 11. Topographic anatomy of the antero-lateral abdominal wall. Weak points. Layers. Vascularization and innervation. Venous porto-caval and cavocaval anastomosis. The surgical anatomy of the the inguinal region. Inguinal canal and inguinal space (at carriers and non-carriers). Surgical anatomy of the external abdominal hernias of the abdominal wall, structure, types, classification. Surgical principles in hernias, peculiarities in children. The basic steps and surgical procedures in white line hernia, umbilical hernia and inguinal hernia. Surgical peculiarities in congenital inguinal hernia, strangulated inguinal hernia and sliding inguinal hernia. Umbilical hernia repair (Lexer-Șpitț, Mayo, Sapejko procedures, techniques with allogeneic materials), inguinal canal plasty (Martinov, Bassini, Kimbarovski, techniques with allogeneic materials). Surgical procedures in children. Ways of spreading of pus. Rational incisions and surgical access to the organs  of abdominal cavity. Laparocentesis.

LESSON 12. Topographic anatomy of the abdominal organs and peritoneal cavities. The surgical anatomy of supramesocolic organs: skeletotopy, holotopy, syntopy. Relationship of the organs with peritoneum, folds, ligaments, bursa (omental, hepatic and pregastric). Lesser and greater omentum.  Topographic anatomy of the vagus nerves.  Vascularization and innervation. Venous portocaval and cavocaval anastomosis. Typical seats of accumulation of the pathologic fluids in the peritoneal cavity. Principles of surgerical intervention on gastrointestinal tract. Intestinal anastomosis and suture.  Surgical operations on the stomach, notions (stomach wound suturing, gastrotomy, gastrostomy, gastroenteroanastomosis, surgical interventions in case of pylorostenosis). Stomach resection (Billroth I and II procedures). Surgical interventions in case of perforated ulcer (Oppel, Judd procedures), on the liver (hepatorrhaphy), gallbladder (cholecystectomy), spleen (splenectomy) and pancreas (surgical access).

LESSON 13. Surgical anatomy on organs situated in the inframesocolic floor (jejunum, ileum and colon). Relationship of the organs with peritoneum: skeletotopy, holotopy, syntopy. Topography of the lateral canal, paracolic sulci, mesenteric sinuses and recesses. Typical seats of accumulation of the pathologic fluids in the peritoneal cavity. The topography of the small and large intestine (cecum and appendix). Critical areas of vascularization. Surgical anatomy of congenital malformations: Meckel diverticulum, megacolon, Hirschsprung's disease (congenital megacolon), atresia. Revision of the peritoneal cavity. Intestinal suture. Intestinal sutures techniques (continuous, separated sutures, Albert, Schmieden, Lambert sutures). Surgical interventions on small intestine (enterostomy, intestinal wounds suturing, intestinal resection, types of anastomoses). Surgical interventions on large intestine (colostomy and artificial anus, appendectomy).

LESSON 14. Topographic anatomy of the lumbar region (postero-lateral wall of the abdomen), spinal column and retroperitoneal space. Layers, weak points (Petit and Lesgaft Grynfelt triangles). Topography of the retroperitoneal organs, fascias, adipose layers and neurovascular structures. Ways of pus spreading from retroperitoneal space. The topography of the spinal column and spinal canal (content, osteoligamentar structures). Basic principles of surgery on retroperitoneal organs. Lumbar spinal canal puncture technique. Spinal anesthesia. Surgical operations on spinal column (laminectomy, spondylodesis). Surgical access on kidneys, ureters and retroperitoneal tissues (retroperitoneal and transperitoneal). Nephrectomy, kidney resection and kidney suture, pyelotomy. Ureteral resection and suture.

LESSON 15. Topographic anatomy of the pelvis and perineum (bones, ligaments , muscles, pelvic organs, relationship with the peritoneum, vascularization, innervation, lymphatic and venous drainage). Age peculiarities. Division of pelvis into "floors". Pudendal canal. The relationship of pelvic organs with peritoneum in women and men (folds, recesses, ligaments). Fasciae and retroperitoneal spaces, ways of pus and hematomas spreading. Surgical access and surgical interventions on pelvic organs. Pudendal nerve block (Alcock). Rectouterine pouch (Douglas pouch) puncture. Surgical interventions in hydrocele (Bergmann - Winkelman). Catheterization, puncture of the urinary bladder, suprapubic cystostomy. Surgical procedures for hemorrhoids, paraproctitis and anal fistulas. Argumentation of the incisions made in case of abcesses and phlegmon. Surgical intervention for anomalies: atresia of the rectum and anus, epispadias, hypospadias.

MID-TERM TEST 3 (theoretical and practical part).

Chief of medical studies

Associate Professor                                                                            Suman S.

http://anatop.usmf.md

"APPROVED"

Head of Department __________

Dr.h., Prof. Catereniuc I.

Course schedule

for Clinical Anatomy, 2nd year students

Faculty of Medicine II spring semester, study year 2021 – 2022

1. Operative surgery and topographical anatomy as a didactic subject, its aims and role in the study process. Content and methods of study. Contribution of scholars to the development of discipline. The main role of N.I. Pirogov as the founder of surgical surgery and topographic anatomy. Surgical anatomy of fascio-cellular formations on the extremities. Pirogov's laws on the ratio of vascular-truncated trunks and fascicles. The practical importance. Surgical act - notion, stages, requirements. General Surgical Instruments (classification, destination, use technique). Basic surgical procedures, peculiarities of use in pediatric surgeon practice. Principles and methods of dissociation and suturing of tissues. Haemostasis.

Dr., prof., V. Nacu

2. Clinical anatomy of upper limb, regions: shoulder, arm, elbow, forearm. Surgical anatomy of fascio-cellular formations, canals, lines of projection of vessels and nerves. Clinical anatomy of the hand, surgical interventions in whitlow and phlegmon. Blood arcade, critical segments. The lesions nn. radial, median, ulnar - manifestations. Congenital malformations of the upper limb. Application value. Osteofibrosis channels, vasculopathy, fascia, and cellular spaces, the practical importance of spreading purulent collections.

Dr., prof., V. Nacu

3. Clinical anatomy of the inferior limb. Surgical anatomy of fascio-cellular formations, canals, lines of projection of vessels and nerves. Blood circle, critical segments. The injuries of nn. sciatic, common lancet, tibial - manifestations. Fascio-cellular beds, osteofibrosis channels, vasculopathy, fascia, and cellular spaces - the spreading pathways of pus and hematomas on regions. Congenital malformations of the inferior limb.

Dr., prof., V. Nacu

4. Surgery on vessels and nerves. Ways of circulating blood circulation in ligature vessels. Critical Segments. Ligature of main vessels, vascular suture, vascularity. Get Endovascular Surgery. Access and nerve discovery, neurolysis, neurotomia, suturing, plasticizing and permutation of the nerves. Operations on the veins: venepunction, venescection, flebectomy. Particularities in children. Trunk anesthesia on upper and lower limbs. Tunnel syndrome. Suture of the tendon (tenorphia). Getting microsurgical interventions. Particularities in children.

Dr., prof., V. Nacu

5. Surgical wounds of limb wounds (processing of soft tissues, tendons, bones, vessels and nerves). Bone surgery (osteosynthesis, osteotomy, osteoclasty, bone resection, osteoplasty, sechestrectomy) and joints (joint puncture, arthrotomy, resection, arthroplasty, arthrodesis, arthrorysis, arthrolysis). Particularities in children. Access routes to bones and joints. Amps and disarticulations - general principles, phases and moments, types, processes. Principles of prosthesis. Age characteristics.

Dr., prof., V. Nacu

6. Surgical anatomy of the head of the brain. Surgical anatomy of topographic regions in successive planes: frontoparietooccipital, temporal, mastoid, and skull base Particularities of vascularization of epicranian tissues, cellular spaces and spread of pus. Tinnitus of the brain. Venous sinuses. The ventricular system of the brain and the cerebrospinal fluid. Venous system of the cerebral region of the head Operating principles in the surgical toilet of the craniocerebral wounds, hemostasis. You're scalding. Cerebral ventricular puncture. Antrotomy. Trepanation (osteoplastic and decompressive) and cranioplasty. Intracranial hematoma. Congenital malformations and general principles of treatment.

Dr., prof., V. Nacu

7. The surgical anatomy of the facial head portion. Topographic regions in successive plans. Vascularization of the facial region of the head, anatomical and clinical features. The venous system and its communication with the intracranial one. The vasculopathy formations. Fascias and cellulosic tissues in the facial region. Nerve Topography: Facial and Trigeminal. Surgical anatomy of the parotid gland. Pathways of spreading. Age characteristics. Block trigeminal nerve branches. Pathways and incisions in purulent parotidity. Opening and draining of the purulent facial region of the head. Operational principles and technical peculiarities in the surgical toilet of maxillofacial wounds, hemostasis. Puncture of the maxillary sinus. General principles of treatment in congenital malformations.

Dr., prof., B. Topor

8. Surgical neck anatomy. Topographical regions. Superficial Elements. Fascils and cellular spaces, their applicative value, the ways of spreading the pus. Topography of the medial and lateral throat triangle. Sternocleidomastoid region. Deep spaces of the cervical region (antescalen and interscale spaces, scalenovertebral triangle). Topography of the glands: thyroid, parathyroid, larynx, trachea, pharynx, esophagus. Surgical anatomy of the thoracic duct, n. Frenic, n. Accessory, n. Recurrent larynx, sympathetic trunk. Congenital malformation. Particularities in children. Surgery on the neck. Approach the organs of the throat, the vessels and the nerves. Dengue and ligation on the tract of the arteries on the throat. Blood circle, critical segments. Topographic argumentation of incisions in the superficial and deep throat phlegm. Loco-regional barriers. Operations on the neck organs (strumectomy, esophagorphy and stomia, suture of esophagus and trachea). Surgery on the upper respiratory tract (cricokonicotomy, tracheostomy, microtraheocentesis). Puncture and cateterization vv. external and internal jugular, subclavicular. The discovery and drainage of the thoracic duct on the neck. Operations in congenital malformations. Particularities in children.

Dr., conf. Gh. Guzun

9. Clinical anatomy of the chest. Stratigraphy. The dishes and nerves. Surgical anatomy of the mammary gland. Topography of the pleura, lungs, diaphragm, mediastinum organs: anterior and posterior. Reflexogenic areas. Congenital malformations of the mediastinal organs, the aorta and the thoracic wall. Operator access pathways on chest cavity organs. Operating principles in emergency surgery on the chest wall - penetrating and non-penetrating wounds (pneumothorax, thoracotomy, coastal resection and heart suture in wounds). Pleural puncture in pneumo- and hydrotrophy, puncture of pericardium. Intubation of the trachea. Incisions in the mastitis and chest phlegmon of the newborn. Congenital malformations, operating principles. Particularity in children.

Dr., prof., B. Topor

10. Topographical Anatomy of the Anterolateral Abdominal Wall. Surgical anatomy of external abdominal hernias. Methods and methods of hernia plasticity, particularities in children. Congenital abdominal wall abnormalities (gastroschisis, umbilical hernias). Vitelin duct, canal and umbilical ring, umbilical layers (congenital umbilical fistula). Surgical anatomy of fascio-cellular formations. Classification of hernias, operative principles in herniotomy. Basic steps and operative procedures in the white, umbilical, inguinal, and femoral hernias. Operational features in congenital hernia, strangled and slipped. Operatory particularities in children.

Dr., prof., B. Topor

11. Topographical Anatomy of peritoneal cavity organs (supramezocolic floor). Topography of scholarships (omental, hepatic and pregastric). General principles in laparatomy. Argumentation of rational incisions and operative access pathways on peritoneal cavity organs. Laparocenteza. Talk about operations on the peritoneal cavity organs. Surgery on the stomach (vagotomy, perforated ulcer surgery, gastric resection - Bilrot I and II, gastrostomy, pilorotomy, gastroenteroanastomoses), parenchymal organs (parenchymal organ suture, liver resection, splenectomy), biliary bile (cholecystectomy). Congenital malformations: pylorostenosis, biliary tract atresia.

Dr., prof., B. Topor

12. Surgical anatomy of inframezocolic organs. Topography of the small and thick intestine, check and appendix. Side channels, mesenteric sinuses and peritoneal recesses. Envelopes, ligaments, scholarships, places of predilection in the accumulation of pathological fluids in the peritoneal cavity. Revision of the peritoneal cavity and small intestine. The intestinal suture. Insect suturing technique (separate and continuous suture, Albert suture and Smyen suture, Lambert serum to serum). Surgery on the small intestine (enterotomy, enteroraphy, suture of intestinal wounds, resection, lateral, endo-lateral enteroanastamoses) and large intestine (colostoma and artificial anus after Maidle, appendectectomy). Particularities in children. Surgical anatomy of inborn vices: Meckel diverticulosis, megacolon, Hirchprung disease (congenital megacolon), pylorostenosis, intestinal atresia.

Dr., prof., B. Topor

13. Topographical Anatomy of the spinal, lumbar and retroperitoneal regions. Topography in layers, weak places (Petit and Lesgaft-Grynfelt triangles). The vertebral canal and its contents. Particularities of vascularization and innervation of the spine. The osteoligmentary system of the lumbar spine. Surgical anatomy of fascio-cellular formations. The ways of spreading the pus. The anatomo-topographic arguments of the access ways and the principles of the operators on the organs of the retroperitoneal space (extraperitoneal and transperitoneal). Kidney surgery (nephrectomy, resection and kidney suture, pyelotomy), ureters (resection and suture of the ureter) and spine (laminectomy). Lumbar puncture, rahianesthesia and epidural block (technique). Particularities in children.

Dr., prof., V. Nacu

14. Topographical Anatomy of pelvic and perineal organs. Divide the small basin cavity into "floors". Fascils and cell spaces, diffusion of purulentness. Topography and age peculiarities of the rectum, ureter, bladder, prostate, and uterus with appendages (relationship to peritoneum, synopia, vessels and nerves, lymphatic circulation). Topography of the perineum. Locoregional blockages (n. Pudend, intrapeline block and spermatic funnel). Getting surgical interventions and access ways to pelvic organs (prostate, bladder, rectum, uterus, testicular and inflammation of the ischiorectal fossa). Congenital malformations of the pelvic organs, manifestation, methods of treatment. Particularities in children.

Dr., prof., B. Topor

15. Transplantation of organs. tissues and cells, Transplantology in the Republic of Moldova (legislation, system organization), Immunity and tissue tolerance, ways to combat incompatibility. Methods of tissue / cell preservation, departmental input in this field. Local practice

Dr., prof., V. Nacu

Head of studies, PhD, associate professor                                                           Suman S.

http://anatop.usmf.md/