Plan de studii
- 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
- 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
- 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
- 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
- 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
- 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.
Ilia Catereniuc _______________
dr.hab. șt. med., prof. univ.
practical lessons in Clinical Anatomy for second year students, Faculty Medicine I and II
in the autumn semester, academic year 2021 - 2022 (duration of the lesson - 3 hours)
LESSON 1. Content, purpose, methods of studying clinical anatomy. Principles and methods. General surgical instruments (classification, destination, technique of use). Basic surgical procedures: principles, stages, types. Principles and methods of dissociation and suturing of tissues. Hemostasis. The technique of tying knots and applying sutures in successive planes.
LESSON 2. Topographic anatomy of the shoulder (subclavicular, deltoid, scapular, axillary and shoulder joint regions). Surgical anatomy of vessels and nerves. Fat spaces, the evolution of phlegmons and hematomas (incisions in the opening of collections). Collateral blood circulation pathways and argumentation of the level of ligation of the axillary artery (optimal and critical arterial segments). Projection lines, access roads, discovery and ligation along the route of the main arteries on the extremities. Hemostasis methods. Argumentation of the surgical aproaches on joints, vessels (a. subclavia, a. axillaris), nerves and in the opening of purulent processes. Puncture of the shoulder joint.
LESSON 3. Topographic anatomy of the arm, cubital region and forearm: stratigraphy, fascia and fasciocellular sheaths, vessels and nerves. Arguing the ways of spreading purulent collections and hematomas, the position of bone fragments in case of fractures of the humeral bone at different levels. Projection lines, access routes in denudation and ligation along the path of the neurovasculara bundles of the arm, forearm, cubital region. Collateral blood circulation pathways and argumentation of the optimal level of ligation of the damaged main arteries. Critical arterial segments. Hemostasis methods. Incisions in purulent lesions and diseases, techniques and anatomical-surgical reasoning. Venesection, venepuncture. Vascular suture.
LESSON 4. Topography of the hand (carpus, metacarpus and fingers). Stratigraphy, fasciocellular fascias and sheaths, channels, synovial sheaths, cell spaces. Pathways of pus. Argumentation of surgical aproaches on vessels and nerves (critical arterial segments). Projection lines, discovery and ligation of vessels on the hand. Anatomo-topographic argumentation of hand incisions in panarites and phlegmons. Types of hand anesthesia. Exarticulation and amputation of the phalanges. Suture of the tendon (tenorafia), nerves (neurorafia and neurolysis).
LESSON 5. Topography of the anteromedial region of the thigh: subginginal space, femoral and obturator canals, femoral triangle (Scarpa), Hunter canal. Surgical anatomy of the femoral hernias. Topographic anatomy of the gluteal and posterior region of the thigh, hip joint.
Surgical anatomy of the knee region (popliteal fossae and Jobert's fossae). The position of bone fragments in the femoral bone fracture at different levels. Arguing the ways of spreading and accessing in purulent processes, rational incisions in their opening. Collateral blood circulation pathways in case of artery damage and possible complications in artery ligation. Vessels and nerves. Projection lines. Arguing the surgical aproaches to discover the femoral canal, femoral vessels. Herniotomy and hernioplasty in the femoral hernia (Bassini, Rudgi, Parlavecio). Amputation and disarticulation: principles, types, stages. Operations on bones and joints, vessels (safenectomy). Types of anesthesia.
LESSON 6. Surgical anatomy of the regions of the leg, talocrural joint and foot itself. Stratigraphy of the medial ankle region, dorsal and plantar regions of the foot itself. Fasciocellular lodges and cell spaces, osteo-fibrous canals, vasculonervous bundles, arterial collaterals, joints and ligaments. Collateral blood circulation pathways in case of artery damage and possible complications in artery ligation. Argumentation of the ways of spread and access in purulent processes, rational incisions in the opening and drainage of phlegmon. The position of bone fragments in the calf fracture at different levels. Projection lines, surgical aproaches, discovery and ligation of main arteries on the extremities. Detection and ligation of arteries in the wound and on the path (at a distance). Amputation and disarticulation: principles, types, stages (Lisfranc, Sharp). Vascular and nerve operations (safenectomy, nerve block). Venesection and venepuncture, places of predilection. Bone and joint operations. Surgical aproaches and operations on bones and joints.
Concluding Nr. 1 (the theoretical part and the practical part).
LESSON 7. Topographic anatomy of the cerebral part of the head. Skull vault. Stratigraphy of the frontoparietooccipital region. Topography of the temporal region. Structural and vascular peculiarities of epicranial tissues. Surgical anatomy of the mastoid region. Brain tunics and intermeningeal spaces. Toilet of craniocerebral wounds. Hemostasis. Skull trepanation (osteoplastic and decompressive). Cranioplasty. Anthropomy. Ventriculopuncture and puncture of the superior sagittal sinus. Operations in the purulent processes of the soft tissues of the head.
LESSON 8. Topographic anatomy of the facial part of the head (cheek, parotidomasometric and deep regions of the face). Stratigraphy. Fascial lodges, fat spaces, vessels, nerves. Nerve topography: facial and trigeminal. Surgical anatomy of the parotid gland. Regions: orbital, nasal and buccal. Rational incisions in purulence of the face. Venous collaterals. Argumentation of the ways of spreading purulent processes. Blockage of the trigeminal nerve branches. Anatomo-topographic argumentation of the incisions on the face. Maxillary sinus puncture.
LESSON 9. Topographic anatomy of the neck: division into regions, triangles, fascias and fat spaces. The suprahyoid and infrahyoid region. Topography of the medial triangle of the neck. The carotid triangle. Sternocleidomastoid region. Region of the lateral triangle of the neck (antescalenic and interscalenic space). The scalenovertebral triangle. Topography of the glands: thyroid, parathyroid, larynx, trachea, pharynx, esophagus. Neck surgery. Wound debridment in the cervical region. Access routes to the organs of the neck, main vessels and nerves. Projection lines. External, internal and subclavicular jugular vein puncture. Tracheostomy and conicotomy (complications), technical features in children. Pathways of purulent processes and hematomas. Argumentation of rational incisions in superficial and deep phlegmon. Argumentation of the ways of spreading purulent processes. Cervical plexus blockage. Discovery and drainage of the thoracic duct on the neck.
LESSON 10. Topographic anatomy of the thorax. Stratigraphy and fasciocellular spaces, vessels and nerves. Clinical anatomy of the mammary gland and intercostal space. Surgical anatomy of the internal thoracic artery. Surgical anatomy of the anterior and posterior mediastinal organs (heart and pericardium, thoracic aorta, esophagus, azygos and hemiazygous veins, splanchnic nerves, vagus, phrenic and recurrent nerves, trachea and bronchi, thoracic duct, sympathetic chain). Reflexogenic areas. Topographic anatomy of the diaphragm, pleura, lungs, hilum (their projection on the chest). Argumentation of the spread of purulent processes. Basic surgeries on the organs of the thoracic cavity. Rational surgical aproaches to the organs of the thoracic cavity. Incisions in case of mastitis. Intercostal blockage. Puncture and drainage of the pleural cavity and pericardium. Methods and technique of surgical debridment of penetrating and non-penetrating wounds of the thorax. Thoracotomy and subperiosteal resection of the rib. Subclavian vein puncture. Operating principles in emergency surgery on the chest wall - plasty (closure) of open pneumothorax. Peculiarities of surgery in children. Notions about heart surgery.
Concluding Nr. 2 (the theoretical part and the practical part).
LESSON 11. Topographic anatomy of the anterolateral abdomenal wall, areas of low resistance. Stratigraphy. Vascularization and innervation. Porto-caval and cavo-caval venous anastomoses. Surgical anatomy of the inguinal region. Inguinal space and canal (in hernia carriers and non-carriers). Surgical anatomy of external abdominal hernias of the abdominal wall structure, types, classification. Operating principles in hernias, peculiarities in children. Basic stages and surgical procedures in white line, umbilical, inguinal hernias. Operating features in congenital hernias, strangulated and sliding hernias. Plasty of the umbilical hernia canal (Lexer-Stitch, Mayo, Sapejko, techniques with allogeneic materials), inguinal canal (Martinov, Bassini, Kimbarovski, techniques with allogeneic materials). Surgery in hernias in children. Argumentation of the ways of spreading purulent processes. Rational incisions and access routes to approach the organs of the abdominal cavity. Laparocentesis.
LESSON 12. Topographic anatomy of the organs of the abdominal and peritoneal cavity. Surgical anatomy of the organs of the supramesocolic store: skeletotopy, holototopy, syntopy. The relationship of the organs with the peritoneum, pounches, ligaments, bursae (omental, hepatic and pregastric). Great and small omentum. Topography of vagus nerves. Vascularization and innervation. Porto-caval and cavo-caval venous anastomoses. The places of predilection in the accumulation of pathological fluids in the peritoneal cavity. Operating principles on the gastrointestinal tract. Anastomoses and intestinal suture. Stomach surgeries, notions (suturing of stomach wounds, gastrotomy, gastrostomy, gastroenteroanastomosis, surgical interventions in case of pylorosthenosis). Stomach resection (Billroth I and II procedure). Operations in the perforating ulcer (Oppel and Juud procedures), on the liver (hepatoraphya), gallbladder (cholecystectomy), spleen (splenectomy) and pancreas (surgical aproaches).
LESSON 13. Surgical anatomy of the organs of the inframesocolic floor (jejunum, ileum and colon). The relationship of the organs with the peritoneum: skeletotopia, holototopia, syntopia. Topography of lateral canals, mesenteric sinuses, envelopes and recesses. The places of predilection in the accumulation of pathological fluids in the peritoneal cavity. Topography of the small and large intestine (cecum and appendix). Areas of critical vascularization. Surgical anatomy of innate defects: Meckel's diverticulum, megacolon, Hirchprung's disease (congenital megacolon), atresia. Peritoneal cavity revision. Intestinal suture. The technique of applying the intestinal suture (separate and continuous thread suture, Albert and Shmieden marginal suture, Lambert sero-serous suture). Small bowel operations (enterostomy, suturing of intestinal wounds, resection, types of anastomoses). Operations on the large intestine (colostoma and artificial anus, appendectomy).
LESSON 14. Topographic anatomy of the lumbar region (latero-posterior wall of the abdomen), spinal cord and retroperitoneal space. Stratigraphy, places of low resistance (Petit and Lesgaft-Grynfelt triangles). Topography of retroperitoneal organs, fascia, fat layers and vasculonervous bundles. Routes of pus spread from the retroperitoneal space. Topography of the spine and spinal canal (content, osteoligamentary apparatus). Operating principles on the organs of the retroperitoneal space. Lumbar spine puncture technique. Spinal anesthesia. Notions of spinal surgery (laminectomy, spondylodesis). Surgical aproaches on the kidneys, ureters and retroperitoneal fat layers (extraperitoneal and transperitoneal). Nephrectomy, resection and suturing of the kidney, pyelotomy. Resection and suturing of the ureters.
LESSON 15. Topographic anatomy of the pelvis and perineum (osteoligament skeleton, muscles, pelvic organs, relationship with the peritoneum, vascularization, innervation, venous and lymphatic reflux). The peculiarities of age. Dividing the small pelvis into "floors". The pudendal canal. The relationship of the organs with the peritoneum in women and men (envelopes, sac bottoms, ligaments). Fasciae and fat spaces. Pathways of spread of pus and hematomas through the fasciocellular spaces. Surgical aproaches and surgeries on the organs of the small pelvis. Pudental nerve block (Alkok). Puncture of the bottom of the vaginal sac. Closed hydrocell operations (Bergmann-Winkelman). Catheterization (survey), bladder puncture, suprapubic cystotomy. Practical interventions for hemorrhoids, paraproctitis and anal fistulas. Argumentation of incisions and drainage of fat spaces. Anomaly operations: atresia of the rectum and anus, epispadium, hypospadias.
Concluding Nr. 3 (the theoretical part and the practical part).
dr. hab. șt. med., conf.univ. Suman Serghei