The plan of practical classes of the discipline "Topographic anatomy and operative surgery"

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The plan of practical classes of the discipline "Topographic anatomy and operative surgery” 
for students of the 2nd cours of the specialty 31.05.01 "General Medicine" for the 2021-2022 
academic year 
№ 
Themes 
1. 
Introduction into the discipline. The methods of studying. The concept of the 
topographical anatomy and operative surgery. The concept of the surgical 
operation. Classification of the operations, their stages.
Mastering manual skills. Fundamentals of general surgical technique. Seam 
technique. Rules for the use of surgical instruments. Technique of knitting surgical 
knots. The imposition of skin sutures on models: single (nodal, single mattress, 
stitch by Spasokukotsky and Donati), continuous (twisting, continuous mattress, 
stitch by Multanovsky), intradermal continuous (cosmetic). 
2. 
Skin grafting. The terms of the plasty. Indications for the operation. Histology of 
scin. The main methods: by local tissues, by pedicle flap, by free skin transplants. 
Free plasty with flaps of different thicknesses. Tiersch’s method, Dragstead-
Wilson’s method, Limberg’s method. The Indian and Italian methods of 
rinoplasty. Bridge pedicle by Sklifasovsky. The scingrafting of round-shaped 
pedicle by Filatov. 
Mastering manual skills.1. Formation of the Filatov`s stem. Skin grafting by 
Limberg.
3. 
Topography of the gluteal region: boundaries, layers, the projection of vascular-
nervous bundles on the skin, fatty tissue space and ways of puss dissemination. 
Surgical access to gluteal arteries, peculiarities of dressing. Blockade of sciatic 
nerve. 
Mastering manual skills.Clinical and anatomical substantiation of the technique for 
performing s / c and i/ m injections, blockade of the sciatic nerve, skin incisions for 
drainage of abscesses and phlegmon. Blockade of the sciatic nerve. 
4. 
Surgical anatomy of the hip joint. The posterior aspect of the thigh and popliteal 
fossa: boundaries, layers, ways of spreading of puss. The projection of sciatic 
nerve. The projection of vascular-nervous bundle of popliteal fossa and its 
topography. The surgical access to popliteal artery through Gobert’s fossa. Arterial 
collateral network of the knee joint. Ligation of the popliteal artery and reduction
of collateral blood flow. The puncture of hip joint. 
Mastering manual skills. The structure of the hip joint, peculiarities in children and 
the elderly. Joint puncture points. Clinical and anatomical substantiation of the 
pathology of childhood (congenital dislocations of the hip, osteochondropathy of 
the femoral head - Perthes disease, hip dysplasia) and old age (fracture of the 
femoral neck). Diagnosis. 
5. 
Topographical anatomy of the anterior aspect of the thigh. The topography of 
femoral triangle (boundaries, bottom, vascular-nervous bundle). Topography of 
femoral canal, walls and openings. Femoral hernia. The topography of the adductor 
canal. Projection of the femoral artery on the skin. Surgical access to the femoral 

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artery, collateral  blood flow in case of ligation of femoral artery. Cross-section of 
thigh in the middle third. 
Mastering manual skills. Operations for femoral hernia. Projection of the femoral 
artery on the skin. Surgical access to the femoral artery, collateral blood flow 
during its ligation.
6. 
Topography of knee joint. Puncture of the joint. Topography of the shin: anterior 
and posterior aspects, boundaries, muscles. The projection of vascular-nervous 
bundle on the skin. Cross-section of the shin in the middle third.
Mastering manual skills.Surgical access to the anterior and posterior tibial arteries. 
Features of the clinical anatomy of the knee joint. Substantiation of limb deformity 
in case of ligament rupture, clinical symptoms: "drawer", balloting of the patella. 
Puncture points of the knee joint. 
7. 
Topographical anatomy of foot. The dorsal aspect and sole: boundaries, layers.
Vessels and nerves, their projection on the skin. Canalis malleolaris, calcaneal 
canal. Ankle joint. Transverse joint of tarsus (Shopar). Tarsometatarsal joint 
(Lisphrank). Ways of spreading of puss.
Mastering manual skills.Clinical and anatomical substantiation of various types of 
flat feet. Congenital malformations of the lower limb: congenital clubfoot and flat 
foot. The pathological positions of the foot in case of damage the tibial, common, 
superficial and deep peroneal nerves. Ankle puncture points. Ways of distribution 
of pus on cellulose. Operations in phlegmons of the foot. Scin incisions by 
Delorm. 
8. 
Amputation and exarticulation of limbs. Methods of amputation. Amputation 
technique. Formation of skin flaps, cutting of muscle, periosteum, bone, 
debridement of vessels and nerves. Exarticulation of toes by Garandzho. 
Amputation of a foot by Sharp. Osteo
-plastic amputation of shin by Pirogov. Shin amputation in the middle third by 
fascioplastical  method. Thigh amputation by Pirogov. Thigh amputation by Gritti-
Shimanorsky. The peculiarities of the amputations in children. 
9.
Topography of scapular region. Deltoid region, infraclavicular region. Boundaries, 
layers, muscular-facial compartments. Vessels and nerves. Ways of puss 
dissemination. Scapular arterial collateral circle. Opening of phlegmon of scapular 
region.
10. 
Topographical anatomy of axillary region: boundaries, walls of axillary fossa. 
Three-lateral and quadrilateral foramens. Axillary vascular-nervous bundle, 
projection of axillary artery on to the skin. Anatomy of brachial plexus. Axillary 
lymph nodes. Spreading of puss from axillary fossa. Surgical access to the axillary 
artery, its ligation, reduction of collateral blood flow.
Mastering manual skills. Spread of pus from the armpit. Surgical access to the 
axillary artery, its ligation, restoration of collateral blood flow. Phlegmon of the 
axillary fossa Clinical and anatomical substantiation of shoulder dislocations and 
methods of their reduction. Shoulder puncture. Amputation of the shoulder using a 
two-flap skin-fascial method.

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11. 
Shoulder joint. External features, peculiarities of its structure. Topography-
anatomical reasons of shoulder joint dislocation. Topography of upper arm: 
boundaries, muscular- facial compartments. Brachial vascular-nervous bundle. 
Brachial artery projection. Topography of the nervus medianus, radialis, ulnaris. 
Puncture of the shoulder joint. Cross-section of up upper arm in the middle third. 
Amputation of upper arm.
Mastering manual skills. Dissemination of pus from the armpit. Surgical access to 
the axillary artery, its ligation, restoration of collateral blood flow. Phlegmon of the 
axillary fossa. Clinical and anatomical substantiation of shoulder dislocations and 
methods of their reduction. Shoulder puncture. Amputation of the arm using a two-
flap skin-fascial method.
12. 
Elbow joint. Peculiarities of its structures. Topography of the cubital fossa: limits, 
neurovascular bundles. Puncture of the elbow joint. Topography of anterior aspect 
of forearm. Limits, muscular facial compartments, muscular layers. neurovascular 
bundles, their projection on to the skin. Topography of the fatty tissue space by 
Pirogov-Paron. Cross-section of the forearm in the middle third. Flaps forearm 
amputation. Opening of phlegmons  of anterior aspect of forearm.
Mastering manual skills. Fractures of the bones of the shoulder and forearm "in a 
typical site." Principles of applying bandages. Projection lines of the main vessels. 
Application of arterial and venous tourniquet. Elbow puncture. Technique for 
filling systems for intravenous drip infusions. Puncture of the elbow joint. 
Amputation of the forearm with a circular skin cuff. Surgical incisions for 
phlegmon of the cellular space of Pirogov-Paron. 
13. 
Topographical anatomy of the wrist. The palm of the wrist. External features, 
projection of vessels and nerves. Muscular facial compartments, their contents. 
Topography of synovial sheath of wrist tendons. Localization of wrist phlegmons, 
surgical incisions. Ways of puss dissemination from the wrist. Topography of a 
finger. Topography of different types of felons. Surgical incisions. Amputation and 
exarticulation of phalanges.
Topographical anatomy and operative surgery of the hand. Dorsum of the hand. 
The palm of the Hand. External landmarks and projections of the vessels and 
nerves of the palm. Muscular-fascial cases, their contents. Topographical anatomy
of the synovial sheaths of the tendons in the hand. Topographical anatomy of the 
Finger. 
Mastering manual skills.Localization of phlegmons of the hand and surgical 
incisions with them. Ways of distribution of pus on the brush. Surgical incisions for 
panaritiums. Amputations and disarticulations of the phalanges of the fingers. The 
position of the hand in case of damage or compression of the nerves. 
14. 
Vascular stitch technique. (principles, special instruments). A method of A.Karrel, 
modification by Morozova, Polantsev, Solovjev. Mechanical vascular stitch. 
Stitchless connection of vessels. Operation on vessels in case of aneurysms. Blood 
vessel plasticity operations in case of varicose veins. Surgical intervention 
technique according to Bebcock, Madelung, Norat. Stitch and tendon plasticity. 
Principles of operations on peripheral nerves: nervolisis, nerve stitch, nervotomy, 
plasticity and displacement of nerves. 

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Mastering manual skills. The implementation of a vascular stitch on the prosthesis.
Stitching of tendons according to Kessler and Kuneo on pork legs. 
15. 
Mastering manual skills. Classification and principles of applying soft bandages.
16. 
Operational day on an experimental animal.
1. 
Topographical anatomy of the cranium. Regions: frontoparietooccipital, temporal, 
the region of the mastoid process (limits, layers, blood supply, innervation, lymph 
out flow). Meninges of brain. The circulation of liquor. Sinuses of dura mater, their 
connection with subcutaneous vein. The localization of intra cranial haemotoms.
Kronlein-Bryusova scheme of cerebral topography. Peculiarities of bones of the 
skull. Primary surgical treatment of wounds of the skull. Arrest of hemorrhage
from subcutaneous vessels, sinuses of dura mater, veins of diploe, a. meningea 
media, trepanation of mastoid posses, the topography of Shipo triangle. 
2. 
Topographical anatomy of the cranium. The inner aspect of the base of the skull:
skull foramens, their contents (nerves and vessels). Typical lines of skull base 
fractures, topography-anatomical reasons for the main symptoms. Topographical 
anatomy of facial part of the head. Topography and functions of the trigeminal and 
facial nerve. Decompressive and osteoplasty trepanation of the skull.
3. 
Topographical anatomy of the face. Regions: region buccalis, parotideomasseterica
and region facialis profundus (limits, vessels and nerves, fatty tissue spaces). The 
peculiarities of facial blood supply. The connection between facial veins and 
sinuses of dura mater. Primary surgical treatment of wounds of the face. Plate 
stitch. 
4. 
Topographical anatomy of the neck. Neck triangles. Neck fascia. Fatty tissue 
spaces of neck. Lymph system of neck. The peculiarities of neck abscesses. 
Topography of submandibular and carotid triangles, medial neurovascular bundle, 
cervical part of sympathetic trunk. Surgical access to carotid arteries, ligation of 
external carotid artery, ways of collateral blood circulation.
5. 
Topographical anatomy of the neck. Topography of gullet, larynx, esophagus, 
trachea, thyroid and parathyroid glands, recurrent laryngeal nerves. Superior and 
inferior tracheotomy. The technique of subtotal, subfascial thyroid gland resection. 
The drainage of the thoracic duct. Surgical access to the cervical part of esophagus. 
Neck vagosympathetic blocade according to Vishnevskiy. Primary surgical 
treatment of neck wounds. Puncture and catheterization of subclavian vein.
6. 
Surgical anatomy of the thorax. Topography of intercostal space. Topography of
mammary gland. Topography of diaphragm. Surgical operations with mastitis. 
Sectoral resection of mammary gland. Radical mastectomy by Holstead. Pleural 
puncture. Primary surgical treatment wounds of thorax. Diaphragm hernia and 
ways of its treatment. Primary surgical treatment of wounds of thorax with open 
pneumothorax.
7. 
Surgical anatomy of the thorax. Topography of mediastinum. Technique of 
pericardium puncture according to Larray. Heart topography, blood supply, 
innervation. Closure of heart wounds. Surgical treatment of ischemic cardiac 
disease. The topography of organs of posterior mediastinum. Surgical anatomy of 

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the lungs. Division of lungs into segments. The concept of pulmoectomy, 
lobectomy.
8. 
Surgical anatomy of anterior abdominal wall. Regions of abdomen. White line 
projection, sheaths of rectus muscles. Umbilical ring. Hernias of anterior 
abdominal wall. Congenital and acquired inguinal hernia. Inguinal canal, 
topography of direct and indirect inguinal hernia. Sliding hernia. Surgical treatment 
of hernia of anterior abdominal wall. Operation by Girar-Spasokukotskiy, 
Kimbarovskiy, Postempskiy, Bassini. Surgical treatment of umbilical hernia 
(according to Lekser, Meyo, Sapezhko), hernia of linea alba, laporotomy, surgical 
accesses to abdominal organs. 
9. 
Topography of peritoneal cavity: floors, canals, sinuses, their clinical meaning. 
Stomach topography: holotopy, skeletopy, syntopy, blood supply, innervation, 
lymph out flow. Operations on stomach: closure of prerogative gastric ulcer. 
Gastrostomy according to Vitzel, Stamm-Senn-Kader, Toprover. Stomach resection 
according to Billrot-1 and Billrot-2. Vagotomy (selective, proximal, trunkular). 
Pyloroplasty. Gastroectomy.
10. 
Surgical anatomy of organs of inferior abdominal floors. Topography of jejunum, 
ileum and large intestine (cecum, appendix, ascending, transverse colon, 
descending, sigmoid colon), holotopy, syntopy, blood supply, innervation, lymph 
out flow. Intestinal stitches, technique. Types of intestinal anastomoses. Small 
intestine resection. Appendectomy. Formation of artificial anus. Hemicolectomy. 
Hartman operation. Revision of abdominal organs, abdominal drainage.
11. 
Surgical anatomy of organs of superior abdominal floors. Surgical anatomy of the 
liver, bile ducts, gall bladder, pancreas, duodenum, spleen (holotopy, sceletotopy, 
syntopy innervation, lymph out flow). Liver stitch. Liver resection. 
Cholecistectomy. Operations in case of portal hypotension. Operations by Tanner 
and Patiora. Cholecistostomy. Choledochotomy. Splenectomy. Pancreatoduodental 
resection. Thorakolaparotomy. 
12. 
Surgical anatomy of retroperitoneal space and pelvis: fascias, fatty tissue spaces, 
vessels, nerves. Organs of retroperitoneal space and pelvic organs. Topography of 
kidneys and ureters, surgical accesses to them. Paranephral blocade according to 
Vishnevskiy. Nephroectomy. Pyelotomy. Nephrostomy. Fascia and fatty tissue 
spaces of pelvis. Layers of pelvis. The topography of rectum, urinary bladder, 
ureter pelvic part, spermatic cord, testicles, ovaries, uterus, uterine tubes. 
Epicystostomy. Urinary bladder stitches features. Pelvic abscess localizations. 
Paraproctitus. Operations on hemorrhoids according to Miligan-Morgan.
Operations with testicle hydropsy according to Vinkelmann.
13. 
Topographical anatomy of the vertebral column and spinal cord. Vertebral column 
topography: subdivisions, ligaments, vertebral arteries and veins, spinal cord 
capsules, intercapsular space. Topography of spinal segments. Operations on the 
vertebral column: lumber puncture. Laminectomy, principles of spondylodes. 
14. 
An operating day on experimental animal. Tracheostomy. Laparotomy. 
Appendoectomy. Small intestine resection. Splenectomy.