Simultaneous operations for multiple and concomitant defects of the limbs in children

According to the World Health Organization, 20-30% of patients with pathology of organs and systems have a combination of lesions requiring surgical correction. Simultaneous (combined, one-step) operations are operations in which several different surgical procedures are performed simultaneously during one anesthesia, in parallel or sequentially, depending on many factors. The aim of the study was to demonstrate the main advantages of simultaneous operations in the treatment of congenital deformities of the feet in combination with other pathologies of the skeleton and defects of internal organs. In the clinics of the city of Yaroslavl for the period from May 2015 to December 2020, 531 children with combined and multiple deformities of the limbs were treated, 1108 operations were performed. Of these, 12.1% met multiple lesions of musculoskeletal system. The combination with other pathologies of internal organs was 2.3%. Th long-term average observation period was 2.9 years. Simultaneous operations made it possible to reduce the number of hospitalizations and the total time of preoperative preparation, as well as the number of bed-days in the hospital. Complications during treatment were observed in four patients, which amounted to 0.75% (2 feet - soft tissue infections around the pins with local inflammation). One patient had a drop in hemoglobin below 70 g / L, which required a single transfusion of the R-mass. In one patient, as a result of surgical correction of amniotic clubfoot, skin and subcutaneous adipose tissue necrosis of the dorsum of the foot and toes with an area of 1% was obtained. Despite this, the modern capabilities of the anesthesia and intensive care service and low-traumatic modern operations allow simultaneous operations in several anatomical areas in one surgical session.