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Despite the significant progress made in reconstructive plastic surgery, the problem of healing and restoring the integrity of the skin after various surgical interventions still remains relevant.

One of the most important provisions the doctrine of wounds is the generality of the biological laws of wound healing, regardless of their origin and localization. It is known that the same cellular elements are involved in wound healing, which provide the overall dynamics of the wound process. To improve the quality of treatment of patients with wound defects of various etiologies, it is necessary to constantly improve the methodology of local therapy through the development of new improved drugs.

The arsenal of medicines is constantly updated and expanded, and among this variety, for 15 years now, the unique development of the head of the cell and tissue growth laboratory of the Institute of Theoretical and Experimental Biophysics of the Russian Academy of Sciences, member International Union fight against burn lesions, doctor of medical sciences, professor Boris Gavrilyuk.

In the laboratory organized by him, the processes of regeneration and self-organization of cells and tissues were studied. The object of the study was the skin, which is the largest organ and performs various functions, such as gas exchange, thermoregulation, participation in metabolic processes, protection from adverse physical, chemical and biological effects. One of the questions of interest was the question of the role of cells, individual proteins and cell membranes, in the process of formation of substances. Where do these substances come from, what is their role in the structure of the skin, how does cell mobility affect regeneration processes. As a result of studying the interaction of skin components with each other, the mechanism of formation of normal and scar tissue became clear. And, most importantly, it became clear which substances should be applied to the affected area of ​​the skin to control wound processes.

For many years, our laboratory has been working on the study and development of fundamentally new biomaterials that can cover wound surfaces, contributing to their speedy healing,” says Boris Gavrilyuk, head of the Cell and Tissue Growth Laboratory, MD.

Clinical trials of the Biokol coating were carried out at the Burn Center of the Institute of Surgery named after V.I. A.M. Vishnevsky, Russian Academy of Medical Sciences, Department of Acute Thermal Injuries, Moscow Research Institute for Emergency Medicine. N.V. Sklifosovsky, Clinic of Thermal Injuries at the Military Medical Academy. CM. Kirov in St. Petersburg, in the Moscow Regional Children's Burn Center and in the Department of Radiation Injury Therapy of the Research Institute of Medical Radiology of the Russian Academy of Medical Sciences.

The difference between Biocol and other drugs

At a time when Professor Gavrilyuk and his colleagues were just starting to create "artificial skin", there were several ways to treat wounds in the arsenal of doctors. The most common and well-known method is treatment with solutions and ointments, followed by the application of bandages on them, which tightly dried to the wound, and they had to be torn off along with damaged skin.

The next method is synthetic dressings, which are made from various polymers and mainly perform a protective function. But they often cause unwanted reactions from the body.

Biological dressings, which have a good therapeutic effect, contain biological substances, such as, for example, collagen. They most often spread over the wound, as they do not have sufficient strength. To increase strength, they are subjected to special effects, chemical crosslinking. After that, the bandage becomes stronger, but loses its bioactive effect.

Biocol combines these 2 polymers, biological and synthetic.

“We managed to create a unique composite that combines the best qualities of synthetic and biological materials,” says Professor Gavrilyuk. - The composite combines the possibility of high regeneration (healing) of tissues in various injuries and the necessary strength. In terms of its physical and chemical properties, this coating is fully consistent with the top layer of the skin. The action of the film, - continues the professor, - goes in several directions.

The first is protection. Due active ingredients isolated from seaweed, it adheres tightly to the skin. It would seem impossible to remove it. But it's not. As soon as there is no need for treatment, the film can be removed with a slight movement of the hand, like a stocking or a candy wrapper. This amazing property is specially set when it was created.

It is also important that the substances that make up the coating are combined with the substances of the wound. As a result, a gel is formed that has optimal properties for regenerative processes. To avoid suppuration, antiseptics are added to the bandage. And so that the patient does not experience suffering, - analgesics.

Other unique property The drug is that the polysaccharides contained in it neutralize toxins and pathogenic microorganisms.

One of the advantages of the drug is that a scar does not form, but the cells that make up the damaged organ grow. There are two layers in the skin: epidermis and fibroblasts. The cells of the epidermis are immobile, while the fibroblasts are very mobile and multiply intensively, fill the wound, and a scar is formed. To put it simply, if we create an environment that will allow not only fibroblasts, but also the epidermis to multiply, then we will get the restoration of normal skin, explains Professor Gavrilyuk.

"Biokol" helped the victims after major disasters, severe fires, explosions in mines, local military conflicts.

Or Best result achieved when the drug is applied literally immediately after skin damage, thereby reducing the severity of the lesion and shortening the treatment period. But the effect is also noticeable when applying a coating to chronic wounds.

The spectrum of application of Biokol

Biocol is used for various types of skin lesions:

1. Treatment of superficial lesions: burns (up to 80% of the skin), residual wounds after extensive burns;

For example, a young lady helped her mother to cook cabbage soup, got a third-degree burn. After two applications of "Biokol" complete restoration of the skin. With burns, even very large ones, if you immediately put a plaster on the wound, the person will not die, says Gavrilyuk.

2. Treatment of trophic, radiation and other ulcers, bedsores and frostbite;

- “Here is a case: once, a middle-aged man turned to a polyclinic, it was a frost of about thirty, and he ran for vodka. Barefoot. He was told: “You have frostbite of the third or fourth degree with necrosis, go home, as soon as everything develops there, we will cut off your legs, you will order prostheses.” Another doctor undertook to treat him with Biocol. Necrotic tissues fell off, new ones grew, and she saved his legs, ”says Gavrilyuk.

3. Effectively closes wound surfaces, gunshot and scalped;

4. Protection of skin grafts;

5. Protection of donor sites in case of burns and plastic surgery;

6. Protection of excised wound surfaces. Treatment of deep external lesions, restoration of tissues affected by necrosis, healing postoperative sutures, bedsores

7. Complex therapy of long-term non-healing fistulas, wounds, etc.

8. Prevention of the formation of coarse keloid scars

9. It can also be used in trichology. The drug activates the blood supply and nutrition of the hair follicles, promotes better growth hair, prevent baldness.

10. The use of cosmetic forms of the drug allows you to improve the structure of the skin and to a large extent bring it closer to the state of the newly formed young skin. It is used both independently and in combination with various cosmetic procedures. Especially successful is the use of the drug after traumatic procedures:

Peeling (chemical, laser, UV),

Microdermabrasion, etc.

Varieties of Biocol

For the possibility of using Biocol for each specific case, which depends on the nature of the skin injury, several forms of wound coverage were created:

The most popular is the standard wound dressing, which is a transparent, elastic, porous film, about 0.1 mm thick, consisting of synthetic polymers and biopolymers of plant origin (for example, polysaccharides). It really does feel like leather to the touch. However, in fact, the "film" is not as simple as it seems at first glance. It took many years to develop it.

If you stick a piece of such a film to a fresh wound, then in a few days there will be no trace of the wound, Gavrilyuk assures. This is an extremely "smart" nanocoating that has a therapeutic effect on the body at the site of its defeat.

The second option is a dual-use coating. First, it has a protective effect. Secondly, cells can be cultivated on it: skin fibroblasts (the “building blocks” of the body's connective tissues) can be grown or applied to a coating. Such cells start regeneration processes, which is very important in various lesions, especially severe ones, when the cells are paralyzed.

The third option is a biodegradable coating. It dissolves in the wound and also “starts” the regeneration processes.

There is also a gel-like form of a remedy that is effective for dry injuries, insect bites. Biokol-Gel” stimulates regeneration, maintains the physiological hydration of the wound, promotes the binding of toxins. The presence of silver ions in the composition of the mixture provides a bacteriostatic effect.

The cosmetic version of the gel is a modification of the "Biocol-gel" with changes in the composition that allow the drug to better penetrate the upper protective layer of the skin. This is a very good cosmetic product.

Advantages of Biocol over other existing drugs on the pharmaceutical market.

1. Securely fixed on the wound; taking the form of various parts of the body;

2. Reduces the number of dressings;

3. Ability to follow the healing process without removing the coating;

4. Easily and painlessly removed and replaced;

5. Reduces pain, shortens the healing time of wounds;

6. Increases the average survival rate of autografts by 10-20%

7. In the treatment of trophic ulcers, it contributes to their rapid cleansing;

8. Normalizes the development of granulation tissue and activates the processes of marginal epithelization

9. Does not cause allergic action;

10. No negative effect on tissue response;

11. Non-toxic;

12.Creates favorable environment for the reproduction of skin cells;

13. Promotes cleansing of the wound from necrotic detritus;

14. Promotes the rapid formation of epithelium at the site of skin damage.

Biokol in cosmetology.

In cosmetology, this drug is successfully used after "traumatic skin" procedures that cause active growth of skin cells. A quick and pronounced effect of Biocol can be assessed after application various kinds peelings: acid, laser, ultrasonic; after a microdermabrasion session; after all kinds of photo-procedures. Along with a cooling and soothing effect, the drug has a biophysical effect on fabrics and skin cells.

Regeneration was not only faster, but also more complete: fibroblast proliferation was more uniform and young squamous epithelial cells were observed in the tissue imprint. The absence of eosinophilic infiltration indicated the absence of an allergic reaction.

The uniqueness of the Biocol cosmetic series of preparations lies in faster and more complete regeneration of skin cells. This minimizes the appearance of scars, and also reduces the time of rehabilitation and restoration of a healthy appearance of the patient's skin.

By the decision of the Committee for New Medical Technology of November 19, 1992, Protocol N10, temporary wound dressing BIOKOL - 1 was approved for industrial production and clinical use.

As you know, a branch of medicine such as plastic surgery began to develop relatively recently. Nevertheless, to date, many discoveries have been made in it. Today, it is possible to increase or decrease almost any organ, change its shape, transplant, etc.

One of the procedures carried out plastic surgeons, is a skin graft. This operation has been practiced for many years, and every year it is being improved. There are cases when almost the entire skin was transplanted. Thanks to this procedure, you can not only hide defects, but also completely change the appearance.

What is a skin graft?

Replacing the damaged area with a new skin flap is called dermoplasty. Such an operation is performed in a surgical department. Indications for it may be different. In most cases, these are damage to the skin and the inability to restore it in another way. There are several types of dermoplasty. The most common way is to transplant skin from one area of ​​the body to another, which is the site of damage.

AT recent times other methods of transplantation are also actively developed. In well-equipped clinics and research institutes, new cells are “cultivated” under special conditions. Thanks to this, the skin can be "created" and not taken from another area. This is a huge breakthrough in medicine! At present, this method is not yet widely used, however, developments in this area are underway.

When is a skin graft performed?

Skin grafting is a surgical intervention that is necessary to replace a damaged area of ​​tissue, as well as to cosmetic purposes. Currently, such a procedure is carried out in almost all major clinics. The technique of skin grafting should be mastered by a surgeon of any specialty. However, in order to avoid a cosmetic defect, it is required special training. Therefore, skin grafting on the face and exposed areas of the body should be performed by a plastic surgeon.

Most often, such a surgical intervention is performed only in cases of need (according to vital indications). Usually, skin grafting is required after radical surgery, massive burns, traumatic injury. In addition, such a surgical intervention may be necessary during plastic procedures. In some cases, people who do not have strict indications for this operation wish to transplant the skin, for example, if they want to hide a scar or tissue pigmentation. Sometimes dermoplasty is performed to change the color of the skin. Nevertheless, it is worth remembering that, like any surgical intervention, this operation has certain risks. Therefore, in most cases, it is performed only when necessary.

Indications for dermoplasty

The main indications for skin grafting are tissue damage. Violation of integrity can be caused by various reasons. There are the following indications for dermoplasty:

• Burns. This refers to significant damage to the skin due to exposure to high temperatures or chemicals. Dermoplasty after burns is especially common among children. This is due to the fact that toddlers are more prone to accidents at home. As a rule, children scalded with boiling water enter the trauma department. Among the adult population, chemical burns received at work are more common, less often at home.

• The presence of scar tissue large area skin cover.
• Traumatic injury. Skin grafting after injury is not carried out immediately. First of all, it is necessary to stabilize the patient's condition. In some cases, dermoplasty is indicated several weeks or months after the formation of the primary scar.
• Long-term non-healing wound surfaces. This group of indications should include bedsores, trophic ulcers in vascular diseases, diabetes mellitus.
• Plastic surgery on the face, joints.

In addition, skin grafting can be performed for dermatological diseases, birth defects. Often this operation is performed in the presence of vitiligo - depigmented tissue areas. Hyperkeratosis and birthmarks large sizes can also be the basis for dermoplasty. In such cases, the indications are considered relative, and the operation is performed at the request of the patient in the absence of severe somatic pathologies.

What are the methods of skin grafting?

There are 3 ways of skin grafting. The choice of method depends on the size of the defect and its localization. Note that the method of skin transplantation is chosen by the attending physician in accordance with the equipment of the clinic. Depending on where the material for transplantation is taken from, auto- and allodermoplasty are distinguished.

A separate type of transplantation is tissue skin grafting.

• Autodermoplasty is performed when less than 30-40% of the body area is affected. Under this surgical intervention is meant the transplantation of the skin from one area to another (affected). That is, the transplant is taken from the same patient. Most often, a skin area is used from the gluteal region, back, and the lateral surface of the chest. The depth of the flaps is from 0.2 to 0.7 mm.
• Allodermoplasty is performed for massive defects. Often, skin grafting is performed in this way after a burn of 3 and 4 degrees. Allodermoplasty refers to the use of a donor skin flap or the use of artificial (synthetic) tissues.
• Cellular dermoplasty. This method is used only in some large clinics. It consists in "growing" skin cells in the laboratory and using them for transplantation.

Currently, autodermoplasty is considered the preferred method, since engraftment of one's own tissues is faster, and the risk of graft rejection is significantly reduced.

Skin graft preparation

Before proceeding with the skin grafting operation, it is necessary to undergo an examination. Even if the defect is not very large, it should be assessed whether there is a risk from surgical intervention, and how high it is in a particular case. Immediately before dermoplasty, laboratory tests are performed. Among them: KLA, OAM, blood biochemistry, coagulogram.

In case of massive injuries, when an allograft is required, it is necessary to pass a larger number of tests. After all, transplantation of the skin from another person (or synthetic material) can lead to rejection. The patient is ready for the surgical procedure if the total blood protein does not exceed 60 g/L. It is also important that the hemoglobin level is within the normal range.

Surgical technique

Skin grafting for burns is not carried out immediately, but after the stabilization of the patient's condition. In this case, dermoplasty is delayed. Depending on where exactly the damage to the skin is localized, how large it is in area and depth, a decision is made on the method of surgical intervention.

First of all, prepare the wound surface. For this purpose, zones of necrosis and pus are removed. Then the defective area is treated with saline. After that, the affected tissue is covered with a graft. It should be borne in mind that the skin flap taken for transplantation decreases in size over time. The edges of healthy tissue and graft are sutured. Then apply a bandage moistened with antiseptics, healing agents, dioxidine ointment. This helps to avoid infection of the postoperative wound. A dry bandage is applied over the top.

Features of the operation depending on the type of dermoplasty

Depending on the depth and localization of the lesion, the technique of the operation may differ slightly. For example, if a skin transplant is performed on the face, it is necessary to perform autodermoplasty. In this case, the skin flap should be split. For this purpose, the graft is taken with a special device - a dermatome. With its help, you can adjust the thickness of the cut of the skin fragment. If facial surgery is required, cellular dermoplasty can be performed.

With massive burns or injuries, the skin's own reserves are often not enough. Therefore, it is necessary to perform allodermoplasty. Skin grafting on the leg big size wound surface is carried out using a synthetic material - a special mesh that fixes the graft.

What complications can occur after dermoplasty?

Skin grafting can cause complications. The most common is transplant rejection. In most cases, it develops due to infection of the sutures. After autodermoplasty, rejection is less common. Another complication is bleeding from the wound.

Skin grafting: photos before and after surgery

Skin transplantation is performed quite often. Before you decide on the operation, you should look at the before and after photos of the surgery. In most cases, qualified doctors predict the outcome and provide the patient with an image that shows what the damaged area will look like when the graft heals.

Prevention of surgical complications

There are several risk factors for developing complications after skin grafting. Among them are the childish and elderly age of the patient, the presence of reduced immunity.

To avoid graft rejection, it is recommended to use hormonal drugs in the form of ointments. To prevent bleeding and inflammation, the drug "Pyrogenal" and antibiotics are prescribed.

British scientists announced important discovery which will allow a person to forget about wounds and burns. One of the medical companies in England conducted the first tests of a synthetic analogue of human skin. It was announced that if further experiments with alternative skin are successful, then in the near future medicine will refuse from difficult operations for its transplantation. However, not all experts consider this discovery revolutionary.

NTV correspondent Yevgeny Ksenzenko visited the scientific laboratory.

Dave Shering, Research Lab: "I just feel a cold touch."

On Dave's arm is a fragment of artificial leather. It is impregnated with a special solution for greater elasticity. If it is now applied to an open wound, then in a month, according to scientists, it will be delayed.

Dave Shering, research lab researcher: "Artificial skin covers the damaged surface, and in four weeks it fuses with human skin."

The laboratory conducted an experiment on six volunteers. They cut out pieces of skin on their forearms, and then transplanted an artificial one.

Paul Camp, director of the research laboratory: "We were amazed at the quality of healing. Even when transplanting ordinary skin, there are some joints. Everything is smooth with us. It is impossible to determine where the wound ends."

Faux leather is similar to human skin. It is based on a fibrin matrix. It is a protein that the body produces to heal wounds. Fibroblasts, that is, human skin cells, are added to it. The creation of a new fabric begins. The conditions are as close to natural as possible. According to scientists, this is how the body fights injury.

Dave Shering, research lab researcher: "We hope that our skin will take root in any part of the human body where there is an injury."

The British are calling it an alternative to skin grafting, and they hope it can help treat burns.

In Russian laboratories, "leather substitutes" are also grown. This is a film based on living fibroblasts.

Elena Zhirkova, researcher at the burn center of the Institute. Sklifosovsky: "We put this film "substrate" on the wound. After a few days it can be removed. In a patient with burns, everything heals on the seventh day."

Russian doctors doubt the novelty of the British idea. In their opinion, it is not yet possible to recreate the structure of human skin.

Elena Zhirkova, researcher at the burn center of the Institute. Sklifosovsky: "What the British called "artificial skin" can be called one of the types of wound coverings. There are now a large number of them."

It was in this way that Boris Popov was cured. He was electrocuted on the train.

Boris Popov: "54% of the skin was burned: face, chest, abdomen and right leg fully. I could only lie on my back."

Doctors joked that Boris was born not in a shirt, but in a bulletproof vest. He recovered in a month, now he knows a lot about the methods of treatment. He does not believe in the appearance of artificial skin.

The British laboratory is not going to convince the doubters. They ask you to wait until the next experiments. In any case, artificial leather will not become available in the coming years. This is an expensive technology that only rich people can afford. While it is cheaper to transplant your own skin.

Plastic surgery offers many ways to change and improve your appearance. Many operations are performed without special indications, only at the request of the patient. But in some cases, for example, after receiving severe burns, a skin graft is prescribed for medical reasons.

In most cases, this procedure is performed after severe and extensive injuries, otherwise a violation of the integrity of the skin can lead to grave consequences for the whole organism.

Indications for dermoplasty

Skin grafting (dermoplasty) is a procedure to replace damaged skin with healthy skin flaps. It is carried out with severe damage, when other methods of tissue repair are powerless. The skin performs a protective function and protects the body from infectious microorganisms, hypothermia and dehydration. Its damage is a threat to the normal functioning of the body.

Statistics show that 1/3 of all cases of burns leads to the complete death of the upper and inner layers of the skin, causing severe pain and leading to the impossibility of healing in a natural way. Even a small, but deep burn is dangerous for infection, the development of sepsis and death.

Skin transplantation after a burn allows you to accelerate tissue healing, stop inflammatory process, prevent infection and dehydration. Modern techniques allow not only to restore the skin, but also to give it its original appearance, to ensure functionality and elasticity.

It is noticed that already on the first day after skin transplantation, the patient's general condition improves.

Indications for skin grafting after a burn are as follows:

1. Deep burns (3rd and 4th degree).
2. Large affected area.
3. Scar formation.
4. Visible skin imperfections.
5. The formation of trophic ulcers at the site of the burn.

Particularly severe injuries occur in children - more than half of patients childhood underwent recovery operations after burn injuries. With deep injuries, scars and cicatricial constrictions remain in children, and uneven traction of healthy and scar tissues leads to twisting of muscles, tendons and improper formation of the skeleton. That is why skin transplantation after a burn in children is carried out as early as possible.

However, this procedure may not always be carried out. Contraindications for transplantation can be considered:

1. Extensive hemorrhages and hematomas can provoke graft rejection.
2. Poor treatment of wounds, remnants of crushed and damaged tissues.
3. Attachment of infection (in some cases it is not a contraindication, therefore it is recommended to conduct a cytological examination).
4. Severe or shock condition of the patient.
5. Unsatisfactory analysis results.

How is the operation carried out?

The success of a skin graft operation depends on many factors. First of all, they are proper preparation and experience of the surgeon.

Only an experienced specialist, having weighed all the pros and cons, will select the right material for transplantation and take into account all the nuances that have arisen during the intervention.

Training

In order for the skin grafting operation to be successful, it is necessary to carry out preparatory measures. First of all, this is a mechanical cleansing of the wound surface from necrotic and damaged tissues. It is necessary to remove all dead cells and damaged tissues that cannot be restored.

A few days before transplantation, training is carried out aimed at improving biological functions, both locally and globally:

Material selection

The graft is especially carefully prepared. It is most preferable to take the patient's own skin from other parts of the body - the inner thighs, buttocks, abdomen, back or shoulders.

If it is not possible to take the patient's tissues, then they take donor skin, it is possible to take a transplant both from a living person and from dead person. Some clinics have the ability to store donor skin, which reduces the waiting time for suitable skin for transplantation.

It is also possible to use animal tissues, the transplant taken from pigs takes root best of all. Recently, it has become possible to grow skin cells artificially, but this technique is not yet widely used.

In some cases, a three-dimensional operation is necessary when, in addition to skin cartilaginous tissues were damaged from burns.

Depending on the lesion, there are three types of graft required for the thickness:

1. Thin - no more than 3 mm.
2. Medium - 3-7 mm.
3. Thick - up to 1.1 cm.

Intervention

The sooner a skin transplant is performed for burns, the faster the patient's condition improves. Therefore, whenever possible, the operation is carried out in the most early dates. Practice shows that in case of minor injuries, plastic surgery is carried out after 3-4 weeks, and in case of extensive burns with deep necrotic manifestations, after 2-3 months.

To speed up the timing of the operation, a necrectomy is performed - the removal of dead tissue. To do this, use external means, physiotherapy and surgical removal of dead tissue. Necrectomy on large areas of the skin leads to a sharp deterioration in the condition, in some cases such an operation becomes the cause of death.

The complexity of the procedure lies in the fact that even an experienced surgeon cannot always assess the depth of the lesion. Therefore, they prefer to use a phased necrectomy - starting from 10-20 days from getting a burn, necrotic tissues and scabs are gradually removed during dressings. It is this method that is used for children, provided that no more than 10% of the skin is damaged.

The timing of the operation in children depends on the condition, it is necessary to consider whether the child will be able to endure a long operation and extensive blood loss.

Therefore, two teams of doctors work simultaneously: one takes the transplant, the other prepares the burn site for transplantation.

After necrectomy, immediately before skin grafting, the surface of the wound is treated with sodium chloride and thoroughly dried. A graft cut to the size of the wound is applied to the wound bed and straightened.

To keep it in this position, several stitches are applied or held with a tight bandage. For extensive burns, drainage must be provided to prevent pooling of blood. The first dressing is carried out 4-7 days after the operation, depending on the area of ​​the transplanted skin.

Possible complications and recovery

Like any surgical intervention, dermoplasty can be accompanied by adverse consequences. What complications can arise:

Often such complications occur when the doctor's recommendations for recovery are not followed, which is divided into three periods:

1. Adaptation: the first two days after the operation.
2. Regenerative: up to 3 months after plastic surgery.
3. Stabilization: three months to full recovery.

In the first period, it is important to provide the patient with all the conditions for improving the condition, engraftment of the graft, and preventing the development of anemia. It is important to monitor the condition of the dressings - abundant wetting may indicate the development of a hematoma and the onset of rejection. To stop this process, the bandage is removed and the hematoma is removed, if this is done in time, so that the chances of the graft engraftment are high enough.

It is important for the patient to stay in bed and avoid pressure on the wound area. In some cases, splints are placed to immobilize the affected limbs. Recommendations to patients:

1. Timely walk on bandages.
2. Do not wet the wound area.
3. Avoid hitting the affected area.
4. Avoid overheating.
5. Observe the drinking regime.
6. Take vitamin and mineral complexes and omega acids.
7. Give up alcohol.
8. Increase your protein intake and avoid high fat foods.

In what cases it is necessary to see a doctor:

For each patient after surgery, certain drugs and physiotherapy are prescribed to prevent transplant rejection and speed up recovery.