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Gastrointestinal stromal tumors (GIST) are the most common type of mesenchymal malignancies of the gastrointestinal (GI) tract. Almost 10% of them are originated outside of the GI tract (extra-GIST), while GIST of the greater omentum constitutes about 1% among stromal tumors. More than 80% of GIST have mutations in c-KIT and PDGFRA genes. Herein we demonstrate the case of successful treatment of patient with giant omental GIST with c-KIT exon 11 mutation. 64-years-old woman, was admitted to the Department of abdominal oncology with complaints of shortness of breath and abdominal enlargement in volume. CT-scan revealed a large tumor in the abdominal cavity with tumor size of 543422 cm. The patient underwent left thoraco-abdominal approach. It was found that the tumor was originated from the greater omentum with several metastases located on the peritoneum of the left lateral channel. Resection of the large omentum, splenectomy, liver resection and was done. Postoperative immunohistochemical study showed the expression of CD117, CD34 in tumor cells. Ki-67 index was 1215%. Genetic study revealed c-KIT exon 11 mutation. Treatment with imatinib 400 mg per day was started. Patient has been treated with imatinib for 12 years. On control examination we have found a metastasis in the anterior abdominal wall 3,532,5 cm in diameter. Afterwards we performed resection of anterior abdominal wall with metastasis on 9 November 2017. Immunohistochemical study confirmed metastasis of GIST. The index of tumor proliferation activity (Ki-67) was 45%. Patient prolonged imatinib treatment at the dose of 400 mg per day after operation. No signs of progression have been revealed on control examination 72 months after the operation. 12-year progression-free survival during imatinib treatment is unique in our practice. Moreover, in the case of further progression, we have second and third-line targeted therapy (sunitinib and regorafenib) and surgery treatment in local progression.

Introduction Surgical treatment of patients with tissue defects of the scalp and face is challenging for surgeons. It is an integral part of the social and labor rehabilitation of such patients. Exposure of the skull bones after extensive polyetiological resections creates a difficult task for reconstruction of complete or partial loss of soft tissues of the head. Autologous dermoplasty, simple in its technical implementation, is impractical on the bones of the facial and cerebral skull because insufficient vascularization of the wound bed creates a risk of early rejection of the graft. The aim of the study was development and evaluation of the effectiveness of the method of restoring the integrity of the skin of the head and face inh extensive defects with exposure of the bones of the skull. Materials and methods Аnalysis of the methods and results of reconstructive surgical treatment of three patients with extensive defects in the tissues of the scalp and face at the Research Institute of the Ochapovsky Regional Clinic Hospital No.1 in 2018-2020. Results The immediate result of surgical treatment was a complete restoration of the skin with the maximum possible preservation of underlying deep anatomical structures after a radical one-step removal of non-viable tissues, both soft and bony. Subjectively, the patients were satisfied. The aesthetic result obtained in all cases satisfied both the patients and the surgical team. Conclusion The treatment of extensive defects of the soft tissues of the face and bones of the skull is a doable task, provided certain conditions are met. Removal of the affected tissues with simultaneous plasty of the resulting wound defect with a autologous greater omentum and skin autografts allows one to simultaneously solve the problem of plastic closure of wound defects of such localization. When performing osteonecrectomy of the outer cortical plate of the skull to the bleeding layer, conditions are created for survival of a free skin autograft on the bone.

The clinical case of treatment in a patient with extensive defects of hairy part skin of the head and face is presented. The autoplasty with split skin with one-stage closing of wound defects with a big auto-omentum was performed. For the best adaptation of biological transplants the autologous platelet enriched plasma, and the allogenic frozen dermal fibroblasts were applied. The good esthetic and functional result was received.

Mylytsya К. M., Lavryk А. S., Lavryk О. А. SIMULTANEOUS DEBULKING OF GREAT OMENTUM LIKE A PALLIATIVE STAGE OF METABOLIC SYNDROM AND OBESITY TREATMENT = СИМУЛЬТАННИЙ ДЕБАЛКІНГ ЧЕПЦЯ ЯК ПАЛІАТИВНИЙ ЕТАП ЛІКУВАННЯ МЕТАБОЛІЧНОГО СИНДРОМУ І ОЖИРІННЯ. Journal of Education, Health and Sport. 2016;6(9):691-698. eISSN 2391-8306. DOI http://dx.doi.org/10.5281/zenodo.159095 http://ojs.ukw.edu.pl/index.php/johs/article/view/3896 The journal has had 7 points in Ministry of Science and Higher Education parametric evaluation. Part B item 755 (23.12.2015). 755 Journal of Education, Health and Sport eISSN 2391-8306 7 © The Author (s) 2016; This article is published with open access at Licensee Open Journal Systems of Kazimierz Wielki University in Bydgoszcz, Poland Open Access. This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited. This is an open access article licensed under the terms of the Creative Commons Attribution Non Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted, non commercial use, distribution and reproduction in any medium, provided the work is properly cited. This is an open access article licensed under the terms of the Creative Commons Attribution Non Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted, non commercial use, distribution and reproduction in any medium, provided the work is properly cited. The authors declare that there is no conflict of interests regarding the publication of this paper. Received: 02.09.2016. Revised 24.09.2016. Accepted: 24.09.2016. SIMULTANEOUS DEBULKING OF GREAT OMENTUM LIKE A PALLIATIVE STAGE OF METABOLIC SYNDROM AND OBESITY TREATMENT К. M. Mylytsya1, А. S. Lavryk2, О. А. Lavryk2 1State Institution “Zaporizhia Medical Academy of Post-Graduate Education Ministry of Health of Ukraine” 2Shalimov National Institute of Surgery and Transplantology of NAMS of Ukraine Summary The article discusses the possibility and expediency of simultaneous visceral fat debulking (omentectomy) in patients with metabolic syndrome and obesity. The investigation of the level index HOMA in the pre- and postoperative period in 50 patients with metabolic syndrome and obesity. Of these various 25 performed abdominal surgery, the rest of the 25 performed similar operations with simultaneous omentectomy. Results indicate that the greater omentum debulking affect carbohydrate metabolism by reducing the severity of insulin resistance and hyperinsulinemia. Key words: debulking, greater omentum, metabolic syndrome, obesity, simultaneous surgery. СИМУЛЬТАННЫЙ ДЕБАЛКИНГ БОЛЬШОГО САЛЬНИКА КАК ПАЛЛИАТИВНЫЙ ЭТАП ЛЕЧЕНИЯ МЕТАБОЛИЧЕСКОГО СИНДРОМА И ОЖИРЕНИЯ К. Н. Милица1, А. С. Лаврик2, О. А. Лаврик2 1 ГУ «Запорожская медицинская академия последипломного образования МЗ Украины», 2Национальный институт хирургии и трансплантологии имени А.А. Шалимова НАМН Украины, Киев Резюме В статье обсуждаются вопросы возможности и целесообразности применения симультанного дебалкинга висцеральной жировой ткани в виде оментэктомии у пациентов с метаболическим синдромом и ожирением. Проведено исследование уровня индекса HOMA в до- и послеоперационном периоде у 50 пациентов с метаболическим синдромом и ожирением. У 25 пациентов выполнены различные абдоминальные операции, у остальных − подобные операции с симультанной оментэктомией. Результаты указывают на то, что дебалкинг большого сальника влияет на углеводный обмен за счет снижения выраженности гиперинсулинемии и инсулинорезистентности. Ключевые слова: дебалкинг, большой сальник, метаболический синдром, ожирение, симультанная хирургия. СИМУЛЬТАННИЙ ДЕБАЛКІНГ ЧЕПЦЯ ЯК ПАЛІАТИВНИЙ ЕТАП ЛІКУВАННЯ МЕТАБОЛІЧНОГО СИНДРОМУ І ОЖИРІННЯ К. М. Милиця1, А. С. Лаврик2, О. А. Лаврик2 1 ДЗ «Запорізька медична академія післядипломної освіти МОЗ України», 2 Національний інститут хірургії та трансплантологiї імені О. О. Шалімова НАМН України, Київ Резюме У статті обговорюються питання можливості і доцільності застосування симультанного дебалкінга вісцеральної жирової тканини у вигляді оментектомії у пацієнтів з метаболічним синдромом та ожирінням. Проведено дослідження рівня індексу HOMA в до- і післяопераційному періоді у 50 пацієнтів з метаболічним синдромом та ожирінням. У 25 пацієнтів виконані різні абдомінальні операції, у інших – подібні операції з симультанною оментектомією. Результати вказують на те, що дебалкінг великого чепця впливає на вуглеводний обмін за рахунок зниження вираженості гіперінсулінемії і інсулінорезистентності. Ключові слова: дебалкінг, великий чепець, метаболічний синдром, ожиріння, симультанна хірургія.