Pirogov's topographical anatomy

Sawing method ("ice sculpture")

Pirogov's main scientific achievement in morphology was the development of the method of sawing frozen corpses. Before this, anatomists used exclusively classical dissection (praeparatio), in which tissues inevitably shifted, disrupting the natural picture.

The essence of this innovative method was as follows: the body was pre-frozen, and then cuts were made in three mutually perpendicular planes — horizontal (transverse), frontal, and sagittal. In the resulting sections, the organs retained their true intravital position without deformation.

The result of these years of work was the foundational atlas "Illustrated Topographical Anatomy of Sections..." (Anatome topographica sectionibus per corpus humanum congelatum triplici directione ductis illustrata), published from 1851 to 1859. This work provided surgeons with precise anatomical landmarks. Today, Pirogov's method is considered the direct precursor of computed tomography (CT), which reproduces the same principle of slice-by-slice study.

Anatomical and experimental approach and amputations

Pirogov became the founder of the anatomical, experimental, and functional approach in surgery. He postulated that any surgical intervention must be strictly justified by a detailed knowledge of the anatomy of a specific region.

Building on this, he developed a number of outstanding surgical techniques:

• In 1852, he first performed osteoplastic foot amputation. This operation was based on a profound understanding of the topography of the ankle joint and made it possible to preserve the weight-bearing function of the stump.
• He developed the three-stage cone-circular method of hip amputation. The method takes into account the layered anatomy of the limb and the differing contractility of tissues. It includes three consecutive stages: dissection of the skin, then the fascia with the superficial muscle layer, and finally the deep muscle layer.

Contributions to maxillofacial surgery and antisepsis

Pirogov's contributions span many areas of medicine:

• Transplantation and plasty: Back in 1835, he formulated the basic laws of transplantation. Between 1836 and 1856, he personally performed about 40 rhinoplasties (for comparison: prior to 1836, only 73 such operations had been recorded worldwide).
• Maxillofacial surgery: Working in the hospital surgery clinic, Pirogov performed over 130 complex operations. Among them: 36 jaw resections for neoplasms, 25 excisions of the lower lip due to cancer, 20 cheiloplasties, 7 cleft lip operations, and 5 removals of sublingual salivary gland tumors. He described his experience in the works "On Resection of the Upper Jaw for Caries" (1841) and "Cancer of the Lower Lip" (1855).
• Pain management and antisepsis: In 1847, together with I.V. Buyalsky and F.I. Inozemtsev, he was one of the first to use ether anesthesia. At the same time, he began using chlorinated lime to prevent surgical complications.

Methods for studying topographical anatomy

In addition to Pirogov's method, modern topographical anatomy uses a whole arsenal of classical and instrumental approaches:

1. Dissection — layered cutting of tissues to study stratigraphy, organ syntopy, and the course of vessels and nerves. It mimics the stages of a surgical operation.
2. Injection method — introduction of colored or contrast masses into vessels and cavities, followed by tissue clearing. It helps study vascular angioarchitecture and anastomoses.
3. Corrosion method — filling hollow structures (bronchi, bile ducts) with a hardening mass. The soft tissues are then dissolved with acid or alkali, yielding a three-dimensional cast.
4. Modern imaging — radiation diagnostics that allow for the study of anatomy in the living patient. It includes CT (assessment of dimensions and topography on horizontal and vertical slices), MRI (detection of tumors, cysts, and abscesses in transverse and sagittal slices), Ultrasound (visualization of parenchymatous organs — liver, spleen, kidneys), and radiological methods (angiography).

Class and exam questions

What else to study on this topic

• Pirogov-Parona space: boundaries and surgical approach
• Topographical anatomy of the foot and ankle joint (basis for Pirogov amputation)
• Topography of the thoracic trachea and main bronchi
• Topography of the hemiazygos vein (v. hemiazygos)
• Surgical treatment of aortic coarctation: topographical and anatomical rationale

Other topics in the "Additional Topics" section

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