[Alternative method of surgical treatment for aortic arteritis in non-repairable forms of vessels damage].

The purpose of the work--the choice of optimal treatment tactics of patients at the extremity tissue ischemia due to nonspecific aortoarteritis (NA). In the surgical treatment of patients with NA, particularly with concomitant peripheral lesions, and to a greater degree of terminal arterial bed, significantly limited the possibility of direct revascularization. Conservative treatment and subthoracal sympathectomy are ineffective. Autotransplantation of mesenchymal stem cells (MSCs), adipose tissue or bone marrow in ischemic tissue in the form of aspirates or selected from these aspirates cell cultures allowed to correct hemodynamic disorders by stimulating angiogenesis and development of collateral circulation.

[Application of autologous aspirates as well as multipotent stromal cells of the bone marrow and adipose tissue in vascular surgery].

Basing on experiments, performed on laboratory animals, and on the literature data, there was proved stimulating influence of transplantation of stromal cells, residing in adipose tissue, in a kind of stromal-adiposal fraction towards angiogenesis and reparative processes in tissues in ischemic conditions. There was elaborated and introduced the tactics of treatment in patients, suffering chronic ischemia of the lower extremities tissues, using combined methods of surgical treatment, including the bone marrow aspirate (BMA) autotransplantation into the ischemized tissues, the rotation ostheotrepanation, reconstructive and endovascular interventions on proximal segment of the extremity. The efficacy and potential of application of the BMA and adipose tissue was proved in the treatment of patients, suffering ischemia of the upper extremities tissues, caused by thromboobliterating affection of peripheral vascular bed.

[The upper extremities revascularization in patients with brachial artery thrombosis due to its chronic damaging by crutches: new approaches to the treatment].

An optimal tactics of treatment of patients, suffering the upper extremities (UE) ischemia, caused by arterial thrombosis, occurred due to subclavian artery damage in those patients, who apply crutches for a long period of time, was elaborated. In modern medicine in patients with the UE arterial bed thrombosis with affection of its peripheral, and more in terminal, portion the possibilities of direct revascularization performance are significantly restricted, especially in patients, suffering from constant mechanical injury of armpit and its vascular content, caused by crutches. Application of the method, consisting of automyelotransplantation of the bone marrow aspirate, have permitted to regulate the disorders of microhemodynamics, using stimulation of angiogenesis and development of a collateral blood flow.

[Method of surgical treatment of "elephantiasis" of the limb: old philosophy, new approach].

The authors had summarized more than 25-year experience of surgical treatment of patients with the lower and upper extremities lymphedema. The aspiration-resectional-plastic method of treatment of severe forms of the limb lymphedema, which intends in the first stage the resection of fibrously changed tissues, preserving the portion of slightly changed cutaneous-subcutaneous flaps and regions in projection of localization of main lymphatic collectors, under which aspiration lipectomy is performed. Postresectional wound surface is covered with special synthetic tissue. In the next stage, after appearance of granulation tissue, autodermoplasty is performed. Two-staged cutaneous plasty and repeated aspirational lipectomy provides for optimal survival of full thickness cutaneous transplants, reduction of the limb volume, improvement of the lymphatic system draining function.

[The method of lifting and fixation of superficial musculo-aponeurotical system in rejuvenation operations on the face].

The method of neck-facial facelifting, consisting of restrited dissection of adiposo-cutaneous flap and fascial sheet of superficial musculo-aponeurotical system (SMAS), its suturing using multiple quilts in a closed loop fashion, lifting of the neck-facial tissues en bloc along vertical vector. The thread is conducted subperiosteal in zygomatic arch region, securing safe fixation of the SMAS flap, permits to achieve harmony and to make the rejuvenation effect more durable.

Pathophysiology and selection of method for surgical management of thoracic outlet syndrome.

Over the period of 1977-82 seventy-eight patients with thoracic outlet syndrome were examined and treated at our Institute. Sixty-eight patients were operated on. The average age of the patients was 34.6. Women prevailed (42 patients). Trauma accounted for syndrome development in 36 patients. In the remaining patients congenital and acquired osseous alterations, supernumerary scalene muscle, congenital fibrous bands were the etiologic factors. Uncomplicated thoracic outlet syndrome was found in 36 patients, a complicated form--in 32 out of 68 patients operated on. The essential role of neurogenic factors in the development of the disease, especially of the uncomplicated variety was disclosed. In bony pathology one noted early appearance and prevalence of vascular complications. First rib resection should be considered the principal type of decompressive operation. Selection of approach and use of other surgical interventions is determined by clinical presentation of complications. Good and satisfactory results after surgical treatment were obtained in 61 patients (89.7%).

[Diagnosis and surgical treatment results in neurovascular thoracic outlet compression syndrome]. / Diagnostika i rezul'taty khirurgicheskogo lecheniia neirososudistogo kompressionnogo sindroma grudnogo vykhoda.

A detailed study of 44 patients with the neuro-vascular compression syndrome of thoracic exit has established the diagnostic value of clinical and special methods of diagnosing the disease. The most frequent symptoms were pain in the anterior scalene muscle (ASM) during palpation (96%) and paresthesia in fingers (93%). Rheography, arteriography and phlebography of the upper extremities combined with the positional tests should be resorted to. In case of marked neurological symptoms the data on the nerve block of the ASM are informative. Surgical treatment was undertaken in 35 patients: resection of the I rib in 14 cases (in 4 resection combined with upper thoracic sympathectomy), resection of the ASM in 12, removal of the accessory cervical rib with scalenotomy in 5, decompressive vascular reconstructive operations in 10 patients with vascular complications. Good results were obtained in 32 patients. It is stressed that detailed examinations of patients with vaso-neurological symptoms in the upper extremity are important for timely diagnosis and surgery before the complications supervene.

[Alloplasty of nerves using cryopreserved grafts subjected to total epineurectomy (experimental-clinical study)]. / Alloplastika nervov kriokonserivirovannym transplantatom, podvergnutym total'noi épinevrektomii (eksperimental'no-klinicheskoe issledovanie).

It was demonstrated in experiments on 24 dogs that microsurgical epineurectomy of a cryopreserved peripheral nerve improves the results of neuroplasty due to acceleration and increase of graft revascularization. From application of the developed method in 12 patients it was concluded that microsurgical alloneuroplasty with a cryopreserved graft may be the method of choice in cases in which autoplasty cannot be performed.

[Prophylactic and correctional measures for thromboembolic complications in performance of the upper extremity replantation and microvascular autotransplantation of combined complex of tissues]. / Mery profilaktiki i korrektsii tromboticheskikh oslozhnenii pri vypolnenii replantatsii verkhnei konechnosti i mikrososudistoi autotransplantatsii slozhnogo kompleksa tkanei.

There were analyzed the causes and factors, influencing the thromboembolic complications frequency, in performance of the upper extremity segment replantation in 220 injured persons and of microsurgical the tissues defect plasty using combined complex of tissues (CCT)--in 154 patients. The role of anticoagulational therapy in complex of remedial measures, directed on the occurrence prophylaxis and medicinal correction of hemodynamic disorders in microvascular anastomoses after the operation, was determined. The advantages of low-molecular weight heparin (Fraxiparine) administration in comparison with the standard heparinotherapy were showed: lowering of thromboembolic and hemorrhagic complications occurrence frequency, the unique method of Fraxiparine subcutaneous injection into the replanted segment and CCT was presented.

[Surgical treatment of injured persons with the main blood vessels damage]. / Khirurgicheskoe lechenie postradavshikh s povrezhdeniem krupnykh krovenosnykh sosudov.

Retrospective analysis of the surgical treatment results of 45 injured persons with damage of main blood vessels was presented. Specific operative methods in injury of the different type main blood vessels, localized in thoracic and abdominal cavities, were depicted. In 35 (77.8%) injured persons good and fair results of restoration operations were noted. The lethality rate was 22.2%. The tactic of surgical treatment of the main blood vessels injury was presented.

[Compression syndromes in chronic venous insufficiency of lower extremities]. / Kompressionnye sindromy pri khronicheskoi venoznoi nedostatochnosti nizhnikh konechnostei.

Results of examination and surgical treatment of 77 patients with severe forms of chronic venous and lymphovenous insufficiency of lower extremities were analyzed. The compression syndrome concept and its role in pathogenesis of severe forms of chronic venous and lymphovenous insufficiency of lower extremities were determined. There was elaborated the tactics of complex treatment of patients, application of which had permitted to achieve the trophic ulcers healing in 98% operated patients, previously considered noncurable.

[Surgical tactic in the injury of neck vessels]. / Khirurgicheskaia taktika pri povrezhdenii sosudov shei.

Retrospective analysis of the surgical treatment results in 50 injured persons with the damage of the neck vessels in 1998-2003 yrs period was presented. Restorational-reconstructive operations were performed in 19 (38%) injured persons with the arteries damage, in 10 (20%)--with the veins damage, the ligature operations were done, accordingly, in 6 (12%) and in 20 (40%). Satisfactory result was noted in 41 (82%) injured persons. Neurological complications had occurred in 4 (8%) of patients. Mortality had constituted 10% (5 patients died). The principles of surgical treatment of the neck vessels damage were stated.

[Experimental substantiation of a two-staged method of microsurgical transplantation of the complex composite flaps]. / Eksperimental'noe obosnovanie dvukhétapnogo metoda mikrokhirurgicheskoi peresadki slozhno-sostavnykh loskutov.

The authors have proposed two-staged flap transplantation, consisting of flap mobilization on vascular pedicle with subsequent its transplantation in several days. In experiment on muscular flaps, obtained from regio epigastrica of 30 rabbits, it was established that optimal time for the second stage of operation conduction may be end of the second--beginning of the third day after the transplant mobilization.

[Current possibilities of the diagnosis and surgical treatment of acute thrombophlebitis and severe forms of varicose disease]. / Sovremennye vozmozhnosti diagnostiki i khirurgicheskogo lecheniia ostrogo tromboflebita i tiazhelykh form varikoznoi bolezni.

The data on examination and surgical treatment of 35 patients, suffering severe forms of varicose disease in stage of trophic disorders occurrence and with an acute thrombophlebitis are adduced. The concept of an active surgical help, including thromboembolic complications prophylaxis, depending on thrombophlebitis localization, correction of the venous hemodynamics disorders and the staged closure of trophic ulcer is substantiated. Introduction of the proposed tactics had permitted to achieve satisfactory outcomes, including the trophic ulcer healing and the trophic disorders regression in all the patients operated on.

[The development and introduction of diagnostic and treatment methods for neurovascular diseases of the upper extremity]. / Razrabotka i vnedrenie metodov diagnostiki i lecheniia neirovaskuliarnykh zabolevanii verkhnei konechnosti.

The diagnosis complex, permitting to reveal the disease cause and the character of the affect faulty and quickly, was elaborated, based on the experience of treatment analysis of more than 600 patients with the upper extremities neurovascular diseases--thoracic inlet syndrome, Raynaud disease and syndrome. Methods of conservative therapy are introduced, indications for operative treatment are substantiated. Application of new methods of restoration-reconstructive interventions permitted to raise the treatment quality, particularly in seriously ill patients with complicated forms of upper extremities neurovascular diseases.

[Experimental studying of the possible pharmacological defense of muscular flap tissues from ischemic and reperfusion injury during its free transplantation]. / Eksperimental'noe izuchenie vozmozhnosti farmakologicheskoi zashchity tkanei myshechnogo loskuta ot ishemicheskogo i reperfuzionnogo povrezhdeniia pri osushchestvlenii ego svobodnoi peresadki.

In experiment on muscle flaps of 20 rabbits the peculiarities of their tissues damage in the ischemia period, and also due to the oxygen-dependent processes activation (peroxidal and free radical oxidation of a membrane phospholipids) in period of its reperfusion were studied. Preliminary introduction of a lipin, unitiol and ascorbic acid mixture in the flap arterial channel had promoted the reduction of damage severity in the translocated flap cells biomembranes due to ischemia and reperfusion, causing inhibition of the lipids peroxidal oxidation processes, rising of the flap tissues antioxidant defense, the cell and subcell membranes stabilization which preserves the vessels endothelium integrity. This showed a promising future for application of these preparations in a free transplantation of compound tissue complexes.

[Revascularization in the skin loss with skull fornix bone exposure]. / Revaskuliarizatsiia pri utrate kozhi c obnazheniem kostei svoda cherepa.

Experience of 69 patients treatment, suffering the soft tissues death with uncovering or partial necrosis of the skull vault bones, occurring after burns and mechanical injuries was summarized. Multiple milling (4 patients) of the uncovered bones is dangerous, lacks efficacy, leads to osteomyelitis and the skull vault defects development. The skull bones revascularization with cutaneo-subcutaneous, complex-composite flaps bringing nutrition from outside was proposed and accomplished. Revascularization methods are depicted, their results are presented in 65 patients. The revascularization conduction in term to 40 days after the injury occurrence permits to reduce the time of treatment, to avert the skull vault bones necroses, to gain good functional results.

[Restorative microsurgery in severe injury and traumatic amputation of the distal portions of the extremities]. / Vosstanovitel'naia mikrokhirurgiia pri tiazhelom povrezhdenii i travmaticheskoi amputatsii distal'nykh otdelov konechnostei.

Application of microsurgical methods and free grafting of the compound complexes of tissues with the vessels and nerves in particular with microanastomoses permitted to achieve high functional results in traumatic amputation of extremities in contiguity, severe destroying traumas and their consequences. Experience of 1000 urgent microsurgical operations, including 638 replantations of digits and their blocks for various kinds of amputation on the palm level was summarized. Classification of amputation, taking into account the injury mechanism and character, promoting the choice of optimal tactic and technique of restoration operation was elaborated. Indication for replantation are substantiated, the results of restoration operation, complications occurring after large segments of extremities replantation and measures for their treatment are analysed. Definite success of operation is determined by the extent of first operation and by subsequent rehabilitation measures conduction including the correcting operations and various conservative methods.