[The long-term results of surgical treatment of critical lower limb ischemia by autotransplantation using different tissues]. / Otdalennye rezul'taty khirurgicheskogo lecheniia kriticheskoi ishemii nizhnikh konechnosteis pomoshch'iu autotransplantatsii razlichnymi tkaniami.

Presented herein is an analysis of the 15-year results of surgical treatment of critical lower limb ischemia (stage IV chronic ischemia according to Fontaine - Pokrovsky classification) in patients suffering from chronic occlusive diseases of lower lirtb arteries (CODLLA) with subtotal and total obliteration of the peripheral arterial system. In total lesion of the talotibial segment when the patients could not be rendered assistance using conventional vascular surgery or when roentgenoendovascular deobliterution was not feasible, use was made of indirect revascularizntion of the ischemized limb by autotransplantation of soft tissue complexes. A flap of the broadest muscle of back (FBMB) was employed as an autotransplant in 56 patients, the greater omentum in 12 patients, and a flap of the anterior dentate muscle (FADM) was used in 9 patients. Twenty-five patients with diffuse lesion of the popliteal talotibial segment were provided combined limb revascularization, when the feasibility of standard bypass graft appeared fairly questionable. The majority of patients were placed under annual observation. It is noteworthy that the monitoring of the ankle/brachial index (ABI), oxygen tension on the foot (TcpO2) and of the proximal-distal temperature gradient as well as the assessment of the number of saved limbs and of the patients' quality of life allow to regard the technique as highly effective in the strategy of the salvage of the terminally inchemized limb from amputation. The technique also makes it possible to solve the problem of patch plasty of the trophically and necrotically changed foot and to maintain its support capacity. Combined revascularization makes it possible to unite the effect of direct and indirect reconstruction of the arterial system and to perform bypass graft in non-conventional situations.

[The organization of microsurgery at a provincial center]. / Organizatsiia mikrokhirurgii v usloviiakh oblastnogo tsentra.

The 5-year experience of microsurgery in regional medical centre is analysed. 1014 operations were performed. Certain managerial items and practical recommendations, necessary for development of microsurgery in regional medical centers are discussed. The importance of a close contract with other surgical services is advocated.