[Microsurgical autotransplantation of tissues in emergency surgery]. / Mikrokhirurgicheskaia autotransplantatsiia tkanei v neotlozhnoi khirurgii.

Results of microsurgical transplantation of 177 autotransplants in 167 patients with tissues defects of different origin and location are presented. Surgeries were urgent and elective with 96.6% survival of autotransplants. Short- and long-term results of surgery were assessed. It is concluded that microsurgical techniques of treatment are more reliable and cost-effective than traditional ones. Expediency of microsurgical autotransplantation in urgent surgery is demonstrated.

[The anesthesiological support for limb segment replantations (20 years' experience)]. / Anesteziologicheskoe obespechenie replantatsii segmentov konechnostei (20-letnii opyt).

Anesthesias for urgent replantations of the limb segments in 1980-1998 are analyzed. A retrospective analysis of case histories and protocols of anesthesia of patients aged 16-64 years is carried out. Specific features of anesthesia for surgery of this kind are demonstrated. The authors suggest an algorithm of preoperative treatment of patients, determined by the severity of injury, and discuss the choice of anesthesia: variants of regional anesthesia, balanced anesthesia based on conduction blocking, and balanced anesthesia with forced ventilation of the lungs. Special attention is paid to components of anesthesia which regulate adequate bloodflow in revascularized segments of the limbs: infusion-transfusion therapy with attaining the hypervolemic hemodilution, maintenance of thermal homeostasis, prevention of "toxic shock" during incorporation of the replanted segment into the bloodflow, and strategy of patient's awakening after long operation and anesthesia.

[The prevention of thrombus formation and the improvement of the blood rheological properties during operations with a microsurgical technic. I. The possibilities for using acelysin--an acetylsalicylic acid derivative]. / Profilaktika tromboobrazovaniia i uluchshenie reologicheskikh svoistv krovi pri operatsiiakh s mikrokhirurgicheskoi tekhnikoi--I. Vozmozhnosti ispol'zovaniia atselizina--proizvodnogo atsetilsalitsilovoi kisloty.

Changes in the blood clotting system and rheology were studied in 39 patients during reconstructive operations making use of microsurgical methods. Effects of various doses of water soluble acelysine, an acetylsalicylic acid preparations (DL-lysine acetylsalicylate and glycine) have been evaluated during surgery and the immediate postoperative period. Clinical and laboratory changes in blood coagulation were determined at different doses (1000, 500, and 250 mg). Even in low doses (3.94 +/- 0.25 mg/kg) acelysine ensured chronometric and structural hypocoagulation as early as 1 h after dosed infusion and throughout the entire intervention, preventing thrombosis of microvascular anastomoses. Administration of acelysine in doses higher than 250 mg is not recommended, because higher doses involve the risk of hypocoagulation complications.

[Plastic surgery of combined cutaneo-osseous defects of the hand]. / Plastika sochetannykh kozhno-kostnykh defektov kisti

The article analyses modern methods for the restoration of of defects in the metacarpal bones, based on microsurgical techniques. A case is described in which a new method for one-stage reconstruction of the hand in combined traumatic defect in the first and second metacarpal bones and an extensive defect in the soft tissues on the back of the hand was used. The hand was reconstructed by means of a vascularized complex autograft on a common vascular pedicle which included two separate fragments of the scapula and a fascial flap of the scapular region. With the application of the described method successful functional rehabilitation of the injured hand was achieved in a short period. A good cosmetic effect of the plastic repair was also noted.

[The replantation of the thumb in avulsive amputations]. / Replantatsiia I pal'tsa kisti pri otryvnykh amputatsiiakh.

A comparative assessment of results of operations was made in 2 groups of patients with abruption of the first finger. An analysis of immediate and long-term results of operations has shown advantages of the method of replantation with heterotopic revascularization of the replanted first finger and reinnervation by means of plasty of the palmar digital nerve.

[Plastic surgery of distal defects of the fingers using free vascularized autologous grafts]. / Plastika terminal'nykh oal'tsev kisti svobodnymi vaskuliarizovannymi pal'tsevymi autotransplantatami.

The results of 50 operations for replacement of soft tissue defects of the fingers are analysed. Plastic repair of the defects in 6 cases was performed with free neurovascular autotransplants taken from the lateral surfaces of the middle or ring finger. In 5 cases the transplanted graft healed, in one case its necrosis occurred. The late-term results were studied in follow-up periods of 4 to 34 weeks. A good aesthetic and functional result was recorded, including restoration of discriminating sense. The suggested operation is considered an alternative method for replacement of soft tissue defects of the finger tips.