[Reconstruction of the lower alveolar nerve during mandible resection due to benign tumors]. / Rekonstruktsiya nizhneal'veolyarnogo nerva pri rezektsii nizhnei chelyusti po povodu dobrokachestvennykh opukholei.

OBJECTIVE: Development of a method for reconstruction of the inferior alveolar nerve and evaluation of its effectiveness in resection of the lower jaw for benign tumors. MATERIAL AND METHODS: In the period from 2018 to 2020, 10 resections were performed for benign odontogenic neoplasms (myxoma, ameloblastoma, osteoblastoclastoma) at the age of 18 to 60 years. Tactile, pain and temperature sensitivity were subjectively studied. The assessment of subjective sensitivity was carried out five times: before the operation, after 21 days, after 3.6 months and a year after the operation, an electromyograph «SYNAPSIS¼ was used for an objective assessment of sensitivity. The studies were conducted twice: 21 days after the operation and 12 months later. Reinervation was carried out by two methods. Method I: by transferring the insertion from the calf nerve and applying end-to-end neuroanastomoses between the proximal and distal ends of the inferior alveolar nerve (5 patients); method II: transferring the insertion from the calf nerve to the lingual nerve. Neuroanastomoses are applied periepineurally between the distal end of the inferior alveolar nerve and the lingual nerve «end to side¼ (5 patients). RESULTS: After 12 months, all types of sensitivity were restored in the control group in all patients, and in the second group in 80%. All patients had areas of hyposthesia in terms of temperature and tactile sensitivity. The results of trigeminal evoked potentials were negative in all patients 21 days after surgery, and peaks of evoked potentials were recorded in 9 (90%) patients 12 months later. CONCLUSION: These reconstruction techniques are effective both when the proximal end of the inferior alveolar nerve is preserved, and when it is impossible to preserve it. With minimal donor damage, the sensitivity of the lower lip is restored, which significantly improves the quality of life of patients and their social adaptation.

[Reconstruction of supraorbital region with a pedicled skin flap from periauricular region under reverse blood flow]. / Rekonstruktsiya nadbrovnoi oblasti loskutom na nozhke s periaurikulyarnoi oblasti na reversivnom krovotoke.

Periorbital soft tissue reconstruction has always been a difficult problem. There are several techniques for correction of supraorbital defects, most often we are talking about aged patients with sagging skin. Local skin grafting is usually used. However, this approach can result additional scars on the face requiring further multiple corrections. We report a good functional and aesthetic result in a young patient after reconstruction of supraorbital region with a pedicled skin flap from periauricular region under reverse blood flow. This technique can be taken into account for complex small periorbital soft tissue defects up to 5.0 x 5.5 cm. The flap adequately closes the defect and repairs facial contour and symmetry.

[Anatomical and clinical rationale for the use of a perforant flap from the periauricular region the blood-supplied from pool of the superficial temporal artery]. / Topografo-anatomicheskoe i klinicheskoe obosnovanie primeneniya perforantnogo krovosnabzhaemogo loskuta s periaurikulyarnoi oblasti iz basseina poverkhnostnoi visochnoi arterii.

There is an urgent desire to use a method for the reconstruction of facial tissues that allows not only to reliably eliminate the defect, but also to recreate all the features of the damaged area, with an inconspicuous scar and minimal trauma. But one of the most difficult issues in microsurgical autotransplantation of tissues of the maxillofacial area is the choice of the donor area and vessels for the safe and adequate isolation and revascularization of flaps. THE AIM OF THE STUDY: Was to increase the efficiency of functional and aesthetic results of surgical treatment by developing new flaps from the STA pool while eliminating limited soft tissue facial defects. MATERIALS AND METHODS: In total, 27 unfixed corpses aged 18 to 78 years were examined, with the study of the topographic and anatomical features of the STA and its branches on both sides. In the period from 2018 to 2020 10 autotransplantations of tissue complexes from the periauricular area were performed. RESULTS: The STA is one of the terminal branches of the external carotid artery. The length of the proximal STA is 15.0±25.5 mm, the diameter is 2.0±2.5 mm. Bifurcation into 2 terminal branches - anterior frontal branch, length 69.8±71.0 mm, diameter 0.9±1.5 mm, at the level of bifurcation 0.5±1.0 mm; and the posterior parietal ramus, length 77.7±78.0 mm, diameter 1.4±1.6 mm, at the level of bifurcation 0.7±1.5 mm. The coefficient of reduction in the diameter of the frontal ramus is 0.65 and the parietal ramus is 0.7. Developed 2 large types of different variations of skin flaps from the periauricular area. In clinical practice, facial defects were eliminated in 10 patients with a skin flap from the periauricular area, and complete healing was observed. CONCLUSION: The flaps from the periauricular area, which we used in reconstructive surgery of the face, are raised to the STA and its terminal sections. Knowledge of the peculiarities of the topographic anatomy of the STA and its branches is important for the maxillofacial, reconstructive and plastic surgeon. Various variations of flaps from the periauricular area are possible, which allows creating a large modification of reconstructive methods for eliminating facial defects, which will reduce postoperative complications.

[Modern integrated approach to surgical treatment of patients with defects and deformations following high-voltage electrical injury]. / Sovremennyi kompleksnyi podkhod v khirurgicheskom lechenii patsientov s defektami i deformatsiyami v rezul'tate vysokovol'tnoi elektrotravmy.

OBJECTIVE: To develop the algorithm for correction of defects following high-voltage electrical trauma with revascularized autografts, to assess the incidence and risk factors of postoperative complications. MATERIAL AND METHODS: Surgical interventions were performed in 16 men. Autografts were selected considering localization of defect and preoperative ultrasound data on perfusion of donor and recipient areas. We applied a sample with temporary compression of the vessels and ultrasound scanning of arteries and veins (a small-sized Doppler sound indicator of blood flow velocity - MINIDOP, BIOSS). RESULTS: Nine patients underwent microsurgical transplantation of revascularized flaps. Six patients with electrical trauma of the upper extremities underwent transplantation of free skin autografts and transposition of flexor and extensor muscles of the fingers in various combinations. In 1 patient, simultaneous microsurgical graft transplantation and plasty with local tissues were carried out. Microsurgical transplantation of thoracodorsal flap was performed in 2 patients with maxillofacial defect (with preliminary deepidermization of the flap in one case). In 3 patients with traumatic amputation of the penis, 2 patients underwent phalloplasty with a thoracodorsal flap and prefabrication of a radial forearm graft at the first stage. At the next stage, urethroplasty with a prefabricated radial forearm graft was performed. In 1 patient, closure of the penis defect was carried out using scrotal flaps. CONCLUSION: An integrated surgical approach, the use of free revascularized autografts and adequate postoperative management ensure high-quality aesthetic and functional restoration, improvement of the quality of life and social adaptation of patients with defects and deformations following high-voltage electrical injury.

[Reverse perforator submental flap for closing soft tissue defects]. / Reversivnyi perforantnyi submental'nyi loskut dlya ustraneniya myagkotkannykh defektov litsa.

The article presents the clinical results of using a new surgical method, involving the reverse perforator submental flap for reconstruction of soft tissue defects in the maxillofacial area in 5 patients aged from 41 to 62 years. The purpose of the study was to expand the indications for the use of the submental flap. A feature of the method is the sampling of a primary thin perforator submental flap with reverse blood flow with a minimal risk of postoperative complications. An algorithm for surgical flap taking has been developed. The study proves the safety and efficiency of the proposed method.

[The use of autogenous free vascularized fibula transplant for the correction of severe mandibular atrophy]. / Primenenie revaskuliarizirovannogo malobertsovogo autotransplantata dlia ustraneniia vyrazhennoi atrofii nizhnei cheliusti.

The purpose of the study was to increase the effectiveness of surgical treatment and rehabilitation of patients with severe mandibular atrophy by means of autogenous free vascularized fibula transplant use with subsequent dental implants placement in the reconstructed mandible and implant-retained fixed dentures. In 2017 5 female patients underwent surgical treatment of severe mandibular atrophy with autogenous free vascularized fibula transplant in Maxillofacial Surgery department of CRID with additional nonvascularized iliac bone grafts and functional rehabilitation with implant-supported constructions in two of the cases. Due to its form, length and vascularization fibular bone represents a good plastic material for full length mandibular alveolar part reconstruction. The inclusion of the skin paddle in the autogenous free vascularized fibula transplant promotes secure primary closure of the surgical wound in the oral cavity. The use autogenous free vascularized fibula transplant in patients with severe mandibular atrophy with demands a thorough presurgical planning and intraoperative modeling.

[Determination of the lesions volume in patients with radionecrosis of the jaws]. / Opredelenie ob''ema porazheniia tkanei cheliustno-litsevoi oblasti u patsientov s osteoradionekrozom cheliustei.

The extent of manifestation of the osteonecrotic process after radiation therapy of malignant neoplasms of the head and neck is currently unknown and little studied. The same can be said about the choice of methods and surgical techniques in this category of patients. We believe that the choice of method is based on the determination of the true size of the defect, the search for the optimal source of complete blood supply as well as the presence of restrictions on the general somatic status. In osteoradionecrosis clinically significant changes occur in the facial vessels, which is reflected both in the bone tissue and in soft tissue structures that correspond not only to irradiation area but also to compromised blood supply area. The study identified histopathological changes in the irradiated vessels, soft tissues and bones of the facial skeleton in 20 of patients. Biopsy findings were correlated with ultrasound and tomographic examination data. Based on the findings summary the methods are proposed for examining patients and choosing the best surgical treatment methods for maximal possible rehabilitation.

[Evolution of the mandibular defects reconstruction with free fibula flapx]. / Évoliutsiia v planirovanii i modelirovanii revaskuliarizuemogo malobertsovogo autotransplantata pri ustranenii defektov nizhnei cheliusti.

One of the most important steps in achieving aesthetical and functional result in mandible reconstruction with fibula free flap is positioning of the bony part relative to the basis of the native mandible. Positioning fibular bony part continuing inferior mandible border may produce a high discrepancy between the residual mandible and fibula bone that results in difficulty in denture rehabilitation. Positioning fibular bony part continuing alveolar mandible border creates asymmetric jowls and changed shape of jawline in border-line zone. The double-barrel technique solves this problem, but needs a meticulous preoperative planning and precision free fibula flap modelling.

[Anatomical rationale for elevating revascularized ulnar forearm fasciocutaneous flap for head and neck reconstruction].

In this paper we studied in detail features of the blood supply to the tissues of the forearm of the pools ulnar and radial arteries, the technique of line access and the formation of skin-fascial ulnar flap by using a layered dissection with contrast vessels on non fixed human cadavers. Blood supply of the forearm carried out by branches radial and ulnar arteries, which allows to create in this area radial flap and ulnar flap loo. The size of the skin-fascial ulnar flap can reach 3-10 cm in length, 2-6 cm in width, the length of vessel pedicle of the transplant can reach 12 cm. The research studied the characteristics of blood supply of the forearm and the comparative evaluation of tissue perfusion of the radial and ulnar arteries; proved localization forming ulnar flap. Studies have shown that revascularised skin-fascial ulnar flap may be can be an alternative donor material for elimination of soft tissue defects with less traumatization donor area and reduce upper limb function compared with radial flap.