[Prefabrication of free fascia-based flaps: initial experience and prospects]. / "Prefabrikatsiia" svobodnykh loskutov na osnove fastsii, pervyi opyt i perspektivy.

The authors describe an original method for preliminary formation, "prefabrication", of free fascia-skin flaps on the basis of the scapular fascia and the fascia covering the anterior serratus muscle. "Prefabrication" makes it possible to obtain tissue complexes with all the signs of flaps with axial circulation; with this method the surgeon has a wide choice of variants of the donor zones, the length of the vascular pedicle, and the texture of the flap skin. The principal distinction of the use of the fascia was two- or one-stage formation of microvascular anastomoses. The author discusses clinical cases in illustration of the "prefabrication" method.

Free transfer of the greater omentum.

Thirty-seven patients with various coverage problems and with lower extremity occlusive disease underwent free transfer of the greater omentum into the defect with a favorable clinical success rate. There are a number of advantages of this technique for such reconstructive problems.

Surgical treatment of radiation injuries of the hand.

This paper describes the wound management and treatment of 12 consecutive patients with severe radiation damage to the hands. Three of these were secondary to therapeutic radiation for squamous cell carcinoma in one and synovial sarcoma in two, and nine were healthy professional people exposed to radiation in the work-place. All lesions were characteristic radiation burns with ulcerative necrotic changes of the skin and subcutaneous tissues. One patient had a lesion on the dorsum of the hand, three patients had lesions on the palm of the hand, and eight patients had lesions in the fingers of the hand. Reconstructive surgery was carried out by debridement to what was felt to be healthy margins, followed by cross-finger flaps or thenar flaps to fingertips in three, radial forearm flaps in three, free flaps from the first web space in three, neurovascular island flaps from the fourth finger in two, a free scapular flap in one, a free inguinal flap with vascularized iliac crest in one, and a wraparound flap from the great toe in one. Two patients required two procedures; thus 14 flaps were done in 12 patients. Follow-up ranged from 2 to 12 months, with a mean of 6 months. All the patients have maintained a healed wound with adequate hand function, except for one patient, who had a recurrent synovial sarcoma in the midportion of the hand, requiring amputation. We conclude that management of radiation-induced injuries to the hand should be done with aggressive debridement and immediate coverage with well-vascularized flaps, either regional or free-tissue transfers. This will result in adequate wound healing and the most rapid, effective return of function with rapid institution of therapeutic modalities.

[Microsurgical tissue transplantation in the treatment of recurrent basaliomas of the head]. / Rol mikrokhirurgicheskoi transplantatsii tkanei v lechenii retsidiviruiushchikh bazaliom golovy.

The authors analyse their experience in the use of microsurgical transplantation of tissues in the management of recurrent basaliomas of the head in 20 patients. Various types of autografts were used, such as: the greater omentum, thoracodorsal, inguinal, scapular, deltoid, and radius grafts. The results were good in most cases. It is claimed that microsurgical autotransplantation of tissue complexes is a necessary component in the treatment of severe forms of basaliomas of the skin of the head.

[Surgical treatment of radiation injuries of the hand]. / Taktika khirurgicheskogo lecheniia luchevykh povrezhdenii kisti.

An analysis is given to pilot experience with up-dated plastic surgery techniques in management of hand radiation injuries. Seven patients underwent surgery involving cross-over skin, scapular, radial and inguinal grafts, sliding Littler island graft. The results (both short- and lond-term) turned promising.

[Comparison of various methods of plastic surgery of radiation injuries]. / Sravnenie razlichnykh metodov khirurgicheskoi plastiki luchevykh povrezhdenii tkanei.

The authors possess experience in surgical treatment of 29 patients with radiation damages of various localization. They compare the efficacy of various methods of plastic surgery of tissue defects, namely, autotransplantation of the greater omentum, transplantation of free tissue flaps, the use of transfer musculocutaneous flaps. The authors suggest a classification of the methods used and the indications for their application. Complete clinical recovery was achieved in 21 patients.

[Hemodynamic characteristics of autologous microsurgical transplantation of the greater omentum]. / Gemodinamicheskie osobennosti mikrokhirurgicheskoi auto-transplantatsii bol'shogo sal'nika.

Free microsurgical autotransplantation of the greater omentum was performed in 24 patients with different pathologies. Dominant character of blood supply of the greater omentum from the right gastro-omental artery was detected as well as the interrelation between repeated arrests of blood supply in the transplant and frequency of necroses of the transplanted greater omentum.

[Autotransplantation of the greater omentum in patients with radiation injuries of the integumentary tissues]. / [Autotransplantatsiia bol'shogo sal'nika u bol'nykh s luchevymi povrezhdeniiami pokrovnykh tkanei.

The treatment of radiation damages of the integumentary tissues is a complicated problem of reconstructive plastic surgery. The condition of the tissues in the irradiated zone do not allow wide application of the traditional methods. Microsurgical autotransplantation of the greater omentum provides the possibility for adequate closure of the radiation ulcers. Operations were conducted on 9 patients with such ulcers of various localization; the cosmetic and functional result was good in 7 of them.

Lower leg replantation in children: railroad amputation.

Replantation in the lower leg, although technically feasible, still remains a complicated clinical issue in terms of the decision-making process. In children, a limb salvage or replant procedure would seem preferable; however, in crush amputations from railroad injury, a very severe trauma, difficulties in treatment should be thoroughly weighed against prosthetic possibilities: for example, only a fair or good functional outcome would justify an attempt to replant a severed shin. Unfortunately, the outcome in most cases is unpredictable at the time of initial evaluation, and even during the replantation procedure itself. To facilitate prognosis, the authors determine four typical variants of replantation course and outcome, based on local patient conditions, although they stress that no clear indications for replantation vs. prosthesis can be derived from the variants listed. Rather, general guidelines for the surgeon's decision at a very early stage of treatment are presented. Choice of procedure and tactics cannot be determined once and for all, because the prognosis for functional outcome can change during the course of treatment. Among a few well-defined situations are clean amputations (replantation is indicated) and traumas with very extensive crushing of the whole lower leg (replantation is contraindicated). In the majority of cases, replantation is a worthwhile attempt, but this does not imply that a replanted extremity must be preserved at any cost. The surgeon must consider the possibility of re-amputation, in case of an unfavorable variant in the postoperative course. A successful case of replantation, involving two lower leg railroad amputations in a child, is presented.