[The anatomical basis of the formation of the pedicled bone grafts on the upper extremity].

The study of the vascular bed of the upper extremities was performed by the method of anatomical preparation of 24 formalin-fixed cadaver specimens from 5 men and 7 women and by the injection of black latex into the arterial bed of 4 male and 4 female cadavers (16 specimens). The arteries, directly feeding the bones, and the arteries that provide blood supply to the muscles, attached to the bones, were studied. M. pectoralis major, m. pronator teres, m. pronator quadratus, mm. lumbricalis and interosseus were examined. These studies were followed by the experimental surgeries during which bone grafts on vascular pedicle were formed and moved. It was found that the feeding arteries of the bone grafts on musculo-vascular pedicle were: on the clavicula--the branches of a. thoracoacromialis, on the brachium--muscular branches of a. brachialis, on the proximal parts of forearm bones--muscular branches of a. radialis and ulnaris, on the distal parts of forearm bones--the branches of a. interosseous anterior, on the metacarpal bones--the branches of aa. metacarpalis palmaris and dorsalis. The size of the bone transplants is determined by the size of the defect of recipient field and varies from 3 to 8 cm. The displacement of vascularised bone graft can be made over the distance from 4 to 8 cm.

[Formation of vascularized bone grafts and their use for treatment of pseudoarthroses and bone defects].

An analysis of 135 transplant surgeries of vascularised bone grafts in treatment of pseudoarthroses and defects of the clavicle, humerous, ulnar, radial, metacarpal,wrist and fingers bones was made. The fusion was noticed in 130 operated patients. The earlier removal of immobilization (in 2), the repeated trauma (in 2) and osteomyelitis of the transplanted graft, which required its removal in 1 patient, were the causes of failure in 5 (3.7%) patients.

[Surgical complications following operative treatment of abdominal obesity in type 2 diabetes mellitus patients].

Results of surgical treatment of 211 patients consisting of 109 patients with DM2 and 102 patients without DM2 were studied. All patients underwent lipoaspiration or abdominoplasty. The aim was to assess the influence of type 2 diabetes mellitus on the frequency and structure of complications after surgery. The risk of anemia and local complications increases after surgical correction of abdominal obesity which are temporary and do not have significant influence on the clinical outcome. There were no cases of clinical manifestations of pulmonary embolism and fat embolism.

[Clinico-anatomical grounds of using flaps with the axial type of blood supply in treatment of patients with open (gunshot) fractures of the crus]. / Kliniko-anatomicheskoe obosnovanie ispol'zovaniia loskutov s osevym tipom krovosnabzheniia pri lechenii bol'nykh s otkrytymi (ognestrel'nymi) perelomami kostei goleni.

The main aim and task of the investigation was to present clinico-anatomical substantiation for plastic operations with the application of flaps with the axial type of blood circulation in treatment of this category of patients. The investigation included 348 clinical cases (for exact statistical data); 65 volunteers (for the assessment of physiological parameters) and 16 topographo-anatomical preparations (variants of the vascular network of the leg). The methods of clinical and rentgenological control were used. The work consisted of 4 stages: 1) clinico-statistical analysis by the materials of 348 clinical observations which allowed to establish the dependence of functional results of the treatment on the sizes of leg soft tissue defects; 2) topographo-anatomical investigations which allowed the topography of the leg vessels to be associated with the typical disposition of the flaps with the axial type of blood supply; 3) physiological investigation using ultrasonic dopplerography and active distance thermography on whose basis the methods were created for exact identification of the sites of the outlet of cutaneous arteries and finding the zones of optimal blood supply of the complex skin flaps being formed; 4) clinical approbation of the results of the investigation. The operations performed on 15 patients have demonstrated high effectiveness the new developed means of preoperative planning.

[2-stage plastic repair of the flexor tendons of the fingers: the indications and technic]. / Dvukhétapnaia plastika sukhozhilii sgibatelei pal'tsev kisti: pokazaniia i tekhnika.

Based on their experiences with treatment of 58 patients with consequences of severe traumas of the hand the authors analyze and substantiate indications for using the method of the two-stages tendoplasty of finger flexors. The technique of implantation of polychlorvinyl rods is described in detail. Relatively high frequency of additional procedures on different anatomical structures of the hand is noted. Special attention is given to intra- and postoperative prophylactics of infectious complications. It was found that time of the second operation should be determined not only by the time of formation of the smooth wall capsule around the implant but also by the degree of liquidation of finger joints contractures.

[Islet flaps from the forearm in plastic surgery of the hand]. / Ostrovkovye loskuty predplech'ia v plasticheskoi khirurgii kisti.

An analysis of islet flaps of the forearm used in the performing of complex reconstructive operations on the hand in 37 patients is presented. A substantial shortcoming of transplantation of the radial and elbow flaps is a possible development of disturbance of blood circulation in the hand tissues which can require emergent plasty of the transected artery. In transplantation of the posterior flap of the forearm the blood circulation in the hand tissues was not disturbed.

[Complex evaluation of the results of emergency microsurgical operations in injuries of the limbs]. / O kompleksnoi otsenke rezul'tatov ekstrennykh mikrokhirurgicheskikh operatsii pri travmakh konechnostei.

Sixty four patients were subjected to 74 urgent operations on microvessels of 83 segments (fingers, hands, forearms, shins ). The nearest results were positive in 80,06%. General functional results of the treatment were positive in 60% of the amount of all the segments operated upon.

[Principles of microsurgical transplantation of tissue complexes in reconstructive surgery of the limbs]. / Osnovnye printsipy mikrokhirurgicheskikh peresadok kompleksov tkanei v rekonstruktivnoi khirurgii konechnostei.

The article describes the experience with 22 free transplantations of tissue complexes performed on 21 patients with traumas and injuries of extremities and gives characteristics of the following general principles responsible for success of the procedure: a) the flap must have the intact internal vascularization and nourishment of all the tissues; b) the patency of microvascular anastomoses must be preserved and compression of the flap vascular pedicle prevented; c) conditions of the flap contact with the recipient bed must be optimized.