[Estimation of regional blood flow in reimplanted segments of upper extremity].

AIM: To examine the state of regional circulation in replanted segment of upper limb and hand, to determine diagnostic and prognostic value of radionuclide scintigraphy. MATERIAL AND METHODS: The study included 26 patients who underwent replantation of upper extremity segments. The control group included 12 patients who underwent autologous transplantation of toes on hand. All patients underwent isotope scintigraphy, ultrasound Doppler and pulse oximetry. Groups were comparable by gender, age, severity of injury. RESULTS: Depending on postoperative course two groups were determined: with favorable (27 patients) and complicated postoperative period (11 patients). Two types of regional circulation were identified according to dynamic scintigraphy: prevalence of blood flow in operated limb (type 1); prevalence of blood flow in healthy limb, or equal volumetric blood flow in operated and healthy limbs (type 2). Favorable early postoperative period was associated with prevalence of blood flow in operated limb. Only in 2 (7.7%) patients patients in this group acute arterial thrombosis was diagnosed. At the same time thrombosis of microanastomosis occurred in 45.4% of cases in the second group what is 5.5 times higher than in the first group. CONCLUSION: Significant prevalence of blood flow in operated limb is favorable prognostic sign of the early postoperative period. On the other hand the identity of blood flow or prevalence of such in healthy limb predispose to acute vascular complications in replantate or autoplantate. Radionuclide scintigraphy provides detailed assessment of regional blood flow in operated limb. However clinical monitoring has leading role in diagnosis of acute circulatory disorders in replantate or autoplantate.

[The clinical and oncological aspects of the treatment of laryngeal and laryngopharyngeal cancer].

The objective of the present study was to estimate the justification of extended cervical lymphodissections and to evaluate the influence of adjuvant medicamental therapy in combination with the targeted treatment on the results of the management of oncological conditions. The 81 patients included in the study were allocated to the three groups. Group 1 was comprised of the patients (n=28) given neoadjuvant therapy and surgical treatment. Group 2 included the patients (n=27) undergoing the surgical treatment followed by remote gamma-therapy during the postoperative period. Group 3 consisted of the patients (n=26) receiving both the surgical treatment and targeted adjuvant medicamental therapy. The study has demonstrated that percent of wound complications after 2--3 courses of polychemotherapy in the patients of group 1 was higher by a factor of 5 in comparison with the patients of the two other groups. Wound healing by second intention was documented in 59% of the patients in group 1 and 10% of those in both groups 2 and 3. The five-year survival rate in the patients of group 3 was estimated at 38.5% (6.4 and 8.9% higher than in groups 1 and 2 respectively).

[Optimization of ostheogenesis with the use of vascularized periosteal-cortical autotransplants in patients with false joints of long bones].

The issue analyzes the use of free revascularizable or rotatable periosteal-cortical autotransplants as an additional source of ostheogenesis in patients with false joints of long tubular bones. The experience of treatment of 58 patients was summarized. The terms of fracture consolidation was similar to that after non-complicated fractures of the same localization.

[Clinical significance and functional outcomes of ligation of exterior carotid artery in surgical treatment of oropharyngeal cancer].

This work was designed to analyse outcomes of the treatment of 65 patients with advanced oropharyngeal cancer who had received combined treatment including radical resection of the tumour. Thirty three patients underwent surgery without ligation of exterior carotid artery while the remaining 32 (control group) were operated after preceding ligation of this vessel. The influence of ligation of exterior carotid artery on cerebral circulation was evaluated by the following methods: estimation of the intraoperative blood loss from A.T. Staroverov's formula, ultrasound dopplerography of extracranial carotid segments, electroencephalography, measurement of the fields of vision using statistical quantitative perimetry, evaluation of the patients' neurologic status. It was shown that ligation of exterior carotid artery has no apparent effect on the intraoperative blood loss during radical surgery for the management of oropharyngeal cancer nor does it influence healing of the postoperative wound and oncological outcome of this treatment.

[Laryngectomy: clinical aspects of preceding tracheostomy].

The objective of this study was to compare results of combined and surgical treatment in 114 patients with stage III-IV T3-4N0M0 laryngeal cancer. Fifty eight patients were treated by laryngectomy without preceding tracheostomy; in the remaining 56 laryngectomy followed tracheostomy (control group). The two groups were matched for all major characteristics, such as age and sex of the patients, histological structure of the tumour, its growth rate and localization, dose and schedule of radiotherapy, extent of surgical intervention. The data obtained were used to evaluate oncological and functional outcomes of the treatment.

[Evaluation of late results of laryngeal cancer treatment with the use of polymer endoprostheses].

Application of biocompatible polymer-based endoprostheses (EG 1-4, TS 42-2-476-85) for the treatment of laryngeal cancer made it possible to achieve good oncological outcome in the late postoperative period and ensured high-quality functional rehabilitation of the patients. The estimated 3-year survival rate following endoprosthetic treatment amounted to 73.9%, 5-year survival rate was 67.6%, and 10-year survival rate 58.7%. Objective assessment of voice rehabilitation with the use of the <> software package (Windows 98, 2000, XP) demonstrated restoration of the vocal function in 70% of the patients while the remaining 30% were able to communicate by whisper speech. Resection of the larynx in patients with its stage II-III cancer in combination with the use of polymer endoprostheses yielded good oncological results and ensured the high rate of vocal function rehabilitation.

[Clinical aspects of tracheostomy as a stage of anterolateral laryngeal resection].

We analysed medical histories of 68 patients with T2-3N0M0 laryngeal cancer who had received combined or surgical treatment. All the patients given the organ preservation treatment were divided into two groups one of which included 36 patients after laryngeal resection without tracheostomy, the other consisted of 32 patients who had undergone laryngectomy with tracheostomy (control). The two groups were matched for age and sex of the patients, the degree of advancement and histological structure of the tumour, its growth rate and localization, dose and schedule of radiotherapy, extent of surgical intervention. The data obtained were used to analyse oncological and functional outcomes of the treatment. Oncological result was estimated based on the survival rate expressed in percentage terms.

[Long-term results of correction of extensive tracheal defects by means of microsurgical technologies].

Up to date, the problem in the correction of extensive tracheal defects has not been solved and remains urgent. For this, the use of microsurgical technologies is promising and these operations have become customary in clinical practice. The Russian Surgery Research Center has gained experience in treating 29 patients undergone correction of extensive tracheal defects, by implanting a revascularized radial autograft into the tracheal defect. After working through the technical aspects of an operation and the specific features of postoperative management, the frequency of hospital-acquired complication is minimal both at the site of tracheal defect and in the donor area. Transplantation of revascularized autotissues with backing fabrics ensures the patency of a newly formed trachea and resistance to infection and prevents degenerative tissue changes. The patients have no problems associated with transplanting the autograft into the tracheal defect in the late postoperative period. Autograft blood supply retains its main type several years after surgery.

[Study of the revascularizing properties of the greater omentum for creating prefabricated complex autografts under experimantal conditions].

The revascularizing properties of the greater omentum used as a vascular pedicle for the prefabrication of skin, skin/cartilage or skin/ bone autografts, and their viability after rotation and recipient zone infection were studied in rat experiments. The experiment showed that complexity factor did not have a significant effect on the revascularizing properties of the greater omentum, and required only an insignificant prolongation of prefabrication period. Skin/omental, skin/cartilageous, and skin/bony autografts based on the greater omentum formed by day 7, 14, and 21, respectively. After these periods prefabricated autografts remained viable upon rotation. In case of infection, the survival rate of prefabricated skin/bone autografts, revascularized with two-layer greater omentum, is lower than that of skin/cartilage ones. The technique of prefabrication of autografts including skin, cartilage, and bone, is a promising method for closure of vast multicomponent defects in complicated clinical situations.

[Identification of the hereditary variants of skin melanoma]. / Identifikatsiia nasledstvennykh variantov melanomy kozhi.

The identification of hereditary variants of cutaneous melanoma and analysis of the role of hereditary factors and syndromes predisposing to cutaneous melanoma were carried out. The involvement of individual nevus phenotypes in the development of this disease was determined. Based on a survey of recent molecular biological data and our studies, the etiological and genetic heterogeneity of cutaneous melanoma is reported. In relatives of patients with cutaneous melanoma and persons with multiple pigmented nevi, the malignant tumors proved to be differentiated in the direction of the neural crist tissues and/or derivatives of cutaneous mesenchyma. Based on the evidence obtained, the approaches have been developed to formation of risk groups for the purpose of early diagnostics of cutaneous melanoma.

[Elimination of large fenestrated tracheal defects with use of microsurgical technique]. / Ustranenie obshirnykh okonchatykh defektov trakhei s ispol'zovaniem mikrokhirurgicheskoi tekhniki.

Operations on the trachea usually entail cutting or dissection of its wall, which requires further elimination of the developed defects. The application of a primary tracheal anastomosis is not always feasible. A number of methods for elimination of large defects of the trachea are not devoid of shortcomings. An original method for elimination of the defects of respiratory ways with the use of revascularized osteo-cutaneous radial complex flap has been developed and used in 8 patients. The sizes of the eliminated defects varied from 8.0 x 2 to 4 x 1.5 cm. The vessels of the grafts were anastomozed with facial vessels by microsurgical technique. This procedure allowed to avoid multistaged treatment mode and the newly formed tracheal wall possessed adequate regidity for breathing. The cutaneous part of the flap was quite fit for substitution of the tracheal mucosa. The method of harvesting the autograft is quite safe, the damage to the donor site in the arm is negligible.

[Treatment of long tubular bone pseudoarthrosis with revascularized cortical layer of radius]. / Lechenie lozhnykh systavov dlinnykh trubchatykh kosteí revaskuliarizirovannym kortikal'nym sloem luchevoí kosti.

The method of osteogenesis without resection of the false joint was employed in the treatment of long tubular bone pseudarthrosis. The authors used a free revascularized radial flap, including the corticoperiosteal layer of the radius as a source of osteogenesis. A thin corticoperiosteal graft was taken from the distal third of the radius with or without a skin flap, if necessary. The graft was placed into the slotted bed of the false joint and fixed by two screws. Final fixation was made by using an Ilizarov apparatus or a metal plate. The authors used this procedure in the treatment of 12 patients with long tubular bone pseudarthrosis who had undergone at two operations on the false joint or fracture. Eight patients suffered from chronic osteomyelitis. Eleven patients completely recovered at postoperative month 12. Radiographic and scintigraphic investigations showed signs of bed-graft adhesion at month 3 after surgery and those of false joint ossification at month 6 postoperatively.

[Evaluation of indications for reoperations after combined treatment of laryngeal cancer with function preserving surgery at the second stage]. / Otsenka pokazanii k povtornym operativnym vmeshatelstvam posle kombinirovannogo lecheniia raka gortani s vypolneniem na II étape funktsionalno-shchadiashchikh operatsii.

Having analyzed the results of the previous treatment, the authors performed sparing resurgery in 11, laryngectomy in 31 and chemotherapy in 29 patients. The resurgery should be indicated only in cases of localized recurrent tumor with clearly outlined margins. Repeated laryngectomy did not change the patients' survival essentially. For elderly patients with disseminated cancer and recurrences resurgery is not recommended.

[The principles of the microsurgical plastic repair of the plantar surface of the foot]. / Printsipy mikrokhirurgicheskoi plastiki podoshvennoi poverkhnosti stopy.

An analysis of long-term results of microsurgical plasty of defects of the plantar surface of the foot of different genesis is presented. 64 microsurgical flaps were transplanted. The main long-term complication of the method is the formation of rubs and trophic ulcers in 37% of patients after the restoration of support on the transplanted flap. Causes of the complications in question were established and methods of surgical treatment are proposed.

[The microsurgical transplantation of vascularized bone from a human fetus to man]. / Mikrokhirurgicheskaia peresadka vaskuliarizirovannoi kosti ot chelovecheskogo ploda cheloveku.

On the basis of the possibilities of microsurgical techniques and the results of some experiments conducted for the purpose of studying the "microsurgical" morphometry of various areas of the body of a fetus, determining the viability of fetal tissues in cold and thermal anoxia, working out microsurgical methods and the operative techniques, and solving organizational problems, three operation were carried out in the clinic for transplantation of vascularized fetal humerus (in one case together with the ulna and radius) to three patients with defects in the bone skeleton of the hand. Immunosuppression was not undertaken. Control over the viability of the brephotransplant was conducted by ultrasonic dopplerography on a vascular pedicle, radioisotope scintigraphy, roentgenography, and histological study in aspiration biopsy. The brephotransplant was removed in one case due to suppuration 4 months after the operation. In the other two cases with a follow-up period of over 6 months the brephotransplants are viable.

[Function-sparing surgery in the combined therapy of laryngeal cancer]. / Funktsional'no-shchadiashchie operatsii pri kombinirovannom lechenii raka gortani.

The reports deals with the principle and methods of making a two-stage diagnosis of laryngeal tumor evolved on the basis of the data on two calibrated groups of 250 patients each and a computer-supported procedure of mathematical analysis. Two programs for a MC-52 microcalculator are suggested to select the scope of surgical intervention. Such procedures of preoperative radiation therapy as exposure under hyperbaric oxygenation conditions, cutting down the preoperative radiation dosage and shortening the interval between ir radiation course and surgery have been improved. Five improved procedures of saving therapy for tumors of the supraglottic area and four--for glottic cancer were used in 142 patients. The functional and oncological results of saving surgery were evaluated in 458 patients receiving combined treatment for laryngeal tumors. Said results were found to be beneficial.

[A method of combined horizontal resection of the larynx with removal of the arytenoid cartilage and its primary reconstruction]. / Sposob kombinirovannoi gorizontal'noi rezektsii gortani s udaleniem cherpalovidnogo khriashcha i pervichnogo ego rekonstruktsiei.

A modified technique of combined laryngeal resection in vestibular cancer T3-T4 (involvement of the arytenoid cartilage) was tried in 8 patients. To compensate for laryngeal separative function after the radical surgery, the reconstruction of the posterior laryngeal wall was performed by mobilization of the upper corniculum of the thyroid cartilage. In satisfactory functional results the method did not contribute to the disease aggravation.

[Organ-sparing surgery in laryngeal cancer]. / Ekonomnye operatsii pri rake gortani.

Basing on their experience with sparing surgery in combined treatment of pharyngeal carcinoma, the authors have developed a method for specification of the diagnosis before treatment and in the course of surgical intervention. Preoperative gamma-beam therapeutic scheme has been improved: long-distance irradiation is carried out under hyperbaric oxygenation with medium-fractionated doses and the total dose is reduced to 23.1 Gy, the intervals between the irradiation and surgery being 7-10 days. In order to improve the functional efficacy of economic radical surgery, methods of sparing surgery for Stages III-IV pharyngeal carcinoma were developed. Favorable functional and 3-year results were achieved in 314 patients with pharyngeal carcinoma, treated according to a multiple-modality scheme, including economic surgery as its second stage.