[Partial replantation following proximal limb injury]. / Réimplantations partielles après traumatisme proximal des membres.

PURPOSE OF THE STUDY: Proximal replantation is a technically feasible but life-threatening procedure. Indications must be restricted to patients in good condition with a good functional prognosis. The goal of replantation must be focused not only on reimplanting the amputated limb but also on achieving a good functional outcome. For the lower limb, simple terminalization remains the best choice in many cases. When a proximal amputation is not suitable for replantation, the main aim of the surgical procedure must be to reconstruct a stump long enough to permit fitting a prosthesis preserving the function of the adjacent joint. If the proximal stump beyond the last joint is very short, it may be possible to restore some length by partial replantation of spared tissues from the amputated part. We present here the results we obtained following this policy. MATERIALS AND METHODS: This series included 16 cases of partial replantations, 14 involving the lower limb and 2 the upper limb. All were osteocutaneous microsurgical transfers. For the lower limb, all transfers recovered protective sensitivity following tibial nerve repair. The functional calcaeoplantar unit was used in 13 cases. The transfer of this specialized weight bearing tissue provided a stable distal surface making higher support unnecessary. In one case, we raised a 13-cm vascularized tibial segment covered with foot skin for additional length. For the upper limb, the osteocutaneous transfer, based on the radial artery, was not reinnervated, but this lack of sensitivity did not impair prosthesis fitting. RESULTS: One vascular failure was finally amputated. This was the only unsuccessful result. For all other patients, the surgical procedure facilitated prosthesis fitting and preserved the proximal joint function despite an initially very proximal amputation. DISCUSSION: The advantages of partial replantation are obvious compared with simple terminalization or secondary reconstruction. There is no secondary donor site and, because there is no major muscle mass in the distal fragment, the overall risk is very low compared with the risk of total proximal leg replantation.

[Current problems of vascular surgery in childhood]. / Aktual'nye voprosy angiokhirurgii detskogo vozrasta.

Under analysis are remote results of treatment of 751 children with congenital and acquired diseases of the vessels. Grounds are given for treatment of these diseases in the light of the classical syndromes of disturbed hemodynamics. The investigation of developmental and individual peculiarities of these syndromes is thought to be necessary. The leading role of microsurgical methods of treatment of such diseases of the vessels in children is stressed.

[Current problems in the reconstructive surgery of the locomotor apparatus in children]. / Aktual'nye voprosy rekonstruktivnoi khirurgii oporno-dvigatel'nogo apparata u detei.

The authors analyze results of treatment of 778 children with malignant and benign tumors of the bones, pseudoarthroses, amputations of lower extremities and fingers, injuries of the tendons, vessels and contused-lacerated wounds of distal phalanges of fingers. The possibility to use a precision technique for the reconstructive operations of the vessels in children is shown.

[Results of therapy for osteogenic sarcoma in children: perspectives of improvement]. / Rezul'taty lecheniia osteogennoi sarkomy u detei: perspektivy uluchsheniia.

A retrospective analysis of treatment of 67 children suffering localized osteogenic sarcoma received at the Institute's Clinic (1977-1995) has been carried out. The best 5-year survival results were obtained with the COSS-91 and PECOSS programs and those for pre- and post-operative COMBAP chemotherapy (77.8 and 70.0%, respectively). Another randomized comparative study of the effectiveness of different polychemotherapy and pre-operative radiation schedules are being planned.

[Clinical aspects, diagnosis and surgical treatment in injuries of the iliofemoral venous segment in children]. / Klinika, diagnostika i khirurgicheskoe lechenie povrezhdenii podvzdoshno-bedrennogo venoznogo segmenta u detei.

In 1985-1991 forty patients aged from 12 days to 14 years were treated for sequelae of iatrogenic injury to the iliofemoral venous segment. Twenty-five various operations for autovenous shunting were performed: cross shunt after Palma in 15, autovenous shunt in the anatomical projection in 3, phlebolysis and ligation of the collaterals in 5 cases, extravasal correction with A. N. Vedensky's casing spiral in one case, and direct anastomosis in a newborn infant.