[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.

[Common aspects of microsurgical tissue transplantation in reconstructive urology].

The article highlights possibilities and common aspects of microsurgical tissue transplantation in reconstructive urology. The authors share the experience of more than 2000 of microsurgical autotransplantations of revascularized and reinnervated free flaps. The method allows the new approach to such urological conditions as traumatic penis amputation, posttraumatic and inflammatory urethra strictures, inborn genital hypoplasia, impaired sexual identification, etc. The issue analyses the results of treatment of 152 patients with inborn urogenital pathology (220 autotransplantations of revascularized flaps) and 146 patients with acquired urogenital diseases (188 autotransplantations of revascularized flaps) during the period from 1991 to 2011 years.

[The microsurgical tissue autotransplantation as a way of local radiation skin injuries' treatment].

The experience of 127 microsurgical autotransplantations of skin-muscular flaps in 93 patients with severe radiation skin injuries was analyzed. As free revascularized flaps the greater omentum, the skin-muscular thoracodorsal flap, the scapular, the radial flap, including flaps with a part of the radial bone, the deltoideus, the rotated skin-muscular flap of the abdominal rectus muscle, the scapular and/or serratus anterior fascia were used. The transplants' acception was registered in all cases. 31 patients demonstrated the development of late radiation ulcers during the long term follow up period, requiring further dissection and replantation.

[Tissue equivalent for the closure of extended urethral defects].

The aim of the present work was to develop a method for culturing epidermal keratinocytes to be used in a tissue equivalent for the closure of extended urethral defects. The experiment was carried out using 15 rabbits. Skin biopsies were obtained from the inner surface of the ear. The tissue equivalent consisted of collagen gel with embedded fibroblasts and epidermal keratinocytes grown on its surface; lavsan-mesh endoprosthesis served as the framework. Prefabrication of the neourethral plate was performed on the superficial fascia of m. rectus abdominis. The neourethral tube was formed after engraftment which was complete in all 15 animals. A histological study revealed morphological similarity of the neourethral tube thus engineered and the normal urethra.

[Extended, combined, and concurrent surgery in patients with neoplastic obturation large bowel obstruction].

The study included 552 patients (mean age 68.9 +/- 1.0 years) with neoplastic obturation large bowel obstruction (NOLBO). They were allocated to 3 groups depending on the character of surgical intervention. Group 1 comprised 172 patients (31.2%) operated under endotracheal anesthesia (ETA) through a medial approach for the resection of the segmented intestine and its tumours with colostomy or ileostomy (n = 154) and primary interintestinal anastomoses (n = 18). Group 2 of 56 patients (10.1%) with neglected NOLBO in very severe condition underwent medial laparotomy under ETA with internal or external colonic decompression without tumour resection. Minimally invasive decompressive ileotsomy or colostomy depending on localization of the tumor was performed under local anesthesia after premedication in 324 (58.7%) patients of group 3. The grave clinical condition of the patients was due to polyorgan insufficiency (POI). Postoperative lethality in groups 1, 2, and 3 following surgery in the acute phase of NOLBO was 26.9, 39.3, and 1.8% respectively. The condition of patients of group 1 and 2 with indications for urgent extended, combined or concurrent surgery was too serious to allow for an adequate intervention; it was possible only in 7 (14.6%) of the 48 patients. Diminution of POI manifestations by restoration of segmented intestine patency by low-invasive intervention in patients of group 3 and their preoperative preparation by balanced diet during 3-4 weeks made possible extended combined surgery in all 50 patients of this group without a fatal outcome.

[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.

[Autodermoplastic closure of defects of donor's zone after taking free revascularized autotransplants]. / Autodermoplastika pri zakrytii defektov donorskoi oblasti posle vziatiia svobodnykh revaskuliariziruemykh autotransplantatov.

Problems of autodermoplasty in donor's zone after taking of free revascularized autotransplants for closure of skin defect in 85 patients are regarded. All the transplants were complex. Free autodermoplasty was used in the zone of forearm -- 50 (58.8%) cases, foot - 22 (25.9%), posterior surface of thorax -- 9 (10.6%), and also in the zone of cnemis, lateral surface of femur, deltoid and scapular region -- one (1.2%) case each. In 52 (61.2%) cases free autoskin required for complete closure of defect in donor's zone and in 33 (38.8%) -- for partial closure. Region of taking of free autoskin was anterior-lateral surface of femur in majority of cases - 73 (85.9%). Split-thickness free autoskin was used the most often -- 79 (92.9%) cases. Graft retention was complete or partial in 77 (90.6%) cases, complete necrosis of free autoskin was seen in 8 (9.4%) clinical cases. It is concluded that method of free autodermoplasty is effective for closure of defects including in combination with microsurgical transplantation of tissues.

[Use of fibrin glue for covering microsurgical autotransplants with free split skin]. / Ispol'zovanie fibrinovogo kleia dlia ukrytiia mikrokhirurgicheskikh autotransplantatov svobodnoi rasshcheplennoi kozhei.

An experimental study on 90 Wistar rats has been carried out. A split skin transplant about 2.25 cm(2) in size was taken from the back of the animal with scalpel and fixed on the neck's muscles with: 1) 8 sutures; 2) pressure dressing of "Pelot" type; 3) 0.2 ml of "Tissukol" fibrin glue. There were no complications. Complete skin retention was achieved in all the cases. Histological study demonstrated acceleration of reparative processes and decreased inflammation in autotransplant and muscular bed due to improvement of revascularization, a decrease of fibrous transformation of the skin graft and muscular tissue when fibrin glue (to a greater extent) and pressure dressing (to a lesser extent) were used for fixation of skin graft. But it is preferable to use fibrin glue due to acceleration of complete skin retention compared with pressure dressing of "Pelot" type.

[Prophylaxis of thrombotic complications in microsurgical auto-transplantation of tissue complexes]. / Profilaktika tromboticheskikh oslozhnenii pri mikrokhirurgicheskoi autotransplantatsii tkanevykh kompleksov.

Problems of prophylaxis of intra- and postoperative thrombotic complications are discussed basing on the experience of treatment of more than 1500 patients who underwent microsurgical autotransplantation of tissues. Influence of non-fractionated heparin, acelysin and low-molecular heparin on hemostasis in combination with standard hemodilution after microsurgical autotransplantation was analyzed. Scheme of treatment before, during and after surgery are developed for prophylaxis of thrombotic complications.

[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.

[Heterotopic replantation of fingers after traumatic amputation]. / Geterotopicheskaia replantatsiia pal'tsev kisti, amputirovannykh v rezyl'tate travmy.

Available are the results of the treatment of 93 patients with multiple traumatic amputations of the fingers, in whom the heterotopic digital replantation was carried out. A total of 367 fingers were amputated, 187 of them have been replanted, which made up 51% of replantability. 148 fingers (79.1%) were replanted heterotopically and 39 (20.9%)--orthotopically. The viability was restored in 167 fingers, which made up 89.3%. Of 148 fingers, which have been replanted heterotopically, 88.6% have survived, and of 39 fingers, being replanted orthotopically, 92.4% survived. The analysis of functional results of the digital replantations in hand comprised the study of the hand biomechanics, blood supply and innervation. A total of 31 patients was followed up and examined in long term period from 8 months to 6 years after replantation. The biomechanics of the hand was assessed according to its capacities for seize and pinch as well as to the extent of movements in the joints of the restoration of digital innervation was assessed by the study of temperature and discrimination sensitivity. For evaluation of blood supply the US dopplerography and scintigraphy were used. The authors came to the conclusion that there was no substantial difference in the function of operated fingers both in orthotopic and heterotopic replantations. Taking into account that heterotopic replantation of the fingers resulted in more active digital function, it is safe to speak about more pronounced increase in the function of the hand in cases of heterotopic replantations of fingers in their multiple traumatic amputation.

[Blood supply of wrist and forearm after exclusion of radial vascular fascicle of all length from blood stream]. / Krovosnabzhenie kisti i predplech'ia posle vykliucheniia iz krovosnabzheniia luchevogo sosudistogo puchka na protiazhenii.

The arm and forearm are commonly used in plastic and reconstructive surgery as a donor site for harvesting free microsurgical revascularized autografts, which include not only soft tissues, but when necessary, a fragment of radial bone as well. The radial autograft is taken together with radial vascular bundle, the radial artery is so being excluded from participation in hand and forearm blood flow. Until now there are no common opinion of expedient reconstruction of the radial artery because there are no evidence of visible blood flow disturbances in the hand. There are no convincing data on the functional status of the hand in long-term postoperative period and on the ways and degree of compensation of circulation. It is very important that evaluation of the ways and degree of blood flow compensation may play a great part in the problem of hand replantation, that is to determine the influence of the extent of blood flow restoration not only on hand viability, but on the long-term functional outcome as well. This investigation has revealed impaired blood supply and metabolism in hand soft tissues and bones by using the forearm as a donor site for taking free microsurgical revascularized autografts by radionuclide and ultrasound methods.