Reconstruction of Fingers Using Skin-Bone Grafts with Microvascular Anastomoses.

The aim of the study was to present a clinical and anatomical rationale for transplantation of skin-bone grafts with microvascular anastomoses for treating terminal and segmental defects of the hand and fingers. MATERIALS AND METHODS: Finger and metacarpal bones were reconstructed in 25 hands of 25 patients by transplanting skin-bone tubular fragments with microvascular anastomoses. Transplants from the second metatarsal bone (n=22) and fibula (n=3) were used. Clinical, radiological, morphological, biomechanical, biophysical, and statistical research methods were used. The developed technology is adjustable to individual vascular anatomy of the foot. The proposed use of non-free skin-fat flaps and skin-bone fragments with microvascular anastomoses has been implemented for reconstructing lost segments. RESULTS: The engraftment of skin-bone fragments was observed in 25 cases. In two cases, partial necrosis of the transplants was detected. Sufficient resistance of the transplanted bone graft to resorption was noted. According to the X-ray evidence, the length of the finger with the metacarpal bone after surgery was 8.44±0.32 cm, in the short term after surgery - 8.10±0.36 cm, and in the long term - 7.87±0.45 cm, indicating mild resorption. We used an individual approach to the transplant selection, which made it possible to obtain generally good long-term results in 3 patients, and satisfactory results - in 22 patients. CONCLUSION: The study showed the feasibility of transplanting skin-bone fragments with microvascular anastomoses for replacing various anatomical defects of the hand and fingers. The proposed modification takes into account the variability of vascular anatomy of the donor region.

[The Effect of Repeated Local Ischemia on the Temperature and Skin Microcirculation in Human Hand].

Thermal imaging and laser Doppler flowmetry were applied to study the effects of infrared (IR) radiation mediated by vascular response in healthy volunteers during regular unilateral arteriovenous occlusion of one of the fingers (4 times a day for 7 months with a gradual increase in exposure from 10 to 30 min). After repeated unilateral exposure, we observed consistent changes in temperature conditions and modes of thermoregulation of corresponding skin areas of both hands. We discovered a high level of positive correlation between the dynamics of IR emission from the experimental and control skin areas in the recovery phase after clamping, which indicates that systemic vascular response is involved. The possible mechanisms of post-occlusive changes in skin of the distal phalanges are discussed. These data suggest that multiple regular unilateral arteriovenous occlusions enhance the intradermal blood flow and can be used for the prevention of disorders of the peripheral microcirculation in various pathological conditions.

[Adaptive training with electromyographic feedback after elimination of traumatic defects of wrist and fingers].

The objective of this work was to analyse the efficiency of adaptive training with electromyographic biological feedback in the early period after reconstruction of fingers depending on the character of wrist defects, the method of their correction, and etiology of the injury. Unique techniques were proposed for the training. Their effectiveness was evaluated based on clinical observations, results of electromyographic and biomechanical studies that demonstrated a significant increase of EMG amplitudes for different groups of wrist and forearm muscles during basic thumb movements (p = 0.05-0.0003) and changes of major biomechanical parameters (p = 0.007-0.000008) in the course of adaptive training with electromyographic biological feedback depending on EMG amplitude.