[Assessment of microhaemodynamics and oxygenation in tissues after the vestibuloplasty with the use of a free dermal autograft in patients after the reconstructive jaw surgery with the use of the revascularized autografts]. / Otsenka sostoyaniya mikrogemodinamiki i oksigenatsii v tkanyakh posle vestibuloplastiki s ispol'zovaniem svobodnogo dermal'nogo autotransplantata u patsientov posle rekonstruktivnoi operatsii na chelyustyakh s primeneniem revaskulyarizirovannykh autotransplantatov.

Purpose of the study: to study the features of microhaemodynamics and oxygenation in soft tissues in the area of the plastically reconstructed jaw after the vestibuloplasty. MATERIALS AND METHODS: The study included 40 patients aged 20 to 65 (21 males and 19 females). The patients were divided into two groups: I group (14 patients) - patients after reconstructive surgery with the use a fibula autograft without the inclusion of a musculocutaneous «islet¼; II group (26 patients) - patients after reconstructive surgery with the use a fibula autograft with the inclusion of a musculocutaneous «islet¼. To correct the prosthetic bed soft tissues, all patients underwent vestibuloplasty with the use of a free dermal autograft. To study microcirculation in tissues, the laser Doppler flowmetry (LDF) method was used. Microcirculation status was assessed by microcirculation index characterizing the level of tissue blood flow; parameter «σ,¼ which determines the oscillability of the flow of red blood cells and by coefficient of variation, characterizing vasomotor activity of microvessels. According to the Wavelet analysis of LDF-grams the blood flow bypass was determined. An oxygenation study was carried out in the tissues of the plastically restored jaw by optical tissue oximetry, the results of which determined the oxygenation index and the specific oxygen consumption index. RESULTS: According to LDF data after vestibuloplasty, it was found that in I group, the microcirculation in soft tissues of the plastically reconstructed jaw restored in 21 days, and in II group in 2 months, which persisted at 6 months. In I group, the level of oxygenation and specific oxygen consumption normalized in 21 days, and in II group in 2 months, which persisted at 6 months. CONCLUSION: Based on the results of this functional study, it was found that before vestibuloplasty microcirculation and oxygenation indices in II group patients were lower than those in I group patients. After vestibuloplasty with the use of a free dermal autograft, microcirculation indices in II group patients restored in 2 months, while in I group patients those indices restored in 21 days.

[Rational choice of revascularized autograft in midface reconstruction]. / Ratsional'nyi vybor revaskuliarizuemogo autotransplantata pri rekonstruktsii srednei zony litsa.

The article presents an analysis of the results of the use of revascularized autografts in the plastic elimination of combined defects in the middle zone of the face. Difficulties and negative moments of each of them were revealed and recommendations were given on the rationality of their clinical application with the development of the algorithm of surgical tactics.

[Determination of the lesions volume in patients with radionecrosis of the jaws]. / Opredelenie ob''ema porazheniia tkanei cheliustno-litsevoi oblasti u patsientov s osteoradionekrozom cheliustei.

The extent of manifestation of the osteonecrotic process after radiation therapy of malignant neoplasms of the head and neck is currently unknown and little studied. The same can be said about the choice of methods and surgical techniques in this category of patients. We believe that the choice of method is based on the determination of the true size of the defect, the search for the optimal source of complete blood supply as well as the presence of restrictions on the general somatic status. In osteoradionecrosis clinically significant changes occur in the facial vessels, which is reflected both in the bone tissue and in soft tissue structures that correspond not only to irradiation area but also to compromised blood supply area. The study identified histopathological changes in the irradiated vessels, soft tissues and bones of the facial skeleton in 20 of patients. Biopsy findings were correlated with ultrasound and tomographic examination data. Based on the findings summary the methods are proposed for examining patients and choosing the best surgical treatment methods for maximal possible rehabilitation.

[Evolution of the mandibular defects reconstruction with free fibula flapx]. / Évoliutsiia v planirovanii i modelirovanii revaskuliarizuemogo malobertsovogo autotransplantata pri ustranenii defektov nizhnei cheliusti.

One of the most important steps in achieving aesthetical and functional result in mandible reconstruction with fibula free flap is positioning of the bony part relative to the basis of the native mandible. Positioning fibular bony part continuing inferior mandible border may produce a high discrepancy between the residual mandible and fibula bone that results in difficulty in denture rehabilitation. Positioning fibular bony part continuing alveolar mandible border creates asymmetric jowls and changed shape of jawline in border-line zone. The double-barrel technique solves this problem, but needs a meticulous preoperative planning and precision free fibula flap modelling.

[Integrated approach to nasal defects reconstruction].

The aim of the study was to define and solve main problems in nasal defects reconstruction procedures planning. Fifty-two patients with nasal defects treated in Central Research Institute of Dentistry and Maxillofacial Surgery in 2010-2015 were included in the study. In 28 cases the defects were reconstructed by means of paramedial forehead flap. The authors highlight typical procedure pitfalls mainly associated with the planning stage. The study results prove paramedical forehead flap to be the most useful tool for subtotal and total nasal defects reconstruction but meticulous procedure planning is a must for success.

[Optimization of staged treatment in patients with extensive combined face defects].

Free autotransplantation of revascularized flaps allow reconstructing soft tissue integrity with simultaneous bone defects elimination in patients with extensive combined face defects, but for eligible reconstruction of facial proportions one may need additional surgical procedures. The study included 161 patients who underwent free autotransplantation of revascularized flaps. Main pitfalls of the method are revealed and reviewed in the paper. When corresponding to deformity type free autotransplantation of revascularized flaps results in full functional and esthetic rehabilitation.

[Anatomical rationale for elevating revascularized ulnar forearm fasciocutaneous flap for head and neck reconstruction].

In this paper we studied in detail features of the blood supply to the tissues of the forearm of the pools ulnar and radial arteries, the technique of line access and the formation of skin-fascial ulnar flap by using a layered dissection with contrast vessels on non fixed human cadavers. Blood supply of the forearm carried out by branches radial and ulnar arteries, which allows to create in this area radial flap and ulnar flap loo. The size of the skin-fascial ulnar flap can reach 3-10 cm in length, 2-6 cm in width, the length of vessel pedicle of the transplant can reach 12 cm. The research studied the characteristics of blood supply of the forearm and the comparative evaluation of tissue perfusion of the radial and ulnar arteries; proved localization forming ulnar flap. Studies have shown that revascularised skin-fascial ulnar flap may be can be an alternative donor material for elimination of soft tissue defects with less traumatization donor area and reduce upper limb function compared with radial flap.

[Spiral computer tomography use on the treatment stages of patients with defects and deformations of face bones and soft tissues].

There are discussed possibilities of spiral computer tomography use in cases of defects and deformations of face bones and soft tissues elimination.