[Early results of microsurgical suture of the median and ulnar nerves in the forearm]. / Blizhaishie rezul'taty mikrokhirurgicheskogo shva sredinnogo i loktevogo nervov na predplech'e.

The author discusses the early results of primary and delayed microsurgical sutures of the median (31) and ulnar (32) nerves in injuries (incised wounds) to the forearm in the middle and lower third. The results of the operation were appraised in follow-up periods of 2 to 4 years in 19 patients (23 nerves). The useful degree of restoration of the strength of the small hand muscles (3 marks and more) was recorded after suturation of 13 of 23 nerves. Skin sensitivity in the autonomous nerve zones was estimated as 4 marks and more in all cases. Two-point discrimination at a distance of less than 15 mm was restored after suture application in 13 of 23 nerves.

[Experimental microsurgical suturing of peripheral nerves]. / Mikrokhirurgicheskii shov perifericheskikh nervov v éksperimente.

It was demonstrated in experiments on 8 rhesus monkeys with suturation of 16 nerves that the relative number of regenerated myelinated fibers was 83.2-96.4% of the initial number in application of sutures with the use of microsurgical techniques and 73.8-81.5% in application of sutures without an operating microscope. The average number of regenerated nonmyelated fibers was 74.3-95.6% of the initial number in the first case and 62.2-77.4% in the second case. In all experiments the mean values of the corresponding indices had no statistically significant differences whatever the method of suture application. A 8/0 supramide thread passed atraumatically through the perineurium induced neither an active cellular reaction in the tissues nor changes in the nerve fibres.

[Donor tissue source in plastic surgery of the hand]. / Donorskii istochnik tkanei v plasticheskoi khirurgii kisti.

From topographic and anatomical examination of 32 upper limbs the authors proved that an island skin-fascia graft supplied with blood by the septocutaneous branches of the posterior interosseous vascular bundle can be formed on the posterior aspect of the forearm. Such a graft on a peripheral vascular pedicle was transplanted in 6 patients with defects in the integumentary tissues of the hand; it healed completely in 4 cases, peripheral necrosis occurred in 2 cases but did not affect the end result. The use of means of optic magnification and prevention of compression of the vascular pedicle in the postoperative period ensure successful transplantation of the graft.

[Current problems in the microsurgery of peripheral nerves]. / Aktual'nye voprosy mikrokhirurgii perifericheskikh nervov.

The experience with 132 surgical interventions on 203 nerves of the upper extremities in 131 patients, experimental findings obtained in monkeys and extremities of corpses enabled the author to discuss some important questions. The author considers the employment of the microsurgery technique to allow to considerably raise the exactness of comparing the bundles in suturing or plasty of the nerves, to decrease the specific weight of "erroneous" (heterotopic or heterogenic) regeneration of the fibres due to possible identification of the corresponding bundles, to improve the quantity of preparing the nerve ends for suturing. It gave better results in suturing the nerves.

[Problems of technic and procedure in replantation of the fingers]. / Nekotorye voprosy tekhniki i taktiki replantatsii pal'tsev kisti.

The method and technique of operations of replantation of 22 fingers following their complete abruption fulfilled in order to recover the main blood flow and functions of the floating apparatus are analyzed. Details of osteosynthesis of the phalanges fragments, succession of the restoration of the vessels and other anatomic structures are discussed as well as specific features of the additional incisions providing closure of the skin wound.

[Classification of the types of blood supply of the muscles from the standpoint of plastic surgery]. / Klassifikatsiia tipov krovosnabzheniia myshts s pozitsii plasticheskoikhirurgii.

Based on an experience with 120 composite flaps including the muscle and with special account of literature data the author describes a new classification of types of blood supply of muscles. The author proposes 6 types of blood supply of muscles and substantiates a direct relationship between the anatomy of muscle vessels and variants of its use for plasty. A comparison of the new classification and other classifications was made.

[Complex evaluation of the results of emergency microsurgical operations in injuries of the limbs]. / O kompleksnoi otsenke rezul'tatov ekstrennykh mikrokhirurgicheskikh operatsii pri travmakh konechnostei.

Sixty four patients were subjected to 74 urgent operations on microvessels of 83 segments (fingers, hands, forearms, shins ). The nearest results were positive in 80,06%. General functional results of the treatment were positive in 60% of the amount of all the segments operated upon.

[Principles of microsurgical transplantation of tissue complexes in reconstructive surgery of the limbs]. / Osnovnye printsipy mikrokhirurgicheskikh peresadok kompleksov tkanei v rekonstruktivnoi khirurgii konechnostei.

The article describes the experience with 22 free transplantations of tissue complexes performed on 21 patients with traumas and injuries of extremities and gives characteristics of the following general principles responsible for success of the procedure: a) the flap must have the intact internal vascularization and nourishment of all the tissues; b) the patency of microvascular anastomoses must be preserved and compression of the flap vascular pedicle prevented; c) conditions of the flap contact with the recipient bed must be optimized.

[Classification of the types of blood supply of integumentary tissues from the standpoint of plastic surgery]. / Klassifikatsiia tipov krovosnabzheniia pokrovnykh tkanei s pozitsii plasticheskoi khirurgii.

The authors propose their classification of blood supply of investing tissues (skin, subcutaneous fat) depending on the structure and arrangement of the vessels approaching the skin at the place of cutting the flap. A possibility to replace the skin flap or that of other tissues is taken into consideration in correspondence with the plan of plastic operation.

[The anatomicophysiological characteristics of the forearm as a donor site for the formation of tissue complexes on vascular pedicles]. / Anatomo-fiziologicheskie osobennosti predplech'ia kak donorskoi oblasti dlia formirovaniia kompleksov tkanei na sosudistykh nozhkakh.

Based upon results of the complex topographical anatomical research fulfilled on 68 upper extremities the forearm area is considered as a single donor zone for the formation of composite cutaneous flaps on the vascular pedicle good for both microsurgical autotransplantation and replacement in the form of islands on the proximal and distal vascular pedicles. Individual differences in the structure and topography of vascular-nervous formations of the forearm are presented as well as a rational technique of the formation of tissue flaps developed with special reference to them.

[2-stage plastic repair of the flexor tendons of the fingers: the indications and technic]. / Dvukhétapnaia plastika sukhozhilii sgibatelei pal'tsev kisti: pokazaniia i tekhnika.

Based on their experiences with treatment of 58 patients with consequences of severe traumas of the hand the authors analyze and substantiate indications for using the method of the two-stages tendoplasty of finger flexors. The technique of implantation of polychlorvinyl rods is described in detail. Relatively high frequency of additional procedures on different anatomical structures of the hand is noted. Special attention is given to intra- and postoperative prophylactics of infectious complications. It was found that time of the second operation should be determined not only by the time of formation of the smooth wall capsule around the implant but also by the degree of liquidation of finger joints contractures.

[Errors and complications of microsurgical autologous transplantation of tissue in trauma]. / Oshibki i oslozhneniia pri mikrokhirurgicheskoi autotransplantatsii tkahei pri travme.

Possible errors and complications are analyzed basing on the experience with microsurgical autotransplantation of 87 tissue complexes fulfilled in 81 patients with traumas. Various complications were established in 25 out of 82 patients (30.4%). Acute disturbance of the transplant blood circulation was noted in 17.2%. Reoperations on the vessels reduced the incidence of failures to 8% of all the transplanted complexes of tissues.

[Variants of microsurgical autologous transplantation of composite skin flaps from the external surface of the hip]. / Nekotorye varianty mikrokhirurgicheskoi autotransplantatsii slozhnykh kozhnykh loskutov s naruzhnoi poverkhnosti bedra.

Topographic anatomical investigations have established the possibility to make a new complex skin flap on the lateral surface of the femur on the branches of the second perforating artery and vein. The authors propose methods of making a transplant in this field on two vascular pedicles with anastomoses in one of them--a larger one and two separate flaps: a skin-fat and a muscular flaps on a single feeding pedicle. The experimental findings were confirmed by successful clinical observations.

[Treatment of injuries of the common and proper palmar digital nerves by microsurgical technics]. / Lechenie povrezhdenii obshchikh i sobstvennykh ladonnykh pal'tsevykh nervov s ispol'zovaniem mikrokhirurgicheskoi tekhniki.

On the basis of the experience with the treatment of injuries of 69 nerves of hands in 36 patients the authors came to a conclusion that the microsurgical technique can return the finest sensitivity of skin denervation resulting from a trauma. The optical magnification considerably facilitates the surgeon's work in the area of the division of major nerves into branches, gives a more exact assessment of the degree and length of altered nerve plexuses and secures the most accurate union during suturing and plasty.

[Regional anticoagulant therapy after microvascular surgery with permanent intra-arterial administration of heparin]. / Regionarnaia antikoaguliantnaia terapiia posle mikrososudistykh operatsii postoiannym vnutriarterial'nym vvedeniem geparina.

Experiments on 32 dogs have shown that the greatest effect of medication on particular anatomical zone may be achieved by maximum approximation of the level of catheterization of the feeding artery to the zone. It may be achieved by the microsurgery technique. Permanent intraarterial administration of solutions of heparin in experiments and clinic is thought to provide a sufficient effect of the regional anticoagulating therapy, by creating a high concentration of the drug in the zone of microanastomosis with its low concentration in the general blood flow.

["Venous flaps" in plastic surgery of the extremities]. / "Venoznye loskuty" v plasticheskoi khirurgii konechnostei.

The article describes data of clinical use and experimental studies of possibilities to preserve vital ability of fascio-cutaneous flaps with a through venous blood flow. Factors influencing the survival of the venous flap are studied and the possibility to increase vital ability of the flap with the through venous blood flow with the help of pharmacological drugs is noted.

[Vascularized tissue complexes from the region of the radial artery in plastic surgery of the arm]. / Krovosnabzhaemye kompleksy tkanei iz basseina luchevoi arterii v plasticheskoi khirurgii konechnostei.

Based upon results of topographo-anatomical research and personal experiences with transplantation of 91 tissue complexes on radial vascular bundle the authors made an attempt to systematize the available data concerning this source of tissues. The substantiation of using the tissue complexes consisting of several fascio-cutaneous (fascio-cutaneous and muscular) flaps at different levels of the vascular pedicle as well as superlong deltoid-radial flap on two vascular pedicles are first given.

[Current prospects of plastic surgery for skin and tendon defects]. / Sobremennye vozmozhnosti plastiki defektov kozhi i sukhozhilii.

Under analysis was an experience with microsurgical autotransplantation of tendino-cutaneous complexes from the back of the foot, forearm, lateral surface of the femur as well as plasty with not-blood-supplied tendinous transplants associated with free transplantation of composite skin flaps performed in 21 patients with mechanical traumas and deep burns. The criteria of choice of the optimum variant of reconstructive operations are described for patients with defects of the skin and tendons.

[Use of a radial flap of the forearm in plastic and reconstructive surgery of the extremities]. / Ispol'zovanie luchevogo loskuta predplech'ia v plasticheskoi i rekonstruktivnoi khirurgii konechnostei.

A detailed characteristic of the ways of using fascio-cutaneous, osteo-cutaneous and muscular-cutaneous flaps disposed in the basin of the radial vascular bundle is given on the basis of an experience with 18 operations. Non-free plasty by an island flap on a peripheral vascular pedicle was used in 13 patients. Free plasty with microvascular anastomoses was used in 4 patients. In 16 of the 17 patients a complete take of the flap took place.