[AN EXPERIMENTAL STUDY OF THE HISTOLOGICAL FIBRO GENESIS ABILITIES IN THE AREA OF IMPLANTATION OF ALOTRANSPLANTATES APPLYING INTRAABDOMINAL AND PREPERITONEAL PLASTIC SURGERY].

The histological fibro genesis abilities in the area of implantation of allotransplantates applying intraabdominal and preperitoneal plastic surgery were examined during experimental research. The experiment involved 12 Russian chinchilla rabbits. The animals were spitted into two groups: I group--operated using IPOM methodology (intraperitonealonlaymesh, n = 6) with the installation "Proceed" mesh made by "Ethicon", group II--modeling preperitoneal plastics with the installation of "Ethicon's Ultrapro" mesh (n = 6). After removing the animals from the experiment, the implants with adhering musculo-aponeurotic tissue layer were excised and sent for histological examination. At the same time the severity of the inflammatory process were rated, the composition of the inflammatory infiltrate, germination of the connective tissue through the pores of the prosthesis and neovascularization. Analyzing the research data of histological connective abilities complexes formed in the area of the allotransplants implantation using intra-abdominal and pre-peritoneal plastic during the experiment, we can conclude that intra-abdominal installation of mesh prostheses reduces the severity of inflammatory changes surrounding tissues and reduces the probability of seroma formation in comparison with the placement of the pre-peritoneal implant.

[Amputation of the metacarpal bones in patients with the complications after long finger hand injuries].

The study included 6 patients for complications of injuries long fingers. The length of their inpatient and outpatient treatment was on average 49.5 days. All patients substantiated indications for surgical treatment, the primary stage of which was amputation of the metacarpal bones and all distally located tissues of damaged finger. Surgical treatment is permite to enable the brush to work and self-service after long periods of inactivity.

[Results of surgical treatment of post-traumatic deformation of three-phalangeal fingers].

Results of surgical treatment of 168 patients with consequences o injury of long fingers were analyzed. After a trauma and emergency surgery in 139 patients had deformation of 200 fingers. Flexion contracture in proximal interphalangeal joint, bone deformation of phalanxes, and also insufficiency of a tendon sutures that resulted need of carrying out corrective operations on 126 (63%) fingers. Results of corrective surgery are estimated as unsatisfactory. Violation in them an arterial blood-supply the retrospective analysis of clinical records, and also clinical inspection of 138 fingers that we consider as the main reason of negative results.

[Complex program for the recovery of the vertebral column motor function].

This paper addresses the problems pertinent to the improvement of the efficacy of restoration of the vertebral column motor function based on the implementation of a comprehensive therapeutic program including massage, thermal procedures, and physical exercises. The program was realized in three phases, viz. preparatory, basic, and consolidating. The results of integral estimation of the whole body and vertebral column condition were taken into consideration. The experiment lasted 6 months and confirmed high efficiency of the comprehensive program.

[Functional and morphologic changes in the tendons and multimicrovacuolar collagen absorbing system of the three-phalanx fingers in disorder of arterial inflow].

Taking into account the fact, that unsatisfactory results of treatment of the thumbs traumatic damage are significantly caused by presence of anatomic disruption of the thumbs palm's own arteries with chronic tissue ischemia occurrence. One of consequences of damage of the three-phalanx thumbs interphalanx joints and the thumbs palm's own arteries is a formation of quickly progressing secondary flexing contracture of proximal interphalanx joints (PIPHJ). In the investigations accomplished there was established, that the changed tissues of the flexors tendons and their sheaths, forming cicatricial blockade distally to the primary trauma site, are taking part in a PIPHJ contracture development while arterial perfusion presence.The tissues damage severity, as well as a severity of clinical features of the tendons and their sheaths damage, depends on a degree of an arterial perfusion disorder present,

[Complications of the finger osteosynthesis using Kirschner's wires in arterial inflow disorder].

At an osteosynthesis of Kirshner wires to one of widespread complications is their spontaneous migration that leads to formation of bone deformation or to necessity of application of less effective kinds of an immobilization. In posttraumatic change of arterial inflow to hand and fingers leads to an oxygen level reduction in tissues, their chronic ischemia and to increase of a lactate and pyruvate contents in peripheral blood that can influence on Kirshner wires. Spontaneous migration of Kirshner wires from bones of fingers and decrease of their fixing in the bones is characteristic for patients with the expressed posttraumatic infringement of arterial inflow. This phenomenon can be explained, in particular, of acidity of peripheral blood change owing to considerable reduction arterial blood flow and secondary changes in bone and metal pin contact surface.

[Peculiarities of using some methods to assess hand and finger functions in clinical practice].

DASH questionnaire constitutes one of universal instrument, which are applied for estimation of the upper extremity function. Its disadvantages are massiveness, subjectivity, necessity of translation on Ukrainian language and adaptation to local conditions, what constitute a hard task. Comparative estimation of DASH questionnaires, short--DASH, Purdue pegboard test, Jebson-Taylor and Hand Tool Dexterity Test application was conducted. The analysis of correlation of the application results suggestion performed, concerning the methods of examination of the lower extremity and the hand function, trusts the possibility of wide application of Purdue pegboard test and Hand Tool Dexterity Test especially. Today the Erchard questionnaire, which is simple and need not to be translated, may serve as an alternative to DASH questionnaire.

[Experiment study of multimicrovacuolar absorbing collagenic system and its role in trophic processes of nonsynovial part of the tendons].

The arterial inflow disorder and occurrence of an acute and subsequent chronic ischemia constitutes frequent complication of a hand and fingers trauma. One of the consequences of ischemic damage of tissues is formation of a flexor contracture of fingers, involving the flexors tendons. In extrasheath zone the blood supply is secured by paratendon--a connective tissue, taking part in the tendons sliding. According to data, obtained during morphological investigation of paratendon in laboratory animals, there was established its principal similarity with multimicrovacuolar collagenic absorbing system of a man. She constitutes a spatial porous structure, packed with cellular elements and vessels. While simulation in experimental conditions of the blood flow disorders, which in physiological environment is secured by paratendon, alike in disorder of the bone-tendon and muscle-tendon pathways of blood supply, there were revealed the coarse changes in the tendon structure and pronounced adhesion of tendons with loss of their sliding capacity, what had permitted to consider the paratendon blood circulation a dominating one.

[Clinic peculiarities of secondary flexion contractur formation in the proximal interphalangeal joint of the triphalanger fingers in conditions of posttraumatic chronic ischemia].

Occurrence of the proximal interphalangeal (PIP) joints contracture is a characteristic consequence of traumas of a forearm and a hand, complicated by the phenomena of a chronic ischemia. Their formation leads to occurrence of considerable functional deficiency of a hand, especially at involving in process of several fingers, and treatment is a complicated problem. Secondary contractures of PIP joints at a chronic ischemia of a hand and fingers differ high severity level, firmness, are characterized by fast formation and progressing. Elimination of the primary factor of blocking of a kinematic chain at a chronic ischemia of a hand and fingers does not render influence on reduction secondary contractures of PIP joints and leads to necessity of performance of additional surgery.

[The arterial blood circulation peculiarities in patients with remote consequences of the hand and fingers trauma].

The arterial inflow disorder and chronic tissue ischemia occurrence constitutes a frequent consequence of a hand and fingers trauma, unfavorably influencing the tissues reparation processes and the lost function restoration tactics. The hand and fingers tissues microcirculation disorders in chronic ischemia are still unsufficiently studied. The qualitative and quantitative preoperative diagnosis of arterial inflow of a hand and fingers was done using arteriography, laser Doppler flowmetry and arterial duplex ultrasonic scanning. Application of these methods had permitted to study up the principal variants of arterial blood circulation in hand and fingers in patients, suffering remote consequences of their trauma.

[Possibilities of reconstructive plastic surgery in the treatment of vascular malformations of the head region].

Results of treatment of 19 patients, suffering vascular malformation of the head region, were analyzed. Application of a new highly informative diagnostic methods of surgical intervention differential methods have promoted significant clinical improvement.

[Surgical correction of cicatricial deformation of the extremity using the tissue expanding method].

Modern approaches to the treatment of cicatricial deformation of extremity are presented. The results of treatment of 20 patients using the tissue expanding method are adduced. During the expander implantation and dermotension in 20% of patients the complications had occurred. The analysis of the results obtained permits to consider dermotension the method of choice in the treatment of the extremity cicatricial deformation.

[Surgical treatment of inveterate defects of the hand II-V fingers extensors tendons in VI-VII zone].

Possibilities and efficacy of secondarily restoration of inveterate defects of the extensors tendons of fingers, owing various extent, were studied in conditions of cicatricial changes in the hand back skin. There was established, that in ischemic and reperfusion damage of the hand tissues the coarse cicatricial changes in the end portions of the traumatized tendons occurs, essentially influencing surgical tactics. Optimal operative techniques, directed on the extensors tendons restoration in various extent of their defects and various severity of the soft tissues changes in the hand back were determined. There was shown the perspective character of substitution of the cicactricially transformed hand back soft tissues and significant defect of the II-V fingers extensors tendons using vascularized compound complex of tissues of the foot back flap with the tendon complex.