Emergency Soft Tissue Reconstruction Algorithm in Patients With Open Tibia Fractures.

Introduction: Tactic of emergency closing of soft tissue defect allows to significantly improve the treatment results concerning patients with severe open fractures. However, a number of certain factors make the implementation of this tactic rather difficult. Injured people's unstable conditions are mong these crucial factors which include, polytrauma in lots of cases, absence of exact recommendations for recovery terms, choice of definite tissue flaps and a type of circulation.

[Microsurgical autotransplantation of tissues in emergency surgery].

Results of microsurgical transplantation of 177 autotransplants in 167 patients with tissues defects of different origin and location are presented. Surgeries were urgent and elective with 96.6% survival of autotransplants.

[The prevention of thrombus formation and the improvement of the blood rheological properties during operations with a microsurgical technic. I. The possibilities for using acelysin--an acetylsalicylic acid derivative].

Changes in the blood clotting system and rheology were studied in 39 patients during reconstructive operations making use of microsurgical methods. Effects of various doses of water soluble acelysine, an acetylsalicylic acid preparations (DL-lysine acetylsalicylate and glycine) have been evaluated during surgery and the immediate postoperative period. Clinical and laboratory changes in blood coagulation were determined at different doses (1000, 500, and 250 mg).

[The anesthesiological support for limb segment replantations (20 years' experience)].

Anesthesias for urgent replantations of the limb segments in 1980-1998 are analyzed. A retrospective analysis of case histories and protocols of anesthesia of patients aged 16-64 years is carried out. Specific features of anesthesia for surgery of this kind are demonstrated.

[Restoration of replanted extremity function with use of microsurgical tissue autotransplantation].

The results of 40 tissue autotransplantations for correction of function of the replanted upper extremities. The peculiar features of vascularised tissue autotransplantation in specific situations of anatomic and morphologic changes in replanted upper extremities are presented. It was proved, that vascularised tissue autotransplantation is a safe and effective method for restoration of function of the extremities, replanted after traumatic amputation, that was accompanied with massive tissue damages.

[Plastic surgery of combined cutaneo-osseous defects of the hand].

The article analyses modern methods for the restoration of of defects in the metacarpal bones, based on microsurgical techniques. A case is described in which a new method for one-stage reconstruction of the hand in combined traumatic defect in the first and second metacarpal bones and an extensive defect in the soft tissues on the back of the hand was used. The hand was reconstructed by means of a vascularized complex autograft on a common vascular pedicle which included two separate fragments of the scapula and a fascial flap of the scapular region.

[The replantation of the thumb in avulsive amputations].

A comparative assessment of results of operations was made in 2 groups of patients with abruption of the first finger. An analysis of immediate and long-term results of operations has shown advantages of the method of replantation with heterotopic revascularization of the replanted first finger and reinnervation by means of plasty of the palmar digital nerve.

Autotransplantation of heterodigital neurovascular free flaps for plasty of finger defects.

The authors report eight microsurgical operations to repair soft tissue defects of the fingers using free neurovascular autografts taken from the lateral surfaces of digits 3 and 4. In seven cases, the transferred flaps survived, and one case resulted in necrosis of the transplant. Follow-ups were from one to 12 months.

[Plastic surgery of distal defects of the fingers using free vascularized autologous grafts].

The results of 50 operations for replacement of soft tissue defects of the fingers are analysed. Plastic repair of the defects in 6 cases was performed with free neurovascular autotransplants taken from the lateral surfaces of the middle or ring finger. In 5 cases the transplanted graft healed, in one case its necrosis occurred.