Facial gunshot wound debridement: debridement of facial soft tissue gunshot wounds.

Over the period 1981-1985 the author treated 1486 patients with facial gunshot wounds sustained in combat in Afghanistan. In the last quarter of 20th century, more powerful and destructive weapons such as M-16 rifles, AK-47 and Kalashnikov submachine guns, became available and a new approach to gunshot wound debridement is required. Modern surgeons have little experience in treatment of such wounds because of rare contact with similar pathology.

[Treatment method of patients with chronic recurred mandibular dislocation].

Original method treatment of patients with chronic recurred mandibular dislocation is offered. Limitation of oral opening within the bounds of physiology was made with nailon ligature which jointed mandible with malar bone. The operation is effective, simple and may be done in out-patient conditions under local anesthesia.

[Stages of bone regeneration and foundation of pharmacоlogical correction of the mandible reparative osteogenesis].

Influents of some medicines on the mandible reparative regeneration in experimental investigations are present in the manuscript. It was discovered that application of parathyroid hormone (PTG) in first 3 days after the mandible fracture decreases of quantity complications on 30% and contributes strong consolidation of bone fragments. Metiluracil in the same period increases complications quantity on 36% and bone fragments consolidation strength was for sure less than after PTG.

[Rational (injection) of calcitonin for stimulation of the mandibular reparative regeneration].

This investigation permit to detect, that first resorption stage of the mandible reparative regeneration terminats after fracture 5 days later. Calcitonine injection during 5 days after fracture i.e.

[Titanium implants integration into mandible distract regenerate].

In experiment on 20 rabbits with distract regenerates in the region of mandible body osteotomy the correlation between the efficacy of titanium implants (introduced into regenerate) integration and the degree of regenerate osseous material differentiation was investigated. Implants integration fixed in 7 and 20 days after distraction process discontinuance passed considerably more efficiently than in rabbits with implants fixed 1 day after distraction process discontinuance. It expressed itself with intensive development and maturation of osseous regenerate around implants and with tendency to "solder" of newly formed bone and implant's surface, i.

[Elimination of mandibular defects with dosed distraction. Part III. Use of dosed distraction for restricted osteoplasty in subtotal and end defects of the mandible].

Two variants (3(rd) and 4(th)) of non-free mandible osteoplasty with the use of compression-distraction apparatus (CDA) elaborated during the war in Afghanistan are described by the author. The 3(rd) variant was used in cases of vast combined defects of lower part of the face when two-sided osteotomy of both mandible stumps in order to create mobile mandible fragments of the length of 2.5 cm and their follow-up shift to the middle line of the face with the help of CDA is made.

[Repair of mandibular defects using dosed distraction. Part II. Bound osteoplasty of the mandible by distraction osteogenesis].

Five variants of bound osteoplasty based on the distraction osteogenesis phenomenon were developed by the author for the treatment of patients with gunshot mandibular defects during the war in Afghanistan. Three of these variants are described in this paper; indications for their use and the technique of operation are presented. In fact, bound osteoplasty for gunshot wounds is primary early osteoplasty of the mandible -- the target of several generations of maxillofacial surgeons.

[Repair of mandibular defects by dosed distraction. Part I. Distraction of the callus for osteoplasty of the mandible by local tissues].

During the war in Afghanistan the author repaired gunshot defects in the mandible using a compression-distraction device (CDD) which he designed in cooperation with A. Kh. Shamsudinov.

[Use of distraction osteogenesis in reconstructive surgical interventions on the temporomandibular joint].

Preserved cadaveric orthotopic grafts, osteocartilagenous autotransplants from the rib, ceramic, plastic, carbon, and titanium explants, etc. are used for osteoplasty of the condylar process. Osteoplasty based on distraction osteogenesis was used in 3 patients for osteoplasty of the condylar process and mandibular head with good results.

[Morphogenic processes in dosed distraction].

Dosed distraction of bone regenerate is paralleled by distraction of soft tissues (skin, muscles, nerves, etc.), which is particularly obvious during liquidation of medium-sized and extensive mandibular defects. Such distraction of soft tissues leads to their regeneration and growth.

[Primary surgical treatment of gunshot wounds of facial skeleton].

The author criticizes the traditional strategy of sparing treatment of gunshot wounds of the face involving the bones, formulated as long ago as in 1943, and suggests radical primary surgical treatment of such wounds. The author used such treatment with good results during 4 years in Afghanistan war.

Non-free osteoplasty of the mandible in maxillofacial gunshot wounds: mandibular reconstruction by compression-osteodistraction.

We have treated 33 young men with medium to large (3-8 cm) bony and soft tissue defects of the lower third of the face caused by gunshot wounds. After debridement, collapsing the proximal segments for primary approximation of soft and hard tissues and a closed osteotomy of a small fragment of mandible, we used an original compression-distraction device, designed in 1982 and tested during 1983 (analogous devices were absent at that time) to reposition the mandible and cause callus to form (during distraction) between the fragment and to use the remaining stumps of bone to fill in the defect. The soft tissues were repaired at the same time.

[Experience in conducting course exams on assignments in test form].

Analysis of the results of examinations in oral surgery making use of tests in 319 fourth-year students showed that such a method of assessing students' knowledge is highly objective.

[Experience in conducting course exams in test form].

Examinations including tasks presented as tests were carried out in 319 fourth-year students of dental surgery. This method for assessing the knowledge and skills of students proved to be highly objective.

Osteoplasty of the mandible by local tissues.

Thirty three patients with 0.5 to 4.5 cm gunshot defects of the mandible were treated.

[Role of the destructive phase of regeneration in reparative osteogenesis].

Experiments were conducted on mongrel male rats to study the dependence of the character of maxillary fracture consolidation on the content of osteo-inducing (01) and osteo-inhibiting (I) proteins in the bone tissue as well as the effect of agents intensifying (parathormone) or reducing (methyluracil) the resorption phase of bone regeneration. It is shown that the ratio of OI and I proteins in the bone tissue determines the healing of the fracture according to the type of uncomplicated or slow consolidation in untreated animals, whereas parathormone administration increases the number of animals with uncomplicated consolidation of the fracture and raises the strength of union of the fragments. Methyluracil fails to produce such on effect.

[The dependence of the osteoinductive activity of the bone matrix on the mass and area of the transplant].

White rat experiments have demonstrated that bone matrix osteoinductive activity (the matrix ability to induce ectopic osteogenesis) is in direct proportion with the transplant mass in cases when this mass is within 0 to 0.16% b. m.

[The elimination of mandibular defects by an osteoplasty method using local tissues].

Mandibular body defects 0.5 to 4.5 cm long were eliminated in 33 patients.

[Changes in the osteoinductive activity of the bone matrix in ontogeny].

Correlation between the animal's age, degree of mineralization of its bone tissue and the osteoinductive activity of the bone organic matrix was established in experiments with rats of the same litter at an age of 2, 4, 8, 16 weeks. The osteoinductive activity was estimated by the capacity of matrix to induce ectopic osteogenesis using biochemical methods. Bone mineralization increased and the capacity for osteoinduction decreased roughly 1,5-fold with the age of donor animals.

[Effect of acid metabolites on the osteoinductive activity of the bone matrix].

The osteoinductive activity of bone matrix demineralized in acid metabolites of glycolysis and Krebs cycle have been studied in rats. The highest osteoinductive effect was reached during the demineralization in oxaloacetic acid, the lowest one--in the malic acid. The regulatory role of glycolysis metabolites and Krebs Cycle in posttraumatic osteogenesis is under discussion.