[Ultrasonic dissection in operative treatment of scars].

The authors have developed a technique of disconnection of soft tissues using an ultrasound dissector for ablation of the changed by scar skin covering. The ultrasound dissector splits the subcutaneous adipose tissue and loose connective tissue without injuring the vascular-nervous bundles. This method substantially reduces the intraoperative blood loss. The complex treatment combining the little traumatic ultrasound dissector with conservative and physiotherapeutic methods of treatment and prophylactics allows considerable reduction of probability of recurrent pathological scars.

[Frostbite in modern fighting pathology]. / Otmorozheniia v sovremennoi boevoi patologii.

In modern war 1-2% in the structure of fighting surgical pathology constitute the frostbites. In cold time of year their frequency increases up to 10%. Late admission of the injured to the stages of medical evacuation, their different and often limited diagnostic and therapeutic potentials influence on the outcomes of frostbites' treatment. The role of rational operative treatment with the use of surgical dermato-plastic methods rises. The analysis of periods, outcomes of treatment, restoration of working capacity and fitness for military service after the frostbites of different degrees and levels of injury permits to propose the military-and-medical classification of this trauma type. Slight, moderate and severe frostbites were selected. The places of final treatment of the injured with reference to the classical scheme of treatment- and evacuation support under conditions of the local armed conflict were determined.

[Substitution of an extensive defect of tissues after resection of the sternum in tumors]. / Zameshchenie obshirnogo defekta tkanei posle rezektsii grudiny po povodu opukholi.

An original method of substitution of great defect of the soft tissues and osteochondral part of the chest wall after resection of the sternum for a malignant tumor is described. Operations were made on 4 patients. Favorable results were noted in all the patients. The terms of follow-up were from 6 to 25 months.

[The current possibilities for plastic repair with axial skin flaps on the lower extremity]. / Sovremennye vozmozhnosti plastiki osevymi kozhnymi loskutami na nizhnei konechnosti.

Based on results of complex topographo-anatomical investigations in 187 lower extremities and experiences with performing 220 operations of free and non-free plasty with axial skin flaps formed in the femur, shin and foot, the authors consider the lower extremity as a donor site and a recipient field for such operations. Eight donor zones are selected on the lower extremity and 39 different flaps can be formed within their limits, 27 of them being tested in the clinic. Comparative characteristics of all donor zones are given. The present-day possibilities of the substitution of different wound defects using the axial skin flaps from the femur, shin and foot are shown.

[Frostbite as a problem for dermatoplastic surgery]. / Otmorozheniia kak problema kozhno-plasticheskoi khirurgii.

An analysis of the 35-years experiences with treatment of 621 patients with the IV-degree frostbite of hands and feet is presented. The surgical strategy of treatment of frostbite has undergone considerable evolution for these years. In addition to classical surgical treatment, the surgeons began to widely use methods of dermo-plastic surgery which allowed not only to save the maximum possible length of the extremity segment stump, but also to reduce the frequency of purulent complications and reamputations and thus to shorten the duration of hospital treatment.

[Topographic-anatomical substantiation and clinical use of anterior- lateral composite thigh skin flaps]. / Topografoanatomicheskie obosnovaniia i klinicheskie ispol'zovanie perednelateral'nykh slozhnykh kozhnykh loskutov bedra.

Possibility of the formation of anterio-lateral composite femoral cutaneous flaps on three different vascular pedicles was proved by topographic-+-anatomical studies on 53 lower extremities. A method of determination of zones of localization of the corresponding cutaneous vessels is proposed. An experience with 12 operations has confirmed that anterio-lateral femoral flaps may be used for autotransplantation independently and in combination with lateral cutaneous femoral flaps as well as for transposition of a permanent vascular pedicle.

[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.

[Free transplantation of skin flaps with axial blood supply in IV degree burns]. / Svobodnaia peresadka kozhnykh loskutov s osevym krovosnabzheniem pri ozhogakh IV stepeni.

The article analyses the results of free transplantation of skin grafts with axial blood supply in 45 patients with IV degree burns and their sequelae. Bearing in mind the peculiarities of damage to the tissues and vessels in a thermal trauma, it is advisable to anastomose the vein grafts with the large subcutaneous veins. Skin grafts with a long vascular pedicle are preferable. The difficulties which are encountered in the choice of the surgical tactics and in planning the operative intervention in patients with multiple areas with IV degree damage or their combination with extensive III degree burns insistently dictate the need for stricter indications for microsurgical transplantations, and rational and substantiated combination of plasty by free grafts and skin flaps with an axial blood supply type.

[Various aspects of organization of microsurgical autologous transplantation of composite skin flaps]. / Nekotorye aspekty organizatsii mikrokhirurgicheskikh autotrans- plantatsii slozhnykh kozhnykh loskutov.

An experience with 137 microsurgical transplantations enabled the authors to consider questions of rational organization of these complex, and severe operations. Different variants of work of the second team of surgeons are analyzed aimed at shortening the duration of the operation and getting less load by its participants.

[Skin grafts with axial blood supply in correcting post-traumatic defect of the foot]. / Kozhnye loskuty s osevym krovosnabzheniem pri ustranenii ranevykh defektov stopy.

The analysis of the results of the surgical treatment and the orthopaedic provision of 117 patients with extensive wound defects of the feet has allowed the authors to consider the most important factors to be as follows: the determination of the limits of the saving approach to the preservation of the bone matrix, the choice of the optimal method of dermatoplasty (the method of plasty, the type of the graft) and the rational prosthetic and orthopaedic provision. Such approach has allowed to work out the possible versions of the surgical treatment using the grafts with axial blood supply in 6 main types of the injuries of various segments of the foot.

[New principles in classifying vascularized tissue complexes used in plastic and reconstructive surgery]. / Novyi printsip klassifikatsii krovosnabzhaemykh kompleksov tkanei, ispo'lzuemykh v plasticheskoi i rekonstruktivnoi khirurgii.

Based on their personal experience of transplantation of 152 free and 367 non-free++ blood-supplied tissue complexes the authors propose to divide them into three main groups in relation to their specific formation and transplantation: mono-, poly- and megacomplexes of tissue (flaps). Distinctions of these three groups of tissue complexes, their general properties as well as indications for their application are discussed.

[Changes in oxygen and carbon dioxide tension in skin capillaries as an indicator of the status of blood supply of compound skin flaps]. / Dinamika izmenenii napriazheniia kisloroda i dioksida ugleroda v kapilliarakh kozhi kak pokazate'l krovosnabzheniia slozhnykh kozhnykh loskutov.

The authors consider that the transcutaneous determination of the level of pO2 and pCO2 at early terms after operation in free and pedicled skin flaps allows to actively estimate the state their blood supply and to detect the alterations before the appearance of distinct clinical symptoms of arterial or venous thrombosis.

[The use of tissue megacomplexes in plastic surgery of patients with extensive injuries of the extremities]. / Ispol'zovanie megakompleksov tkanei pri plasticheskikh operatsiiakh u bol'nykh s obshirnymi povrezhdeniiami konechnostei.

On the basis of topographoanatomical studies and experience with 14 successful operations, the authors suggested several new tissue megacomplexes receiving their blood supply from two vascular pedicles. The possible variants were discussed, and as well the advantages and perspectives of the use of such complexes in surgery of the extremities.

[The first experience with crural plastic surgery using island composite skin flaps]. / Pervyi opyt plastiki ostrovkovymi slozhnymi kozhnymi loskutami goleni.

An analysis of literature data, topographo-anatomical studies of 23 lower extremities and an experience with using 18 island fasciocutaneous flaps of the lower leg are presented. The article describes the possibilities of using a new donor area for plasty of limited defects of the lower leg and foot after various traumas and their sequelae.

[Accelerated plastic surgery using inguinal flap on temporary feeding pedicle]. / Uskorennaia plastika pakhovym loskutom na vremennoi pitaiushchei nozhke.

The method of accelerated plasty with an inguinal flap was used for treatment of 13 patients with electric burns and frostbites of the IV degree. The 2nd step of the non-free skin plasty was performed 5 days (120 hours) after the first operation which was possible following a special training--a periodical, with increasing duration of the compression of the flap feeding pedicle which was started next day after the first step of the plasty.