[Diagnostics and correction of vascular disorders in upper extremity muscular transplants].

The features of clinical presentation, diagnosis and treatment of the acute circulatory disorders of muscular transplants in 7 patients after 59 transplantations of revascularized and reinnervated muscle grafts in severe consequences of upper extremities injuries were presented in the article. Tissue complex on pedicle were transplanted to upper extremity in Volkmann contracture (n=47), in consequences of the gunshot wound (n=7) and electric trauma (n=5). Signs of circulatory disorders of the transplanted tissue complex were registered shortly after the operation in 7 patients. Diagnosis was based on the findings of visual and ultrasound investigations. In all cases of circulatory disorders disorders patients were reoperated within 24 hours. Arterial thrombosis occurred in 3 cases and venous - in 2. The cause of impaired venous outflow was a hematoma in 2 cases. Repeated reconstruction of anastomoses with wound drainage in 5 cases led to restoration of blood circulation in transplants. Reoperation was not successful in 2 cases with developing transplant necrosis.

Reconstruction of the brachial artery in supracondylar humerus fractures and forearm dislocations.

Presented herein is an analysis of the short- and long-term results of the treatment of brachial artery injuries in 25 patients with extension supracondylar humerus fractures and anterior forearm dislocations. The cause of arterial injury was a blunt trauma in 11 patients and contused-crushed wounds in 12 cases. In two patients, iatrogenic injury of the brachial artery occurred after reposition of humerus fractures in other medical institutions. Fourteen patients were admitted to the Department for the first 6 hours from the time of injury, 5 after up to 12 hours, and 6 patients after 12 hours. Decompensation of limb circulation was marked in 2 and subcompensation in 6 patients. In the remaining cases, limb circulation was assessed as compensated. In different medical institutions, the artery was repaired in 4 cases. Operation was complicated by thrombosis in all the cases. Reconstruction of the neurovascular bundle was accomplished under optic magnification in all the patients. The circular suture of the artery was applied in 9, autogenous vein grafting was performed in 7, Y- plasty of the brachial bifurcation in 4, brachioradial bypass grafting in 3, and brachioulnar in 2 cases. Thrombosis of the autogenous vein graft in the short-term postoperative period was identified in 2 patients. Repeated arterial reconstruction appeared successful. The long-term results were followed up in 17 patients over the period as long as 5 years. Anastomosis patency was well preserved in all the cases.

Traumatic injuries of the popliteal and tibial arteries: limb ischemia and problems of surgical management.

This paper analyzes the results of examination of 106 patients with traumatic injuries of the popliteal (n=36) and leg arteries (n=70) including gunshot (n=48), punctured and incized (n=32), contused-crushed (n=17) wounds and blunt (n=9) traumas. Sixty-two patients were admitted within 8 hours of injury and 20 within 8 to 24 hours, 24 patients within 1 to 15 days. Sixty-five patients had been rendered first aid at other medical institutions. It is to be noted that the prehospital diagnostic and tactic errors had been made in 67.7% of cases. In the patient group with injuries of the leg arteries, the severity of ischemia correlated with the number of the injured arteries and in the group of patients with popliteal artery injuries, there was a relationship between the severity of ischemia and the character of injury. In injury of the popliteal and leg arteries, severe limb ischemia was present in 72.2 and 34.3% of cases respectively. The surgical management was worked out depending on the severity of the patient general condition and the degree of limb ischemia. Primary limb amputation was performed in 17 (16%) patients; the indications for it were moist gangrene, severe traumas with major destructions and defects of other anatomic structures (inadvisability of revascularization), critical condition of the casualty, severe circulatory decompensation observed even in the early times of referral, when it was necessary to save the patient's life. Different surgical interventions were undertaken in 89 patients: ligation of the vessel in the event of one artery injury (24), revascularization (61) and fasciotomy, hematoma evacuation and bone reposition (4). Eleven (10.4%) patients underwent secondary amputation. Beneficial results with complete circulatory compensation were obtained in 78 (73.6%) patients. The total incidence of amputation and lethality accounted for 26.4%.

[Symptoms, diagnosis and surgical treatment of posttraumatic arterial occlusion]. / Klinika, diagnostika i khirurgicheskoe lechenie posttravmaticheskoi arterial'noi neprokhodimosti.

Diagnosis and surgical treatment of ischemic complications of trauma of peripheral vessels are analyzed. Thirty-eight patients with disease of ligated vessel and 48 patients with posttraumatic occlusion of great vessels were examined. Both diseases are included in one group called "posttraumatic arterial occlusion" due to similarity of clinical manifestations. This disease is diagnosed in 15 - 40% patients after vascular trauma. Bypass surgeries is the methods of choice for treatment of complications of isolated vascular trauma. This kind of surgery was used in 33 patients. If there are additional injuries of nervous trunks and tendons, direct autovenous revascularization is indicated. One-stage correction of injured vessels and adjacent structures was performed in 49.7% cases. The best results were achieved after bypass surgeries. The most number of unsatisfactory results were seen in patients with injuries of adjacent structures.

Surgical management of traumatic injuries to the tibial arteries.

Altogether 60 patients with traumatic injuries to the tibial arteries were entered into the study. Twenty-four patients presented with gunshot, 24 with stab and incised, 10 with contused and lacerated wounds, and 2 patients had blunt traumas. Thirty-nine patients were admitted to the clinic within the period as long as 8 hours since the time of wounding, 9 patients within 8 to 24 hours, and 12 patients within the period as long as one to 15 days. 39 patients had been rendered first medical aid at other treatment institutions. It was established that prehospital diagnostic, tactic and technical errors had been made in 25 of the 39 patients. All the patients were distributed into three groups: group I (n=8) included patients with isolated injuries of one of the tibial arteries; group II (n=11) with injuries of two arteries and group III included patients with damage to all three arteries. In group I, circulation remained made for irrespective of the times of ischemic state existence. In groups II and III, all the patients demonstrated circulatory decompensation. Surgical management depended on the severity of the general condition and the degree of limb ischemia. Primary amputation was indicated to 11 (18.3%) patients (humid gangrene was diagnosed in 5 patients, severe trauma with major defects of soft tissues and bone fractures in 6 patients). The remaining 49 victims underwent different surgical interventions such as ligation of the vessel at injury to one artery (23); revascularization (22); fasciotomy, hematoma evacuation and reposition of the bones in an isolated form (4). Five (10.2%) patients required secondary amputation. Beneficial results with complete circulatory compensation were obtained in 44 (73,3%) patients. The overall amputation rate accounted for 26.6%.