The influence of radiotherapy and chemotherapy on regeneration at arterial microanastomoses: an experimental and clinical study.

The regeneration of anastomosed aortas after radiotherapy and chemotherapy was studied by light, scanning, and transmission electron microscopy in a rat model. At the ultrastructural level, it was observed that sublethal doses of these methods of cancer treatment did not severely block endothelial proliferation in the region of the microanastomosis. Based on the experimental results, myocutaneous free flap transfers were completed in patients with malignant tumors who had been undergoing radiotherapy and chemotherapy to cover defects resulting from their excision.

Vascularized bone flaps for thoracolumbar spinal fusion.

Vascularized bone flaps for thoracolumbar and lumbosacral spine fusion were developed in dissections on 52 cadavers, using iliac wing bone based on (1) the quadratus lumborum muscle and (2) the deep circumflex iliac artery. Fifteen clinical fusions were performed using these procedures. It was demonstrated roentgenologically that these vascularized bone flaps do not undergo resorption but maintain bone density 1.5 to 2 times that of nonvascularized bone. Bone flaps with a dual blood supply demonstrated increased strength of bony fusion.

Peripheral arteriovenous anastomosis: an alternative technique in a free flap transfer.

Prevention of thrombosis in the inflow and outflow vessels of a free flap is a problem of current interest. The method of creating a peripheral arteriovenous anastomosis within a free flap was validated in an experimental study and substantiated in a clinical case. No thrombotic complications were observed in 16 transfers of saphenous fasciocutaneous flaps in a dog model, as well as in an elderly patient with free radial forearm flap transfer to an irradiated foot. Scanning electron microscopy of the venous anastomosis proximal to the arteriovenous fistula revealed the difference of pathologic changes as early as 4 hr following surgery. It is the conclusion of the authors, that performing a distal arteriovenous fistula in a free flap, is an effective procedure for prevention of early occlusion in a proximally anastomosed artery and vein.

[Postponed osteoplasty of the mandible with revascularized grafts]. / Otsrochennaia kostnaia plastika nizhnei cheliusti revaskuliarizovannymi transplantatami.

Basing on the results of treatment of 5 patients, the authors claim that revascularized transplants from the iliac crest may be employed for osteogenic osteoplasty of mandibular defects combined with coarse cicatricial changes in soft tissues and bone fragment atrophy. The advantages of bone, muscle, and skin transplants are discussed, permitting monitoring of blood supply to the transplanted tissue from the skin status.

[Use of a transplant from the iliac crest with axial blood supply for anterior spondylodesis of the lower lumbar and lumbosacral segments of the spine]. / Ispol'zovanie transplantata iz grebnia podvzdoshnoi kosti s osevym istochnikom krovosnabzdeniia dlia perednego spondilodeza nizhnepoiasnichnogo i poiasnichno-kresttsovogo otdelov pozvonochnika.

The method of anterior osseoplasic stabilization of inferiolumbar and lumbosacral parts of spine by means of non-free vascularized transplant from the anterior part of the iliac crest has been developed. In the anatomical experiment at 100 objects there have been studied alternative surgical anatomy of vascular transplant pedicle from deep vessels, surrounding the iliac bone, ascertained the possibility of its lengthening at the cost of the muscular-periosteal "cuff". 9 patients have been operated on with positive results. There have been achieved an acceleration of the osseous stabilization of the spine by 1.5-2 times as compared with the traditional methods without essential restructuring of resolution of transplants with vascular connections.

[The use of island flaps and transplants with a blood supply in the reconstructive microsurgery of injuries to the fingers and hand]. / Ispol'zovanie ostrovkovykh loskutov i krovosnabzhaemykh transplantatov v rekonstruktivnoi mikrokhirurgii povrezhdenii pal'tsev i kisti.

The variants of operative tactics and technique of early microsurgical autoplasty of the extensive crushed and scalped wounds of the digits and hand in 15 patients are presented. Three main groups of the sufferers were distinguished: with scalping of the I digit, with crushing of the digits and a skin defect of the butt-end of a hand stump, with totally scalped wounds of the hand and low third of the forearm. The advantages of the use of reversed flaps of the forearm with suture of a sensory nerve in limited defects, and free transplant of the greater omentum in extensive wounds are shown.

[Microsurgical autotransplantation in the correction of post-traumatic foot defects]. / Mikrokhirurgicheskaia autotransplantatsia pri korrektsii posttravmaticheskikh defectov stopy.

In the article is analyzed the experience of treatment of 211 patients with traumata, which are the results of thermal and irradiation foot injuries. 30 patients were subjected to microsurgical reconstruction with application of complex of tissular transplants. There were differentiated 3 types of foot tissue injuries, determining transplants and operative technique selection. It has been determined that the closure of ulcerous defects in case of post-thrombotic disease is possible with utilization of radial graft of forearm on long venous pedicle. Prevention of venous anastomosis thrombosis is contributed to by formation of peripheral arteriovenous anastomosis in the transplant. Impartment of the points of fixation of the muscular part with the locomotive nerve suture contributes to the increase of adequate reliability of musculocutaneous graft. Utilization of osseous transplant of iliac crest allows to perform an orthopaedic correction of the lost anterior part of foot and prevents limb amputation.

[The microsurgical transplantation of skin-fascia autografts in maxillofacial surgery]. / Mikrokhirurgicheskaia peresadka kozhno-fastsial'nykh autotransplantatov v khirurgii cheliustno-litsevoi oblasti.

The authors analyze the results of 6 transplantations of dermofascial rear flaps from the sole and of a radial transplant from the forearm, made to replace maxillofacial defects after tumor removal and injuries. Radial artery-based grafts were found preferable, the possibility of taking a skin-and-bone transplant being among the advantages of such transplantations. The authors recommend a wide use of radial grafts from the forearm for elimination of head and neck defects, oral cavity defects included.

[Use of the vascularized iliac crest transplant in disorders of the processes of consolidation of diaphyseal fractures of the femur]. / Primenenie transplantata iz grebnia podvzdoshnoi kosti na sosudistykh sviaziakh pri narushenii protsessov konsolidatsii diafizarnykh perelomov bedra.

The authors describe a method of plasty of proximal parts of the femoral diaphysis with a nonfree vascularized autotransplant from the iliac crest on the muscular-vascular connections including the strainer of the wide fascia, portion of the musculus gluteus medius and the feeding ascending branch of the lateral artery surrounding the femoral bone with the accompanying veins. The operation has anatomical and experimental grounds. Results of treatment of 6 patients have shown its high effectiveness in disturbed processes of consolidation of fractures of the upper and medial thirds of the femur diaphysis.

[Microsurgical plastic operations in the treatment of patients with cancer]. / Mikrokhirurgicheskie plasticheskie operatsii v lechenii onkologicheskikh bol'nykh.

An experience of with the treatment of 21 patients with tumors and local radiation injuries is described. Terms of the preceding treatment were up to 22 years. Transplantation of free vascularized bone and soft tissue transplants was performed in 14 cases, pedicled ones (by the methods of microsurgery) in 8 patients. The transplantation proved to be a success in 20 patients. Plastic operations in the complex of medical measures facilitated rapid and successful rehabilitation of patients with recurrent tumors and metastases.

[Experimental rationale and clinical efficacy of microsurgical automyoplasty]. / Eksperimental'noe obosnovanie i klinicheskaia éffektivnost' mikrokhirurgicheskoi automioplastiki.

In the experiment (90 operations of transplantation of musculocutaneous neurovascular autografts on the basis of musculus gracilis of a dog), the processes of morphofunctional adaptation of free and non-free muscular grafts, possibilities for improving survival of such transplants are studied. The effectiveness of microsurgical automyoplasty in treating 32 patients with sequelae to injuries and diseases of the locomotor system is shown.

Application of composite microsurgical tissue forearm flaps using radial artery.

The authors analyze the results of microsurgical autotransplantation of 13 composite forearm tissue flaps using radial artery. They show that these can be successfully used in the surgery of the hand in a single-time reconstructions of the fingers, in the removal of neurotrophic ulcers in regions deficient in blood supply, especially in the leg, and also in plastic operations in the cranial and cervical regions, and in stomatological practice. The application of vascularized tendon grafts is advantageous for restoring the locomotor apparatus of the hand. Reconstruction of 2 veins of the flap improved the results. The paper shows the advantage of covering the donor site in the forearm with the aid of combination plastic surgery which covers the flexor tendons with muscular fascicles as well as local tissue and split-skin grafts. Simultaneously, it is necessary to reconstruct the radial artery with the aid of venous autografts.

[Treatment of injuries of the major blood vessels in children and adolescents]. / Lechenie povrezhdenii magistral'nykh sosudov u detei i podrostkov.

An analysis of treatment of injured vessels in 136 children is presented. Good results were noted in 32 of 53 patients observed at remote terms after trauma.