[Clinical efficacy of alprostan in treatment of obliterating multifocal atherosclerotic affection of arteries in patients with critical ischemia of lower extremities]. / Klinicheskiaia éffektivnost' alprostana pri lechenii obliteriruiushchego multifokal'nogo ateroskleroticheskogo porazheniia arterii u bol'nykh s kriticheskoi ishemiei nizhnikh konechnostei.

Experience of application of alprostan (PGE1, alprostadil) in 19 patients with atherosclerotic affection of vessels, chronic and acute ischemia of lower extremities in III-IV stage in combination with affection of other vascular basins was summarized. In 10 patients, to whom operative vascular reconstruction was contraindicated and/or technically unrealizable, the conservative treatment was conducted using alprostan during 12-25 days up to the clinical effect achievement (total dose up to 1.6 mg). In 9 patients after performance of conservative treatment using alprostan the vascular bed reconstruction was done. Daily infusion of alprostan in 0.1 mg dose diluted in 250-400 ml of isotonic solution of sodium chloride during 2.5-3 h with duration of course not less than 15 days and 1.2-2.2 mg total dose of preparation constitutes an optimal scheme of treatment. Good result was noted in treatment of patients in stage II of ischemia, application of alprostan in stage IV of ischemia had permitted to reduce the extremity amputation volume or to escape it on the whole, and to restore more rapidly the cutaneous integrity in the trophic disorders regions. The alprostan usage is trustworthy in patients with multifocal atherosclerosis with the cardiac coronary vessels affection in an ischemic heart disease.

[Application of clexane in reconstructive surgery of the aorta arch vessels for the arterial thrombosis prophylaxis]. / Ispol'zovanie kleksana v rekonstruktivnoi khirurgii sosudov dugi aorta dlia preduprezhdeniia vozniknoveniia arterial'nogo tromboza.

Results of treatment of 114 patients for ten-year period, operated on for diseases of extracranial vessels, were adduced. Up to 1998 after performance of reconstructive operation as anticoagulant heparin was used in 80 patients and in last time--low-molecular heparin clexane in 34. After operation all patients survived. An ischemic insult occurred in 2-3 days after the operation in 2(2.5%) patients, while application of heparin, in 5--positive changes of the disease course were absent, in 19(23.75%)--postoperative hemorrhagic complications occurred. When clexane was administered in 2(5.9%) patients the cerebral hemodynamics improvement was not noted, complications in the early and late postoperative periods were absent. In term of observation up to 5 years good results was noted in 21(62.3%) patient, fair--in 9 (27.2%). In late postoperative period the brain hemodynamics improvement was not noted in 2 (5.9%) patients. Application of clexane for the arterial thrombosis prophylaxis is clinically substantiated and permits to reduce significantly the risk of the complications occurrence, which are observed with usage of heparin.

[Lateral shoulder graft for microsurgic plasty of hand and foot]. / Lateral'nyi loskut plecha dlia mikrokhirurgisheskoi plastiki na funktsional'no--vazhnykh zonakh kisti i stopy.

The authors have thoroughly studied the versions of anatomic structure, peculiarities of blood circulation and innervation of lateral arm graft at 20 recent cadavers. The graft can be utilized in different modifications; cutaneofascial, subcutaneofascial, musculocutaneous, osteocutaneous. In the clinic were made 8 free microsurgic transplantations of lateral arm graft for plasty of tissues of different genesis in functionally important zones of hand and foot. In long-term post-operative period all patients demonstrated good functional and cosmetic results.

[Use of external brachial cutaneo-fascial flap for plastic microsurgery of defects of functionally important areas of the hand and foot]. / Ispol'zovanie naruzhnogo kozhno-fastsial'nogo loskuta plecha dlia mikrokhirurgicheskoi plastiki defektov tkanei funktsional'no znachimykh zon kisti i stopy.

On the basis of morphological investigations on 20 non-fixed cadavers, the microsurgical anatomy of the external fasciocutaneous brachial flap was detailed . A flap was successfully used for plasty of the tissue defects of the foot, forearm and hand in 14 patients. The recommendations concerning the technique of flap elevation and transplantation are given.