[First experience of supraclavicular flap application for the closure of defects localized in the lower third of the face and neck].

First experience of the supraclavicular flap transposition for closure of superficial, but extended, defects of the soft tissues in the lower third of face and neck region in 6 patients is presented. In all the patients good functional and cosmetic result was achieved.

[Possibilities of reconstructive plastic surgery in the treatment of vascular malformations of the head region].

Results of treatment of 19 patients, suffering vascular malformation of the head region, were analyzed. Application of a new highly informative diagnostic methods of surgical intervention differential methods have promoted significant clinical improvement.

[Autotransplantation of composit complexes of tissues for restoration of the combined bone-soft tissue post-traumatic defects of the wrist and the hand].

The experience of treatment of 27 patients, suffering the extended bone-soft tissue defects of the wrist and the hand was summarized. In 12 patients (1-st group) the bone plasty was performed, using nonvascularized fragment of os ilei wing with simultaneous excision of the damaged soft tissues and free transplantation of m. latissimus dorsi or m. serratus anterior flaps. In 15 patients (2-nd group) autotransplantation of m. serratus anterior flap, including the vascularized costal fragments in its content, was performed. The musculo-costal flap application had appeared a perspective procedure while restoration of carpal bones defects. Plastic properties of such a transplant are relative technical simplicity of its mobilization, minimal aesthetic defect in the donor zone, possibility of creation of a necessary long vascular pedicle, tolerance of the complex to infection, what secures the expediency of its application in reconstructive plastic surgery.

[Surgical treatment of inveterate defects of the hand II-V fingers extensors tendons in VI-VII zone].

Possibilities and efficacy of secondarily restoration of inveterate defects of the extensors tendons of fingers, owing various extent, were studied in conditions of cicatricial changes in the hand back skin. There was established, that in ischemic and reperfusion damage of the hand tissues the coarse cicatricial changes in the end portions of the traumatized tendons occurs, essentially influencing surgical tactics. Optimal operative techniques, directed on the extensors tendons restoration in various extent of their defects and various severity of the soft tissues changes in the hand back were determined. There was shown the perspective character of substitution of the cicactricially transformed hand back soft tissues and significant defect of the II-V fingers extensors tendons using vascularized compound complex of tissues of the foot back flap with the tendon complex.

[Transplantation of the muscular perforant flaps for restoration of tissues defects in the extremities].

There was summarized the experience of surgical treatment of 9 patients with the soft tissues defects of various etiology, localization and size, in whom microsurgical autotransplantation of the perforant flaps was performed on thoracospinal and medial gastrocnemial arteries. Peculiarities of preparation and mobilization of perforating vessels, securing the motor nerves branches, were presented. The perforant flaps advantages are: their small thickness, plasticity, mobility and minimal complications in the donor's zone. The perforant flaps advantages secure the wider diapason of their usage comparing with conventional composed complexes of tissues.

[Surgical tactic in the injury of neck vessels]. / Khirurgicheskaia taktika pri povrezhdenii sosudov shei.

Retrospective analysis of the surgical treatment results in 50 injured persons with the damage of the neck vessels in 1998-2003 yrs period was presented. Restorational-reconstructive operations were performed in 19 (38%) injured persons with the arteries damage, in 10 (20%)--with the veins damage, the ligature operations were done, accordingly, in 6 (12%) and in 20 (40%). Satisfactory result was noted in 41 (82%) injured persons. Neurological complications had occurred in 4 (8%) of patients. Mortality had constituted 10% (5 patients died). The principles of surgical treatment of the neck vessels damage were stated.

[Surgical treatment of injured persons with the main blood vessels damage]. / Khirurgicheskoe lechenie postradavshikh s povrezhdeniem krupnykh krovenosnykh sosudov.

Retrospective analysis of the surgical treatment results of 45 injured persons with damage of main blood vessels was presented. Specific operative methods in injury of the different type main blood vessels, localized in thoracic and abdominal cavities, were depicted. In 35 (77.8%) injured persons good and fair results of restoration operations were noted. The lethality rate was 22.2%. The tactic of surgical treatment of the main blood vessels injury was presented.

[Aspects of oxygen regimen and metabolism in patients after operative intervention under neuroleptic analgesia]. / Osobennosti kislorodnogo rezhima i metabolizma u bol'nykh posle osushchestvleniia operativnogo vmeshatel'stva v usloviiakh neiroleptanalgezii.

Result of microsurgical correction of posttraumatic defect of soft tissues depends a lot on anesthesiological support. During the operation the inhibition of energetic status causes the occurrence of oxygentransporting debt, metabolic acidosis develops. Analgosedation, peculiar to anesthesy, promotes an organism defense toward operative trauma of middle severity, causes temporary hypometabolic effect, changed than by oxidantic stress and general adaptive syndrome development.

[Prophylactic and correctional measures for thromboembolic complications in performance of the upper extremity replantation and microvascular autotransplantation of combined complex of tissues]. / Mery profilaktiki i korrektsii tromboticheskikh oslozhnenii pri vypolnenii replantatsii verkhnei konechnosti i mikrososudistoi autotransplantatsii slozhnogo kompleksa tkanei.

There were analyzed the causes and factors, influencing the thromboembolic complications frequency, in performance of the upper extremity segment replantation in 220 injured persons and of microsurgical the tissues defect plasty using combined complex of tissues (CCT)--in 154 patients. The role of anticoagulational therapy in complex of remedial measures, directed on the occurrence prophylaxis and medicinal correction of hemodynamic disorders in microvascular anastomoses after the operation, was determined. The advantages of low-molecular weight heparin (Fraxiparine) administration in comparison with the standard heparinotherapy were showed: lowering of thromboembolic and hemorrhagic complications occurrence frequency, the unique method of Fraxiparine subcutaneous injection into the replanted segment and CCT was presented.

[Restorative microsurgery in severe injury and traumatic amputation of the distal portions of the extremities]. / Vosstanovitel'naia mikrokhirurgiia pri tiazhelom povrezhdenii i travmaticheskoi amputatsii distal'nykh otdelov konechnostei.

Application of microsurgical methods and free grafting of the compound complexes of tissues with the vessels and nerves in particular with microanastomoses permitted to achieve high functional results in traumatic amputation of extremities in contiguity, severe destroying traumas and their consequences. Experience of 1000 urgent microsurgical operations, including 638 replantations of digits and their blocks for various kinds of amputation on the palm level was summarized. Classification of amputation, taking into account the injury mechanism and character, promoting the choice of optimal tactic and technique of restoration operation was elaborated. Indication for replantation are substantiated, the results of restoration operation, complications occurring after large segments of extremities replantation and measures for their treatment are analysed. Definite success of operation is determined by the extent of first operation and by subsequent rehabilitation measures conduction including the correcting operations and various conservative methods.

[Microsurgical methods of restoration of finger flexor tendon functions with the cicatricial transformation of surrounding tissues using complex flaps]. / Mikrokhirurgicheskie metody vosstanovleniia funktsii sukhozhilii sgibatelei pal'tsev kisti v usloviiakh rubtsovoi transformatsii okruzhaiushchikh tkanei s ispol'zovaniem slozhnykh loskutov.

Experience of treatment of 115 patients with late consequences of the fingers flexors tendons traumatic damage, complicated by cicatricial transformation of soft tissues was reflected. Results of application of methods using microsurgical autotransplantation of complex flaps to replace the cicatricial and necrotic-purulent defects of soft tissues with subsequent autotendoplasty were analyzed. Method of treatment providing the tendons isolation from the cicatricial tissues for the functional results improvement, elaborated in the department of microsurgery and plastic surgery, is presented.

[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.