[SURGICAL TREATMENT OF THE FACE CAPILLARY MALFORMATION]

Results of surgical treatment of 37 patients for the head and neck capillary malformations were analyzed. Optimal surgical tactics, depending on the malformation form and localization, was proposed. Restitution of the tissues defect after excision of malformation, using the flaps transposition, have permitted to achieve good esthetic results.

[Combined treatment of arteriovenous malformations of the head and neck]

An arteriovenous malformation (AVM) is a vascular developmental abnormality conditioned by impaired embryonic morphogenesis and characterized by the development of an abnormal connection between arteries and veins. More than 50% of the total number of patients suffering from this pathology are those having the pathological foci localizing in the area of the head and neck. At present, a combined method is both a generally accepted and the most radical one used for treatment for AVM. However, in the majority of cases, excision of the malformation leaves an extensive and complicated defect of tissues, whose direct closure leads to coarse cicatricious deformities. Over the period from 2004 to 2012, we followed up a total of 37 patients presenting with arteriovenous malformations of the head and neck. At admission the patients underwent preoperative examination including clinical tests, ultrasound duplex scanning, arteriography, MRT, and computed tomography. 24-72 hours prior to the operative intervention the patients were subjected to embolisation of the main vessels supplying the vascular malformation. Excision of the AVM was in 8 cases followed by primary closure of the postoperative wound, in 17 patients the defect was closed by transposition of the axial flaps, and 12 subjects underwent free transplantation of composite complexes of tissues. Relapse of the disease was revealed in 17 patients. In the majority of cases, relapses developed during the first year after the operative intervention (10 cases). The control of the disease's course was obtained in 20 patients. In 8 of the 12 patients with free transplantation of flaps we managed to obtain long-term control over the disease's course (more than 5 years). Hence, free microsurgical transplantation of compound complexes of tissues may be considered as a method of choice for closing the defect after excising an AVM in the area of the head and neck. Replacement of the defect with a well-vascularized tissue complex considerably improves regional haemodynamics, decreases tissue ischaemia, and is capable of providing longterm control over the disease's course.

[Adaptation of surface of implants towards a recipient tissues]

The investigation was devoted to application of the adaptation method of the polymeric implants surface towards a recipient tissues, basing on application of proteins from the blood autoserum. There was conducted a comparative analysis, basing on results of histological investigations of tissues around implants after processing with adapting composition (AC) and without such. There was established in experiment and clinic, that application of AC for the prosthesis processing guarantees practically complete adaptation of their surface to the patient tissues.

[Physical methods to determine compatibility of implants]

The effect of the living organism on the polymer materials used for the manufacture of grids for implants. It is shown that the recipient's body is actively working to exogenous material , destroying its surface layer and forms around the implant insulating fibro-connective tissue capsule, the thickness of which depends on the severity of the organism's reaction to a foreign body. Proposed instrumental method of determining compatibility before surgery implant material with the recipient using an atomic force microscope (AFM).

[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.

[Using cartilage-mucosal flap from lateral side of the nose for the correction of eyelid defects]

Authors represented first experience of the removal of eyelid defects by lower lid reconstruction (3 patients) using transposition of chondro-mucosal flap from lateral side of the nose. The details of the technique and donor site closure were described. All the patients were satisfied about results.

[Surgical correction of tubular breast deformities]

The results of tubular chest surgical correction in 24 patients--women were analyzed. Differentiated approach to the operative treatment method choice was applied, depending on the chest volume and tubularity type. Positive aesthetic result was achieved.

[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.

[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.

[Surgical correction of cicatricial deformation of the extremity using the tissue expanding method]

Modern approaches to the treatment of cicatricial deformation of extremity are presented. The results of treatment of 20 patients using the tissue expanding method are adduced. During the expander implantation and dermotension in 20% of patients the complications had occurred. The analysis of the results obtained permits to consider dermotension the method of choice in the treatment of the extremity cicatricial deformation.

[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.

[Use of antioxidant defense of tissues in free microsurgical transplant of complex-composite flaps]

In experiment on 25 epigastric muscular flaps of rabbits the possibilities of the flap tissues damage prophylaxis in the ischemia period were studied up as well as their defense from peroxidal and the free-radicals oxidation of the membrane phospholipids in the reperfusion period. There were noted suppression of the lipid's peroxidation processes, the raise of the flap's tissues antioxidant defense, the cellular and subcellular membranes stabilization with preservation of the vessels endothelium integrity after preliminary intraarterial infusion of the lipin, unithiol, ascorbic acid and isoptin mixture into the flap. The data obtained witness the perspective of the studied preparations application during microsurgical transplantation of composite complexes of tissues.

[Experimental studying of the possible pharmacological defense of muscular flap tissues from ischemic and reperfusion injury during its free transplantation]

In experiment on muscle flaps of 20 rabbits the peculiarities of their tissues damage in the ischemia period, and also due to the oxygen-dependent processes activation (peroxidal and free radical oxidation of a membrane phospholipids) in period of its reperfusion were studied. Preliminary introduction of a lipin, unitiol and ascorbic acid mixture in the flap arterial channel had promoted the reduction of damage severity in the translocated flap cells biomembranes due to ischemia and reperfusion, causing inhibition of the lipids peroxidal oxidation processes, rising of the flap tissues antioxidant defense, the cell and subcell membranes stabilization which preserves the vessels endothelium integrity. This showed a promising future for application of these preparations in a free transplantation of compound tissue complexes.

[Experimental substantiation of a two-staged method of microsurgical transplantation of the complex composite flaps]

The authors have proposed two-staged flap transplantation, consisting of flap mobilization on vascular pedicle with subsequent its transplantation in several days. In experiment on muscular flaps, obtained from regio epigastrica of 30 rabbits, it was established that optimal time for the second stage of operation conduction may be end of the second--beginning of the third day after the transplant mobilization.

[Revascularization in the skin loss with skull fornix bone exposure]

Experience of 69 patients treatment, suffering the soft tissues death with uncovering or partial necrosis of the skull vault bones, occurring after burns and mechanical injuries was summarized. Multiple milling (4 patients) of the uncovered bones is dangerous, lacks efficacy, leads to osteomyelitis and the skull vault defects development. The skull bones revascularization with cutaneo-subcutaneous, complex-composite flaps bringing nutrition from outside was proposed and accomplished. Revascularization methods are depicted, their results are presented in 65 patients. The revascularization conduction in term to 40 days after the injury occurrence permits to reduce the time of treatment, to avert the skull vault bones necroses, to gain good functional results.

[Restorative microsurgery in severe injury and traumatic amputation of the distal portions of the extremities]

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.

[Lateral shoulder graft for microsurgic plasty of hand and foot]

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.

[Surgical treatment of sequelae of nerve trunk injuries of the lower limbs]

The authors have analysed the results of surgical treatment of 63 patients with consequences of traumatic injuries of the nerves of the lower extremities. Characteristic peculiarities of the injuries of the nerves of the lower extremities are noted. The possibilities of reconstructive microsurgery in the treatment of severe traumatic lesions in this contingent of the patients are demonstrated.

[Alloplasty of nerves using cryopreserved grafts subjected to total epineurectomy (experimental-clinical study)]

It was demonstrated in experiments on 24 dogs that microsurgical epineurectomy of a cryopreserved peripheral nerve improves the results of neuroplasty due to acceleration and increase of graft revascularization. From application of the developed method in 12 patients it was concluded that microsurgical alloneuroplasty with a cryopreserved graft may be the method of choice in cases in which autoplasty cannot be performed.