Biomedical subjects
Publications and source records attributed to M Frankovicová.
Authors deal with the causes of complications in reconstructive and replantation surgery of the hand. The most common complications are of vascular origin. Early revision, removal of all devitalized tissue and autoplastics of arteries and veins combined with ATB treatment contribute to their successful management. (Fig. 7, Ref. 6.)
The authors present the results of reconstructive vascular operations performed during the period from 1990 to 1994. According to the criteria of the European Vascular Surgery Council the lowest patency was recorded in the distal type of femoropopliteal bypasses in the lower extremities. They emphasize the necessity to apply the "Graft Surveillance Programme" in vascular consultation centre. (Tab. 2, Ref. 7.).
Even when we assess accurately the preoperative vascular damage of the blood vessel we intend to use for reconstruction, difficulties may arise during operation which cannot be resolved by routine methods. Microvascular surgery is an important part of many modern reconstruction procedures which can be used during reconstruction of the extremity. As an example the authors describe injuries of the left foot involving loos in a 41-year-old patient who was knocked down by a taxi. The defect denuded the bone and loss of soft tissues of the heel called for free transfer of a vascularized flap. During operation venous thrombosis and subsequently arterial thrombosis developed. The use of an interposed vein helped to ensure a sufficient blood supply to the transferred tissue. The left foot healed well.
The authors present the case-history of a 20-year-old worker with an amputation of the forearm in the distal third. After shortening of the bone by 2.5 cm and osteosynthesis by means of grooved splints the blood vessels of the forearm were reconstructed by means of three autoveins. After 12 hours venous and arterial thrombosis developed. During reoperation the thrombotic portions of the vessels were resected and were again reconstructed by means of new autovenous grafts. Streptokinase was instilled into the amputate via the ulnar artery. During the subsequent postoperative period no serious vascular complications developed. Lymphorrhea persisted for some two weeks. To achieve satisfactory function of the hand a corrective operation will be necessary.
The author describes an indirect revascularization of the corpora cavernosa by double epigastricocavernous anastomosis according to A. C. Benhamou. Four patients were subjected to the operation. The longest follow up one patient) is 15 months.
The authors present the case-history of a 16-year-old student with subtotal amputation of the distal part of the right forearm. After shortening of the bone by 3 cm they reconstructed the blood vessels of the forearm by means of five venous grafts. The operation lasted seven hours. The function of the right hand is excellent.
The authors present an account on the treatment of blood vessels in 15 patients with serious devastating injuries of the extremities in 1982-1989. In 10 patients the injury was on the upper and in 5 on the lower extremity. In the majority of patients for reconstruction of arteries and veins venous grafts were used. In 8 patients, i.e. in 53.3%, the result was good, in 2, i.e. 13.3%, it was satisfactory and in 5, i.e. 33.3% patients, a secondary amputation had to be performed. The authors describe the surgical procedure and emphasize the necessity of team work of the vascular surgeon, traumatic surgeon and possibly plastic surgeon in the treatment of devastating injuries of the extremities. The authors draw attention to the importance of compartment and reperfusion syndrome which may complicate these injuries, as well as to the role of free oxygen radicals and the necessity to influence their noxious effect during treatment of these injuries during the per- and postoperative period.
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