[Forecasting for and prospects of the development of surgery in 21st century].
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Forecasting↗
Biomedical subjects
N O Milanov
Publications and source records attributed to N O Milanov.
[Heterotopic replantation of fingers after traumatic amputation].
Available are the results of the treatment of 93 patients with multiple traumatic amputations of the fingers, in whom the heterotopic digital replantation was carried out. A total of 367 fingers were amputated, 187 of them have been replanted, which made up 51% of replantability. 148 fingers (79.1%) were replanted heterotopically and 39 (20.9%)--orthotopically. The viability was restored in 167 fingers, which made up 89.3%. Of 148 fingers, which have been replanted heterotopically, 88.6% have survived, and of 39 fingers, being replanted orthotopically, 92.4% survived. The analysis of functional results of the digital replantations in hand comprised the study of the hand biomechanics, blood supply and innervation. A total of 31 patients was followed up and examined in long term period from 8 months to 6 years after replantation. The biomechanics of the hand was assessed according to its capacities for seize and pinch as well as to the extent of movements in the joints of the restoration of digital innervation was assessed by the study of temperature and discrimination sensitivity. For evaluation of blood supply the US dopplerography and scintigraphy were used. The authors came to the conclusion that there was no substantial difference in the function of operated fingers both in orthotopic and heterotopic replantations. Taking into account that heterotopic replantation of the fingers resulted in more active digital function, it is safe to speak about more pronounced increase in the function of the hand in cases of heterotopic replantations of fingers in their multiple traumatic amputation.
Adolescent↗
[Elimination of large fenestrated tracheal defects with use of microsurgical technique].
Operations on the trachea usually entail cutting or dissection of its wall, which requires further elimination of the developed defects. The application of a primary tracheal anastomosis is not always feasible. A number of methods for elimination of large defects of the trachea are not devoid of shortcomings. An original method for elimination of the defects of respiratory ways with the use of revascularized osteo-cutaneous radial complex flap has been developed and used in 8 patients. The sizes of the eliminated defects varied from 8.0 x 2 to 4 x 1.5 cm. The vessels of the grafts were anastomozed with facial vessels by microsurgical technique. This procedure allowed to avoid multistaged treatment mode and the newly formed tracheal wall possessed adequate regidity for breathing. The cutaneous part of the flap was quite fit for substitution of the tracheal mucosa. The method of harvesting the autograft is quite safe, the damage to the donor site in the arm is negligible.
Adolescent↗
[Surgery Research Center, Russian Academy of Medical Sciences: advanced post of Russian reconstructive surgery (on occasion of 35th anniversary)].
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Academies and Institutes↗
[Blood supply of wrist and forearm after exclusion of radial vascular fascicle of all length from blood stream].
The arm and forearm are commonly used in plastic and reconstructive surgery as a donor site for harvesting free microsurgical revascularized autografts, which include not only soft tissues, but when necessary, a fragment of radial bone as well. The radial autograft is taken together with radial vascular bundle, the radial artery is so being excluded from participation in hand and forearm blood flow. Until now there are no common opinion of expedient reconstruction of the radial artery because there are no evidence of visible blood flow disturbances in the hand. There are no convincing data on the functional status of the hand in long-term postoperative period and on the ways and degree of compensation of circulation. It is very important that evaluation of the ways and degree of blood flow compensation may play a great part in the problem of hand replantation, that is to determine the influence of the extent of blood flow restoration not only on hand viability, but on the long-term functional outcome as well. This investigation has revealed impaired blood supply and metabolism in hand soft tissues and bones by using the forearm as a donor site for taking free microsurgical revascularized autografts by radionuclide and ultrasound methods.
Blood Flow Velocity↗
[Plastic microsurgery of the fingers defects].
The experience of plastic operations in small segmental defects of the hand with the use of "insular" Litteler's flap has been analysed. Long-term results are available for 10 patients. The difference of reception has been found in transplanted and recipient's finger. The patients feel the zone of the plasty like a donor finger. This causes problems with the operated hand movement coordination. In 23 cases the original method of microsurgical technique has been used to avoid this effect. The nerve was cut near the transplant edge and then sutured with the nerve of recipient finger. Functional results of the modified operations are more adequate to the demands of plastic region.
Adult↗
[Restoration of replanted extremity function with use of microsurgical tissue autotransplantation].
The results of 40 tissue autotransplantations for correction of function of the replanted upper extremities. The peculiar features of vascularised tissue autotransplantation in specific situations of anatomic and morphologic changes in replanted upper extremities are presented. It was proved, that vascularised tissue autotransplantation is a safe and effective method for restoration of function of the extremities, replanted after traumatic amputation, that was accompanied with massive tissue damages. Microsurgical autotransplantation expands the indications in replantation surgery and makes it possible to perform replantation in cases, when function restoration was considered nonprospective.
Adult↗
[Treatment of long tubular bone pseudoarthrosis with revascularized cortical layer of radius].
The method of osteogenesis without resection of the false joint was employed in the treatment of long tubular bone pseudarthrosis. The authors used a free revascularized radial flap, including the corticoperiosteal layer of the radius as a source of osteogenesis. A thin corticoperiosteal graft was taken from the distal third of the radius with or without a skin flap, if necessary. The graft was placed into the slotted bed of the false joint and fixed by two screws. Final fixation was made by using an Ilizarov apparatus or a metal plate. The authors used this procedure in the treatment of 12 patients with long tubular bone pseudarthrosis who had undergone at two operations on the false joint or fracture. Eight patients suffered from chronic osteomyelitis. Eleven patients completely recovered at postoperative month 12. Radiographic and scintigraphic investigations showed signs of bed-graft adhesion at month 3 after surgery and those of false joint ossification at month 6 postoperatively.
Adult↗
Microsurgery in Russia: past and present.
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Child↗
Functional results of microsurgical reconstruction of plantar defects.
Of 57 patients who underwent microvascular free flap reconstruction of the plantar surface, 21 developed recurrent trophic ulcerations. Clinical and roentgenographic examination demonstrated that the recurrences were primarily traumatic in origin, resulting either from exogenous factors such as footwear or from endogenous factors such as osteophytes. A new method of surgically reconstructing the plantar aponeurosis was found to be effective in reducing the rate of recurrence.
Adolescent↗
[Results of electroneuromyographic study in patients after replantation of the lower extremities on the crus level].
We applied ENMG (electroneuromyography) in dynamics in the longterm postoperative period on 7 replanted segments of the lower limbs in 5 patients (in 2 patients both lower limbs were replanted). Seven nerve trunks were restored in 7 replanted segments. Analysis of the ENMG findings showed that restoration of the nerve trunks in replantation of amputated segments of the lower limbs through the crus restored conduction along the sensory and motor fibers in 56.3% of cases; in 37.5% of cases conduction along the motor fibres was restored partly; conduction was completely absent along the sensory fibers in 45.7% and along the motor fibers in 6-7% of cases. ENMG makes it possible to evaluate the degree of restoration of the motor and sensory functions of the nerves after restoration of their continuity in replantation of large lower-limb segments at the level of the crus. The obtained quantitative data are sufficiently impressive arguments in favor of replantation of large segments of the lower limbs in serious traumatic amputation.
Electromyography↗
[Indications for replantation of lower limbs after their traumatic amputation at the shin level].
From analysis of the results of replantation of 37 lower limbs at the level of the leg, which were amputated as the result of injury in 33 patients, the authors determine the tactical approach to the choice of indications for replantation. The authors believe that replantation at the level of the leg is always indicated in children if it is executable technically and the patient's somatic status presents no general contraindications. In other cases the formation of a stump and subsequent prosthetics should be considered more advisable.
Adolescent↗
[Prefabrication of free fascia-based flaps: initial experience and prospects].
The authors describe an original method for preliminary formation, "prefabrication", of free fascia-skin flaps on the basis of the scapular fascia and the fascia covering the anterior serratus muscle. "Prefabrication" makes it possible to obtain tissue complexes with all the signs of flaps with axial circulation; with this method the surgeon has a wide choice of variants of the donor zones, the length of the vascular pedicle, and the texture of the flap skin. The principal distinction of the use of the fascia was two- or one-stage formation of microvascular anastomoses. The author discusses clinical cases in illustration of the "prefabrication" method.
Adult↗
Free transfer of the greater omentum.
Thirty-seven patients with various coverage problems and with lower extremity occlusive disease underwent free transfer of the greater omentum into the defect with a favorable clinical success rate. There are a number of advantages of this technique for such reconstructive problems.
Adult↗
Surgical treatment of radiation injuries of the hand.
This paper describes the wound management and treatment of 12 consecutive patients with severe radiation damage to the hands. Three of these were secondary to therapeutic radiation for squamous cell carcinoma in one and synovial sarcoma in two, and nine were healthy professional people exposed to radiation in the work-place. All lesions were characteristic radiation burns with ulcerative necrotic changes of the skin and subcutaneous tissues. One patient had a lesion on the dorsum of the hand, three patients had lesions on the palm of the hand, and eight patients had lesions in the fingers of the hand. Reconstructive surgery was carried out by debridement to what was felt to be healthy margins, followed by cross-finger flaps or thenar flaps to fingertips in three, radial forearm flaps in three, free flaps from the first web space in three, neurovascular island flaps from the fourth finger in two, a free scapular flap in one, a free inguinal flap with vascularized iliac crest in one, and a wraparound flap from the great toe in one. Two patients required two procedures; thus 14 flaps were done in 12 patients. Follow-up ranged from 2 to 12 months, with a mean of 6 months. All the patients have maintained a healed wound with adequate hand function, except for one patient, who had a recurrent synovial sarcoma in the midportion of the hand, requiring amputation. We conclude that management of radiation-induced injuries to the hand should be done with aggressive debridement and immediate coverage with well-vascularized flaps, either regional or free-tissue transfers. This will result in adequate wound healing and the most rapid, effective return of function with rapid institution of therapeutic modalities.
Accidents, Occupational↗
[Morphometric rationale for utilization of peripheral nerves of the human fetus as vascularized allografts].
The authors performed morphometric section studies of the peripheral nerves of 25 human fetuses of 17-26 week development. The purpose of the study was determination of the technical possibility of using revascularized nerves of the human fetus as grafts for replacement of post-traumatic defects in the peripheral nerves. The peripheral nerves of the upper limbs of fetuses of the indicated developmental periods were found to be formed morphologically. The results of morphometric study showed that it is technically possible to obtain the median, ulnar, and radial nerves on a vascular pedicle. The length and diameter of the vessels of the vascular pedicle of the upper limb peripheral nerves allow revascularization of the brephograft to be accomplished by means of microsurgical techniques.
Fetal Tissue Transplantation↗
[Microsurgical tissue transplantation in the treatment of recurrent basaliomas of the head].
The authors analyse their experience in the use of microsurgical transplantation of tissues in the management of recurrent basaliomas of the head in 20 patients. Various types of autografts were used, such as: the greater omentum, thoracodorsal, inguinal, scapular, deltoid, and radius grafts. The results were good in most cases. It is claimed that microsurgical autotransplantation of tissue complexes is a necessary component in the treatment of severe forms of basaliomas of the skin of the head.
Adult↗
[Microsurgical allotransplantation of fetal bone on a vascular peduncle: immunological aspects].
The authors studied the immunological profile of three patients after transplantation of bone allobrephotransplants with their microsurgical revascularization in the recipient zone. A reaction of rejection of the transplanted brephobone did not occur in any of the three cases. In transplantation of a complex brephobone the soft tissues overlying it, rejection of the soft tissues was encountered but there were no signs of bone rejection. The data of immunological monitoring correlate with the results of the clinicolaboratory and histological studies.
Bone Transplantation↗