The treatment of traumatic soft tissue detachments is an urgent problem for a first-level trauma hospital. This paper provides an analysis of the literature sources of the PubMed database, which are devoted to the classification, diagnosis and treatment of traumatic skin detachments. It was revealed that most of the works are publications of 1–2 clinical cases, only a few works are retrospective studies of patient groups. Currently, there is no generally accepted classification of traumatic detachment of soft tissues, due to the complexity and mosaic nature of pathoanatomical signs. According to the tactics of treatment, there is a difference in approaches for low-energy trauma (sports injury) and high-energy impact (traffic accidents, falls from a height). In the first case, the treatment methods are compression therapy, physiotherapy, and in rare cases, puncture. In the second case, puncture and drainage are the main method of treatment, and in persistent recurrent cases, chemical ablation or open surgery to excise the capsule in combination with vacuum drainage are the methods of treatment. Methods of endoscopic treatment of the walls of the detachment, ligation of the lymphatic vessels around the detachment, and the use of blockable sutures for obliteration of the detachment cavity are currently new methods of treatment, which effectiveness requires further study.

Introduction. Injuries to the brachial plexus are one of the most severe types of injuries to the nerves of the upper limb, and variants with the separation of the roots from the spinal cord represent a very difficult category of injuries to treat. Among patients who have received such injuries, there is a very high incidence of disability, since it is possible to achieve only partial restoration of the function of the upper limb. Recently, the method of transposition of functioning muscles has been growing in popularity due to its reliability and relatively short recovery time of function. The purpose of the work is to analyze the literature data on the possibility of using the method of transposition of functioning muscles in the complex treatment of victims with brachial plexus injuries. The authors have searched PubMed and RSCI databases over the past 25 years for keywords: peripheral nerve damage, tendon transposition, transposition of functioning muscles, nerve injury, brachial plexus injury, spinal cord root avulsion. In the selected 23 most relevant papers, the muscles used for transposition, indications and timing of operations, results and complications were analyzed, compared with other methods of surgical treatment of brachial plexus injuries. The analysis of studies has shown that the transposition of functioning muscles allows in most cases to restore the target movement to the useful level of M3–M4 on the MRC scale, is a more reliable method and allows achieving better results, especially in patients with severe complete injuries of the brachial plexus. An important disadvantage of free hip thin muscle transplantation operations is the risk of microanastomosis thrombosis, which requires detailed preoperative planning and good microsurgical technique of the operating team. Conclusion. Free transplantation of 2 functioning muscles is currently the method of choice for restoring upper limb movements in patients with complete brachial plexus injuries.

Background. The quality of fractures reposition in open osteosynthesis is one of the important factors determining the outcome of treatment. Often, the reposition and fixation of bone fragments is not an easy task. The authors propose a method of reposition and temporary fixation of fragments using plastic ty-raps used in electrical work. The aim of the study is to demonstrate the possibilities of new method of intraoperative reposition and fixation of bone fragments using plastic ty-raps. Materials and Methods. Ty-raps were sterilized before the surgery in the modes intended for the preparation of polymer products. After the fragments were dissected, their reposition and fixation are carried out with the help of clamps and bone clamps. At this stage, there is a need for the use of ty-raps, since the bone clamps prevent the plate from laying on the bone. To do this, 3-4 plastic ty-raps were applied to the areas of bone free from bone clamps in the area of the fragments contact. In those places where an intact periosteum and muscles are attached to the fragment, narrow transverse channels in soft tissues are formed with the instrument to wrap the bone with a ty-rap. Then the free end of the ty-rap is passed through its lock and tightened as much as possible. After tightening all the ty-raps, the bone clamps are removed. The applied ty-raps reliably keep the bone fragments from any displacement, even when the segment rotates. A bone plate is placed on the bone surface with tightened ty-raps. Then the plate fixed to the bone with screws. The plate should be placed on the bone without strong pressing, which allows you to remove the ty-raps from under the plate at any stage of osteosynthesis. The ty-raps are removed by cutting them with a scalpel or snacking with wire cutter, then the plate is fixed to the bone with the remaining screws. Conclusion. Ty-raps have many positive properties: they are affordable, cheap, do not lose their mechanical properties after sterilization, allow you to securely hold bone fragments during reposition, X-ray negative. The method has demonstrated convenience and reliability.

Unfortunately, suppuration of a postoperative wound remains the most frequent complication of surgical intervention. If suppuration is located superficially, within the subcutaneous fat, it can be successfully managed with minimal functional losses. The clinical course is significantly complicated if the focus of infection is located under the skin, in the thickness of the muscles, in the fracture zone. In the case of suppuration in the area of osteosynthesis, the complication may become critical.Such a complication is a serious condition that requires multi-stage complex and sometimes multidisciplinary treatment.The conditions for a successful outcome in this pathology are the minimum period from the moment of suppuration, active surgical tactics, stability of the implant, and good vascularization of the surrounding soft tissues.Active surgical tactics involves the opening and sanitation of purulent foci, leaks, recesses. Staged necrectomies are inevitable companions of surgical treatment and can cause the formation of defects in the skin, subcutaneous tissue, and muscles.The resulting soft tissue defect leads to exposure of the bone and plate. Removal of the metal fixator becomes inevitable.Only the closure of the defect with a complex of tissues based on free vascularized composite grafts can radically solve the problem.The article presents two clinical observations of deep wound infection after bone osteosynthesis, where autotransplantation of a vascularized flap was used. The use of this technique made it possible to achieve suppression of infection, wound healing by primary intention, to create conditions for consolidation of the fracture, restoration of function and preservation of the limb as a whole.

Background . Severe open injuries of the lower extremities in most cases are the result of high-energy trauma, because the foot and ankle are damaged as a result of automobile accidents almost in every fourth victim. According to the literature, the percentage of infectious complications after surgical debridement of open injuries of the foot is 43–67.9% and shows no tendency to decrease. Material and methods . We performed 32 operations with the use of free revascularized grafts in patients aged from 16 to 70 years with extensive posttraumatic defects of the foot between 2010 and 2018. Results . As a result, 30 (93.7%) out of 32 grafts provided foot support ability provided during the post-operative period. When replacing large defects (more than 80 cm 2 ) of soft tissues supporting surface of the foot we used free musculocutaneous flap of the latissimus dorsi, fasciocutaneous flaps were used for defects of the dorsum of the foot (less than 80 cm 2 ). Long-term results were assessed using the Foot and ankle ability Measure (FAAM) questionnaire. Conclusion . Primary early replacement of tissue defects on the foot with free revascularized autografts is the method of choice for solving this problem, as it allows you to maintain the supporting function of the foot and is often alternative method to amputation.

Background. Severe open injuries of the lower extremities in most cases are the result of high-energy trauma, because the foot and ankle are damaged as a result of automobile accidents almost in every fourth victim. According to the literature, the percentage of infectious complications after surgical debridement of open injuries of the foot is 43–67.9% and shows no tendency to decrease.Material and methods. We performed 32 operations with the use of free revascularized grafts in patients aged from 16 to 70 years with extensive posttraumatic defects of the foot between 2010 and 2018.Results. As a result, 30 (93.7%) out of 32 grafts provided foot support ability provided during the post-operative period. When replacing large defects (more than 80 cm2) of soft tissues supporting surface of the foot we used free musculocutaneous flap of the latissimus dorsi, fasciocutaneous flaps were used for defects of the dorsum of the foot (less than 80 cm2). Long-term results were assessed using the Foot and ankle ability Measure (FAAM) questionnaire.Conclusion. Primary early replacement of tissue defects on the foot with free revascularized autografts is the method of choice for solving this problem, as it allows you to maintain the supporting function of the foot and is often alternative method to amputation.

Background.Vascular bone graft transposition is the one of most effective method of nonunion fracture and bone defect treatment. However, the use of this technique is associated with some difficulties. One is the adjustment of recipient bed size and the graft. The other is the difficulty to reconstruct the alignment and length of bone. A promising method of preparing for the vascular bone graft transposition is virtual three-dimensional planning based on computed tomography data and three-dimensional printing templates.The aimwas to summarize our experience in the treatment of bone nonunion and defects with vascular bone autografts using tree-dimensional virtual planning and printing.Material and methods.We analyzed the treatment process and outcomes of 4 patients with limb bone nonunion and 6 patients with bone defects. In all cases, we used vascular bone grafts. Internal fixation of grafts was used in 7 cases, external fixation was used in 3 cases. At preparation stage in 4 cases, we used tree-dimensional virtual surgery planning and printing templates.Results.One case was diagnosed with bone graft necrosis caused by venous thrombosis. Consolidation was achieved in all patients; a late consolidation was observed in 2 cases. Hematoma in donor area was seen in 2 patients. When using three-dimensional virtual planning and tree-dimensional printing templates, the operation time was decreased by 1 hour 5 minutes. We identified two cases of poor reposition in the group without virtual planning. No poor reposition was observed in the cases where tree-dimensional planning was used.Conclusion.Vascularized bone grafts provide an effective method to treat bone defects and nonunion. But the planning of graft and recipient site sizes is associated with certain difficulties. Our preliminary results have shown that virtual three-dimensional planning and printing allow improving the precision of the surgical procedure and decreasing operative time.

Background Due to the non-decreasing incidence of such injuries, prolonged treatment and high incidence of complications, treatment of posttraumatic soft tissue defects of extremities is an actual problem within traumatology and plastic and reconstructive surgery. Aim of study Development of tactics for the treatment of posttraumatic soft tissue defects of extremities with the use of vascularized tissues (flaps) and evaluation of its results. Materials and methods: 118 patients with posttraumatic soft tissue defects of extremities were included into the study. Patients were divided into 2 groups. In the comparison group (49 patients), the traditional management for posttraumatic defects was performed: local treatment of the wound followed by autodermoplasty. In the second group (study group), the developed procedure of cover tissues restoration using vascularized tissue complexes (69 patients) was applied. Results The developed treatment reduced the incidence of deep wound infection by 13.6%, necrosis of naked functional structures by 36.3%, chronic osteomyelitis by 17% and contraction of adjacent joints by 18.2%. At the same time, we noted a decrease in the duration of inpatient treatment by 14.7 days in patients with posttraumatic soft tissue defects of extremities. Conclusion The developed tactics of cover tissues restoration using vascularized tissue complexes reduced the incidence of complications and improved the functional results of treatment in patients with posttraumatic soft tissue defects of extremities.

Background. Growing number of patients with pelvic fractures is associated with evolution of high-speed transport, high-rise construction and industrial production. The optimal surgical procedure for pubic rami fractures must ensure a stable fixation and simultaneously minimize the risk of postoperative complications. Our aim was to evaluate the efficiency of a new technique for pubic bones fixation by a titanium nail in patients with pelvic fractures.Material and Methods. The authors present the experience on treatment of 18 patients who underwent 25 surgeries for internal fixation of pubic rami fractures by a designed solid titanium nail. Mean age of patients was 40.16±10.35 years. Proposed surgical method provides for mandatory use of image intensifier during all stages of the procedure. With patient in a supine position the authors performed internal fixation of pubic bones by a retrograde nail inserted using a navigating handle through a skin incision of1 cm in the area of symphysis. After complete insertion into the bone the nail was interlocked proximally by two3.5 mm cortex screws through an additional skin incision of1.0 cm using a navigating handle and guiding sleeves. All pelvic ring fractures were classified according to AO/OTA classification and pubic fractures by Nakatani classification. Functional outcome was evaluated by Majeed score.Results. Bilateral fractures were diagnosed in 7 (38.8%) patients (floating pubic symphysis). 13 (72.2%) patients featured polytrauma with average ISS score of 25.1±7.8. 2 (11,1%) patients were diagnosed with open pelvic fractures, 3 (16.6%) patients had a concomitant acetabular fracture. The authors performed epicystostomy in two (11.1%) patients and laparotomy bringing out the drainages in 5 (27,8%) patients. Mean follow up was 7.8±6.2 months. Stable fixation was obtained in all patients. By the moment of the present publication x-ray healing of pubic bones was observed in 16 (64%) cases, in remaining 9 (36%) cases the follow up period was less than mean healing period (2 months). In 11 (68.8%) patients the functional outcome averaged 91±3.9 by Majeed score 6 months postoperatively, in 8 (50%) patients – 93.8±2.9 by Majeed score 12 months postoperatively and more. No complications like skin necrosis, secondary fragments displacement or infection were not observed.Conclusion. Preliminary results demonstrated the absence of wound infection and reliable fragments fixation. This technique can be applied in patients with stomas and drainages upon the anterior abdominal wall which extends the indication range for surgical treatment of anterior pelvic ring. High fixation properties of proposed nailing create conditions for early mobilization of the patients and for conducting the exercise therapy.

Inadequate attention is paid to the preparation of quality illustrations for scientific publications on traumatology and orthopaedics. Review of the quality of 1221 pictures in three typical journals shows that the majority of patients’ photographs are made against the bad background, with presence of foreign objects, and the photos are made from the angle that does not allow making a reliable picture of function restoration. X-ray examination results and intraoperative photographs are not without disadvantages. Recommendations that can considerably improve the quality of the presenting illustrations and its informational content are given.

Introduction: Tactic of emergency closing of soft tissue defect allows to significantly improve the treatment results concerning patients with severe open fractures. However, a number of certain factors make the implementation of this tactic rather difficult. Injured people’s unstable conditions are mong these crucial factors which include, polytrauma in lots of cases, absence of exact recommendations for recovery terms, choice of definite tissue flaps and a type of circulation. The Aim of Study: is to develop exact, usable and in practice algorithm of emergency reconstruction of leg soft tissues in patients with severe open tibia fractures, based on the usage of the most foolproof and simple methods. Data (Patients) and Methods: 85 patients with open tibia fractures complicated by soft tissue defects were included in our study. Patients were divided into two groups. The control group consisted of 56 patients. Soft tissue reconstruction in this group was provided without an exact algorithm, after continuous attempts on local healing. After analyzing the treatment process and the treatment results we have developed the algorithm of emergency soft tissue reconstruction. It was used in 29 patients (the study group). This algorithm allows choosing optimal timing for tissue reconstruction and appropriate method to be applied, depending on the patient’s condition, the mechanism of soft tissue defect formation, and its square and localization. Results: We observed a statistical decrease in deep wound infection frequency, partial tibia necrosis frequency, chronic osteomyelitis frequency, duration of hospitalization in patients with severe open tibia fractures because of using our algorithm.

BACKGROUND. Requirements for the graft used in microsurgery are simple retrieval, minimal anatomic variability, the possibility to operate on one surgical area, great length and diameter of flap vessels.PURPOSE OF STUDY. Evaluation of the results and advantages of revascularized free anterolateral muscle flap usage in emergency surgery.MATERIALS AND METHODS. Free muscle flap of the lateral vastus muscle on a vascular pedicle of the descending branch of the lateral femoral circumflex artery (anterolateral flap) was used to replace the defect in 2 patients. In one case, a patient had open fractures of the lower leg, complicated with primary defects of soft tissue, and in the other case a patient had incomplete traumatic amputation of the left foot. All the victims underwent soft tissue defects restoration within the first hours after the injury, next to fixation of the fracture.RESULTS. All grafts have completely healed, total necrosis of muscle flaps hasn’t been observed. All patients had primary wound healing after the transfer. Cases of deep purulent infection after the surgery haven’t been noted.CONCLUSION. The transfer of a free anterolateral muscle flap is the best method for emergency plastic and reconstructive surgery of the lower limbs. The advantages are simple and prompt retreival, no need to turn the patient to the lateral position, large amount of the flap, great length and caliber of vessels.

RESUME. The aim of our study is to develop and introduce the algorithm of the early soft tissue reconstruction for the patients with severe open tibia fractures. We analyzed the treatment results retrospectively and prospectively 84 patients with severe open tibia fractures, complicated by soft tissue defects. In the comparison group (56 patients) we apply late soft tissue reconstruction. In the study group (28 patients) we applied the algorithm of early soft tissue reconstruction by plastic surgery methods. Surgery tactic depends on the patient’s condition, trauma mechanism, soft tissue defects size and localization. The algorithm of early soft tissue reconstruction was used for patients with severe open tibia fractures decreases duration of hospital treatment, rate of deep wound infection and partial necrosis of tibia bone.

RESUME. The aim of our study is to develop and introduce the algorithm of the early soft tissue reconstruction for the patients with severe open tibia fractures. We analyzed the treatment results retrospectively and prospectively 84 patients with severe open tibia fractures, complicated by soft tissue defects. In the comparison group (56 patients) we apply late soft tissue reconstruction. In the study group (28 patients) we applied the algorithm of early soft tissue reconstruction by plastic surgery methods. Surgery tactic depends on the patient’s condition, trauma mechanism, soft tissue defects size and localization. The algorithm of early soft tissue reconstruction was used for patients with severe open tibia fractures decreases duration of hospital treatment, rate of deep wound infection and partial necrosis of tibia bone.

In the article the results of 67 procedures of soft tissue reconstructions for the patients with open tibia fractures were analyzed. In the group, where the authors used skin rotational flaps, afterwards there were 3 (37.5%) patients with deep infection. The skin flap necrosis was diagnosed in 5 (62.5%) cases. In the group, where the authors used the reverse sural flap the deep infection occurred in 2 (28.6%) cases, but the flap necrosis developed in 3 (42.9%) cases. In the group where the authors used local muscular flaps, the deep infection occurred in 5 cases (13.2%) and the flap necrosis developed in 5 cases. In the group where we used the free muscular flap there was only 1 patient who got the deep wound infection and there were 2 patients who got necrosis. The clinical results that demonstrated the best healing and minimal complication rate of muscular flaps were confirmed high blood flow data in those flaps, measured by laser Doppler flowmetry. It means that using muscular flaps technique is most suitable for the soft tissue reconstructions in open tibia fractures. The type of the flap’s utilization is not important. Skin flap is a second line method of choice if it’s not possible to use muscular flap technique.

At department of concomitant and multiple trauma of Scientific Research Institute of Emergency Care named after N.V. Sklifisovskiy 177 patients with polytrauma were treated from 1999 to 2009. All patients had avulsions and crushes of large segments of extremity including crus (66 patients - 37%), thigh (44 patients - 25%), foot (41 patients - 23%), shoulder (14 patients - 8%) and forearm (12 patients - 7%). In 99 patients (control group) the treatment was performed according to routine protocol: amputation by the type of primary surgical treatment (PST), topical treatment of wounds using antiseptic and salve dressings, autodermoplasty after wound granulation. In 78 patients (test group) new tactics of treatment was applied. Terms of performance and volume of amputation were determined based on the principles of injury control. In stable condition of patients amputation within the limits of intact tissues with stump formation and suturing was performed. In avulsion of extremity at the superior third of crus the amputation by type of PST was applied for preservation of knee joint. Sawing tibia surface was covered by gastrocnemius muscle and local wound treatment was performed with hydrohelium dressings and vacuum systems. After wound preparation autodermaplasty was carried out. In severe condition of patients the amputation by type of PST was performed at any level of avulsion. After stabilization of patients state topical wound treatment or reamputation within the limits of intact tissues was performed. Use of new treatment tactics allows decreasing the rate lethality by 6% versus 11% in control group, shortening the terms for patients' preparation for injured bone osteosynthesis, decrease of hospital treatment duration and terms of preparation for prosthetics and significantly improving functional treatment results.