Relevance. Despite the successes and achievements of modern traumatology, the method of microsurgical autotransplantation of tissue complexes remains an urgent topic today. Unfortunately, in various situations, for various reasons, it is not possible to perform microsurgical surgery. The best results of the implantation of free autografts are achieved provided that the defect plastic is performed early, in the acute phase of the wound process, when the wound is contaminated but not yet microbially colonized. Often, the general condition of the victim does not allow for autotransplantation, since an open injury to the lower leg may be part of a multiple or combined injury. There is a contradiction between the need to close a soft tissue defect and the very possibility of performing a large reconstructive operation. The aim is to study and analyze currently existing studies on the use of reconstructive plastic surgery using perforant flaps in patients with a traumatological profile. Highlighting the main directions that can be applied in clinical practice, reviewing and delving into the technical aspects of this method of surgical treatment.Materials and methods. The search for literary sources was carried out using the bibliographic databases of eLibrary.RU, PubMed, Google Scholar and Scopus.Conclusion. Thanks to the review, the main directions of soft limb transplantation were identified. The search for solutions to the problem of treating soft tissue defects in the lower third of the lower leg is far from complete. An in-depth study of the possibilities of perforant skin fascial flaps will allow us to obtain a tool with which it will be possible to improve the results of surgical treatment of this group of patients.

Background. Despite the many accesses described in the literature for open Achilles tendon repair, there is no evidence of the benefits of this or that access confirmed by clinical observations.The aim is to determine and justify optimal access during open Achilles tendon repair.Material and methods. The article shows the result of the analysis of data from a literary search, experimental work on 12 lower limbs of 6 cadavers, a clinical study based on a retro-prospective analysis of the treatment of 128 people in the Department of Emergency Traumatology N.V. Sklifosovsky Research Institute from 2014 to 2022. The comparison group retrospectively included 47 patients (36.7%) with Achilles tendon injury, who underwent suture of the Achilles tendon from S and Z–shaped accesses from 2014 to 2017. The main group prospectively included 81 patients (63.3%) for 2018-2022, who underwent paramedial tendon access.Results. The analysis of a retrospective study showed that 3 patients from the comparison group with Achilles tendon injury in the postoperative period had ischemia of the wound edges with subsequent formation of necrosis and skin defect; 1 patient had a hypertrophic painful scar, which ulcerated from the constant traumatization of his shoe back (the total number of complications was 8.5%). In the patients of the main group, there were no complications in the postoperative period in any case. Conclusion. In our opinion, the paramedial tendon access is optimal, because there are no complications from the skin and leads to improved functional results.

Allogeneic tendon grafts are seriously demand in knee joint plastic surgery. The novel method of tendon cryopreservation, including sterilization with supercritical carbon dioxide, was developed in N.V. Sklifosovsky Research Institute for Emergency Cryopreserved tendons retain their normal fiber structure without significant loss of mechanical properties. At the next stage it was necessary to evaluate cryopreserved tendons′ integration inside bone canal in experimental animals. The aim of study. To evaluate morphologic changes of autologous and allogeneic tendons inside the femur in rats and to determine the effect of tendon transplantation on the physical activity. Material and methods. The study was conducted on white inbreed male rats. Three groups of animals were formed: the control group (animals without tendon transplantation), the 1st experimental group – animals with autologous tendon transplantation, the 2nd experimental group – animals with allogeneic tendon transplantation. In animals of the experimental groups the through channel was formed in the distal metaepiphysis of the femur and a tail tendon graft 0.5 x 0.1 cm was placed there. To assess the physical activity of the animals, we studied maximum distance that the animals could run 3 and 6 weeks after transplantation was determined, using treadmill test. The graft structure was evaluated on histological preparations in transmitted light, stained with hematoxylin-eosin and Van Gieson′s stain. To assess the preservation of collagen fibers we checked the autofluorescence intensity of collagen. Results. According to the treadmill test, the distance run by the animals of both experimental groups did not significantly differ from the values in the control group. Histological analysis after 3 weeks in both experimental groups revealed signs of fibers′ decomposition in the absence of inflammatory infiltration and maintaining close contact with bone trabeculae. The autofluorescence intensity of the collagen fibers in grafts corresponded to normal or was close to normal. After 6 weeks, the animals of both experimental groups revealed areas of graft fusion with their own bone, Sharpe fibers were actively formed. In both groups, numerous small vessels with diameters up to 10 microns were detected in the area of tendon-bone contact. Infiltration of grafts by inflammatory cells was absent or very insignificant, active migration of fibroblasts to the tendon area was also not observed. In both groups, tendon grafts had areas where fiber decompactization was observed. In the area of contact with the bone, the autofluorescence of tendon fibers was sharply increased, which indicates the chemical cleavage of collagen. At 3 and 6 weeks after transplantation the effect of fixation (integration) of the tendon with bone tissue was observed in both experimental groups. Conclusions. Allogeneic tendon grafts did not cause a pronounced inflammatory or immune reaction in experimental animals. 6 weeks after transplantation of autologous and allogeneic tendons, the integration of grafts inside the femoral canal was observed. Cryopreserved allogeneic tendons were able to integrate into the body's own tissues without pronounced structural and functional disorders. According to the treadmill test, the distance covered by the animals of both experimental groups did not differ statistically significantly from the values in the control group (without tendon transplantation) after 3 and 6 weeks

RELEVANCE The overall incidence of Achilles tendon rupture has been increasing in recent decades due to population aging, the growing prevalence of obesity and increased participation in sports. Achilles tendon ruptures are common injuries of the musculoskeletal system, and according to various authors, they account for 47% of all ruptures of human tendons and muscles, about 18 cases per 100 thousand people per year. Despite the abundance of various options of tendon suture in surgery, a wide choice of suture material and the use of precision techniques in tendon reconstruction, the proposed methods of macroscopic reconstruction of the tendon apparatus do not solve the problem of tendon suture failure.CONCLUSION Despite the abundance of proposed accesses to the Achilles tendon, the optimal one for all types of injuries has not yet been developed. Currently, there are no clear recommendations for choosing a specific method of treating an Achilles tendon rupture.

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.

The paper considers an approach to solving a problem in the recovery of the cervical esophagus and in the closure of fenestrated tracheal defects in modern reconstructive thoracic surgery. It describes the clinical observation of a patient with postnecrotic cervical esophageal defect, extensive cicatricial stenosis and defect of the trachea. Methods for esophageal segmental plasty using a small intestine autograft, prefabrication, and movement of a graft on the basis of the pectoralis major muscle and free costal cartilages are depicted.

The paper considers an approach to solving a problem in the recovery of the cervical esophagus and in the closure of fenestrated tracheal defects in modern reconstructive thoracic surgery. It describes the clinical observation of a patient with postnecrotic cervical esophageal defect, extensive cicatricial stenosis and defect of the trachea. Methods for esophageal segmental plasty using a small intestine autograft, prefabrication, and movement of a graft on the basis of the pectoralis major muscle and free costal cartilages are depicted.

Background. There is now only one method for replacement of virtually any integumentary defects differing in extent, which satisfies all the requirements of primary plastic repair – microsurgical autotransplantation of tissue units on a vascular pedicle. Primary plastic repair by microsurgical autotransplantation makes it possible not only to perform adequate reconstructive manipulations of an injured limb, but also to create the optimal conditions for delayed surgical interventions.Materials and methods. Since 2000, the N.V. Sklifosovsky Research Institute of Emergency Care has been performing autotransplantation of vascularized tissue units to cover soft tissue defects. For this time, 57 flaps have been grafted in 57 patients with open limb bone fractures. For closure of soft tissue defects, the authors have successfully applied free autografts comprising the muscles and skin.Results and discussion. Out of the 57 primary microsurgical autotransplantations of tissue flaps, only 4 cases required emergency intervention; the others needed delayed one. To close soft tissue defects, the authors successfully applied free autografts comprising the muscles and skin. All the transplanted autografts got implanted completely.Conclusion. The used procedure furnishes a means of minimizing donor site damage and ultimately improves both functional and aesthetic surgical results. The authors’ experience permits one to recommend a more active introduction of microsurgical plastic methods into clinical practice.

The paper provides a case of foot replantation by the autotransplantation type after train run-over-inflicted injury, by shortening the limb by 12 cm, followed by distraction in the external fixation apparatus. The technical features of the procedure comprising the elements of autotransplantation and up-to-date orthopedic technology of bone elongation are described. A patient’s good rehabilitation is shown to be possible after replantation of a limb in severe injury generally resulting in its loss. The described procedure assures a high reliability and predictability of functional and aesthetic results that cannot be achieved via prosthesis replacement.

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.

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.