scholarly journals IMPLEMENTATION THE PRINCIPLES OF RECONSTRUCTIVE SURGERY WOUNDED WITH SOFT TISSUE DEFECTS AT THE IV LEVEL OF MEDICAL CARE

World Science ◽  
2020 ◽  
Author(s):  
Хоменко І. П. ◽  
Гуменюк К. В. ◽  
Король С. О. ◽  
Михайлусов Р. М. ◽  
Тертишний С. В. ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Medical Care ◽  
Soft Tissues ◽  
Surgical Care ◽  
Relative Number ◽  
Functional Results ◽  
Surgical Trauma ◽  
Soft Tissue Defects ◽  
Surgical Tactics ◽  
Tissue Defects

Resume. The experience of providing medical care during the anti-terrorist operation in eastern Ukraine has shown that in the structure of modern combat surgical trauma gunshot wounds with soft tissue defects are 64.9-68.2%, of which 36.4-37.5% small and medium, 28.5-30.7% are large and very large defects. Goal: To improve the results of surgical care for soft tissue defects by introducing differentiated surgical tactics for wound closure to each level. Material and methods. The total amount of the study was 136 wounded with shrapnel, bullet and explosive injuries from April 2014 to September 2018. Determination of surgical tactics for closing soft tissue defects was performed on the basis of metric classification, taking into account the area, volume and anatomical areas of the lesion. Results. The combination of metric characteristics of wound defects by area, volume and location of wounds in a single classification allowed to offer a comprehensive approach to sorting the wounded by the level of medical care and determine further reconstructive surgical tactics to close soft tissue defects. Conclusions. The introduction of differentiated surgical tactics in wounded with gunshot defects of the soft tissues at the all levels of medical care improved functional results: the proportion of satisfactory increased from 46.9% to 53.7%, the relative number of unsatisfactory decreased from 18.8% to 11.6%

scholarly journals Organization of stage rehabilitation of servicemen with gunshot defects of soft tissues at the levels of medical care

2021 ◽  
Vol 26 (4) ◽  
pp. 188-195
Author(s):  
K.D. Babov ◽  
I.P. Khomenko ◽  
S.V. Tertyshnyi ◽  
Babova I.K. Babova I.K. ◽  
R.S. Vastianov
Keyword(s):  
Surgical Treatment ◽  
Soft Tissue ◽  
Medical Care ◽  
Soft Tissues ◽  
Lower Extremities ◽  
Gunshot Wounds ◽  
Care Quality ◽  
Rehabilitation Service ◽  
Soft Tissue Defects ◽  
Tissue Defects

Building a modern system of rehabilitation of servicemen in Ukraine is an integral part of providing medical care in armed conflict. Rehabilitation of servicemen after gunshot wounds with soft tissue defects of the lower extremities is a common but difficult problem for surgical and rehabilitation teams. The process of rehabilitation requires the implementation of certain methodological provisions. At present, medical care for servicemen is a four-levels’ one. Rehabilitation service is provided at the third and fourth levels of medical care. The aim of the study was to improve the quality of medical care for servicemen after gunshot wounds with soft tissue defects of the lower extremities by introducing a system of staged rehabilitation. Organizational and methodological bases of the system of staged rehabilitation of wounded servicemen with soft tissue defects at different levels of medical care have been developed. Two models of rehabilitation depending on the severity of the injury and the tactics of surgical treatment are proposed. The division of the stage of early sanatorium rehabilitation for the wounded with severe soft tissue injuries depending on the stage of surgical treatment and the formation of a "skin patch" is justified. The introduction of the proposed models of rehabilitation of wounded with soft tissue defects in the practice of early sanatorium rehabilitation will provide increasing of medical care quality.

scholarly journals THE FIRST STAGE RECONSTRUCTION OF THE SOFT TISSUE DEFECTS OF GUNSHOT WOUNDS

2020 ◽  
pp. 31-35
Author(s):  
І. П. Хоменко ◽  
К. В. Гуменюк ◽  
Є. В. Цема ◽  
Р. М. Михайлусов ◽  
С. В. Тертишний ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Soft Tissue ◽  
Medical Care ◽  
Military Personnel ◽  
Functional Ability ◽  
Soft Tissues ◽  
Gunshot Wounds ◽  
Soft Tissue Defects ◽  
Tissue Defects

The aim. To investigate and used a multimodal diagnostic scheme during the first stage of reconstructive surgical treatment of wounded with soft tissue defects at the second level of medical care.Materials and methods. By identifying thermographic areas with gunshot wounds of the soft tissues, we observed at the second level of medical care during 4 months of 2020 (from March to July) 37 cases.Results. We used a multimodal scheme in the pre-, intra- and postoperative period helps to reduce the area of defects in 23 (62.2%) cases out of 37 against the background of restoration and preservation of microcirculation in the damaged structure, and the number of subjectively unsatisfactory military personnel in 4 (12.8%) of the total the number of wounded, a decrease in the loss of functional ability in 19 (51.2%) cases.Conclusions. The combination of dynamic digital thermography in combination with an audio doppler at the second level of medical care can improve the quality of primary surgical treatment by performing surgery with clear indications of the proposed technique; maintain a larger volume of viable tissues, reduce the area of the defect and the number of complications in the further treatment of the wounded.

scholarly journals A META-ANALYSIS OF THE SOFT TISSUE DEFECTS CLASSIFICATION AND JUSTIFICATION OF THE OPTIMAL SURGICAL RECONSTRUCTION METHOD

2021 ◽  
Vol 121 (1) ◽  
pp. 112-123
Author(s):  
Sergiy Tertyshnyi ◽  
Igor Khomenko ◽  
Кostyantyn Gumenyuk ◽  
Sergiy Korol ◽  
Yevgen Tsema ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Soft Tissues ◽  
Meta Analysis ◽  
Surgical Reconstruction ◽  
Reconstruction Method ◽  
Soft Tissue Defects ◽  
Military Conflict ◽  
Preoperative Training ◽  
Defects Classification ◽  
Tissue Defects

During the military conflict in the East of Ukraine, considerable experience in providing medical assistance to wounded and injured with soft tissue defects has been accumulated. Taking into account the considerable diversity of defects of soft tissues on numerous a number of signs, which involves the application in the process of treatment of fundamentally different algorithms of preoperative training, planning of reconstructive intervention and method of surgical reconstruction there was a need to systematize the accumulated knowledge by developing the integral classification of soft tissue defects.

Treatment of the Diabetic Foot with Exposed Os Calcis

Foot & Ankle ◽  
1980 ◽  
Vol 1 (3) ◽  
pp. 173-178 ◽  
Author(s):  
Richard L. Jacobs ◽  
Allastair M. Karmody
Keyword(s):  
Soft Tissue ◽  
Medical Care ◽  
Diabetic Foot ◽  
Survival Rates ◽  
Soft Tissue Defects ◽  
Os Calcis ◽  
Soft Tissue Problems ◽  
Improved Methods ◽  
Tissue Defects

With improved methods of medical care, the survival rates in all types of diabetes are improving. There are increasing numbers of older diabetics with complicated soft tissue problems. This is a report of our experiences in treating 15 consecutive patients with soft tissue defects involving the hindfoot. Each of these patients had an intact forefoot.

scholarly journals NEW METHOD FOR RESTORATION OF LOWER FACE

2017 ◽  
Vol 21 (4) ◽  
pp. 207-210
Author(s):  
Mikhail Borisovich Shvyrkov
Keyword(s):  
Soft Tissue ◽  
Trauma Surgery ◽  
Functional Results ◽  
New Method ◽  
Minor Trauma ◽  
Soft Tissue Defects ◽  
Lower Face ◽  
Distraction Device ◽  
The Face ◽  
Tissue Defects

Application of the method developed by the author of the restoration of the lower of the face with his proposed technique free osteoplasty of the mandible in conjunction with komressionno-distraction device (KDD) own design allowed simultaneously to replace extensive bone and soft tissue defects immediately after they are lost or in distant time. Minor trauma surgery postoperative high aesthetic and functional results, allows widely recommend this type of plastic in the practice of maxillofacial surgeons.

Hindfoot Containment Orthosis for Management of Bone and Soft-Tissue Defects of the Heel

2005 ◽  
Vol 26 (3) ◽  
pp. 198-203 ◽  
Author(s):  
Jeffrey E. Johnson ◽  
Jonas R. Rudzki ◽  
Erick Janisse ◽  
Dennis J. Janisse ◽  
Ray R. Valdez ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Revision Surgery ◽  
Soft Tissues ◽  
Tissue Injury ◽  
Soft Tissue Injury ◽  
Soft Tissue Defects ◽  
Heel Pad ◽  
Periodic Monitoring ◽  
Growth Change ◽  
Tissue Defects

Background: Bone, soft-tissue, and nerve deficits of the weightbearing surface of the foot are frequent sequelae from foot trauma or diabetes mellitus and present challenging treatment issues. Injury to the specialized, shock-absorbing, heel-pad tissue containing spirally arranged fat chambers is particularly difficult to manage. Appropriate footwear modifications and shoe inserts for protection of this skin are essential to the long-term management of bone and soft-tissue defects of the heel. This study evaluated the performance of a new custom total contact foot orthosis (Hindfoot Containment Orthosis, HCO) which was designed to contain the soft tissues of the heel, reduce shear forces, redistribute weightbearing load, and accommodate bone or soft-tissue deformity of the heel. Methods: Twenty-two patients treated with HCO were retrospectively reviewed. Followup averaged 26 months. The effectiveness of the orthosis was assessed by how well the integrity of the soft tissue was maintained (e.g. the number of ulcerations since dispensing the orthosis), the number of refabrications of the orthosis that were required, and whether or not revision surgery was required. Results: Ten patients had superficial ulcerations. No patient required revision surgery. A total of 62 refabrications of the orthoses in 22 patients were required over a 2-year period. Overall results were good in 17 (77%) patients, fair in four (18%), and poor in one. Conclusions: The HCO is effective for preservation of soft-tissue integrity of the heel pad after bony or soft-tissue injury. Important factors in achieving success with the HCO are patient compliance and periodic monitoring for refabrication of the orthosis to accommodate skeletal growth, change in foot size or shape, and compression or wear of insert materials.

Reverse-Flow Intrinsic Fasciocutaneous Island Flaps in Foot Reconstruction

2017 ◽  
Vol 16 (4) ◽  
pp. 296-301
Author(s):  
Sujin Bahk ◽  
GyeongHyeon Doh ◽  
Ki Yong Hong ◽  
SooA Lim ◽  
SuRak Eo
Keyword(s):  
Soft Tissue ◽  
Soft Tissues ◽  
Reverse Flow ◽  
Donor Site ◽  
Skin Grafting ◽  
Soft Tissue Defects ◽  
Satisfactory Outcome ◽  
Split Thickness Skin Grafting ◽  
Foot Reconstruction ◽  
Tissue Defects

Reconstruction of soft tissue defects in the foot remains a challenge due to its specialized tissue for weightbearing and ambulation. Considering the principle of replacing “like with like,” adjacent soft tissues would be a best option for a donor site. Although several kinds of reverse-flow island flaps for the lower leg have been well described, intrinsic foot reverse flow flaps have been rarely reported. We describe 3 kinds of reverse-flow intrinsic fasciocutaneous flaps (RIFFs) for foot reconstruction. From September 2012 to August 2015, a retrospective study was done on case notes of all patients who had a RIFF for coverage of soft tissue defects within the foot following trauma or tumor ablation. A total of 7 patients were included in this study, with an average of 5 × 3.5 cm sized defects in the forefoot, second and third web space, and sole, which were reconstructed with RIFF. All flaps were well perfused and recovered excellent function of the foot with satisfactory aesthetics and minimal limitations in range of motion. However, one case showed a complication of venous congestion, due to remnant scar tissues, which resolved after medical leech application. Donor defects healed completely with split thickness skin grafting in all cases. Soft tissue defects within the foot were repaired successfully by RIFF. In spite of its technical challenges, it is a reliable one-stage procedure requiring no microsurgical anastomosis. Precise vascular evaluation of the reverse inflow has to be preceded for satisfactory outcome of RIFF.

A Simple and Convenient Alternative for the Reconstruction of Lower Extremity Soft Tissue Defects due to Different Types of Etiologies: Bipedicled Flap

2021 ◽  
pp. 153473462110094
Author(s):  
Zeynep Altuntaş ◽  
Mahmut Tekecik ◽  
Mehmet Dadacı
Keyword(s):  
Soft Tissue ◽  
Lower Extremity ◽  
Soft Tissues ◽  
Soft Tissue Defects ◽  
Peripheral Vascular ◽  
Muscle Flaps ◽  
Limited Mobility ◽  
Different Types ◽  
Neurovascular Structures ◽  
Tissue Defects

Reconstruction of soft tissue defects in the lower extremity due to different etiologies can be a challenging process for surgeons. Compelling reasons for reconstruction include the anatomy of the lower extremity, limited mobility of soft tissues especially the presence of bone, tendon, and neurovascular structures under the defect, and the exposed fixation materials make these defects more complicated. Local fasciocutaneous and muscle flaps are frequently used for the reconstruction of these defects. The patients in our study were with multiple comorbidities such as diabetes mellitus, hypertension, atherosclerosis, and peripheral vascular disease. In this study, with a clinic series consisting of 42 patients (29 male and 13 female), we present a reconstruction with a bipedicled flap as a safe, simple, and efficient reconstructive modality in the treatment of lower extremity soft tissue defects. Except for 1 total flap loss, all defects were successfully reconstructed without any major complications. When reconstruction is performed with a bipedicled flap, the main neurovascular structures are not damaged, free flap and other locoregional flaps can be used as a salvage protocol.

scholarly journals Reconstruction of massive tibial bone and soft tissue defects by trifocal bone transport combined with soft tissue distraction: experience from 31 cases

2021 ◽  
Author(s):  
Yong-Qing Xu ◽  
Xin-Yu Fan ◽  
Xiao-Qing He ◽  
Hong Jie Wen
Keyword(s):  
Soft Tissue ◽  
External Fixation ◽  
Functional Results ◽  
Bone Transport ◽  
Fixation Index ◽  
Soft Tissue Defects ◽  
Safety And Efficacy ◽  
Tibial Bone ◽  
The Mean ◽  
Tissue Defects

Abstract Background Large post-traumatic tibial bone defects combined with soft tissue defects are a common orthopedic clinical problem associated with poor outcomes when treated using traditional surgical methods. The study was designed to investigate the safety and efficacy of trifocal bone transport (TFT) and soft-tissue transport with the Ilizarov technique for large posttraumatic tibial bone and soft tissue defects. Methods We retrospectively reviewed 31 patients with massive posttraumatic tibial bone and soft tissue defects from May 2009 to May 2016. All of the eligible patients were managed by TFT and soft-tissue transport. The median age was 33.4 years (range, 2-58 years). The mean defect of bone was 11.87cm ± 2.78cm (range, 8.2-18.2cm) after radical resection performed by TFT. The soft tissue defects ranged from 7cm x 8cm to 24cm x 12cm. The observed results included bone union time, wound close time and true complications. The Association for the Study and Application of the Method of Ilizarov (ASAMI) scoring system was used to assess bone and functional results and postoperative complications were evaluated by Paley classification. Results The mean duration of follow-up after frame removal was 32 months (range, 12-96 months). All cases achieved complete union in both the elongation sites and the docking sites, and eradication of infection. The mean bone transport time was 94.04 ± 23.33 days (range, 63.7-147 days). The mean external fixation time was 22.74 ± 6.82 months (range, 14-37 months), and the mean external fixation index (EFI) was 1.91 ± 0.3 months/cm (range, 1.2–2.5 months/cm). The bone results were excellent in 6 patients, good in 14 patients, fair in 8 patients and poor in 3 patients. The functional results were excellent in 8 patients, good in 15 patients, fair in 5 patients and poor in 3 patients. Conclusion: TFT, in conjunction with soft tissue transport technique, can give good results in most patients (in this article, good and excellent results were observed in 64% of patients). Soft tissue transport is a feasible method in providing good soft tissue coverage on the bone ends. Although it has no advantages over microvascular techniques, it might be an good alternative in the absence of an experienced flap surgeon. Nonetheless, high-quality controlled studies are needed to assess its long-term safety and efficacy.

scholarly journals Reconstruction of massive tibial bone and soft tissue defects by trifocal bone transport combined with soft tissue distraction: experience from 31 cases

2020 ◽  
Author(s):  
Yong-Qing Xu ◽  
Xin-Yu Fan ◽  
Xiao-Qing He ◽  
Hong Jie Wen
Keyword(s):  
Soft Tissue ◽  
External Fixation ◽  
Functional Results ◽  
Bone Transport ◽  
Fixation Index ◽  
Soft Tissue Defects ◽  
Safety And Efficacy ◽  
Tibial Bone ◽  
The Mean ◽  
Tissue Defects

Abstract Background Large post-traumatic tibial bone defects combined with soft tissue defects are a common orthopedic clinical problem associated with poor outcomes when treated using traditional surgical methods. The study was designed to investigate the safety and efficacy of trifocal bone transport (TFT) and soft-tissue transport with the Ilizarov technique for large posttraumatic tibial bone and soft tissue defects. Methods We retrospectively reviewed 31 patients with massive posttraumatic tibial bone and soft tissue defects from May 2009 to May 2016. All of the eligible patients were managed by TFT and soft-tissue transport. The median age was 33.4 years (range, 2-58 years). The mean defect of bone was 11.87cm ± 2.78cm (range, 8.2-18.2cm) after radical resection performed by TFT. The soft tissue defects ranged from 7cm x 8cm to 24cm x 12cm. The observed results included bone union time, wound close time and true complications. The Association for the Study and Application of the Method of Ilizarov (ASAMI) scoring system was used to assess bone and functional results and postoperative complications were evaluated by Paley classification. Results The mean duration of follow-up after frame removal was 32 months (range, 12-96 months). All cases achieved complete union in both the elongation sites and the docking sites, and eradication of infection. The mean bone transport time was 94.04 ± 23.33 days (range, 63.7-147 days). The mean external fixation time was 22.74 ± 6.82 months (range, 14-37 months), and the mean external fixation index (EFI) was 1.91 ± 0.3 months/cm (range, 1.2–2.5 months/cm). The bone results were excellent in 6 patients, good in 14 patients, fair in 8 patients and poor in 3 patients. The functional results were excellent in 8 patients, good in 15 patients, fair in 5 patients and poor in 3 patients. Conclusion: TFT, in conjunction with soft tissue transport technique, can give good results in most patients (in this article, good and excellent results were observed in 64% of patients). Soft tissue transport is a feasible method in providing good soft tissue coverage on the bone ends. Although it has no advantages over microvascular techniques, it might be an good alternative in the absence of an experienced flap surgeon. Nonetheless, high-quality controlled studies are needed to assess its long-term safety and efficacy.

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