Combined versus Single Perforator Propeller Flaps for Reconstruction of Large Soft Tissue Defects: A Retrospective Clinical Study

Sufficient wound closure of large soft tissue defects remains a challenge for reconstructive surgeons. We aimed to investigate whether combined perforator propeller flaps (PPFs) are suitable to expand reconstructive options. Patients undergoing PPF reconstruction surgery between 2008 and 2021 were screened and evaluated retrospectively. Of 86 identified patients, 69 patients received one perforator propeller flap, while 17 patients underwent combined PPF reconstruction with multiple flaps. We chose major complications as our primary outcome and defined those as complications that required additional surgery. Postoperatively, 27 patients (31.4%) suffered major complications. The propeller flap size, the type of intervention as well as the operation time were not associated with a higher risk of major complications. A defect size larger than 100 cm2, however, was identified as a significant risk factor for major complications among single PPFs but not among combined PPFs (OR: 2.82, 95% CI: 1.01−8.36; p = 0.05 vs. OR: 0.30, 95% CI: 0.02−3.37; p = 0.32). In conclusion, combined PPFs proved to be a reliable technique and should be preferred over single PPFs in the reconstruction of large soft tissue defects at the trunk and proximal lower extremity.

Analysis of the cellular composition of the native auto-transplantation mixture used for plastics of bone tissue defects

The cell composition of native transplant autosmes (NTA) used for bone plastics was studied. The histological examination showed the fragments of bone beams with preserved osteoblasts, the foci of myeloid and lymphoid hematopoiesis and the fibrin deposits, which suggested the presence of MMSCs. Immunophenotyping of the NTA cell population revealed a high level of expression of the surface markers CD105, CD73, and CD90 characteristic for MMSC. DNA-flow cytometry of the bone dust confirmed almost complete preservation of graft viability on the 3rd day of culturing (97.7 % of live cells). The data of this study confirm the presence of the osteogenic, osteoinductive, and osteoconductive properties of the bone dust and emphasize the importance of a further study of this-type bone graft for use in surgical interventions.

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

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.

COMPUTER TECHNOLOGIES FOR DETERMINING INDEX ASSESSMENT OF THE DESTRUCTION OF DENTAL HARD TISSUES

The aim of the study was to compare the obtained data of hard dental tissues destruction indices with the corresponding indications for the choice of the method of treatment by means of mathematical analysis. Materials & methods. 120 patients aged 20 to 55 were examined and 358 teeth hard tissue defects were identified in them. The data of indices was obtained and compared with the indications for orthopedic treatment according two indices in the same clinical situation. Results. The study showed that the indices had different meanings and different indications for treatment in the same situations. Such discrepancies in indications for treatment indicate the subjective data of one of the indices, which does not take into account the depth of destruction and the volume of the remaining natural tissue of the teeth. Comparison of these indices showed different figures in the same clinical situation, identifying corresponding incorrect indications for the choice of the design of the first investigated index, as well as more accurate data of the proposed index. Conclusion. The index assessment of hard dental tissues destruction serves as the main guideline for the dentist when choosing a method for tooth restoration, and can be calculated using photographs, scans and computer software.

The Use of the Dorsal Metacarpal Artery for Reconstruction of Distal Dorsal Finger Defects: An Anatomic Study and Clinical Experience

Purpose: Dorsal metacarpal artery (DMA) flaps have been used successfully for distal dorsal finger defects. Some studies have reported inconsistent DMA anatomy, and there have been no studies on the anatomic variation of DMAs in Asian cadavers. Therefore, we evaluated the anatomy of DMA using Korean fresh cadavers and reported the clinical outcomes of the DMA flaps.Methods: In the cadaver study, four human forearms from adult fresh cadavers were dissected. The dorsal metacarpal arteries and their communicating branches were identified. From July 2016 to June 2019, five patients with dorsal finger defects underwent a first DMA (FDMA) flap or a reversed DMA (RDMA) flap.Results: In our cadaver study, the ulnar branch of the FDMA and the second and third DMAs were absent in two of four (50%) of the cadavers. In our case series, five flaps survived, and one had partial necrosis, which healed by the second intention. The mean operation time was approximately 100 minutes, and the mean outpatient follow-up period was 6 months.Conclusion: DMA flaps are a reliable flap for the reconstruction of relatively large soft tissue defects of the dorsal finger. However, in our anatomical study, inconsistency of the anatomy of DMAs was identified. Therefore, preoperative Doppler examination is required to evaluate the anatomy of the DMA before considering the use of DMA flaps.

The possibility of using autologous adipose tissue for the stage shin wound closing

Extensive soft tissue defects can be complicated by systemic diseases (trophic ulcers in diabetes mellitus, chronic arterial insufficiency) or the result of trauma (domestic, military, operating, etc.). The current increase in the incidence of this pathology is due to the spread of cardiovascular diseases and diabetes mellitus. Closing an infected long-term non-healing wound, such as a tendon or bone, is one of the most difficult tasks of reconstructive surgery. For example, the use of classical methods of closing wound conditions is difficult to a degree due to the patient's polymorbid background. The clinical case presented in the article shows the possibility of closing deep shin wound with a complex relief by the transplantation of autologous adipose tissue, a patient with severe concomitant pathology.