Year 2013 Vol. 21 No 5




Avicenna Tajik State Medical University, Dushanbe
The Republic of Tajikistan

Objectives. To analyze the experience of restoration of the loss of hand muscle function in patients with severe outcomes of the upper limb traumas who have undergone free muscle transplantation.
Methods. In the Tajikistan Republican Scientific Center of the cardiovascular surgery the muscular grafts were transplanted on the upper limb in 61 patients with sever outcomes of the upper limb trauma. Prior surgeries such as interventions on the vessels of the forearm, reconstruction and neurolysis of the nervous trunks, arthrodesis of the wrist joint and opponentodesis of the thumb have been performed in patients before the transplantation of complex tissues. Plastic surgery was carried out 6 months after orthopedic and neurologic preparation of the limb. Musculus latissimus dorsi flap was used in 42 cases, musculus latissimus dorsi flap with the fascia of the serratus anterior muscle flap in 16 and soft thigh muscle flap in 3 ones. The long-term results from 4 months of 10 yeans of the flap transplantation have been studied in 32 patients.
Results. In the recent postoperative period the blood circulation disturbance of the tissue complex developed in 7 operated patients. Necrosis of the muscular transplants occurred in 3 cases (5%). Starting from the 4th month the first voluntary contractions of the transplanted muscular grafts have appeared; maximal regeneration continued within one year and further. In 16 patients in saving the function of own hand muscles except restoration of the cylindrical and spherical grip some fine movements of affected fingers became possible. In studying the degree and force of contraction of transplanted muscular graft it was found out that the force of the flap contraction of the musculus latissimus dorsi in complex with serratus muscle was much more effective in comparison with the other tissue complexes.
Conclusions. Severe outcomes of the upper limb traumas demand on the application of the multi-step complex reconstructions. At present free microsurgical transplantation of the muscular grafts is considered to be the better alternative in case of loss of the upper limb function.

Keywords: upper limb, trauma outcome, restorative surgery, muscular grafts, Volkmanns contracture, thoracodorsal flap
p. 111 - 116 of the original issue
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Address for correspondence:
734003, Respublika Tadzhikistan, g. Dushanbe, ulitsa Sanoi, d. 33. Respublikanskii nauchnyi tsentr serdechno-sosudistoi khirurgii Ministerstva zdravookhraneniia Respubliki Tadzhikistan, otdelenie rekonstruktivnoi i plasticheskoi mikrokhirurgii,
Malikov Mirzobadal Khalifaevich
Information about the authors:
Malikov M.H. PhD, an associate professor of the chair of surgical diseases 2 of Avicenna Tajik State Medical University, a microsurgeon of the chair of plastic and reconstructive microsurgery of the Republican Scientific Center for Cardiovascular Surgery .
Kurbanov U.A. MD, director of Avicenna Tajik State Medical University.
Davlatov A.A. PhD, a head of the department of plastic and reconstructive microsurgery of the Republican scientific center for cardiovascular surgery
Khvan I.N. PhD, an associate professor of the chair of surgical diseases 2 of Avicenna Tajik State Medical University.
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