Year 2013 Vol. 21 No 5

EXCHANGE OF EXPERIENCE

M.H. MALIKOV, U.A. KURBANOV, A.A. DAVLATOV, I.N. KHVAN

THE TRANSPLANTATION OF TISSUE COMPLEX IN A CASE OF LOSS OF THE UPPER LIMB MUSCLE FUNCTION

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
References
  1. Milanov NO, Antokhii NI, Trofimov EI, Gainullin PM. Povtornye operatsii po povodu sosudistykh oslozhnenii pri peresadke torakodorsal'nykh loskutov [Repeated surgery of vascular complications in transplantation of thoracodorsal grafts]. Khirurgiia. Zhurn im NI Pirogova.1989;(6):105107.
  2. Trofimov EI, Gurdzhidze TIu, Suvorov NA, Mekhtikhanova GM. Ustranenie defektov i rubtsovykh deformatsii distal'nykh otdelov konechnostei svobodnymi mikrokhirurgicheskimi autotransplantatami [Elimination of defects and scar deformities of the distal parts of the limbs by free microsurgical autografts]. Ann Plast Rekonstrukt i Estet Khirurgii. 2010;(2):6672.
  3. Duymaz A, Karabekmez FE, Keskin M, Tosun Z, Savaci N. The reconstruction of soft tissue defects in the elbow area: a treatment algorithm proposal. Ulus Travma Acil Cerrahi Derg. 2009 Nov;15(6):59198.
  4. Tikhilov RM, Kochish AIu, Rodomanova LA, Kutianov DI, Afanas'ev AO. Vozmozhnosti sovremennykh metodov rekonstruktivno-plasticheskoi khirurgii v lechenii bol'nykh s obshirnymi posttravmaticheskimi defektami tkanei konechnostei [The capabilities of modern methods of reconstructive surgery in the treatment of patients with extensive post-traumatic defects of the extremity tissues]. Travmatol i Ortoped Rossii. 2011;60(2):16470.
  5. Minasov BSh, Valeev MM. Funktsional'nye i esteticheskie rezul'taty zameshcheniia defektov miagkikh tkanei krovosnabzhaemymi loskutami [The functional and aesthetic results of replacement of soft tissue defects by blood supplies flap]. Travmatol i Ortoped Rossii. 2006;(1):3035.
  6. Koudstaal MJ, De Ridder VA, De Lange S, Ulrich C. Pediatric supracondylar humerus fractures: the anterior approach. J Orthop Trauma. 2002 Jul;16(6):40912.
  7. Ulrich D, Fuchs P, Bozkurt A, Pallua N. Free serratus anterior fascia flap for reconstruction of hand and finger defects. Arch Orthop Trauma Surg. 2010 Feb;130(2):21722.
  8. Milanov NO, Eiubov Iu.Sh. Autodermoplastika pri zakrytii defektov donorskoi oblasti posle vziatiia svobodnykh revaskuliariziruemykh autotransplantatov [Autodermoplastics at the closure of the defects of the donor area after the capture of free revascular autografts]. Khirurgiia. 2004;(8):1316.
  9. Mikhailov IA, Iudenich AA, Moroz VIu. Otsenka sostoianiia sosudistoi nozhki pri mikrokhirurgicheskoi tkanevoi autotransplantatsii [Assessment of the vascular pedicle at microsurgical tissue transplantation]. Angiol i Sosud Khirurgiia. 2008;(3)14:11823.
  10. Yan H, Zhang F, Akdemir O, Songcharoen S, Jones NI, Angel M, Brook D. Clinical applications of venous flaps in the reconstruction of hands and fingers. Arch Orthop Trauma Surg. 2011 Jan;131(1):6574.
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,
e-mail: malikovm@yahoo.com,
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.
Contacts | ©Vitebsk State Medical University, 2007-2023