Year 2019 Vol. 27 No 1




I.M. Sechenov First Moscow State Medical University,
The Russian Federation

Objective. Comprehensive analysis of opportunities, technical features and disadvantages of wound plasty with distant pedicled flap closing wound defects of the limbs was performed.
Methods. The study included 14 patients with limb wounds of different origin, who were treated using distant pedicled flaps grafting. Wounds were of different origin (deep frostbites, chronic osteomyelitis, neurotrophic disorders), diverse localization and perimeter. The indication for this type of full-layer plastics was the need to treat the wound in a functionally significant zone and the impossibility of using other, less complex methods of skin grafting.
Results. A positive immediate result of treatment was obtained in all 14 cases of distant flaps grafting. The development of complications (critical bend of the pedicle of the flap, sub-flap hematoma, the flaps edge necrosis) was registered in 3 cases in the early postoperative period, those complications did not significantly affect the immediate outcome of the operation. Long-term outcomes of treatment were evaluated in 8 patients in terms from 1 to 22 years after the operation. The key point determining the long-term treatment outcome was the patients compliance in the conditions of denervation of the flap and closure of wounds in functionally important areas. A flap necrosis in the plantar area occurred in two cases in patients, who did not follow the recommendations. In the remaining observations a stable positive result was obtained.
Conclusions. The distant pedicled flaps grafting is an effective method of reconstruction in functionally important areas under the conditions of limited plastic reserves of the surrounding skin. Denervation of such flaps exposes additional requirements to patients in terms of compliance with recommendations. The success of the operation in the long term period is largely determined by the patients compliance.

Keywords: extensive wounds, skin transplantation, surgical flaps, distant flaps plasty, "Italian plasty"
p. 42-48 of the original issue
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Address for correspondence:
119991, The Russian Federation,
Moscow, Bolshaya Pirogovskaya Str., 2-4,
I.M. Sechenov First Moscow
State Medical University,
General Surgery Department.
Tel. office: +7495 915-39-21,
Tel. mobile: 89031478876,
Elena A. Komarova
Information about the authors:
Lipatov Konstantin V., MD, Professor of General Surgery Department, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation.
Komarova Elena A., PhD, Assistant of General Surgery Department, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation.
Khrupkin Valery I., MD, Professor of General Surgery Department, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation.
Kiryupina Maria A., the 4th-Year Student, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation.
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