A combined graft consisting of a free full-thickness skin flap and cultured autologous fibroblast-like bone marrow mesenchymal stem cells was effectively implanted and healed on the facial soft tissue defect after removal of a pathological vascular conglomeration in a female patient with congenital arteriovenous macrofistulous dysplasia. In order to reduce bloodflow intensity and arteriovenous shunting, repeated endovascular occlusion and transcutaneous ligature of regional vessels from the carotid artery basin feeding the pathological zone was carried out followed by resection of this tumor-like vascular formation.

BACKGROUND: Parry Romberg syndrome or progressive hemifacial atrophy is a rare disease that is usually unilateral with soft and hard tissue atrophy. Surgical treatment is conducted in different ways and only with pronounced cosmetic and functional defects. Currently, no randomized trials and clinical recommendations are reported on the choice of surgical methods of Parry Romberg syndrome intervention. AIM: This study aimed to evaluate the effectiveness of the microsurgical method for correcting facial cosmetic defects in Parry Romberg syndrome. CASE REPORT: Clinical signs of Parry Romberg syndrome appeared in a boy from the age of 11 years. The ongoing conservative treatment could not prevent the progression of atrophy of the right half of the face. At 16 years old, he underwent a microsurgical operation, the technique of which was as follows: a graft of the greater omentum on a vascular pedicle was laparoscopically taken from the abdominal cavity and placed in a prepared bed under the right cheek skin with an anastomosis formation of the temporal artery. The postoperative period was without complications. At the age of 2 and 4 years, small defects were eliminated by 2 ml lipofilling. The vascularized flap had a positive effect on the trophism of the surrounding tissues, and skin elasticity and color were completely restored. Currently, 9 years after the operation, the cosmetic results are good, and the patient does not experience psychological discomfort. Herein, presented the data of computed tomography, patient photographs, and operation stages. CONCLUSION: The presented clinical case of a microsurgical operation by autotransplantation of the greater omentum in a patient with Parry Romberg syndrome shows the effectiveness of this method, which was confirmed by a 9-year follow-up period.

Treatment results of 83 children, aged 5-15, with primary malignant tumors of long bones are analysed. Efficacy of combined and selective pre- and postoperative chemotherapy are shown. Criteria of conservative treatment subjective and objective evaluation are determined as a factor to perform limb-saving operation. In children over 12 the tumor removal and hip/knee total joint replacement has been carried out simultaneously. Three types of limb-saving operations, i.e. free bone autoplasty, Ganas operation and bone microsurgical autoplasty are described. These operations can be performed in children of any aged group. Adverse reactions and complications are presented. All positions are confirmed by clinical observations.