Цель исследования-изучить эффективность реконструкции пальцев кисти с использованием различных кожно-костных комплексов на питающей ножке при последствиях отморожений кисти. Проведена реконструкция 56 пальцев кисти с использованием различных кожно-костных комплексов на питающей ножке у 33 больных, перенесших холодовую травму, на 40 кистях. Выполнены перемещение культи пальца и пястной кости поврежденной кисти на типичной (10) и дистрагированных (32) постоянных питающих ножках, лучевого кожно-костного комплекса на дистальной питающей ножке (7), пересадка комплексов тканей (культя пальца противоположной кисти, фрагмент второй плюсневой кости, латерального края лопатки с кожным лоскутом, второй палец стопы) на микрососудистой ножке (7). В работе применены клинические, рентгенологические, морфологические, биомеханические, биофизические и статистические методы исследования. Разработаны технологии перемещения лучевого кожно-костного комплекса, а также сегментов кисти после проведения их хирургической тренировки, позволяющие обеспечить профилактику ишемических осложнений и восстановление одного или нескольких пальцев кисти с минимальным донорским изъяном. При наиболее тяжелых дефектах кисти реализовано сочетанное применение различных видов комплексов тканей. Достигнуто приживление комплексов тканей и кожножировых лоскутов во всех случаях. В отдаленные сроки после операции восстановление двухстороннего схвата достигнуто у 97% (28/29) больных на 35 кистях. Тест Вебера на восстановленных пальцах в случае перемещения сегментов кисти составил 5,29±0,78 мм. Эффективность применения различных кожнокостных комплексов была одинаковой (Ртмф=0,25). Рентгенометрически установлено незначительное (3 мм) уменьшение длины перемещенного пястного сегмента (р<0,05) при использовании дистрагированных питающих ножек. В остальных случаях перемещения и пересадки кожно-костных комплексов длина костного трансплантата достоверно не менялась. Проведенное исследование показало целесообразность применения кожно-костных комплексов на питающей ножке для реконструкции пальцев кисти при последствиях холодовой травмы. Ключевые слова: последствия холодовой травмы, культи пальцев кисти, микрохирургия, метод дистракции, пересадка и перемещение кожно-костных трансплантатов, пересадка несвободных кожно-жировых лоскутов.

The aim of the study was to present a clinical and anatomical rationale for transplantation of skin-bone grafts with microvascular anastomoses for treating terminal and segmental defects of the hand and fingers. Materials and Methods. Finger and metacarpal bones were reconstructed in 25 hands of 25 patients by transplanting skin-bone tubular fragments with microvascular anastomoses. Transplants from the second metatarsal bone (n=22) and fibula (n=3) were used. Clinical, radiological, morphological, biomechanical, biophysical, and statistical research methods were used. The developed technology is adjustable to individual vascular anatomy of the foot. The proposed use of non-free skin-fat flaps and skin-bone fragments with microvascular anastomoses has been implemented for reconstructing lost segments. Results. The engraftment of skin-bone fragments was observed in 25 cases. In two cases, partial necrosis of the transplants was detected. Sufficient resistance of the transplanted bone graft to resorption was noted. According to the X-ray evidence, the length of the finger with the metacarpal bone after surgery was 8.44±0.32 cm, in the short term after surgery-8.10±0.36 cm, and in the long term-7.87±0.45 cm, indicating mild resorption. We used an individual approach to the transplant selection, which made it possible to obtain generally good long-term results in 3 patients, and satisfactory results-in 22 patients. Conclusion. The study showed the feasibility of transplanting skin-bone fragments with microvascular anastomoses for replacing various anatomical defects of the hand and fingers. The proposed modification takes into account the variability of vascular anatomy of the donor region.

in frostbite patients. Material and methods Medical histories and long-term results of treatment of two frostbite patients with finger stumps of both hands were reviewed. The triphalangeal finger and the thumb were reconstructed by transplanting the opposable finger stump together with the metacarpophalangeal joint using microvascular and microneural anastomoses. The stumps were mobilized and transplanted to the distal ulnar artery with the venous drainage performed using the dorsal saphenous vein of the hand. Long-term results were examined at 10 years and 2.5 years of surgery. Clinical, radiological, biomechanical and biophysical investigations were produced. Results The bilateral gripping function was restored in recipient stumps without functional damage to the donor stumps. Discriminatory sensitivity of reconstructed fingers was 6mm and 8 mm, the range of active motion in the transplanted joint was 55 and 66 degrees. Discussion Opposable digital stump transplantation with microvascular anastomoses has significant advantages over the classical surgery. The technique allows for one-stage restoration of a finger to have sufficient length, function, adequate blood supply and innervation due to a short digital stump being transplanted with the metacarpophalangeal joint. The advantage over a toe transplant consists of the use of digital structures of the hand that are identical in functionality and the anatomy reducing the need for secondary interventions. Conclusion The method of management can be successfully applied for frostbite patients with hand stumps according to indications.

from the second metatarsal bone on microvascular anastomoses (Patent RF №2534851). The effectiveness of the proposed approach has been assessed in two groups of patients. In the first group the lengthening has been carried out under the traditional method and in the second one it has been performed under the elaborated technique. Improved blood circulation of tissues and the restoration of adequate stump skin due to the use of the developed method has promoted the reducing incidence of complications associated with the insufficient regenerate formation, the delayed consolidation of bone graft and the retraction of distracted soft tissues (P = 0.020). The average lengthening of the main phalanx has been 2.22 ± 0.48 cm and 2.50 ± 0.26 cm of the metacarpal bone. The hand grasp is restored in 95% of the patients who have completed the treatment.