Background:During military operations, one aspect of a plastic surgeon’s work is to restore extensive and deep wound defects in a short period of time and provide a high degree of functional recovery to the damaged area. Because many injuries caused by military operations cannot be closed using a primary suture, the specialist has to select another surgical approach to close the wound defect. Surgeons must select methods that not only cover the extensive wound defect in 1 step but also allow skin coverage that is anatomically, functionally, and visually similar to the surrounding tissues to reduce the length of the hospital stay and ensure optimal functional recovery of the damaged organ.Methods:From 2014 to 2015, 25 patients underwent 36 reconstructions at our center after receiving mine-shrapnel and gunshot wounds. All reconstructions occurred during the acute period and used keystone island perforator flaps. The authors’ wound management technique was characterized by an aggressive surgical and antibiotic therapy protocol.Results:In all cases, after surgical debridement, the mine-shrapnel and gunshot wound defects were completely closed in 1 stage during the acute period. The working time in the operating room to perform the transposition of the flap ranged from 45 to 90 minutes, with an average of 68 minutes. All displaced flaps were similar in structure and color to the surrounding tissues and did not change the contours of the body. The adequate restoration of skin allowed patients to begin early recovery of functional activity.Conclusions:Local keystone island perforator flaps can be considered one of the primary methods of plastic closure of extensive defects caused by mine-shrapnel and gunshot wounds at different anatomical locations, providing that the tissue surrounding the defect is intact and usable as a donor resource.

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Introduction: In practice worldwide, there are experiences affecting different body functions via central control mechanisms with the help of psychotherapy methods. In plastic and reconstructive surgery, there is the experience of applying hypnosis, with the main goal of eliminating pain. The aim of this research is to study the impact of hypnosis on the perfusion level in perforator flaps in the early postoperative period, which could enhance flap survival. Patients and Methods: For studying the impact of hypnosis on blood circulation in perforator flaps, the analysis of a 18 cases has been conducted. All patients had hypnosis sessions on the second day after the reconstruction, and some had additional sessions on the third and fifth days. In the state of trance, the patient was given specially organized instructions aimed at improvement of perforator flap perfusion. Monitoring of microcirculation in the flap during hypnosis sessions was carried out using a Moor VMS-LDF1 Laser Doppler Perfusion and Temperature Monitor. Results: When applying hypnosis, the vast majority of patients had significant increases in perfusion as well as flap surface temperature rise. Most of the patients had significant increases in perfusion during the second part of the hypnosis session in synchrony with hypnosis instruction translation aimed at increasing perfusion. Conclusions: The results of our research cannot be distributed widely in medical practice, but, despite that, they illustrate the central nervous system influence on perforator flap perfusion. Including hypnosis in a medical protocol can contribute to increasing the effectiveness of flap surgery.

The aim — to increase the efficiency of the defect’s reconstruction of the hand cover tissues considering the functional and aesthetic aspects.Materials and methods. 12 patients with soft tissue defects of the hand were undergoing a surgery with the flap on the first dorsal metacarpal artery and its modification during the period from 2015 to 2018. To assess the effectiveness of treatment, the level of complications and the level of aesthetic and functional state of the hand in 6 months after treatment, the questionnaire «Assessing the level of daily life and quality of life of patients with the injured hand» were used.Results and discussion. The treatment helped to restore the anatomical integrity and function of the hand. According to the questionnaire, the level of everyday life and quality of life of patients with hand disorders in 6 months after treatment was from 23 to 27 points (median — 26.0 ± 1.3 points, which corresponds to a high level of satisfaction with the treatment result.Conclusions. One­stage reconstruction of the soft tissue defects of the hand with the first dorsal metacarpal artery flap plasty allows to increase the efficiency of surgical treatment (provides for the initial closure of the soft tissue defect and the early restoration of the hand function, as well as the restoration of the lost skin without the contours of the hand distortion and deformation of the donor area) and a high level of satisfaction with the treatment results in patient.