Total deep facial burns represent one of the most complex clinical tasks for a surgeon. A child’s quality of life and complexity of subsequent treatment stages depends on effective surgical tactics used during the acute period of a burn trauma. The article describes the use of full-thickness graft preliminarily stretched with an endoexpander when treating deep facial burns in a child with the total burns involving 60% of body surface and thermoinhalation lesion. The surgery was done on the 36th day of staying at the hospital in spite of the patient’s severe condition.

Two-stage repair is a well-developed method that is commonly used to repair chronic ruptures of flexor digitorum profundus tendons. However, its use in pediatric hand surgery is limited due to the absence of tendon implants adapted for children. The article describes a modified Paneva-Holevich/Hunter technique for two-stage tendon reconstruction using original, oval, Lavsan-reinforced silicone prosthetic implants of four sizes (depending on patients' age). The surgery was performed in 34 children aged 1.5-17 years. Long-term outcomes were assessed in 12 patients (8 boys and 4 girls) using the Total Active Motion scale. The follow-up period was 30 months. The average active range of motion accounted for 178.8° in boys and 218.8° in girls. The results of treatment (TAM %) were considered good in all the girls (average score of 84.3 %), and in those boys who received surgery for fingers IV and V (average score of 80.0 %). The boys who received tendon repair for fingers II and III had "good" and "poor" results (average score of 67.0 %). The proposed method of two-stage tendon repair of chronic tendon ruptures in fibro-synovial channels in children was shown to provide good results with minimal complication rates and acceptable donor site deficiency.Двухэтапная тендопластика сухожилий сгибателей пальцев кисти у детей с застарелыми повреждениями в зоне фиброзно-синовиальных каналов Two-stage repair of finger flexor tendons in children with chronic tendon ruptures in fibro-synovial canals Двухэтапная тендопластика -хорошо разработанный метод лечения застарелых повреждений сухожилий глубоких сгибателей пальцев кисти, однако его применение в детской кистевой хирургии ограничивается отсутствием адаптиро-ванных для детей эндопротезов сухожилий. В статье описана модификация метода двухэтапной тендопластики Пане-вой-Холевич и Hunter с использованием оригинальных силиконовых эндопротезов овального сечения, армированных лавсановой лентой, четырех типоразмеров, соответствующих различным возрастным группам. Были прооперированы 34 ребенка в возрасте 1,5-17 лет, у 12 из них (8 мальчиков и 4 девочек) были оценены отдаленные результаты лече-ния по шкале Total Active Motion (срок наблюдения -30 мес.). Средний активный объем движений поврежденного пальца в группе мальчиков составил 178,8°, в группе девочек -218,8°. Хорошие результаты лечения (TAM %) были отмечены у всех девочек (в среднем 84,3 %), а также у мальчиков, которым оперировали IV и V пальцы (в среднем 80,0 %). У мальчиков, которым оперировали II и III пальцы, наблюдали хорошие и плохие результаты (в среднем 67,0 %). Предложенный метод двухэтапной тендопластики при застарелых повреждениях сухожилий в области фиброзно-си-новиальных каналов у детей позволяет достичь хорошего результата с минимальными осложнениями и приемлемым донорским дефицитом.Ключевые слова: двухэтапная тендопластика, сухожильные силиконовые эндопротезы, сухожилия глубоких сгиба-телей пальцев кисти, застарелые повреждения

Objective. Hand injuries in children are quite common. Most challenging within plastic and reconstructive surgery/reconstructive microsurgery expertise were there traumatic hand defect and upper extremities open injuries sequels. There were wide variety of reconstruction techniques to deal with hand defects in general and with distal phalanx defects particularly. The core problem is how to make very choice of reconstructive method and technique from diversity of local, regional and distant flaps. Injuries of distal phalanges are the most common type of hand trauma in children. The problem of coverage of soft tissue defects of distal phalanges remains actual. A lot of methods of coverage of distal phalanges defects are developed. There is no generally accepted approach or an algorithm in the treatment of adults and children with such type of trauma.Material and methods. In the period from 2018 to 2021 at the Microsurgery Department of N.F. Filatov Moscow Clinical Hospital for Children 152 surgical operations using local (68), regional (72) and distant (12) flaps were performed.Results. All flaps in all patients within our clinical series have survived. There were neither major complication no secondary revisional procedures. Used different flaps in general provided transport of adequate viable donor tissues to recipient areas of critical functional significance. The selection of particular flap we have been making on individual basis mostly depending on type and injury severity, and functional requirement and prognosis.Conclusion. We are considering surgeon’s own experience is main defining factor to make selection of certain method from the diversity of different flaps.

BACKGROUND: Injuries of distal phalanges are the most common type of hand trauma in children. The problem of coverage of soft tissue defects of distal phalanges remains. Many methods of coverage of distal phalanges defects have been developed. There is no generally accepted approach or an algorithm in treatment of adults and children with such type of trauma. AIM: This study aimed to reveal the most universal method of coverage of distal phalanges defects in children using various reconstruction methods that are used at the Department of Reconstructive Microsurgery of Filatov State Children Hospital. MATERIALS AND METHODS: From 2019 to 2020, 70 children with defects of distal phalanges were treated. The coverage of defects was performed by using a flap (n = 23), cross-finger flap (n = 5), V-Y advancement flap (n = 28), reverse-flow homodigital island flap (n = 11), and full-thickness skin graft (n = 3). Results of the defect coverage were evaluated by objective (difference between the lengths of the operated and contralateral phalanges, two-point discrimination test, presence/absence of stiffness in the distal interphalangeal joint) and subjective (definition of cold intolerance, Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire) criteria. RESULTS: The largest difference between the lengths of the operated and contralateral phalanges was obtained in V-Y plasty. The two-point discrimination sensitivity was the highest in V-Y plasty and a little less with island flap. Cold intolerance was the most common complication of homodigital island flap. Results of the DASH survey was the best in the homodigital island flap and full-thickness skin graft. CONCLUSION: Based on the analysis of the experience of surgeries to close soft tissue defects of the nail phalanges, the best results were obtained with reverse-flow homodigital island, which is considered as the most versatile and reliable approach.

Objective. Damage to peripheral nerves has a strong impact on the life of patients, as the absence during the care provided can lead to disability. It is important to determine the prognostic factors that affect the outcome of the disease.Material and methods. During the initial selection, 1902 publications (PubMed) and 675 results were found using the Google Scholar database. From the initially identified search results, an analysis of 5 papers was carried out.Results. The total number of patients with peripheral nerve injuries of the upper extremities was 120. The average age of patients is (9.1 ± 1.5) years old. The conducted meta-analysis of the difference in the average values of recovery of motor function of peripheral nerves after surgery showed: the final increase in the recovery rate of motor function, depending on age, was 0.47 (0.08–0.87) %, p < 0.02; the final increase in the recovery rate of motor function, depending on the level of damage, was 0.71 (0.27–1.13) %, p < 0.02.Conclusion. The obtained results showed the prognostic value of such indicators as age at the time of surgery and the level of damage. Thus, we can confidently say that the smaller the age of the child and the more distal the level of damage, the better results can be expected after surgery.