При выполнении реконструктивных оперативных вмешательств у детей, страдающих от обширных послеожо-говых гипертрофических рубцов, главной проблемой является дефицит донорских резервов -неизмененной кожи. Цель: определить возможности использования метода экспандерной дермотензии при получении свободных толсто-расщепленных кожных аутотрансплантатов большой площади. Материалы и методы. Проведен сравнительный анализ лечения 39 детей с обширными послеожоговыми гипертрофическими рубцами. У 16 детей (основная группа) первым этапом выполнена дермотензия донор-ской области для получения толсто-расщепленного кожного трансплантата большой площади (более 100 см²). У 23 детей (контрольная группа) трансплантаты большой площади срезались без предварительной дермотен-зии донорской области. Результаты исследования показали, что при необходимости закрытия раневого изъяна площадью более 100 см² целесообразно выполнять предварительную экспандерную дермотензию донорского места. Эта методи-ка позволяет не только получить резистентный к травме свободной имплантации полноценный пластический материал, но и обеспечивает многократную эксплуатацию донорской области, не нарушая эстетику последней.Ключевые слова: термическая травма, гипертрофические рубцы, рубцовые деформации, экспандерная дермо-тензия. FREE SKIN GRAFTING IN RECONSTRUCTIVE SURGERY OF BURNS IN CHILDREN © K.A. Afonichev, M.S. Nikitin, Ya.N. ProshchenkoThe Turner Scientific and Research Institute for Children's Orthopedics, Saint Petersburg, Russia When performing reconstructive surgery in children suffering from extensive post-burn hypertrophic scars, the main problem is deficiency of donor intact skin. Aim. This study aimed to determine the possibility of using the expander skin balloon expansion method for obtaining free, large area split-thickness skin autografts. Materials and methods. A comparative analysis of treatment for 39 children with extensive post-burn hypertrophic scars was performed. In 16 children (experimental group), balloon skin expansion of a donor site for obtaining large area split-thickness skin grafts (more than 100 cm²) was performed. In 23 children (control group), the large area grafts were cut off without prior balloon skin expansion of the donor site. Results. In cases where it is necessary to close a wound defect over 100 cm², it is advisable to perform prior balloon skin expansion of the donor site. This technique enables attainment of an injury-resistant free implant full grafting material and also provides multiple uses of a donor site without disturbing the esthetics.

Relevance. Treatment of children with post-burn foot deformities is an important task of reconstructive plastic surgery. The scars formed on the back surface of the feet, even with adequate surgical approach, in the acute period of thermal injury, further often lead to deformities of the entire foot, which leads to a derangement of its support function. The importance of the problem lies in the fact that with the growth of the child, secondary abnormal changes develop on the part of the joints of the lower extremities and the spine, leading to impaired locomotor function, including deviations in the body balance control system. Purpose of the study. To study postural stability in children with post-burn foot deformities before and after surgical treatment. Material and methods. The stabilometric study was conducted in 12 patients with post-burn cicatricial foot deformity, the average age of the patients was 9.8 ± 0.93 years old. The control group consisted of 12 children of the same age with no signs of orthopedic abnormality. To assess the results, the methods of descriptive statistics with the inclusion of correlation and regression analysis were used. Results. In patients with post-burn cicatricial deformity of the foot at the pre-treatment stage, a compensatory redistribution of the static load towards the intact lower limb was revealed. Analysis of postural control indicators in patients of the main group showed an abnormal increase in the synchronization of the system of body balance control. After reconstructive operations on the affected foot, symmetry of the distribution of the load and restoration of the support of the limb of the affected side were noted. Correlation analysis revealed a pronounced decrease in abnormal hypersynchronization between stabilometric parameters, which may indicate a trend towards normalization of the postural control strategy in patients after treatment. Conclusion. Elimination of post-burn foot deformity contributed to the restoration of its anatomical shape and was accompanied by pronounced positive dynamics in the state of the system of vertical balance of the patient’s body.

Background. The recurrence rate of adolescent chronic shoulder instability is approximately 56%–68%. However, this pathology is often missed in childhood and adolescence.Aim. To identify the clinical forms of shoulder joint instability in pediatric patients.Materials and methods. The authors present the data from 57 pediatric patients aged 3−17 years with a total of 61 unstable shoulder joints. All patients were divided into groups according to the form of instability. Traumatic chronic shoulder instability was identified in 40 patients (Bankart and Hill–Sachs injuries). Of these, non-traumatic shoulder instability was diagnose in 17, including five with recurrent dislocation, and spontaneous shoulder dislocation due to dysplasia of glenoid and labrum was diagnosed in 12. Of the 57 patients in the study cohort, 53 underwent surgery. Postoperatively, two patients developed recurrent shoulder dislocation (Andreev–Boichev technique) due type III shoulder dysplasia in the first patient and multidirectional injury in the second.Conclusions. Shoulder joint instability should be considered as the traumatic or non-traumatic form. Treatment decisions should be based on anatomical characteristics that predispose to recurrent dislocation.

Background.Shoulder joint injuries and shoulder instability often occur in adolescents.Materials and methods. During a 3-year period, we performed arthroscopic surgery on 42 patients with shoulder joint injuries.Results and discussion. The majority (76.2%) of the patients on whom we performed arthroscopic shoulder joint surgery were male. This is likely due to more aggressive physical activity among males. Most of the patients were injured during exercise (n = 27, 64.3%). Arthroscopy is a highly effective surgical method for the treatment of shoulder joint injuries. Prolonged non-operative treatment with no well-established indications and an incorrect diagnosis can lead to rapid progression of degenerative and dystrophic changes of the shoulder joint and may result in shoulder joint dysfunction.