For the Medical Practitioners
doi: 10.25005/2074-0581-2021-23-3-450-461
THE OUTCOMES OF THE FOREARM FLAP APPLICATIONS IN THE UPPER LIMB SEVERE INJURIES RECONSTRUCTION

G.D. Karim-Zade1, M.Kh. Malikov1, B.A. Odinaev1, M.A. Khasanov1, N.M. Mirzoev1, N.A. Makhmadkulova2

1Department of Surgical Diseases № 2 named after Academician N.U. Usmanov, Avicenna Tajik State Medical University, Dushanbe, Republic of Tajikistan
2Department of Operative Surgery and Topographic Anatomy, Avicenna Tajik State Medical University, Dushanbe, Republic of Tajikistan

Objective: Improving the outcomes of surgical treatment of upper limb (UL) injuries by using regional soft tissue flaps.

Methods: The analysis of surgical interventions outcomes of integumentary tissue defects and forearm and hand structures of traumatic genesis was conducted in 37 patients. Traumatic injuries to the forearm and hand structures with soft tissue defects occurred in 11 patients, and 26 trauma patients were hospitalized. The patients had superficial soft tissue defects (STDs) involving various areas, accompanied by damage to the underlying neurovascular bundles (NVBs), tendons and bones.

Results: Depending on the nature of trauma and the injured tissues’ state, the reconstruction sequence’s principle was followed. In 32 (86.5%) cases, the restoration of functional skin integument and reconstruction of injured anatomical structures of the limb were performed in a single stage. Twostage reconstruction was carried out in 5 (13.5%) patients, with initial STDs repair followed by reconstruction of the NVBs and tendons. Selection criteria for a sequence of surgical repair included the nature of the injury and the severity of the patient’s condition in emergencies. The following grafts were used: RFFF: radial forearm free flap (n=3); RRF: the reverse radial forearm flap (n=25); the ulnar reverse forearm flap (n=6), PIA: posterior interosseous artery flap (n=3). In the immediate postoperative period, compromised blood circulation in the transplanted flaps were observed in 2 (5.4%) cases. Timely diagnosis and treatment resulted in a positive outcome. Long-term functional and aesthetic outcomes of the reconstruction were considered acceptable in all patients.

Conclusion: A proper surgical procedure selection for UL structures injuries and their consequences influences long term postoperative aesthetic and functional outcomes. Choice of single or multiple stages of reconstruction largely depends on the location of the defect, the state of the tissues in the recipient area and the nature of the injury to the underlying anatomical structures of the limb.

Keywords: Upper limb, injuries and their consequences, soft-tissue defect, flaps.

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Authors' information:

Karim-Zade Gulandom Dzhangovarovna
Candidate of Medical Sciences, Assistant of the Department of Surgical Diseases № 2 named after Academician N.U. Usmanov, Avicenna Tajik State Medical University
ORCID ID: 0000-0003-0845-3197
E-mail: gulandom71@mail.ru

Malikov Mirzobadal Khalifaevich
Doctor of Medical Sciences, Associate Professor, Head of the Department of Surgical Diseases № 2 named after Academician N.U. Usmanov, Avicenna Tajik State Medical University
ORCID ID: 0000-0002-7816-5521
E-mail: mmirzobadal@mail.ru

Odinaev Bakhodur Avezovich
PhD Student of the Department of Surgical Diseases № 2 named after Academician N.U. Usmanov, Avicenna Tajik State Medical University
ORCID ID: 000-0002-9613-2467
E-mail: medicodinaev@mail.ru

Khasanov Makhmadsharif Abdusattorovich
Postgraduate Student of the Department of Surgical Diseases № 2 named after Academician N.U. Usmanov, Avicenna Tajik State Medical University
ORCID ID: 0000-0001-6694-3173
SPIN: 2109-5394
E-mail: doc3292@mail.ru

Mirzoev Nabijon Mirzoevich
PhD Student of the Department of Surgical Diseases № 2 named after Academician N.U. Usmanov, Avicenna Tajik State Medical University
ORCID ID: 0000-0002-2840-3472
E-mail: mirzovnabijon@mail.ru

Makhmadkulova Nigora Akhtamovna
Candidate of Medical Sciences, Assistant of the Department of Topographic Anatomy and Operative Surgery, Avicenna Tajik State Medical University
ORCID ID: 0000-0002-4269-6611
E-mail: malikovanigora@mail.ru

Information about support in the form of grants, equipment, medications

The authors did not receive financial support from companies manufacturing medications and medical equipment

Conflicts of interest: No conflict

Address for correspondence:

Karim-Zade Gulandom Dzhangovarovna
Candidate of Medical Sciences, Assistant of the Department of Surgical Diseases № 2 named after Academician N.U. Usmanov, Avicenna Tajik State Medical University

734003, Republic of Tajikistan, Dushanbe, Rudaki Ave., 139

Tel.: +992 (918) 808766

E-mail: gulandom71@mail.ru

Materials on the topic:
  1. CHALLENGES IN THE DIAGNOSTICS AND TREATMENT OF DUODENUM INJURIES IN CHILDREN
  2. DELAYED RECONSTRUCTIVE SURGERY FOR SEVERE HAND INJURIES
  3. SURGICAL MANAGEMENT OF POST-BURN SCAR EXTENSION CONTRACTURES OF THE TOES
  4. GIANT FRONTOETHMOIDAL OSTEOMAS: A RATIONAL APPROACH TO THE SURGICAL REMOVAL AND THE IMMEDIATE RECONSTRUCTION OF THE ANTERIOR WALL OF THE FRONTAL SINUS
  5. THE LATISSIMUS DORSI MUSCLE FLAP TRANSFER IN SURGICAL CORRECTION OF POST-TRAUMATIC UPPER LIMB DYSFUNCTION
  6. NERVE TRANSFER IN IRREVERSIBLE INJURIES OF UPPER LIMB NERVE: CURRENT KNOWLEDGE AND FUTURE PERSPECTIVE
  7. SURGICAL REPAIR OF LATERAL AND ANTEROLATERAL HERNIAS OF THE ABDOMINAL WALL
  8. RESULTS OF LAPAROSCOPIC AND CONVENTIONAL HERNIOPLASTY IN OLDER PATIENTS AND MORPHOLOGICAL CHANGES IN THE TISSUES OF THE INGUINAL CANAL
  9. IMMEDIATE RESULTS OF URETROPLASTY IN DIFFERENT FORMS OF HYPOSPADIAS
  10. ANALYSIS OF THE EFFICIENCY OF APPLICATION OF THE TWO SURGERY METHODS OF TREATMENT OF THE URETHRAL INJURY CONSEQUENCES

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