International Medical Journal, Vol. 20., Iss. 1, 2014, P. 65−69.
IMPROVEMENT OF PRELIMINARY ISCHEMIC PREPARATION OF TISSUES FOR COMPOSITE FLAPS PLASTIC SURGERY OF THE EXTREMITIES
A.I. Meshaninov Kharkiv City Clinical Emergency Hospital
Preparation of tissues for staged flap plastic surgery on the extremities was improved. Delay method promotes creation of alternating ischemia−reperfusion up to 4−5 days after the first stage of the operation, distant training is performed by means of interval interruption of the blood flow in a healthy extremity using a blood pressure cuff applied three times for 10 minutes per session with 2−3−minute intervals. Starting from day 6−7 and to the second stage of surgery, training is performed by means of a systematic cross clamping of vessels in the extremity at Italian plastics −− recipient, at Indian −− the extremity with the isolated flap followed by clamping of vessels in the temporary feeding pedicle of the flap or the tissue bridge at the top of the flap when preparing with delay method. Everyday clamping time is increased by 5 minutes (from 5 to 30 minutes) per each training session. After compensation of the blood flow in the flap, this tissue bridge may be conclusively forced by application of suture. A prognostic test of flap viability based on evaluation of intensity of postischemic hyperemia was suggested. Sufficient blood flow in the tissues is determined with the appearance of homogeneous post−ischemic hyperemia of the flap tissues (including its distant areas) and white spot sign for less then 3 seconds. Insufficient blood flow is determined by absence or decrease in intensity of post−ischemic hyperemia and white spit sign time over 4−5 seconds. This flap viability prognostic test and method of ischemic recipient wound and flap tissues preparation were successfully used in treatment of 8 patients.
Key words: method of ischemic preparation of tissue of recipient injury and flap, prognostic test of viability of skin flap, wounds, extremity revascularization, plastic surgery.