TWO-STAGED HAND REVASCULARISATION PLASTY TECHNIQUE FOLLOWING TOTAL LOSS OF HAND AND FINGERS SKIN

摘要

FIELD: medicine; surgery.;SUBSTANCE: two-staged hand revascularisation plasty following total loss of hand and fingers skin involves temporary pedicle flap grafting on defect of soft tissues, flap fixation and excision 30-40 days later. The flap is made of a pedicle omentum and meshed split-skin grafts. The omentum is delivered from hypochondrium opposite to a hand thereby to ensure wrapping thereof. After the hand is wrapped with the omentum, its pedicle is delivered thereon closest possible to radial artery of forearm or its branch within anatomic snuffbox. The omentum is fixed in avascular regions to hand, fingers and forearm tissues with thin Capron. The split-skin grafts to be meshed and laid on the omentum are taken in. Then they along with the omentum are made up to hand, fingers and forearm tissues in avascular regions. A limb is fixed by disciplinary suturing to anterior abdominal wall and immobilised with soft cloth bandage preventing intention of the omentum pedicle. Then the limb is immobilised with Smirnov-Weinstein's plaster bandage; while dressing the wound, sterile Vaseline bandage is applied. Two weeks later, to train the graft, its pedicle is compressed at first for 1 minute 3 times a day, with gradually increasing the compression time to 15-17 minutes 6-7 times a day. Six weeks later, hand vessels with compressed and noncompressed pedicle are examined with Doppler ultrasonography to detect those of donor zone and of the omentum to be marked with cutting off the omentum pedicle. The vessels in temporary pedicle of anterior abdominal wall are tied up, and heparin filling is sealed into the pedicle vessels and clipped. Anterior abdominal wall are cut down in layers. The pedicle artery earlier marked as a donor one is inserted in radial artery or its branch in anatomic snuffbox.;EFFECT: preservation of arterial blood flow herewith providing better feeding, reducing time the limb is immobilised to the body.;2 ex, 3 dwg