CORRECTION OF SOFT-TISSUE DEFECTS AND CONSEQUENCES OF NEUROVASCULAR BUNDLES DAMAGE OF THE UPPER EXTREMITIES

Abstract

Objective: Improving the results of the post-traumatic soft tissue defects and the consequences of damage of the neurovascular bundles of the upper limbs (CDNBUL), determining the sequence of repairing damaged structures. Methods: The results of various surgical interventions in 60 patients with soft tissue defects and CDNBUL were analyzed. Causes of soft tissue defects and CDNBUL were: severe degree Volkmann’s contracture (24), complications of various wounds of the forearm and hand (19), the consequences of damage to electric machines (8), electrical injury (5) and gunshot wounds (4). Concomitant damage was noted to 52 arteries, intersection 32 and compression of 16 nerve trunks; the area of defects varied from 80 cm2 to 95.47 cm2. Results: An important criterion in the treatment of this category of patients is the determination of the stages of the operation. Depending on the duration of the injury and the nature of the damage, as well as the functional significance of the hand, in some cases skin and fascial (33) were used, in others – skin and muscle (24), and also avascular grafts (3). The nature of operations on damaged underlying structures also depended on the type of lesion. If the indications for the restoration of damaged nerve trunks were absolute in all cases (neurolysis – 8, epineural suture – 9, autonervous plasty – 10), then during restoration of vessels, indications for reconstruction were narrowed (reconstruction of arteries – 28, arteriolysis – 4). The final rehabilitation of victims in some cases was achieved by corrective operations on the hand itself. Conclusion: Achieving final functional results for soft tissue defects and CNDBUL requires the application of a number of complex reconstructive interventions.

Keywords

• soft-tissue defects of the upper limb
• transplants
• volkmann’s contracture
• neurovascular bundle.