Biomedical subjects
Publications and source records attributed to A E Belousov.
In the early 1980s Japanese surgeons introduced very long free flaps based on two vascular pedicles from the thoracodorsal and groin territories. Such flaps, vascularized through two pedicles, may be called megaflaps. One or both bundles may be anastomosed as necessary to vascularize the flap. Anatomical studies and clinical experience point to new donor sites for such megaflaps.
Advances during the last 15 years in microsurgical technique and in our understanding of vascular anatomy have led to the development of two new branches of plastic and reconstructive surgery. The first is the transfer of free composite flaps with microvascular anastomoses. The second is transposition of island flaps solely on a proximal or distal vascular bundle. Both types of operations require an adequate vascular pedicle to provide sufficient blood circulation for flap viability and survival in the recipient site.
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The article describes data of clinical use and experimental studies of possibilities to preserve vital ability of fascio-cutaneous flaps with a through venous blood flow. Factors influencing the survival of the venous flap are studied and the possibility to increase vital ability of the flap with the through venous blood flow with the help of pharmacological drugs is noted.
Based upon results of the complex topographical anatomical research fulfilled on 68 upper extremities the forearm area is considered as a single donor zone for the formation of composite cutaneous flaps on the vascular pedicle good for both microsurgical autotransplantation and replacement in the form of islands on the proximal and distal vascular pedicles. Individual differences in the structure and topography of vascular-nervous formations of the forearm are presented as well as a rational technique of the formation of tissue flaps developed with special reference to them.
Under analysis was an experience with microsurgical autotransplantation of tendino-cutaneous complexes from the back of the foot, forearm, lateral surface of the femur as well as plasty with not-blood-supplied tendinous transplants associated with free transplantation of composite skin flaps performed in 21 patients with mechanical traumas and deep burns. The criteria of choice of the optimum variant of reconstructive operations are described for patients with defects of the skin and tendons.
Based upon results of topographo-anatomical research and personal experiences with transplantation of 91 tissue complexes on radial vascular bundle the authors made an attempt to systematize the available data concerning this source of tissues. The substantiation of using the tissue complexes consisting of several fascio-cutaneous (fascio-cutaneous and muscular) flaps at different levels of the vascular pedicle as well as superlong deltoid-radial flap on two vascular pedicles are first given.
The authors propose their classification of blood supply of investing tissues (skin, subcutaneous fat) depending on the structure and arrangement of the vessels approaching the skin at the place of cutting the flap. A possibility to replace the skin flap or that of other tissues is taken into consideration in correspondence with the plan of plastic operation.
Based on an experience with 120 composite flaps including the muscle and with special account of literature data the author describes a new classification of types of blood supply of muscles. The author proposes 6 types of blood supply of muscles and substantiates a direct relationship between the anatomy of muscle vessels and variants of its use for plasty. A comparison of the new classification and other classifications was made.
Based on their personal experience of transplantation of 152 free and 367 non-free++ blood-supplied tissue complexes the authors propose to divide them into three main groups in relation to their specific formation and transplantation: mono-, poly- and megacomplexes of tissue (flaps). Distinctions of these three groups of tissue complexes, their general properties as well as indications for their application are discussed.
An experimental investigation in 40 rabbits and 13 dogs has shown that arrest of blood flow in tissues is accompanied by activation of lipid peroxidation processes with reduced activity of the antioxidant system. Tissue anoxia during 4h sharply activates lipid peroxidation processes which is considerably aggravated after early performance of oxygenobarotherapy sessions (1h after revascularization). Relatively late sessions of oxygenobarotherapy (10h after the reestablishment of bloodflow) are not accompanied by activation of lipid peroxidation and decrease of the level of antioxidants of lipid nature, alpha-tocopherol acetate has a marked antioxidation effect and enhances tissue survival after anoxia.
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In chronic experiment performed on 6 dogs, by means of some neurohistological techniques peculiarities of regeneration of nerves have been studied, when their defects are substituted for vascularized and common autoneurotransplants. When the vascularized autoneurotransplants are applied, more favourable conditions are made for the nerve regeneration, than at a free plastisity and amount of regenerated fibers distal to the graft reaches 34-88%, more often making 48-52% of the initial number of fibers in the proximal parts of the nerves in 3 months after the operation. When in the same animals in the contralateral side common autoneurotransplants have been applied, during the same time the amount of fibers regenerated into the peripheral parts of the nerves makes 10-26%, more often 17-20% from the initial level, or in 2-2.5 times less than at substitution of the defects for the vascularized grafts. Absence of an active cellular reaction of the surrounding tissues to the sutural material supramid is used.
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On the basis of topographoanatomical studies and experience with 14 successful operations, the authors suggested several new tissue megacomplexes receiving their blood supply from two vascular pedicles. The possible variants were discussed, and as well the advantages and perspectives of the use of such complexes in surgery of the extremities.
From topographic and anatomical examination of 32 upper limbs the authors proved that an island skin-fascia graft supplied with blood by the septocutaneous branches of the posterior interosseous vascular bundle can be formed on the posterior aspect of the forearm. Such a graft on a peripheral vascular pedicle was transplanted in 6 patients with defects in the integumentary tissues of the hand; it healed completely in 4 cases, peripheral necrosis occurred in 2 cases but did not affect the end result. The use of means of optic magnification and prevention of compression of the vascular pedicle in the postoperative period ensure successful transplantation of the graft.
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An analysis of islet flaps of the forearm used in the performing of complex reconstructive operations on the hand in 37 patients is presented. A substantial shortcoming of transplantation of the radial and elbow flaps is a possible development of disturbance of blood circulation in the hand tissues which can require emergent plasty of the transected artery. In transplantation of the posterior flap of the forearm the blood circulation in the hand tissues was not disturbed.