Использование технологий реконструктивно-пластической микрохирургии в системе лечения больных с патологией локтевого сустава

Abstract

Objective: 9 patients with sequela of serious injuries and burns of the shoulder joint region operated in Vreden’s Scientific Research Institute of traumatology and orthopaedics (Saint-Petersburg, Russia) within the period from 2000 to 2011. Methods: 12 microsurgical operations having used 12 flaps were performed. In 10 cases it was pedicled flap transfer, in 2 cases - free tissue transfer. Patients with defects of bones have been additionally fulfilled 4 operations of shoulder arthrodesis and 2 operations of interlocking intramedullary nailing of proximal humerus. The results of treatment were estimated according to modified UCLA end-results score. Results: for reconstruction of isolated scar deformations and defects of skin in the shoulder joint region in 6 cases we used pedicled latissimus dorsi musculocutaneous flaps, in 1 case - pedicled trapezius musculocutaneous flap, and in 1 case - free radial forearm flap. In cases of shoulder arthrodesis we used pedicled latissimus dorsi osseous musculocutaneous flap with a segment of the 8th rib and free vascularized graft of iliac bone in patients with defects of bones. In two patients with circular defects of proximal humerus we fulfilled osteoplasty of the area of contact of fragments with pedicled grafts from the lower corner of scapula. 4 patients with scar contractures of shoulder-joint had excellent results, others had good results. Conclusion: tactics of using microsurgical technologies and choice of flaps in patients with pathology of shoulder-joint region should be specified for every concrete occasion. Microsurgical operations form an important part of the system of surgical treatment and are usually fulfilled simultaneously with other orthopedic operations.