Diagnosis of microcirculation disorders when transplanting complex flaps in injured with blast trauma

The efficiency of diagnosis of microcirculation disorders via laser Doppler flowmetry was assessed when transplanting perfused grafts with temporary pedicles in injured after methane-coal mixture explosions. In the Donetsk burn center, laser Doppler flowmetry was used to study flap microcirculation in 10 patients. Surgical interventions: plasty of hand defects using inguinal flaps - 3 injured, hand plasty with skin-fat flap of the anterior abdominal wall - 3 patients, shin defect plasty with rotary muscle flap of the gastrocnemius muscle - 2 patients, skin-fascial shin flap - 2 patients. In 4 cases microcirculation parameters were decreased. Additional immobilization reduced the bend of the vascular pedicle and improved perfusion back to normal. In two cases (rotary flap of the gastrocnemius muscle), areas without perfusion were revealed after 48 hours; timely correction of the flap prevented necrotic complications. When deciding on timing of cutting off a supply pedicle in one case with inguinal flap and in two cases with skin-fat abdominal flaps, the second phase of plasty was delayed until normal values of microcirculation during three-hour flap workouts. Thus, the laser Doppler flowmetry is an effective method for non-invasive evaluation of the microcirculation in flaps with supply pedicles in the postoperative period, making it possible to identify accurately the early stages of vascular disorders and to plan correctly cutting off graft supply pedicles.

чрезвычайная ситуация, взрывная травма, лазерная допплеровская флоуметрия, нарушение микроциркуляции, сложный лоскут, emergency, blast trauma, laser Doppler flowmetry, microcirculatory disorder, composite flap

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