PECULIARITIES OF CHOOSING RECONSTRUCTION METHOD OF DEFECT SOFT TISSUES IN CASE OF LOWER LIMB WOUNDS

Abstract

The aim of the work: to develop an approach for choosing a method of reconstruction of soft tissue defects of the lower extremities due to traumatic injuries of the lower extremities.

Materials and Methods. The results of the treatment of 52 patients who were undergoing inpatient treatment at the Clinical Highly Specialized Surgical Center with Minimally Invasive Technologies of "VRKH named after M. Pirogov" with defects of soft tissues of the lower limbs, received as a result of combat trauma of the limbs for the period of 2022-2024 were analyzed. The causes were explosive trauma with wounds in 47 patients, bullet wounds in 5 patients. Isolated injuries of the limbs were observed in 18 cases (34.62%), in 34 (65.38%) – combined injuries: with organs of the abdominal and thoracic cavity – in 28 (53.84%), and with the head injury – in 3 (5.77 %), damage to the pelvis and organs of the pelvic cavity was observed in 3 patients (5.77%). Depending on the size, volume of soft tissue defects, localization, types of tissue damage and their depth, the patients were divided into four groups.

Results and Discussion. Small and medium defects of the soft tissues of the lower extremities were closed in patients of the first group (18 patients), with their own tissues using dermatotension sutures. When preparing soft tissue defects for their closure, staged repeated (secondary) surgical debridment were performed using physical methods and vacuum therapy. Patients of the second group (15) with large and extensive, but shallow, soft tissue defects underwent autodermoplasty with a free split flap according to the Thirsch method. In three, or 5.77 %, cases, partial necrosis of the autodermal graft was observed. In the third group of patients (14 patients total) with large and extensive deep defects of the soft tissues of the lower limbs below the level of the deep fascia, different types of complex flap plastic surgery were used after their appropriate preparation. In 10 patients plastic surgery was performed using sliding flaps (V and Y-plasty), in 2 patients - transposition (Z-plasty) and in other 2 patients - rotational (propeller plastic). In 2, or 3.85 %, cases, ischemic marginal necrosis was observed in the postoperative period after V-shaped plastic surgery. Patients of the fourth group (5) with large and extensive defects of the soft tissues of the lower extremities with damage to deeper lying structures required a multidisciplinary approach. After appropriate preparation of the defect for closure, 5 reconstructions were performed with rotary "propeller" flaps on the vascular pedicle. In the postoperative period, one case (1.92%) of marginal necrosis due to ischemia of the autodermal graft was observed.

Thus, the proposed approach with the distribution of patients into groups depending on the size of defects, their depth, types of tissue damage allows to optimize the choice of the method for their closure and obtain satisfactory treatment results in 88.46 % of patients.