Search

BACKGROUND: Extensive and deep limb defects remain a difficult problem of reconstructive surgery in children. Free microsurgical flaps are used to resolve this problem. Free flaps can be complex in composition and include muscles and bone parts, which allow replacing large and multicomponent limb defects. The technique is used in patients with posttraumatic deformities, burns, acquired limb deformities, and congenital deformities of the extremities. AIM: To retrospectively analyze free flaps in children for the replacement of limb defects. MATERIALS AND METHODS: This single-center retrospective study analyzed 120 cases of microsurgical autotransplantation of free flaps to replace defects of the upper and lower extremities in children. The patients were children aged 117 years who had injuries and burns, acquired limb deformities, and congenital limb deformities. RESULTS: The average age of the patients was 9.5 years, and 72% of the patients were boys. Moreover, 95% of the children had posttraumatic deformities, burns, and acquired pathologies. Free latissimus dorsi flaps were used in 70% of the patients. The recipient area was the upper limb in 53% of the cases. The survival rate of free flaps was 96%. The general surgical complications were inflammation, pneumothorax, deformities, and specific vascular thrombosis. CONCLUSIONS: Replacement of extensive limb defects with free flaps remains a practical method in children.

BACKGROUND: The shortening of the forearm in children with congenital radial clubhand and multi-plane deformity of the ulna is challenging to treat by surgery. The literature shows single studies using the Ortho-SUV frame for the correction of forearm deformity in multiple exostosis chondrodysplasia and patients with posttraumatic deformities. CLINICAL CASE: A 17-year-old patient with congenital radial clubhand who had a relapse of hand deviation undergo correction of forearm deformity. The elimination of radial hand deviation and ulnar deformity correction in the distal part with subsequent elongation were performed. DISCUSSION: No data on the use of the Ortho-SUV frame for the correction of ulnar multiplanar deformity in radial clubhand are available. Indicators, i.e., fixation index, osteosynthesis index, lengthening, and complications, were compared with the indicators used for ulnar elongation with a small angle of radial deviation of the hand. CONCLUSIONS: Personalized plan of forearm deformity correction based on the anatomical features of the congenital radial clubhand and X-ray indicators allowed achieving good cosmetic and functional results.

Background. Applications of traditional treatment methods in children with congenital and acquired pathology of the musculoskeletal system are often limited, as wound defects of significant area and depth with a soft tissue and bone deficit may occur during the reconstruction of the segment. Microsurgical techniques, including autotransplantation of blood-supplied tissue complexes, make it possible to realize the aims of musculoskeletal segment reconstruction and reduce surgical treatment time. Aim. This study aimed to perform a retrospective (statistical) analysis of using microsurgical autotransplantation of tissue complexes in children. Materials and methods. Treatment outcomes of 871 patients with congenital and development deformities of the musculoskeletal system who underwent 1048 microsurgical autotransplantations of various tissue complexes in 19842018 were analyzed. Complications associated with impaired blood supply to transplanted autografts, requiring revision microsurgical interventions, were also statistically processed. Results. The mean patient age was 5.8 years (range, 10 months to 17 years). In children with congenital pathology (n = 597), transplantation of blood-supplied tissue complexes in 85.9% of the cases was performed in cases with hand deformities. In 285 cases of acquired deformities, post-traumatic finger stumps accounted for 45.5%, scar changes of soft tissues for 39.6%, and other pathological conditions for 14.9%. Most of the microsurgical operations were toe-to-hand transfers, which accounted for 81.8% of the total number of surgeries. In 79.4% of the cases, the second toe was used for the toe-to-hand transfer. Accordingly, the remaining toes were transferred in 20.6% of the cases. When replacing soft tissue defects, a thoracodorsal flap was used in 84 cases, which was 5.6% (of the total number of autotransplantations), and a groin flap was used in 22 patients. To replace bone defects, a blood-supplied fibula graft was used in 47 patients and a metatarsal bone graft in 41 children. Circulatory disorders in the postoperative period were noted in 5.9% of the total operations, which in 3.1% of cases resulted in the necrosis of the transplanted autograft. Conclusion. The treatment outcomes of using microsurgical autotransplantation of blood-supplied tissue complexes in the reconstruction of tissues and segments of the musculoskeletal system confirm their high efficacy.

Background. Congenital radial club hand is characterized by the radial deviation of the hand, the longitudinal underdevelopment of the forearm, and the dysfunction of the upper limb. The shortening of the ulna is observed in all types of congenital radial club hand. The average shortening of the ulna surgical treatment was 33.3% compared to the intact contralateral side. Aim. This study aimed to evaluate the results of ulna elongation by the method of external fixation, depending on the level of osteotomy, in patients with congenital radial club hand type IIIIV. Materials and methods. The treatment results of 36 patients with congenital radial club hand type IIIIV from 1998 to 2018 were analyzed. The average age of the patients was 7.4 years 3.5 years. The patients were divided into three groups, depending on the level of ulnar osteotomy. Shortening of the ulna, correction of the angle of deformity of the ulna, radial deviation of the hand, period of correction, elongation obtained, index of fixation and osteosynthesis, and associated complications were analyzed. Results. The observation period was an average of 5.8 years. Before surgical treatment, the ulna was 33.3% shorter, while after surgery, it was 16%. Before surgery, the angle of deformation was 20.5 14.8, while after surgery, it was 7.4 5.6; this gives an angle of deformity correction of 63.9%. The elongation of the ulna was 3.2 1.1 cm. In patients who underwent proximal osteotomy, the resulting elongation was 32% and 18.4% more, respectively, than in patients who underwent an osteotomy in the middle and distal sections of the ulna. In group 1, the correction period was 24.4% and 28.9% more than in groups 2 and 3, respectively. The index of fixation in group 1 was 53.6%, which was 45.7% less than in groups 1 and 3. Postoperative complications included a false joint (15%), inflammation (10%), and forearm deformities (7.5%). Conclusions. In patients with congenital radial club hand type IIIIV, the optimal part of an ulna osteotomy is the proximal section. With a hand deviation of more than 20, osteotomy is performed in the distal section with simultaneous correction of the deformity.

Background. Congenital radial club hand (CRCH) is characterized by longitudinal underdevelopment of the forearm and hand on the radial surface. Underdevelopment can range from hypoplasia to aplasia of the radius. More than 50 methods to correct the forearm deformities, depending on the degree of radius underdevelopment, have been proposed. Aim. We evaluated the results of CRCH treatment using microsurgical technique and external fixation. Methods. We analyzed 16 patients (age, 4.6 0.9 years) with CRCH type II, according to the classification of Bayne and Klug, treated between 1994 and 2017. The patients were divided into two groups: Group 1 were patients undergoing microsurgical autotransplants of the epimetaphyseal second metatarsal bone with growth plate to the position of the radius defect and group 2 were patients treated by lengthening of the radius with external fixation. We analyzed the types of deformities, size of the radius defects, and range of motion in upper limb joints before the stage of the lengthening. External fixation index and number of complications also were determined. The type and number of recurrent deformities and timing of their detection were analyzed. Results. The observation period ranged from 12 months to 10 years (average, 3.8 years). In group 1, good results were obtained in 62.5% of cases. After transplantation of the metatarsal bone growth plate, the work of the growth plate continued, characterized by increasing radius length in the later observation period. In group 2, good results were obtained in 50% of cases. Clinical and X-ray examinations showed recurrent hand deviation and radius shortening, which required repeated radius lengthening. Conclusion. Microsurgical transplantation of the second metatarsal bone with growth plate is accepted more in reconstruction of the radial bone in patients with CRCH type II due to creation of a growth zone in the distal part of the radius. Radius lengthening via external fixation is applicable while maintaining the distal epimetaphysis and normal transverse dimensions of the radial bone.

Introduction. In 1733, Petit first described the deformation of the forearm, congenital radial clubhand. A large number of modifications in the surgical treatment of this deformation have been developed. In the available literature, there is no comparative analysis of the applied designs of the sections. Aim. The goal is a comparative analysis of the effectiveness of the use of dorsal rotation flap by Evans, and incision designs by Bayne, in the correction of congenital radial clubhand in children. Material and methods. Between 2013 and 2016, block randomization of 40 children with congenital radial clubhand was used and grouped by procedures. Surgical correction was performed using two different incision designs (the first group by Bayne and the second by Evans). The analysis of the early postoperative complications was performed. The evaluation in the late postoperative period of soft tissue condition of the forearm using a pinch test, Vancouver scale, and a visual analog scale was carried out. Results. Based upon gender, patients were divided with male predominance in both groups with 7 girls and 13 boys in the first group, and 8 girls and 12 boys in the second group. In the immediate postoperative period, marginal necrosis was observed in the first group (35%). In the late postoperative period, the study showed an advantage of using dorsal rotation flap by Evans versus the incision designs by Bayne. Conclusion. Using incision designs by Evans with the formation of a dorsal rotation flap provided a more aesthetic and functional result.

Bone reconstruction is one of the most topical problems of orthopedics and traumatology. According to the literature, search for the best methods and materials for bone grafting is carried out for a long time and is currently ongoing. The development of microsurgery provided new opportunities of bone remodeling, especially in pediatric orthopedics. However, as with any method, the predominance of the positive aspects of this method is accompanied by the existence of flaws. So the question of bone grafting remains relevant and debatable.

Radial club hand is a developmental anomaly of the upper extremity, being characterized as a longitudinal underdevelopment of a forearm and a hand on the radial surface, consisting in a hypo-/ aplazy radial bone and the thumb of various degree of expressiveness. Characteristic symptoms of this developmental anomaly are: shortening and bow-shaped curvature of a forearm, palmar and radial deviation of a hand, underdevelopment of the thumb from its proximal departments and structures, anomaly of development of three-phalanx fingers of a hand (is more often than the 2-4th), violation of a cosmetic condition and functionality of the affected segment. From 2000 for 2012 in FSI SRICO n.a. H.Turner examination and treatment of 23 children with various syndromes at which the radial club hand was revealed are conducted. The main syndromes at which it is revealed radial club hand - Holt-Orama syndrome, TAR- syndrome and VACTERL syndrome. Tactics and techniques of surgical treatment of a radial club hand it various syndromes most often don’t differ from treatment of other types of a radial club hand though demand an individual approach depending on severity and a type of deformation of the upper extremity.