Possibilities of using microsurgical autotransplantation of tissue complexes in children

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Abstract

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 1984–2018 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.

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About the authors

Natalia V. Avdeychik

H. Turner National Medical Research Centre for Children’s Orthopedics and Trauma Surgery

Author for correspondence.
Email: natali_avdeichik@mail.ru
ORCID iD: 0000-0001-7837-4676
SPIN-code: 6059-4464
Scopus Author ID: 57193273547

MD, orthopedic surgeon of the Department of Reconstructive Microsurgery and Hand Surgery

Russian Federation, Saint Petersburg

Sergey I. Golyana

H. Turner National Medical Research Centre for Children’s Orthopedics and Trauma Surgery

Email: ser.golyana@yandex.ru
ORCID iD: 0000-0003-1319-8979

MD, PhD, Scientific Supervisor Department of Reconstructive Microsurgery and Hand Surgery

Russian Federation, Saint Petersburg

Denis Yu. Grankin

H. Turner National Medical Research Centre for Children’s Orthopedics and Trauma Surgery

Email: grankin.md@gmail.com
ORCID iD: 0000-0001-8948-9225

MD, Research Associate of the Department of Reconstructive Microsurgery and Hand Surgery

Russian Federation, Saint Petersburg

Andrey V. Safonov

H. Turner National Medical Research Centre for Children’s Orthopedics and Trauma Surgery

Email: safo125@gmail.com
ORCID iD: 0000-0003-1923-7289

MD, PhD, Chief of the Department of Reconstructive Microsurgery and Hand Surgery

Russian Federation, Saint Petersburg

Tatyana I. Tikhonenko

H. Turner National Medical Research Centre for Children’s Orthopedics and Trauma Surgery

Email: Tikhonenko_turner@mail.ru
ORCID iD: 0000-0002-5379-6028

MD, PhD, Research Associate of the Department of Reconstructive Microsurgery and Hand Surgery

Russian Federation, Saint Petersburg

Natalia S. Galkina

H. Turner National Medical Research Centre for Children’s Orthopedics and Trauma Surgery

Email: galkinadoc@gmail.com
ORCID iD: 0000-0001-9201-7827

MD, orthopedic surgeon of the Department of Reconstructive Microsurgery and Hand Surgery

Russian Federation, Saint Petersburg

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Supplementary files

Supplementary Files
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1. Fig. 1. Use of various tissue complexes as blood-supplied autografts in children

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2. Fig. 2. Microsurgical autotransplantation of the thoracodorsal flap: (a) distribution by diagnosis; (b) variants of the recipient area

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3. Fig. 3. Microsurgical autotransplantation of the thoracodorsal flap with reinnervation of m. latissimus dorsi in the recipient area: (a) distribution by diagnosis; (b) variants of the recipient area

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4. Fig. 4. Microsurgical autotransplantation of the inguinal flap: (a) distribution by diagnosis; (b) variants of the recipient area

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5. Fig. 5. Microsurgical autotransplantation of the metatarsophalangeal and interphalangeal articulations: (a) distribution by diagnosis; (b) variants of the recipient area

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6. Fig. 6. Microsurgical autotransplantation of II metatarsal bone epimetaphysis with growth plate: (a) distribution by diagnosis; (b) variants of the recipient area

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7. Fig. 7. Microsurgical autotransplantation of tibial diaphysis fragment: (a) distribution by diagnosis; (b) variants of the recipient area

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8. Fig. 8. Distribution of patients by diagnosis in microsurgical autotransplantation of toes to the hand

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9. Fig. 9. Distribution of patients according to the used donor area (foot) autografts for transplantation to the hand

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10. Fig. 10. Distribution of patients by variants of fingers restored on the hand

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Copyright (c) 2021 Avdeychik N.V., Golyana S.I., Grankin D.Y., Safonov A.V., Tikhonenko T.I., Galkina N.S.

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