Vol 5, No 3 (2017)

Aim. We aimed to evaluate the possibility of reconstruction of amputated fingers using various methods of hand segment transfer in children.

Materials and methods. A retrospective analysis of the reconstruction of the first and triphalangeal fingers of an injured hand using a segment transfer method in 31 children was performed. Eleven patients had a mechanical injury; 12, a gunshot injury; 7, a burn injury; and 1, a freezing injury. The reconstruction of 32 fingers was performed by the transfer of an intact triphalangeal finger (3), defective finger (3), finger stump (14), and a metacarpal (12). The surgery was performed using traditional (16) and original (16) methods. In 26 cases, skin grafting using donor resources from remote areas was required for segment transfer. Newly developed approaches enable the transfer of the defective finger and any stump of the main finger phalanges and metacarpals, irrespective of their location, amputation level, hand defect character, level of cicatrical changes of the soft tissues, and impaired circulation, while adequately preventing ischemic complications.

Results. Survival of all the transferred segments, including those with total cicatrical tissue changes and vascular disruptions, was achieved. The analysis of results showed that handgrip was restored in 31 hands. The best results were achieved in the transfer of intact fingers. Transfer of the utile segments enabled the reconstruction of the double-sided grip with minimum donor retrieval. Two-point discrimination was 2 mm for finger transfer, 4.5 mm for finger stump, and 6.5–7.4 mm for the metacarpal stump.

Conclusion. The transfer of injured hand segments in children for finger reconstruction provides acceptable functional and anatomical results. This method can be used in combination with other finger reconstruction methods. Advanced technical and tactical approaches have widened the criteria of segment suitability and indications for the use of this method.

Background. The state of the microcirculatory bed in the scar tissue is extremely important for determining the most appropriate methods of conservative and surgical treatments. Only few studies have assessed the vascular features of scar tissue.

The objective was to study and analyze the morphological features of the vascular bed of scar tissue and their clinical implications.

Materials and methods. Fifty-four patients with hypertrophic post-burn scars were examined. The study used a clinical method and performed histological analysis of the scars biopsy specimens, including a survey light microscopy, a morphometric assessment of the vascular bed as well as the verification of the collagen fibers of scar tissue with an immunohistochemical (IHC) analysis with specific monoclonal antibodies (AT) (Novocastra, Bond) to Type I and III collagens.

Results. A significant increase in the total area of the vessels of the rumen in the first 6 months of its formation was observed in comparison with intact skin and later maturation of the scar tissue (in % in 1 mm2 of intact skin – 8.50, in the rumen in terms of up to 6 months – 13.10). The average number of vessels in the scar tissue and the total area of their lumen in the maturing rumen from 2 to 5 years decreased in comparison with that in the intact skin. The nodes were detected in the scars by an early appearance of the clinical signs of vascular disorders including blisters and erosions on thickened and hyperemic scar tissues.

Discussion. In the developing hypertrophic rumen, the circulatory conditions gradually deteriorated due to the compression and obliteration of the vessels of the skin with collagen. The enhancement in perfusion recorded using laser Doppler fluorometry may be associated with a significant dilatation of the rumen vessels, rather than because of actual enhanced perfusion.

Conclusions. 1. The increase in the vascular cross sectional area in the early stages of scar formation is attributable to the expansion of their lumen vessels. In the ripened rumen, the number of vessels is 3 times less than that in intact skin. 2. Hyperemia of the hypertrophic scar is caused by a substantial widening of the vessels of the scar tissue, and not by an increase in their number. 3. The use of a hypertrophic scar for the creation of rotational and other flaps is associated with a high risk of trophic complications.

Introduction. The injury rate in children remains an urgent and unresolved problem in the field of medicine. In recent years, the average injury rate in 0- to 17-year-old children is 116–118 injuries per 1000 children of the corresponding population in Russia.

Aim. The study aimed to analyze the injury rates in the children in St. Petersburg in 2016 and to compare them with the injury rates of previous years and those of children in Russia.

Material and methods. Based on state statistics, the indices of injury rate in the children in St. Petersburg in 2016 were evaluated. The disability in children as a result of external actions and the activities of medical and preventive institutions for providing specialized care to children with injuries were also investigated.

Results and discussion. A new form of reporting by Rosstat enabled the clarification of the data with respect to the nature of the injuries and the number of bone fractures in various locations of the body in accordance with the XIX class of the ICD-10, as well as with respect to the morbidity and mortality in children owing to external causes (class XX of the ICD) that include road-traffic accidents and physical abuse.

Conclusions. The rate of injury in children aged 0–14 years decreased when compared with that suggested by the previous year’s data. Further, in adolescents aged 15–17 years, the rate of injury was significantly higher than the average rate in Russia. The disability in children as a result of external actions has decreased. However, the prevention of child injuries in St. Petersburg, especially in adolescents, remains an urgent medical and social problem.

Introduction. Cerebral palsy (CP) has a significant prevalence in industrialized countries and is characterized by a high level of disability. Children and adolescents with CP face challenging situations. Physical defects repeatedly manifest in the daily life of a child in the form of other extraordinary events such as hospitalization, surgery, prolonged immobilization, and separation from family. Such events can be accompanied by feelings of fear, anxiety, helplessness, and pronounced symptoms of maladjustment. Under these conditions, certain biological and social compensatory manifestations help to identify such complicated conditions and restore the normal functioning of the body. Compensatory manifestations are a type of compensatory defense mechanisms. The major role in establishing a system of protection is played by the relationship between a child and his or her parents. Defense mechanisms can be formed during the process of assimilation of protective parental behavior, or because of the inappropriate attitude of mothers to the child’s illness. The purpose of the research was to study the defense mechanisms in children with CP in the context of mothers’ relationship to her child’s illness.

Materials and methods. The research involved 120 people. The experimental group included 30 children with CP aged 5 to 11 years and their mothers. The control group consisted of relatively healthy children (30) and their mothers. The following was used to achieve the goal: the elements of clinical and biographical method, projective technique, the technique of diagnostics of attitude to the child’s illness.

Results and discussion. The repertoire of psychological defense mechanisms in children with CP is limited in comparison with those in healthy children. Children with CP are dominated by the defense mechanism of “denial” that can play a negative role in the process of adaptation of these children in a situation involving complex treatments. The mothers of children with CP share an emotionally intense relationship with their child’s disease. Excessively disturbing attitudes of the mother to the disease of her child can contribute to the formation of negative psychological defense mechanisms of negation type in the child, which reduces the child’s psychological compensatory capacity and capability of adaptation in conditions of complex treatment.

Introduction. Three-dimensional (3D) modeling and prototyping are increasingly being used in various branches of surgery for planning and performing surgical interventions. In orthopedics, this technology was first used in 1990 for performing knee-joint surgery. This was followed by the development of protocols for creating and applying individual patterns for navigation in the surgical interventions for various bones.

Aim. The study aimed to develop a new 3D method for planning and performing corrective osteotomy of the femoral bone using an individual pattern and to identify the advantages of the proposed method in comparison with the standard method of planning and performing surgical intervention.

Materials and methods. A new method for planning and performing corrective osteotomy of the femoral bone in children with various pathologies of the hip joint is presented. The outcomes of planning and performing corrective osteotomy of the femoral bone in 27 patients aged 5 to 18 years (32 hip joints) with congenital and acquired deformity of the femoral bone were analyzed.

Conclusion. The use of computer 3D modeling for planning and implementing corrective interventions on the femoral bone improves the treatment results owing to an almost perfect performance accuracy achieved by the minimization of possible human errors reduction in the surgery duration; and reduction in the radiation exposure for the patient.

Destructive changes in the bones are rarely observed in daily practice of pediatric orthopedic surgeons. Clinical and X-ray signs of destructive changes in the bone tissue are characteristic of tumoral, infectious, and inflammatory damages of bones. These signs do not always correspond to a specific disease, and differential diagnostics without histological evaluation is difficult. This is especially true for tumors of the sternum, 85% of which are malignant.

Two rare clinical cases of primary malignant sternal neoplastic lesions in pediatric patients, and a detailed analysis of their clinical, radiologic, and morphologic data are presented. The importance of early histological verification for determining the choice of treatment is demonstrated. A short literature review is also presented.