For the Medical Practitioners
doi: 10.25005/2074-0581-2022-24-3-404-412
DELAYED RECONSTRUCTIVE SURGERY FOR SEVERE HAND INJURIES

M.Kh. Malikov1, K.P. Artykov1, G.D. Karim-Zade1, A.A. Davlatov1, D.D. Dzhononov2, N.A. Makhmadkulova3

1Department of Surgical Diseases № 2 named after Academician N.U. Usmanov, Avicenna Tajik State Medical University, Dushanbe, Republic of Tajikistan
2Department of Plastic and Reconstructive Microsurgery, Republican Scientific Center for Cardiovascular Surgery, Dushanbe, Republic of Tajikistan
3Department of Topographic Anatomy and Operative Surgery, Avicenna Tajik State Medical University, Dushanbe, Republic of Tajikistan

Objective: To justify the use of delayed reconstructive interventions in severe complex hand injuries.

Methods: The results of delayed reconstructive surgery in 22 patients with a severe complex hand injury for the period from 2010 to 2022 were analyzed. Most of the patients (81.8%) were admitted within 4 to 7 days after injury and received primary care in non-specialized institutions. The age of patients ranged from 17 to 45 years, with the mean age being 28.3 years. They had crush hand injuries with an incomplete avulsion of all fingers (3), II-V fingers (6), II-IV fingers (9), and II-III fingers (1), in three cases, an extensive wound defect of the hand was accompanied by complete amputation of II-III (1) and II-IV fingers (2). The concomitant defect of integumentary tissues had an extended character in case of damage by electric machines (101.2±3.6 cm2) and gunshot wounds (92.1±3.7 cm2).

Results: The rationale for the use of delaying tactics was the severity of the injury, the time point of admission, and the decompensation of blood circulation in the fingers in 8 out of 16 admitted patients. All the patients underwent delayed necrosectomy with preservation of the maximum length of viable bone fragments. An extensive defect of the integumentary tissues was covered with a skin-fascial inguinal flap. The second stage performed was one-step directed nerve implantation with phalangization of the transplanted flap (6). For reinnervation, the superficial branch of the radial nerve was most often used as a donor’s nerve. The restoration of sensitivity was registered 3 months after the surgery.

Conclusion: As a result of multi-stage complex reconstructive plastic surgery performed on a primary-delayed basis for severe complex hand and fingers injuries, followed by correcting operations to improve the sensory input of the residual segments; the adequate functional outcome was obtained with an improvement in the patient’s quality of life.

Keywords: Severe hand injury, hand defects, hand reconstruction, flaps, neurotization.

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Authors' information:

Malikov Mirzobadal Khalifaevich
Doctor of Medical Sciences, Associate Professor, Head of the Department of Surgical Diseases № 2 named after Academician N.U. Usmanov, Avicenna Tajik State Medical University
Researcher ID: ABG-2983-2021
Scopus ID: 21934165100
ORCID ID: 0000-0002-7816-5521
Author ID: 375497
E-mail: mmirzobadal@mail.ru

Artykov Karimdzhon Pulatovich
Doctor of Medical Sciences, Full Professor, Professor of the Department of Surgical Diseases № 2 named after Academician N.U. Usmanov, Avicenna Tajik State Medical University
Researcher ID: AAC-5534-2019
Scopus ID: 6506551678
ORCID ID: 0000-0002-6346-0851
SPIN: 2480-6526
Author ID: 909829
E-mail: artikov53@mail.ru

Karim-Zade Gulandom Dzhangovarovna
Candidate of Medical Sciences, Assistant of the Department of Surgical Diseases № 2 named after Academician N.U. Usmanov, Avicenna Tajik State Medical University
Researcher ID: ABD-4810-2021
Scopus ID: 55908934800
ORCID ID: 0000-0003-0845-3197
E-mail: gulandom71@mail.ru

Davlatov Abdumalik Abdulkhakovich
Candidate of Medical Sciences, Assistant of the Department of Surgical Diseases № 2 named after Academician N.U. Usmanov, Avicenna Tajik State Medical University; Resident of the Department of Reconstructive and Plastic Microsurgery, Republican Scientific Center for Cardiovascular Surgery
Researcher ID: AAF-6440-2022
Scopus ID: 21933830600
ORCID ID: 0000-0003-2776-074X
SPIN: 3766-9641
Author ID: 998715
Е-mail: davlatov.abdumalik@mail.ru

Dzhononov Dzhonibek Davlatbekovich
Candidate of Medical Sciences, Surgeon of the Department of Plastic and Reconstructive Microsurgery, Republican Scientific Center for Cardiovascular Surgery
ORCID ID: 0000-0003-2383-7770
E-mail: dr.jonibek@mail.ru

Makhmadkulova Nigora Akhtamovna
Candidate of Medical Sciences, Assistant of the Department of Topographic Anatomy and Operative Surgery, Avicenna Tajik State Medical University
ORCID ID: 0000-0002-4269-6611
E-mail: malikovanigora@mail.ru

Information about support in the form of grants, equipment, medications

The authors did not receive financial support from manufacturers of medicines and medical equipment

Conflicts of interest: No conflict

Address for correspondence:

Karim-Zade Gulandom Dzhangovarovna
Candidate of Medical Sciences, Assistant of the Department of Surgical Diseases № 2 named after Academician N.U. Usmanov, Avicenna Tajik State Medical University

734003, Republic of Tajikistan, Dushanbe, Rudaki Ave., 139

Tel.: +992 (918) 808766

E-mail: gulandom71@mail.ru

Materials on the topic:
  1. CHALLENGES IN THE DIAGNOSTICS AND TREATMENT OF DUODENUM INJURIES IN CHILDREN
  2. SURGICAL MANAGEMENT OF POST-BURN SCAR EXTENSION CONTRACTURES OF THE TOES
  3. GIANT FRONTOETHMOIDAL OSTEOMAS: A RATIONAL APPROACH TO THE SURGICAL REMOVAL AND THE IMMEDIATE RECONSTRUCTION OF THE ANTERIOR WALL OF THE FRONTAL SINUS
  4. THE LATISSIMUS DORSI MUSCLE FLAP TRANSFER IN SURGICAL CORRECTION OF POST-TRAUMATIC UPPER LIMB DYSFUNCTION
  5. NERVE TRANSFER IN IRREVERSIBLE INJURIES OF UPPER LIMB NERVE: CURRENT KNOWLEDGE AND FUTURE PERSPECTIVE
  6. SURGICAL REPAIR OF LATERAL AND ANTEROLATERAL HERNIAS OF THE ABDOMINAL WALL
  7. RESULTS OF LAPAROSCOPIC AND CONVENTIONAL HERNIOPLASTY IN OLDER PATIENTS AND MORPHOLOGICAL CHANGES IN THE TISSUES OF THE INGUINAL CANAL
  8. IMMEDIATE RESULTS OF URETROPLASTY IN DIFFERENT FORMS OF HYPOSPADIAS
  9. ANALYSIS OF THE EFFICIENCY OF APPLICATION OF THE TWO SURGERY METHODS OF TREATMENT OF THE URETHRAL INJURY CONSEQUENCES
  10. THE OUTCOMES OF THE FOREARM FLAP APPLICATIONS IN THE UPPER LIMB SEVERE INJURIES RECONSTRUCTION

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