EVOLUTION OF TECHNOLOGIES FOR CLOSURE OF VAST AND DEEP SOFT-TISSUE DEFECTS OF HUMAN BODY

The paper studies the evolution of technologies for closure of vast and deep soft-tissue defects of human body based on vascular anatomy of the applied plastic material. Local plastic surgery (Burow, V-Y plastic, rotational and advanced flaps, Limberg rhomboid flaps) was based initially on the continuity of subpapillar or subpapillar + deep dermal vascular plexus. This surgery has serious limitations on its application if the length-towidth ratio of the plastic material is not chosen properly (1 : 1). An increase in the area of plastic material through splitting of a Filatov-Gillies adipodermal tubed “jumping” flap formed based on the compensatoryintensified blood stream in subpapillar and deep dermal vascular plexus is an extremely long and unreliable method because of the random blood stream in the wall of a tubed flap. The method of formation of a tubed Вопросы реконструктивной и пластической хирургии № 1 (64) март’2018 Байтингер В.Ф., Селянинов К.В., Курочкина О.С. и др. “jumping” adipodermal flap around the axis of a subdermal artery and an accompanying vein, namely, the formation of reliable (well blood-supplied) plastic material of larger area could provide wide promises. However, due to limited mobility, the tubed flap with the axial type of blood supply failed to find wide utility in practice. The extremely mobile non-free Ponten fasciocutaneous flap based on subdermal vessels has widened drastically the possibilities of plastic surgery of vast wounds mostly on extremities. Perforator flaps and their modifications: propeller and boomerang flaps based on direct and indirect dermal perforators provide now the widest promises for closure of soft-tissue defects in human body.

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