DOI: https://doi.org/10.22263/2312-4156.2025.4.9
K.A. Fedorov1, V.G. Bogdan2, A.I. Kubarko3
Evaluation of neurovascular fascio-cutaneous flaps microcirculation in various kinds of plastic surgeries
1432 Order of the Red Star Main Military Clinical Medical Center of the Armed Forces of the Republic of Belarus, Minsk, Republic of Belarus
2National Academy of Sciences of Belarus, Minsk, Republic of Belarus
3Belarusian State Medical University, Minsk, Republic of Belarus
Vestnik VGMU. 2025;24(4):9-18.
Abstract.
Objectives. To evaluate the dynamics of changes in spectrometry parameters in the assessment of soft tissue microcirculation in various kinds of plastic surgery of extensive post-traumatic soft tissue defects of the distal lower extremities using non-free neurovascular fascio-cutaneous flaps.
Material and methods. Within the framework of the research work of the Department of Military Field Surgery of the Military Medical Institute of the Belarusian State Medical University on the topic of «Improving the directions of diagnostics and complex treatment of patients with post-traumatic defects of soft tissues of the extremities» (state registration No. 20170424 dated March 29, 2017), a comparative analysis of the dynamics of changes in spectrometry parameters was carried out in 30 patients with the extensive defects of soft tissues of the distal parts of the lower extremities who underwent surgical treatment at the 432 Order of the Red Star Main Military Clinical Medical Center of the Armed Forces of the Republic of Belarus during the period 2016-2021.
Results. The article analyzes the two-phase dynamics of changes in the microcirculation parameters of the neurovascular fascio-cutaneous flaps in various plastic surgery options for the extensive post-traumatic soft tissue defects of the lower limbs distal segments based on the results of percutaneous spectrometry.
Conclusions. It has been proven that the restoration of microcirculation parameters in the displaced neurovascular flap during plastic surgeries using the developed method occurs two days earlier than during a standard reconstructive surgery due to full functional adaptation of tissues by the fifth day after surgery with normalization of the blood oxygen saturation and complete compensation of the vascular network density. A decrease in the absolute values of oxyhemoglobin content in the early postoperative period and individual critical values of blood vessel density in the range of 0.05-0.01% may be prognostically unfavorable signs indicating the possibility of irreversible changes in the displaced flap.
Keywords: extensive soft tissue defect; distal segment of the lower limb; neurovascular flap; spectrometry.
References
1. Baytinger VF, Baytinger AV, Ezhov AA. Neuro-cutaneous flap in reconstructive surgery. Voprosy Rekonstruktivnoi Plasticheskoi Khirurgii. 2010;(2):5-9. (In Russ.).
2. Shtutin AA, Mikhaylichenko VYu, Shtutin IA, Samarin SA. Features of plastic closure of wound defects of distal parts of the lower extremity by sural flap. Plasticheskaya Khirurgiya Esteticheskaya Meditsina. 2021;(1):52-57. (In Russ.). doi: http://dx.doi.org/10.17116/plast.hirurgia2021011521
3. Kutyanov DI, Rodomanova LA. Modern principles and trends in the use of axial blood supply flap in reconstructive limb surgery. Travmatologiya Ortopediya Rossii. 2015;(1):106-115. (In Russ.).
4. Shibaev EYu, Ivanov PA, Nevedrov AV, Lazarev MP, Vlasov AP, Tsoglin LL, i dr. Treatment of post-traumatic soft tissue defects in the extremities. Zhurnal im NV Sklifosovskogo Neotlozhnaya Meditsinskaya Pomoshch'. 2018;7(1):37-43. (In Russ.). doi: http://dx.doi.org/10.23934/2223-9022-2018-7-1-37-43
5. Baytinger VF, Selyaninov KV. Reperfusion syndrome: vascular manifestations in the facial skin flap. Plasticheskaya Khirurgiya Esteticheskaya Meditsina. 2021;(2):40-47. (In Russ.). doi: http://dx.doi.org/10.17116/plast.hirurgia202102140
6. Tsapaeva NL, Tsapaev VG. Microcirculation (part 3 - methods of research on microcirculation). Neotlozhnaya Kardiologiya Kardiovaskulyarnye Riski. 2024;8(2):2224-2236. (In Russ.). doi: http://dx.doi.org/10.51922/2616-633X.2024.8.2.2224
7. Malykhina IF, Nerobeev AI, Dobrodeev AS, Verbo EV, Garelik EI, Salikhov KS. Tissue oximetry: evaluation of the viability of free flaps in head and neck reconstruction. Voprosy Rekonstruktivnoi Plasticheskoi Khirurgii. 2015;18(2):11-24. (In Russ.).
8. Nerobeev AI, Dobrodeev AS, Malykhina IF, Somova MM, Garelik EI. Criteria for survival of muscle lamella based on somatic tissue oxymetry. Annaly Plasticheskoi Rekonstruktivnoi Esteticheskoi Khirurgii. 2014;(3):10-18. (In Russ.).
9. Dobrodeev AS, Nerobeev AI, Malykhina IF, Verbo EV, Garelik EI. Tissue oximetry in evaluation of the viability of fibrillar lamellae in head and neck reconstruction. Khirurg. 2015;(5-6):60-68. (In Russ.).
10. Bagyan AR, Malinin AA, Tsygankov YuM, Chomaeva AA. Microcirculation and oxygen treatment of skin flap tissue. Klinicheskaya Fiziologiya Krovoobrashcheniya. 2024;21(1):56-68. (In Russ.). doi: http://dx.doi.org/10.24022/1814-6910-2024-21-1-56-68
11. Bogdan VG, Trukhan AP, Sukharev AA, Fedorov KA; Belorus gos med un-t; 432-i Gl voen klin med tsentr Vooruzh sil Resp Belarus'. Treatment of extensive defects of soft tissues of distal parts of the lower extremities by non-free neurovascular facial skin flaps: instruktsiya po primeneniyu № 076-0820: utv. M-vom zdravookhraneniya Resp Belarus' 26.08.2020 g. Minsk, RB; 2020. 7 р. (In Russ.).
12. Ahmed SK, Fung BKK, Ip WY, Fok M, Chow SP. The versatile reverse flow sural artery neurocutaneous flap: A case series and review of literature. Journal of Orthopaedic Surgery and Research. 2008 Apr;3:15. doi: http://dx.doi.org/10.1186/1749-799X-3-15
13. Masquelet AC, Romana MC, Wolf G. Skin island flaps supplied by the vascular axis of the sensitive superficial nerves: anatomic study and clinical experience in the leg. Plastic and Reconstructive Surgery. 1992 Jun;89(6):1115-1121. doi: http://dx.doi.org/10.1097/00006534-199206000-00018
14. de Blacam C, Colakoglu S, Ogunleye AA, Nguyen JT, Ibrahim AMS, Lin SJ, et al. Risk factors associated with complications in lower-extremity reconstruction with the distally based sural flap: a systematic review and pooled analysis. Journal of Plastic Reconstructive and Aesthetic Surgery. 2014 May;67(5):607-616. doi: http://dx.doi.org/10.1016/j.bjps.2014.01.044
15. Technical description of automated optical fiber spectrophotometer AvaSpec-256. URL: https://www.avantes.ru/spectroavaspec256.php [Accessed 15th August 2025]. (In Russ.).
16. Venttsel ES. Theory of probability. 4-e izd, stereotip. Moscow, RF: Nauka, 1969. 576 р.
Submitted 18.07.2025
Accepted 22.08.2025
Information about authors:
Fedorov Konstantin A. – head of the 2nd Trauma Department, 432 Order of the Red Star Main Military Clinical Medical Center of the Armed Forces of the Republic of Belarus, https://orcid.org/0009-0000-2838-1237, e-mail: Этот адрес электронной почты защищён от спам-ботов. У вас должен быть включен JavaScript для просмотра.;
V.G. Bogdan, – Doctor of Medical Sciences, Professor, Academician-Secretary of the Chair of Medicine of the National Academy of Sciences of Belarus, https://orcid.org/0000-0001-7849-6497
A.I. Kubarko – Doctor of Medical Sciences, Professor, Consultant of the Chair of Normal Physiology, Belarusian State Medical University.
