Italian method of skin plasty. Skin plasty (plastic surgery). After surgery: results
test questions
1. The concept of skin plastics (KP).
2. Classification of skin plastics.
3. Main types of free skin grafting.
4. The main types of non-free skin plastics.
5. Combined skin grafting.
6. Indications for skin grafting.
7. Contraindications for skin grafting.
The task of skin plastic surgery is the art of partial or complete restoration of the appearance, shape and function of various organs and areas of the human body that have been damaged or lost as a result of trauma, disease, as well as due to malformations or age-related changes.
Skin - integumentary tissue that protects the body from external adverse influences, through which the body is interconnected with the external environment. It ensures the constancy of the body's environment, without which metabolic processes cannot proceed correctly. The total skin area is on average 1600 cm 2 . The thickness of the skin reaches 1 mm, on the palms the thickness of the skin is 1.5-2 mm, on the soles - up to 3 mm.
Assessing the importance of skin structures for wound healing, it is appropriate to emphasize the dual mechanism of this process. Wounds heal as a result of epithelialization from the edges of the wound and the convergence of the edges of the wound by the connective tissue, which occurs due to contraction of the fibrous tissue that develops at the bottom of the wound.
The non-free type of KP includes methods in which the moved skin flap is left in permanent connection with the donor site (KP with local tissues) or temporary -for a period of engraftment in a new place (plasty from distant parts of the body) on a temporary feeding leg.
KP methods in which the area of skin transferred to a new site is completely separated from the donor site are called free skin grafting, and the flap resulting from this can be split or full-thickness. Depending on the thickness of the graft, 2 types of free skin grafting are respectively distinguished: split-flap grafting and full-thickness flap grafting.
AT practical work often it is necessary to use both free and non-free skin grafting, which makes it possible to distinguish combined methods of CP.
In non-free KP, the presenting tissues and skin from distant areas are used to replace defects.
For plasty with local tissues, the edges of the wound are mobilized and brought together with sutures, through notches and skin incisions are made to relieve tissue tension and freely connect the edges of the wound.
This group also includes the rotational method, when the mobilized flap is rotated to the defect and fixed with separate sutures.
The classic method of plasty with local tissues is the movement of oncoming triangular-shaped flaps along A.A. Limberg. It is used after excision of tightening scars, with small pigmented tumors, long-term non-healing wounds on the limbs.
Plastic surgery with skin from distant parts of the body consists in transferring the skin on a feeding leg, often in several stages.
One of the methods of non-free skin grafting is the Italian method: a tongue-shaped flap is cut out, it is fixed with sutures on the defect, and the donor site is closed with local tissues.
Of the other methods, plastic with bridge-like flaps and a round stem according to V.P. is widely used. Filatov.
The latter method is multi-stage, but it is justified in plastic surgery when closing defects on the face and when it is necessary to close a volumetric tissue defect on the supporting surface of the foot.
With all methods of non-free KP, the flap includes skin, subcutaneous tissue, fascia with blood vessels supplying the flap. The fixation of the flaps is carried out without any tension on the feeding leg.
With free transplantation, skin flaps are completely isolated from the circulatory system and placed on the defect for ingrowth.
Engraftment of free skin grafts is carried out in three stages. Literally from the first minutes, the skin graft adheres to the bottom of the wound, during which fibrin falls out between both wound surfaces. In the following hours and days, the graft is nourished by the diffusion of cell-rich tissue fluid, which maintains cellular metabolism at the proper level. Thin grafts, consisting predominantly of the epithelium and having no blood vessels (Thirsch flap), can immediately use tissue fluid and in the following days are completely content with such an interstitial blood supply. This is the basis for the unpretentiousness of thin skin flaps for nutrition and the possibility of their engraftment on a wound with poor conditions for its own blood supply. Conversely, with thick skin grafts that include a layer of the dermis, nutrition occurs only when tissue fluid enters the vessels of the graft. Revascularization, and with it the final engraftment of the skin graft, is carried out within an interval of up to 2 weeks due to vascular germination. The degree of restoration of blood circulation in different transplants is different. Their thickness and healing mechanism are decisive. Circulation in the newly sprouted capillaries becomes significant only from about the 7th - 8th day and is established in one direction. When using a free graft, it is necessary to take into account its tendency to mobile wrinkling, which occurs due to the contraction of collagen fibers. Secondary wrinkling occurs during the healing process, due to the formation of scars under the skin flap. The thinner the graft, the more pronounced it is. Conversely, a more powerful whole skin flap undergoes less retraction.
The ratio of tissues at the site of graft engraftment certainly plays an important role. An immovable base (bones, fascia) does not cause the graft to wrinkle, while transplanting it to muscles or very mobile areas of the body (neck) causes a significant reduction in the area of the transplanted skin.
Sensory innervation of the transplanted skin appears after 3-6 months due to the ingrowth of nerve fibers from the edges of the wound and from its depth. After 1-1.5 years, this process is completed completely. Recovery occurs in the following sequence: first, tactile sensitivity appears, then pain and thermal perceptions.
The appearance of freely transplanted skin is restored due to the formation of connective and adipose tissues within a few months.
Plastic surgery of skin defects with split dermatomal flaps is currently widely used (I. Paget, 1939). In the absence of skin deficiency, it is more expedient to close the defect with a solid perforated graft. With extensive wound surfaces, the split flap is dissected and transplanted in the form of postage stamps, placing them from each other at a distance equal to the width of the "stamp" (Gabarro's method, 1943).
Among the methods of full-layer plasty, the Dregstedt-Wilson-Parin method is most widely used for closing defects on the face, hand, and joint area. The flap is cut out at the donor site, separated from the subcutaneous tissue, perforated and transferred to the defect. It is fixed with separate sutures in the state of tension of the flap, a pressure bandage is applied. According to the same rules, skin reimplantation is performed according to V.K. Krasovitov (1935) with extensive scalped wounds. Plastic skin-fat flaps with vascular anastomoses are possible, i.e. free transplantation of a segment of the skin and subcutaneous fat using intervascular anastomosis. The most important prerequisite for successful transplantation, for example, when eliminating a skin defect after tumor removal, is the presence of healthy skin in the hypogastric region or on the back of the foot with a well-pulsing artery and at least one vein with sufficient drainage capacity.
Combined skin grafting includes a combination of non-free grafting with free grafting. The classic option is the method of A. K. Tychinkina (1960). Indications for its use are, first of all, defects on the supporting surface of the foot.
According to the period from the moment the defect occurs to the moment of its closure, its plasticity is divided into primary and secondary. Skin grafting of postoperative and fresh wounds in the first hours after injury is called primary.
Secondary is called KP of wounds after the formation of granulations (early plastic) or with long-term non-healing wounds and ulcers (late plastic).
Indications for primary skin grafting:
Accidental wounds;
Scalped wounds;
Wounds after excision of limited burns;
Postoperative wounds (after removal of tumors, hemangiomas);
Malformations (syndactyly, phalanging of the hand, forearm);
Wounds after excision of dermogenic contractures, extensive scars.
Indications for secondary skin grafting:
Granulating wounds;
Long-term non-healing wounds;
Ulcers of various origins.
For the implementation of the primary CP, the following methods can be applied:
Mobilization of wound edges with and without laxative incisions;
Plastic surgery with split flaps;
Skin reimplantation according to Krasovitov;
Moving opposite triangular flaps along Limberg;
Italian way.
The following methods can be used for secondary CP:
Mobilization of the edges of the wound;
split flap;
Moving counter triangular flaps;
Plastic stem Filatov;
Combined KP. Contraindications for primary skin grafting are as follows:
Lack of confidence in reliable excision of the edges of the wound;
Impossibility to subject tissues to primary excision due to extensive damage
The need to use plastic methods that cannot be used when providing the first medical care;
Unreliability of hemostasis;
The severity of the general condition of the patient.
Special requirements should be imposed in the primary plastic wounds of the hand. In this case, it is necessary to intervene immediately, and the intervention must be exhaustive and final.
Italian method(Fig. 10). The place of the skin defect, where the flap moves, must be specially prepared: the edges of the ulcerative surface, scar tissue are excised, and thorough hemostasis is provided. A flap with a feeding leg in the entire thickness of the skin is cut out according to the shape of the defect, but somewhat larger in size, since after separation from the underlying tissues, it contracts. The length of the flap should not exceed the width of the pedicle by more than 2 times. Kinking of the pedicle and tension on the flap should be avoided. At the same time, the forced position of the patient should not be particularly painful. The wound surface remaining at the site of the displaced flap is closed with sutures or it heals under the fat bandage by secondary intention. This outcome limits the possibility of transplanting large-sized pedicled flaps.
Rice. 10. Types of skin plasty with local tissues.
I and II - according to Yu. K. Shimanovsky; III - according to A. A. Limberg; IV - Indian method; V - Italian method (method variant).
Plastic round stem according to V. P. Filatov(1916). It consists of three stages: 1) formation of the stem, 2) transplanting it, and 3) spreading the stem onto the defect (Fig. 11). The best place for harvesting the stem are the covers of the abdomen and chest. The flap is given an oblique or longitudinal direction, since the girdle flaps are relatively easily injured. In addition, the oblique arrangement of the stem corresponds to the distribution of blood vessels in the subcutaneous tissue of these areas. You can create a stem in other parts of the body, where it is possible to capture the skin in a fold of the desired size.
Rice. 11. Methods for cutting out the skin stalk according to V. P. Filatov.
The size of the flap and the place of its formation are set depending on the size and localization of the wound surface. If small stems 2-5 cm wide are suitable for restoring the nasal septum or parts of the auricle, then 8X9 cm flaps are required to form the chin. The width of the skin tape should be related to its length as 1:3.
Two parallel incisions are made and the separated skin flap with the subcutaneous layer is sutured in the form of a tube, with the skin outward. It turns out a skin stalk with two feeding legs, without a wound surface. Depending on the thickness of the layer of adipose tissue, the entire cellular tissue or only part of it is included in the flap. With a small amount of fatty tissue, it is taken along with the fascia.
For better nutrition and comparison of the edges of the flap, parallel cuts at the ends of the stem are bred at an angle of 130-150 ° (B. E. Frankenberg). You can cut out additional triangular patches. The skin with tissue under the flap is separated from the edges and the wound is tightly sutured with thick silk sutures.
One of the most crucial moments in the formation of the stem is the suturing of the wound under its legs. The great tension of the skin that has arisen here can lead to divergence of the sutures and even necrosis of the stem due to impaired blood circulation. To prevent such complications, it is most advisable to cut out additional skin flaps at the legs of the stem, which are then moved (M. T. Sheftel, A. A. Limberg, A. A. Kyandsky, etc.).
In cases where it is very difficult to bring the edges of the skin wound on the maternal soil together, additional laxative incisions 1-2 cm long are applied parallel to the edge of the wound in a checkerboard pattern.
Before resorting to transplanting the stem to a new place, a “training” of its vessels is carried out, which begins after the removal of the sutures, not earlier than the 10th day. To do this, the leg is pinched daily, which is then to be crossed, using a soft intestinal pulp or a thin rubber tourniquet. They start from 15 minutes 3-4 times a day, add 15 minutes daily, increasing the duration of clamping to 3 hours (M. V. Mukhin). If at the same time the stem retains its pink color, does not turn pale, it can be considered ready for transplantation. When the stem is transplanted to the face, then on the 20th-30th day after the formation of the stem, the trained leg is crossed and transferred more often to the rear of the left hand (the first “step” of the stem), if the distance does not allow this end of the stem to be sewn directly onto the face. The leg is cut off from the maternal base with an oval incision, the wound is sutured tightly. In the area where the stem leg is transplanted, (a semilunar incision of the skin with subcutaneous tissue is made. The size of the incision corresponds to the cross section of the stem, which is sutured to the edges of the incision. In this case, the hand used to move the stem is fixed with a plaster or other bandage to the body, otherwise the stem may be unnecessarily injured and even torn off.
After 2-3 weeks, the second leg of the stem, trained as described above, is transplanted into the edge of the facial defect (the second "step" of the stem), and after it, according to the same rules, the leg is cut off by hand and transplanted onto the face. It is better to create a bed for the stem stem in the area of the defect to be closed in unaltered tissues, slightly retreating from the edge of the defect. A stem stalk transplanted into scar tissues that are not well supplied with blood will be in less favorable conditions for engraftment.
The stem is flattened after excision of the scar on it and sutured to the edges of the defect, and sometimes give it the desired shape.
Transplantation of an acute Filatov stem according to L. R. Balon.
The difference of this method is that after cutting out the skin tape with a fatty lining and creating the Filatov stem, one of its legs is immediately crossed. The free leg of the stem is transplanted onto the arm if the stem was formed on the abdomen, or directly to the edge of the facial defect if the stem was formed on the shoulder. The wound is sutured with or without cutting out an additional triangular flap (Fig. 12).
Rice. 12. Stages of creating a stem according to L. R. Balon.
The ratio of the width of the stem to the length should be at least 1:2, and when forming large stems - even 1:1.5, so that necrosis of the crossed stem does not develop. The dimensions of the cut flap, depending on the size of the defect, can be from 4X6 to 9X16 cm.
The advantage of the method is the reduction of the flap transfer time by 3-4 weeks.
The purpose of skin plastic surgery is to restore the continuity of the skin, improve appearance parts of the body, as well as preventing the formation of rough scars at the site of skin defects.
With free skin grafting, the graft (transplanted skin fragment) is completely cut off from the donor area (the place where the graft was taken).
Types of free skin grafting:
1. Plasty with a full-thickness skin flap - the skin is used as a graft for its entire thickness.
2. Plastic surgery with a split skin flap - the epidermis is used as a graft.
With non-free skin grafting, the graft is not completely cut off from the donor area. The graft in this type of skin grafting is usually called a flap.
Types of non-free skin plastics:
1. Plasty with local tissues - nearby tissues are sutured over the defect.
2. Plasty with a flap on a feeding leg - a flap is formed, which replaces the defect.
Features of types of skin plastics.
Free skin grafting with a full-thickness flap.
With this type of skin grafting, the skin in the donor area is not restored. There remains a defect that needs to be sutured (the so-called "donor wound"). Areas of the body with movable skin are chosen as donor zones, where the defect can be sutured without tension. For example, a section of the thigh or anterior abdominal wall. In addition, this significantly limits the size of the graft.
The skin of the selected area, for the convenience of cutting, can be injected with saline or 0.25-0.5% novocaine solution. Given that during healing, cicatricial wrinkling occurs along the stitching line, the graft should be 1/4 - 1/5 more than the defect. The graft is placed on the skin defect and sutured along the edges with separate sutures. In some cases, it is necessary to increase the size of the graft. To do this, the graft is perforated - through parallel notches are made, arranged in a "staggered" order, and stretched. In addition, perforation improves the outflow of wound discharge from under the graft.
Free skin grafting with a split flap.
With this type of plastic surgery, the skin in the donor area is restored. This is due to the fact that after the graft is taken, fragments of the epidermis capable of regeneration remain in the mouths of the hair follicles and sebaceous glands. They are also preserved in the thickness of the skin, due to the folding of the epidermal-dermal junction (the so-called "dermal papillae"). Consequently, with plastic surgery with a split flap, it is possible to fence significantly more about larger transplants.
Areas of the body with small curvature and relatively large skin areas (thighs, anterior abdominal wall) are used as donor zones. If necessary, it is possible to use other areas of the body as donor zones.
The thickness of the split graft is 0.2-0.4 mm. For its fence, special knives or special dermatome tools with manual or mechanical drive of the blades are used. Sewing of the graft along the edges is optional. If necessary, the graft is perforated and stretched.
Non-free skin plastic.
When plasty with local tissues, the resulting tension is eliminated by relaxing incisions (for example, Y-shaped).
Types of plastic surgery with a pedicle flap:
1. With the formation of a flap close to the defect - for example, plastic with oncoming triangular flaps of the Limberg type.
2. With the formation of a flap at a distance from the defect:
a. "Italian method" of rhinoplasty - with the replacement of the defect of the tip of the nose with soft tissues of the shoulder;
b. plastic surgery of the soft tissues of the fingertip with temporary sewing it into the soft tissues of the palm - the so-called. palmar plasty of the fingertip);
c. plastic stalk flap according to Filatov.
A stalk-like flap in the form of a "suitcase handle" is formed from the skin and subcutaneous adipose tissue. One end of the flap replaces the defect. The other end is periodically clamped (so-called "flap training") to develop blood circulation at the site of the closed defect. In the future, the flap is finally cut off and moved to the defect;
d. Plasty with an “island” flap - the feeding leg of the flap is dissected, leaving only blood vessels, which increases the length and direction of movement of the flap.
General issues. Question 12.
Skin plasty is a surgical intervention in which the skin is restored on wound surfaces that cannot heal naturally.
Most often, skin grafting is used to close extensive skin defects - it is believed that a wound with an area of more than 50 square centimeters will most likely not heal on its own and will require skin grafting.
A necessary condition for skin grafting is a good blood supply to the skin grafting area, otherwise the graft will not take root. That is why plastic is limited in the treatment of such long-term non-healing wounds as trophic ulcers and bedsores.
Indications for skin grafting:
Extensive skin defects (burns, wounds, defects after operations to remove large skin formations, scars)
Long-term non-healing chronic wounds.
Types of skin plastics
There are free and non-free skin plastics, as well as plastics with local tissues.
Loose plastic
It is carried out with a skin flap, which is transferred from a healthy area of \u200b\u200bthe skin to the wound. There are various methods of free skin grafting - "islands", full-thickness flap, split flap. Currently, split-flap plasty is most commonly used. To do this, a thin strip of skin is removed from the donor area with a special tool (dermatotome). When removed, the instrument itself makes notches on the flap, thanks to which the flap can be stretched and closed rather large wound defects.
In the photo below - an example of skin plasty with a split flap
Wound before plasty:
The wound immediately after plastic surgery - the split flap is laid on the wound surface:
Healed wound:
Non-free plastic
The essence of the method is to transplant a pre-prepared flap on a vascular pedicle. For example, the classic version - Italian plastic surgery - closing a nose defect with a flap from the shoulder. To do this, a flap is isolated on the shoulder on a vascular pedicle, which ensures its good blood supply. The flap is fixed to the nose, in this position the patient is until the engraftment of the flap, after which the leg is crossed.
Plastic surgery with local tissues
With this type of plastic surgery, wound defects are closed without transferring skin flaps, by making additional incisions near the wound, as well as other techniques that allow closing the wound defect with tissues located near the wound.
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Additional Information
Why plastic surgery for patients with gangrene?
Plastic surgery is closely related to vascular surgery. Large tissue defects that occur as a result of vascular disease are difficult to heal even after recovery normal conditions circulation of the affected organ. The surgeon is faced with the question of how to achieve complete healing and recovery even with long-term non-healing open ulcerative surfaces, necrosis of certain segments of the limb and achieve a speedy return of the patient from illness to health. In this process, the leading place belongs to reconstructive plastic surgery. Our clinic differs from others in that we not only restore tissue blood circulation, but also close all skin defects that have developed during gangrene.
Skin grafting with local tissues
It is used against the background of restored blood circulation to close small areas, but important in function. Such plastic is important when closing the stump of the foot or lower leg, closing trophic ulcers on the heel. Provides an excellent functional result, but unfortunately is not always feasible. Sometimes there are not enough local tissues to close skin defects. In this case, it is possible to use special, stretching endo-expanders, which create excess skin and increase the possibilities of the method.
Skin grafting for any wound defects!
Center for Vascular Surgery
Skin plasty for large wounds
In the treatment of gangrene, it is necessary not only to restore the blood supply to the limb, but also to remove all dead tissue. After that, extensive defects are formed that require plastic closure.
Our clinic is a unique vascular center that not only restores blood circulation in gangrene, but also performs various plastic surgery, allowing to maintain the support of the limb and the ability to walk.
Closure of skin defects and bone wounds can be achieved in various ways. Most often, simple methods of skin plastics of granulating wounds, plastics with local tissues are used.
Our surgeons use complex microsurgical methods to perform plastic surgery of "hopeless" defects after gangrene.
Principles of skin grafting
Skin grafting can only take root on a wound that has good blood circulation and no dead tissue. Wound defects on the foot, heel or shin that remain after gangrene often spread to the bone tissue. This is especially important on the supporting surface of the foot or heel. Such wounds are constantly under pressure under load and are unable to heal on their own. For healing, our surgeons use two methods.
Movement of the islet flaps
Microsurgical variant of skin plasty with local tissues. The point is to create a skin flap on a vascular pedicle that can be rotated in different directions, but its nutrition is not disturbed. This plasty is used to close complex skin defects in the area of the sole of the foot and joints.
Requires virtuoso performance, but if successful leads to full recovery functions of affected organs. The bottom line is to isolate the island, which includes the entire layer of skin with muscles, nerves and blood vessels to the main vessel that supplies this island with blood. Then the flap is rotated along its axis to the tissue defect, which completely closes.
The islet is taken from the unloaded part of the foot or lower leg, and the wound remaining after its isolation is closed with a free skin graft with a split flap. In this way we close deep wounds and ulcers on the heel or ankles. The advantages of islet skin grafting lie in the complete closure of the wound defect on the supporting surfaces with skin identical in structure to the given area. Such a skin flap holds the load well and does not require special treatment in the future.
Free microsurgical transplantation of the tissue complex
Extensive necrosis of the supporting surfaces of the foot in critical ischemia significantly worsens the prognosis of limb preservation. To solve this problem, for the first time in Russia, our clinic used the technology of transplanting blood-supplied flaps on a vascular pedicle. In essence, this technology can be described as follows. The surgeon takes a piece of skin with muscle and subcutaneous tissue using a special technology while preserving the supply vessels. After that, these vessels are connected to other arteries and veins in the area of an extensive skin defect. After that, the blood-supplied flap takes root and is built into a new place with the preservation of the blood supply.
An island of tissues can be isolated in any part of the human body, but the main supply vessel is crossed. After that, under a microscope, the vessels of the islet are connected to the vessels near the skin defect, which ensures the nutrition of this islet of tissues. Then the island is sutured to large skin defects, covering them completely. This is truly a piece of jewelry, but this method allows you to close any, even very complex defects in any part of the tissue and opens up boundless horizons in reconstructive plastic surgery. Free plastic with a complex of tissues is used to close complex supporting and articular surfaces. The point is to isolate a musculoskeletal flap with a vascular pedicle, which is transplanted to the problem area with the connection of its vascular pedicle to the supply vessels. The operations are very painstaking, but in some cases there is no alternative to them.
Skin grafting with a split skin flap
It is carried out with extensive granulating wounds after the removal of dead skin areas and the restoration of normal blood circulation in the tissues. Without these conditions, it is doomed to failure. The meaning of the plasty is to transplant a thin (0.4 mm) skin flap onto a previously prepared surface. Wounds at the site of the flap are superficial and heal on their own. In case of success of skin plating, the wound surface heals with a thin light scar. This is the most common plastic surgery in our practice. Our plastic surgeons perform at least 200 skin plastics per year with good results
The cost of skin transplantation depends on the nature of the operation and costs in our clinic from 8,000 to 200,000 rubles.
Clinical Cases
FAQ
Flight with occlusion of the vertebral arteryGood afternoon! My father (60 years old, type 2 diabetes) was informed by a doctor a few months ago of a probable occlusion of the vertebral artery. To confirm the diagnosis, it was necessary to wait for the examination, then wait for the results. They are...
Answer: Let it fly. Do not worry.
Gangrene of the fourth fingerHello, my father's right leg was amputated above the knee due to diabetes. Now gangrene of the fourth finger has begun on the left leg and has begun to move to the foot and little finger. We are from Kazakhstan...
Answer: Good afternoon. Send a photo of the leg in several projections and data from the study of the vessels of the leg (ultrasound, arteriography, CT angiography of the arteries of the leg) by e-mail [email protected]
diabetic foot treatmentMy husband underwent skin grafting on his foot after surgery to remove the little toe in the diagnosis of diabetic foot, type 2 diabetes. Q: What can be recommended for the fastest healing wounds - while imposed ...
Answer: It is difficult to answer without knowing the state of blood circulation and the type of wound. Send the examination data and photos of the leg in the correspondence section with the doctor.
blockage of the carotid artery 100%what to do, how to be, and what can be expected in such a situation, with respect, Nikolai.
Answer: You can't do anything with this. If there are problems with another carotid artery, then it is desirable to eliminate them.
removal of plaques on the carotid artery. and removal of the S-shaped bendAfter the operation, 2 days later, CDS was done, during the examination they found a 100% blockage of the artery, the question is, is a stroke or death possible in the future?
Answer: The main manifestations of acute blockage of the carotid artery occur in the first days
Angiography\" Angiography of the internal and external carotid arteries was performed weeks ago. X-ray endovascular occlusion of a malformation of the left half of the face. ..
Answer: if there was no irradiation of the pelvic organs, the probability of affecting the fetus and pregnancy tends to zero
Operation on the artery of the lower extremities.Good afternoon! Can you perform surgery on the artery of the lower extremities according to compulsory medical insurance? Registration Volgograd region.
Answer: Good afternoon! At present, the operation compulsory medical insurance policy residents of the Moscow region can receive in our clinic. Residents of other regions can apply for specialized medical care either locally...
stroke and amputationGood evening! Please read and advise! Today with the mother-in-law were on reception at the vascular surgeon. Doctor's decision: amputation above the knee! I attach a file with a description, but I can’t read anything. Thank you. Sincerely, Olga ....
Answer: Good afternoon. Please send files by email [email protected]
gangreneGood afternoon! Dad has dry gangrene of the heel, outer side of the foot and toes. Can you help him? He is 91 years old, but his heart is strong.
Answer: Send photos to [email protected]
Can the leg be saved?My husband is 48 years old. They performed an operation to restore the blood flow of the left lower limb. The foot of the foot turned black. They advise to undergo a course of treatment at the place of residence. They said it takes time to observe the stoma.
Answer: Hello. You need in urgently send the data of the discharge summary, the data of ultrasound duplex scanning of the arteries of the lower extremities before and after the operation performed by your husband, photos of the leg (take a picture of the foot from different ...
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