Traumatology and Orthopedics of RussiaTraumatology and Orthopedics of RussiaТравматология и ортопедия России2311-29052542-0933Vreden National Medical Research Center of Traumatology and Orthopedics5310.21823/2311-2905-53ReviewsОбзорыReviewsUnknownEvolution of «the problem of soft tissues» in the field of knee arthroplasty: role and function of flap surgeryЭволюция «проблемы мягких тканей» при эндопротезировании коленного сустава и роль технологий реконструктивнопластической микрохирургии в ее решенииKutyanovD. I.КутяновД. И.
Russian Federation
kutianov@rambler.ruRodomanovaL. A.РодомановаЛ. А.
Russian Federation
rodomanovaliubov@rambler.ruVreden Russian Research Institute of Traumatology and OrthopedicsФГБУ «Российский научно-исследовательский институт травматологии и ортопедии им. Р.Р. Вредена» Минздрава РоссииMechnikov North-Western State Medical UniversityГБОУ ВПО «Северо-Западный государственный медицинский университет им. И.И. Мечникова» Минздрава России1206201420111312112092016Copyright ©; 2014,Copyright ©; 2014,2014https://journal.rniito.org/jour/article/view/53

The authors have analyzed scientific works on various aspects of the problem of knee arthroplasty connected with the pathology of periarticular soft tissues. One of the main goals was to trace the evolution of flap surgery principles in the treatment of patients with this pathology. It has been stated that today we can trace two sides in «the problem of soft tissues». The first one in the historical perspective is an operative management of complex wounds following knee arthroplasty, and this side has been studied well enough. The second one is the prophylaxis of skin necrosis and wound infection via flap surgery. This problem is still far from solving. Although in the tradition of world orthopedic surgery pedicled flap transfer and free tissue transfer in the complex cases of knee arthroplasty is not an exclusive practice, the methodology of flap surgery demands further development and scientific foundation.

Проведен анализ научной литературы по различным аспектам проблемы эндопротезирования коленного сустава, связанным с патологией околосуставных мягких тканей. Прослежена эволюция лечебно-методологических принципов использования в таких ситуациях технологий реконструктивно-пластической микрохирургии, на основании чего выделено две грани рассматриваемой проблемы: реконструкция околосуставных мягких тканей у больных, нуждающихся в эндопротезировании и лечение местных инфекционно-некротических осложнений этих операций. Установлено, что если вопросы лечения пациентов с осложненным течением послеоперационного раневого процесса к настоящему времени разработаны достаточно полно, то вопросы профилактики таких осложнений, в том числе и путем микрохирургических реконструкций, еще очень далеки от своего окончательного решения. И хотя для мировой ортопедической практики пересадки кровоснабжаемых мягкотканных комплексов в сложных случаях эндопротезирования коленного сустава на сегодняшний день нельзя назвать исключительным явлением, вопросы тактики использования микрохирургических технологий требуют дальнейшей углубленной разработки и научного обоснования.

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