Development of microsurgery and reconstructive surgery at the Clinical Hospital Centre in Rijeka

Klinička mikrovaskulama kirurgija afirmirala se prvo u replantacijama amputiranih prstiju i udova. Iz literatureje teško odrediti gdje je učinjena prva mikrovaskulama replantacija. Temeljni radovi o replantaciji obavljeni su 1975. - dr. Chen, NR Kina, 6. narodna bolnica Shanghai. U KBC Rijeka prva uspješna replantacija podlaktice učinjena je 1983. godine. Od tada su u KBC-u učinjene brojne replantacije prstiju i dijelova gornjih ekstremiteta. Kod uspješnih replantacija rezultati su funkcionalno i estetski zadovoljavajući. Koristili smo sljedeći red operacijsko-rekonstmkcijskih zahvata: osteosintezu, anastomozu, rekonstmkciju vaskulamih elemenata, rekonstrukciju živaca, rekonstmkciju tetiva ili mišića, rekonstmkciju mekog pokrova (direktne suture, slobodni kožni transplantati i prijenos kože i potkožja u smislu slobodnih režnjeva ili vezanih ingvinalnih režnjeva). Kako bismo izbjegli kolamu nekrozu kod replantacije, posebice na nadlakticama i podlakticama, pri rekonstrukciji koštanih elemenata činili smo skraćenje otprilike do 8 i 10 cm bez znatnih funkcionalnih i estetskih oštećenja. Iste metode koristimo kod rekonstrukcije živčanih elemenata kada postoji oštećenje istih jer usporedni rezultati direktnih epineuralnih sutura živaca i interfascikulame transplantacije su u korist direktnih epineuralnih šavova. Pravu sliku vrijednosti mikrokirurgije (replantacije) dobivamo u usporedbi invalidima bez udova iz vremena kada nisu činjene replantacije ili s neuspješnim rekonstrukcijama.Clinical microvascular surgery was first affirmed with replantations of amputated digits and limbs. From the literature it is very difficult to determine exactly when the first microvascular replantation took place. The basic replantation activities began in 1975 by Dr Chen of the 6th National Hospital in Shanghai, China. The first successful forearm replantation at the Clinical Hospital Centre in Rijeka was performed in 1983. Since then many of digit and upper limb parts\u27 replantations have been done. In a successful replantation the results are satisfactory both functionaly and esthetically. During replantation, operative reconstructive grips are performed in the following order: osteosynthesis, anastomosis and reconstruction of vascular elements, reconstruction of nerves, reconstruction of tendons or muscles, reconstruction of soft covering (direct sutures, free skin transplants and skin and subcutaneous tissue transfers in form of free flaps or island groin flaps). In order to avoid collar necrosis in replantation, especially in the upper arm and the forearm, during reconstruction of osseous elements a shortening of up to 8-10 cm was performed, without considerable functional and aesthetic defects. The same methods were used in the reconstruction of defective nervous elements, because the compared results of direct epineural sutures of nerves and interfascicular transplantation are in favour of direct epineural sutures. The real value of microsurgery (replantation) is understood when comparing successfully treated patients with the disabled people with amputated extremities from the time when replantations were not performed or as a result of an unsuccessful reconstructions