Filatov stem. Indications for replacement of defects of tissues and organs MFA Filatov stem. Methods of harvesting stem migration, training and closure of the defect.
Defects in skin, oral mucosa, nose, methods of closing them free flap: indications, techniques of free skin plastic.
The tube pedicle flaps
The tube pedicle was developed simultaneously yet independently by Sir Harold Gillies at the Queen’s Hospital Sidcup and ophthalmic surgeon Vladimir Petrovich Filatov in
The procedure begins with the lifting of a long, large flap of skin by making a roughly ‘U’ shaped incision. The rounded end of the flap is cut to shape to fit the area to be repaired. The long edges of the skin flap are stitched together to form a tube to prevent drying out and infection of the raw side of the skin flap. The shaped end of the tube is then attached to the site to be repaired whilst the other end of the tube remains attached to its site of origin. After a number of weeks, the tube is cut near the area to be repaired leaving enough skin on the graft site to shape and model. The remainder of the tube can once again be opened and returned to its original position. On occasion, multiple tubes might be taken to rebuild substantial parts of the face or body.
Tissue must be taken from distant parts of the body in stages. For example a tube might be taken from the stomach area and attached to the wrist. After a number of weeks the tube would be disconnected from the stomach, the arm raised and the loose end of the tube attached to the site on the face to be repaired. Once again after a number of weeks the tube is disconnected from the wrist and this loose end of the tube is attached to another part of the face. Only then can the tube be opened and modelled to the face.
Clinical situation.
A special problem was encountered in cases with facial defects following low-voltage accidents. Two electricians who had suffered facial injuries from a 380 V electric shock were selected. A 29-year-old man with a contact burn in the supraorbital and zygomatic region was grafted and nine months later he asked for eyebrow reconstruction, having returned to work between times (Figs. 1, 2).
Another 21-year old man collapsed while working on an electrical panel, losing consciousness and suffering from cardiac arrest. Immediate cardiopulmonary resuscitation was initiated and on admission the patient was alert, although suffering from amnesia. The sensory and motor examinations were normal. X-ray of the skull and ECG showed no changes. The destruction of the temporal and periorbital region and the radix of the nose required necrectomies (Figs. 3a,b).
Xenografting was used to cover the defects temporarily, while a tube pedicle flap on the left arm was prepared (Figs. 4, 5a,b). Before transfer of one pedicle to the glabella region, the open frontal sinus was examined. All the flap surgery was carried out under local anaesthesia, without any antibiotics, because all the bacteriological swabs were repeatedly negative and there was no clinical sign of infection.
One year later the patient requested reconstruction of his post-traumatic saddle nose. An osteocartilaginous allograft removed from a cosmetic “hard” nose was used. The patient has since returned to work and married one of our patients (Figs. 6a,b, 7).
