Objective. Hand injuries in children are quite common. Most challenging within plastic and reconstructive surgery/reconstructive microsurgery expertise were there traumatic hand defect and upper extremities open injuries sequels. There were wide variety of reconstruction techniques to deal with hand defects in general and with distal phalanx defects particularly. The core problem is how to make very choice of reconstructive method and technique from diversity of local, regional and distant flaps. Injuries of distal phalanges are the most common type of hand trauma in children. The problem of coverage of soft tissue defects of distal phalanges remains actual. A lot of methods of coverage of distal phalanges defects are developed. There is no generally accepted approach or an algorithm in the treatment of adults and children with such type of trauma.
Material and methods. In the period from 2018 to 2021 at the Microsurgery Department of N.F. Filatov Moscow Clinical Hospital for Children 152 surgical operations using local (68), regional (72) and distant (12) flaps were performed.
Results. All flaps in all patients within our clinical series have survived. There were neither major complication no secondary revisional procedures. Used different flaps in general provided transport of adequate viable donor tissues to recipient areas of critical functional significance. The selection of particular flap we have been making on individual basis mostly depending on type and injury severity, and functional requirement and prognosis.
Conclusion. We are considering surgeon’s own experience is main defining factor to make selection of certain method from the diversity of different flaps.

The paper presents clinical results of using a new method of reconstruction of the lower alveolar nerve during mandible resection due to benign tumors for 10 patients aged 18 to 60 years. The aim of this work is to include in the concept of complete rehabilitation of the patient in the case of mandible resection the restoration of the sensitivity of the lower lip and the innervation zone of the lower alveolar nerve. A feature of the method is the use of the sural nerve as a donor and the lingual nerve as a recipient, if it is impossible to preserve the proximal end of the lower alveolar nerve. An algorithm for simultaneous nerve reconstruction was developed. The safety and effectiveness of this method were evaluated.

Erectile dysfunction (ED) is a fairly urgent problem in modern medicine. The epidemiological situation confirms the need to develop new methods and treatment for ED. Microchemic surgeries in the treatment of ED have more than half a century of history. This manuscript provides an overview of microsurgical treatments for erectile dysfunction.

Objective. Despite the recent advances and innovations in the field of microsurgery and free flaps, vascular anastomoses are still manual and surgeon dependent with traditional methods. The purpose of this study is to evaluate the effectiveness, in the short and medium-term, of glutaraldehyde with bovine serum albumin (BSA) surgical adhesive in the performance of arterial microanastomoses.
Material and methods. Fourteen femoral end to end anastomoses (Group 1) and 10 aortic anastomoses (Group 2) were performed in 18 Wistar rats. Flux was measured before, immediately after the anastomoses, and 24 hours later, with a transit-time ultrasound to have quantitative data. Anastomoses technique consisted in using minimal stitches to approximate the vessels and applying BioGlue® adhesive to seal the union. The SSPS® package was used for the statistical study.
Results. A median of 2 stitches were necessary in femoral arteries, and 4 stitches in aorta. The median anastomoses time was 16.5 minutes in Group 1 and 32.5 in Group 2. 93% anastomoses of Group 1 and 100% in Group 2, were permeable immediately, and 77% in Group 1 and 100% in Group 2 were permeable after 24 hours, with adequate flux measures. There were no differences in pre and postanastomotic – 24 h aorta-diameter.
Conclusions. The use of glutaraldehyde with BSA is a promising technique for the microsurgery of the future, and it is a fast, easy, and reliable alternative to perform microvascular anastomoses, especially when surgeon needs to avoid repeated trauma in the vessel wall or wants to reduce the material inside the lumen and reduce the risk of thrombosis.

The paper describes the reconstruction of the rat hind limb lymphedema model according to the method of V. Triacca et al. (2019), presents in detail morphological changes in the skin and subcutaneous tissue of animals at different stages of the development of chronic lymphatic edema. Histological changes in the tissues of the dermis and hypodermis up to 3 months are characteristic of acute lymphatic edema, from the 4th to the 6th month the histological picture is characteristic of the compensation stage. The most pronounced changes characteristic of chronic lymphatic edema develop by the 6th month.

Introduction. Microvascular training constitutes a foundational element of many highly specialized surgical fields. This manuscript describes my experience (D.A. Devia) as a neurosurgical resident during the advanced microsurgical course guided by the senior author (Ye. Akelina) at the Microsurgery Training and Research laboratory, Dept of Orthopedic Surgery, Columbia University Irving Medical Center.
Methods. The technical aspects of advanced vascular exercises performed in the microsurgery laboratory are reviewed and presented, accompanied by figures of each exercise accomplished.
Conclusions. Microsurgery vascular training is an important tool in every cerebrovascular surgeon, or any other specialty interested microvascular procedures. The experience and exercises demonstrated in this paper are extremely useful for microvascular practice and should be included in any advanced course around the world for every surgeon interested in this field.

The COVID-19 pandemic has challenged the way microsurgery is taught. In response, a live online program was created for surgeons to improve their microsurgical skill set as well as for non-experienced students to be introduced to the field. The curriculum included recorded video modules and live online sessions with the instructor. Three different student workstation setups were analyzed for its microsurgery training efficacy. In this paper, we illustrate Columbia University’s development of a virtual microsurgery course and why the “scope to scope” workstation setup is the preferred method for microsurgical training.

The purpose of this study was to share our clinical experience of using a new technique for tongue reconstruction after hemi-, subtotal and total resection with a bineural musculocutaneous anterolateral thigh flap (ALT).
Material and Methods. During the period from 2020 to 2021 four patients were diagnosed with oral cavity cancer and underwent radical surgical treatment with cervical lymphadenectomy and simultaneous tongue reconstruction using binerval ALT flap, with the performance of neural anastomoses of the sensitive branch to the great auricular nerve, and the motor branch to the accessory branch of the hypoglossal nerve.
Results. All patients were aged 36 to 64 years.. Squamous cell carcinoma was diagnosed in all cases. Disease stages according to TNM were from II to IVa. Tracheostomy was performed in 3 out of 4 cases. The duration of hospital stay varied from 14 to 27 days. The development of postoperative complications was not observed. Oral meals were started on average 3 weeks after surgery. Decanulation in 3-4 weeks after surgery. Speech intelligibility was assessed on a scale, in 3 patients it was rated as good (4), in 1 patient it was poor (2). Swallowing score on a scale, 7 points in 2 patients, 6 points in 1 patient, 4 points in 1 patient. All sensory tests were satisfactory in all cases. No recurrence was observed.
Conclusion. The ALT flap gained its popularity in tongue reconstruction due to a long and reliable vascular pedicle, the ability to vary the amount of tissue required to replace various defects, both in hemiglossectomy and in total glossectomy and low donor site morbidity. Also the flap has the advantages of double reinnervation, which ensures its functionality.

In honour of Professor Isao Koshima’s 70th birthday, a short manuscript regarding his main contributions to microsurgery, as well as impact on the surgical specialty in Russian Federation is discussed. The numerous achievements of Professor Koshima are built upon years of experience. Currently, Isao Koshima is the Chief of the International Center for Lymphedema, at Hiroshima University Hospital (Japan). He is known be all as an enthusiastic and extremely talented microsurgeon and a world-known scientist. In 1989, I. Koshima first introduced the epigastric artery perforator flap, and the discovery of the DIEP flap is widely accredited to him. He introduced this flap at the 1st International Course on Perforator Flaps held in Ghent in 1997. Professor Koshima’s numerous contributions to the field of microsurgery are truly invaluable. His life and career are respected by all and his guidance is requested daily around the World. I. Koshima’s contribution to lymphatic supermicrosurgery is especially prominent, as this field is completely built upon his pronounced expertise. To this day, Isao Koshima offers lectures, training programs and is an active participant of many congresses worldwide, making him one of the most sought teachers in the history of microsurgery.