RU2000748C1 - Method of treatment of long tubular bone chronic osteomyelitis together with defect of osteal and soft tissues - Google Patents

Abstract

Usage: in orthopedics and reconstructive surgery. Purpose: preserving the integrity of the chest. Essence: resected tissues are resected, free thoracodorsal musculoskeletal flap defect free austoplasty is performed. As a bone graft, use the lower-outer segment of the scapular bone on the branches of the thoracodorsal artery and vein with the application of microvascular anastomoses and transosseous osteosynthesis with an external fixation device. Positive effect: maintaining the integrity of the chest

Description

The invention relates to medicine, namely to traumatology and orthopedics, and may find application in the treatment of chronic osteomyelitis and infected pseudoarthrosis complicated by scarring or a defect in soft tissues.

Known methods for treating false joints and bone defects on the apparatus and according to the method of G. A. Ilizarov. However, a direct contraindication to the use of these methods is the presence of severe scarring or soft tissue defect.

The closest in technical solution to the proposed one is a method of treating chronic post-traumatic osteomyelitis of the leg with bone defect by free autoplasty on microvascular anastomoses of the thoracodorsal musculocutaneous flap with a fence on the ribs that overlap the single vascular leg of the bones of the bones area of the false joint or defect.

The disadvantages of this method are its high morbidity and unfavorable anatomical features of the megatransplant - insignificant length of the perforating artery and collateral blood supply of the bone graft, the location of the ribs perpendicular to the axis

and at the end of the latissimus dorsi.

The essence of the invention lies in the fact that for the treatment of chronic osteomyelitis and infected false joints complicated by a defect in soft tissues using megatransplant, including

This is the lower lateral segment of the scapular bone on a single vascular pedicle with a thoracodorsal musculocutaneous flap, which creates optimal conditions for revascularization of the osteosynthesis zone and shorten the consolidation time.

The method is carried out as follows. Cicatricially altered tissues are excised. Resect the pseudoarthrosis zone or the ends of bone fragments to full bone tissue. A bone vascular graft bed is formed at the ends of the bone fragments. Recipient vessels, located near the osteosynghesis zone, are isolated. Typical access in the axillary region with a transition to the midline axial line of the chest is to form a musculocutaneous flap on the thoracodorsal artery and vein, and lift it from the periphery to the center. Separate vascular legs extending from the thoracodorsal artery to the lower lateral edge of the scapula are isolated. The specified segment of the scapula is cut off from the donor5

fifty

5

0

5

0

5 0 5

place and together with the musculocutaneous flap are transferred to the osteosynthesis zone. The segment of the scapula is placed in the prepared groove, and the skin defect above the joint is closed with a torecodorsal musculocutaneous flap. The thoracodorsal artery and the superior vein with the recipient vessels are sutured. Osteosynthesis is performed by an external fixation apparatus.

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Example. Patient 3., 23 years old, was admitted with an infected pseudoarthrosis of both bones of the right lower leg, complicated by scarring of soft tissues. After a shin bone fracture 5 years ago, complicated by chronic osteomyelitis, the patient was repeatedly operated on. Closed and open osteosynthesis was performed in the Ilizarov apparatus, skin plastic was applied, and the infection process was stopped. However, in spite of the undertaken treatment, it was not possible to joint the false joint. Made an operation. Cicatricially altered skin and soft tissue above the pseudarthrosis were excised. The zone of the false joint itself is resected, the bone channels are reamed. Osteosynthesis by Ilizarov apparatus. A bed for a segment of the scapular bone is prepared at the ends of the bone fragments. Of the scars, the tibia of the ovary artery with commissive veins was isolated. In the area of the back, a skin-muscle flap was cut to the size corresponding to a defect of the soft tissues of the lower leg. The flap is raised from the periphery to the center, the flap vessels and the place where the vascular pedicle leaves from them, going to the lower lateral edge of the scapular bone, are distinguished. A 3x5 cm scapula segment was taken on this leg. The entire tissue complex was lifted onto the thoracodorsal artery with the co-vein, cut off and transferred to the lower leg. A segment of the scapular bone is laid in a prepared bed and fixed with two spokes with solders. An end-to-side flap artery suture with a posterior tibial artery was made, end-to-end flap vein suture with a commissible tibial artery vein. After 4.5 months, the Ilizarov apparatus was dismantled, a complete fusion of the pseudoarthrosis zone was achieved.

The proposed method is shown for the most complex and difficult to treat group of patients with a defect or a false joint of the bone, complicated by a chronic infection and cicatricial degeneration of soft tissues In cases where

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generally accepted treatment methods, including (56) by A.E. Belousov. S.S. Tkachenko. Microchia hardware, do not give a result. Rugil in traumatology. L .: 1988, p. 168.

Claims (1)

Formula of the invention g of microvascular anastomoses and transosseous METHOD OF TREATMENT OF CHRONIC OSTEOMELIA TA of a long TUBULAR bone with a DEFECT of co-fixation, characterized in that, with soft and soft TISSUES by resection due to the preservation of the integrity of the chest tissue changes, free autoelasticity in iop transplant using thoracodorsal dermal-muscle defect lower external scapular segment a flap with the inclusion of bone tissue 10 BONES on B6TVIAU of the thoracodorsal artery on a single vascular pedicle with arterial vein overlay