RU2297804C1 - Method for finger reconstruction - Google Patents

Abstract

FIELD: medicine, surgery.

SUBSTANCE: the present innovation deals with stage-by-stage forming a finger out of the skin of anterior abdominal wall and a bony autotransplant. In inguinal area above iliac crest it is important to form a tubular flap upon one supplying tissue pedicle according to a certain technique, in the course of flap's cutting procedure it is necessary to include a bony transplant formed out of iliac crest into its composition by not affecting vascular bonds with the skin. The flap developed should be sutured up to the finger's stump, moreover, one should fulfill osteosynthesis between the bony transplant and zonal bone of finger. In 4 wk one should dissect flap's supplying pedicle against the stomach to form a finger finally. The innovation enables to avoid resolution of bony transplant in remote period and shorten terms of rehabilitation considerably.

EFFECT: higher efficiency.

4 dwg, 1 ex

Description

The invention relates to medicine, namely to surgery.

There are various methods for reconstructing the fingers of the hand when they are lost. All of them come down to the formation of a finger from the patient’s own tissues, cut out on the donor site of the body.

A known method of reconstructing fingers of a hand by transplanting fingers from the foot, which includes taking as a transplant the second or third toes, which are transferred to the stump of the finger, performing osteosynthesis between the metacarpal bone of the hand and the bones of the transplanted finger and stitching blood vessels, finger nerves and tendons (Belousov A .E. Plastic reconstructive and aesthetic surgery. - SPb. 1998. - p.).

However, with all the advantages of this method, it requires the surgeon to have special skills in vascular microsurgery and expensive equipment, and therefore, in the current socio-economic situation, it is practically inaccessible to the vast majority of patients. Fence of the toe as a transplant leads to a violation of its supporting function. Many patients who have suffered a traumatic loss of fingers are psychologically unprepared for a transplant of a finger from the foot and related dysfunction of the lower limb and categorically refuse surgery.

There is also known a method of reconstruction of the fingers of the hand with a reversible radial flap, including cutting a skin-bone flap on the middle third of the radial surface of the forearm on an isolated vascular pedicle and forming an absent finger from it (Belousov A.E., Pinchuk V.D., Yurkevich V.V. . // Vestnik Khir. - 1990. - T.144, No. 1. - S.85-89).

However, to perform this method also requires expensive microsurgical equipment. In this way, you can reconstruct only the first finger of the brush. Possible flap necrosis due to torsion or compression of the vascular pedicle. Radial bone fractures are possible in the long term due to a decrease in its diameter from the bone graft.

As the closest analogue, the method for reconstructing the fingers of the brush according to Nikoladoni was adopted, which includes four stages. At the first stage, a skin tubular flap is formed with two feeding legs on the front surface of the abdominal wall according to Filatov. At the second stage, after 4 weeks, one of the feeding legs is cut off and sutured to the stump of the finger after refreshing its end. At the third stage, after 4 weeks, the second feeding leg is cut off from the abdomen and the skin of the finger is formed. At the fourth stage, after 1-3 months, in the area of the postoperative scar, at the border between the flap and the stump of the finger, a longitudinal incision is made of 3-4 cm, a longitudinal channel is formed in the flap into which a free bone graft is taken, taken from the iliac crest, ribs or front surface of the tibia. Perform osteosynthesis of the metacarpal bone with a bone graft and sutured the wound. After 5-6 weeks, after the bone fusion, they begin medical gymnastics (Azolov V.V. // Medical rehabilitation of patients with thermal injuries: Resp. Scientific scientific papers. - Gorky, 1981. - P.89-96).

However, the known method has several significant disadvantages.

The introduction of a bone graft at the last stage of the operation can disrupt the blood supply to the skin flap, which will lead to ischemic necrosis.

A free bone graft, being deprived of normal blood supply, often undergoes partial and sometimes complete resorption, which negates the functional result of the treatment.

Treatment for 6-8 months, repeated surgical interventions exhaust the patient, already having an unfavorable psychological background due to the loss of fingers, which significantly violates the quality of life.

The objective of the invention is to provide a highly effective method of reconstruction of a finger of the hand, which allows to reduce treatment time and prevent possible complications.

The essence of the invention lies in the fact that in the method of reconstruction of the finger of the hand, which includes the stepwise formation of it from the skin of the anterior abdominal wall and a bone autograft, a tubular flap is formed in the inguinal region above the iliac crest according to Blokhin-Converse, in the process of cutting the flap in its composition, without violating vascular connections with the skin covering it, a bone graft is formed, formed from the iliac crest, the formed flap is sutured to the finger stump, while roizvoditsya osteosynthesis between the bone graft and bone finger metacarpal, 4 weeks made clipping pedicle flap from the abdomen, and the final formation of the finger.

Using the invention allows to obtain the following technical result.

The method is technically simple and does not require the use of expensive microsurgical equipment.

The inclusion of the iliac crest graft in the flap without violating its vascular connections with the covering skin ensures its normal blood supply and prevents its resorption in the long term.

Reducing the stages of surgical treatment to two significantly reduces the rehabilitation time, which improves the quality of life of the patient.

The technical result is achieved due to the fact that in the process of cutting out a skin flap, a bone graft formed from the iliac crest is included in its composition without violating vascular connections with the skin covering it. This prevents the resorption of the graft in the long term and allows you to reduce the treatment to two stages.

The method is as follows.

The first step in the inguinal region above the iliac crest is an S-shaped incision that forms two skin-fascial halves of a tubular flap on one feeding tissue leg according to Blokhin-Converse (Fig. 1). In the process of cutting a flap into one of the fascial and fascial halves, without violating its vascular connections with the covering skin, a bone graft 7-8 cm long and 2-2.5 cm wide is turned on, cut down with a chisel or circular saw from the iliac crest (Fig. .2). Two halves are sewn together with the formation of a tubular flap (figure 3). The formed flap is sutured to the stump of the finger, after refreshing its end, while osteosynthesis with Kirschner spokes between the bone graft and metacarpal bone of the finger is performed (Fig. 4).

The second stage, 4 weeks after preliminary training by briefly clamping the feeding leg for 30 minutes a day, starting from the fifth day of the postoperative period, the feeding leg of the flap is cut off from the abdomen and the finger is finally formed.

Fixing spokes are removed after radiologically confirmed consolidation of the bone graft with metacarpal bone.

Example. Patient S., 42 years old, came to the clinic with a diagnosis of post-traumatic stumps of 1, 2, 3 fingers of the right hand.

After preoperative preparation, the patient underwent surgery according to the proposed method.

The first stage in the inguinal region above the iliac crest with an S-shaped incision was formed two skin-fascial halves of the tubular flap according to Blokhin-Converse. In the process of cutting a flap into one of the fascial and fascial halves, without breaking its vascular connections with the covering skin, a bone graft of 7-8 cm long and 2-2.5 cm wide, formed from the iliac crest, is included. A tubular flap was formed and stitched to the stump of 1 finger after refreshing its end, while osteosynthesis with Kirschner spokes between the bone graft and metacarpal bone of the finger was performed.

After 4 weeks, after preliminary training of the flap by short-term clamping of the feeding leg for 30 minutes per day, the feeding leg of the flap was cut off from the abdomen and finally the formation of the finger.

Fixing knitting needles removed after radiologically confirmed consolidation of the bone graft with metacarpal bone 6 weeks after the first operation. Physiotherapy exercises have been prescribed.

At the control examination, the cosmetic result is good, the cylindrical grip of the brush is restored.

Claims (1)

A method for reconstructing a finger of a hand, including the stepwise formation of it from tissue of the anterior abdominal wall and a bone autograft from the iliac wing, characterized in that two skin-fascial halves of a tubular flap are formed in the inguinal region above the iliac crest on a single supply tissue leg according to Blokhin-Converse , in the process of cutting the flap into one half, without breaking the vascular connections with the skin covering it, include a bone autograft, the formed flap is sutured to the finger stump, at the same time, osteosynthesis is performed between the bone autograft and the metacarpal bone of the finger, after 4 weeks, the feeding leg of the flap is cut off from the abdomen and the final formation of the finger.

Images