RU2402987C2 - Method of tendion replacement by dermal autograft - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to traumatology and orthopaedics, and it is applied in surgical correction of various traumatic injures when tendon grafting is required. Lengthwise sections are performed in 2/3 of tendon diametre and 1.5 cm long on the tendon. A defect is replaced by a dermal autograft of the length exceeding the diastasis dimensions between the tendon ends by 3.0 cm. The graft is dipped in 96% ethanol for 10 minutes. Then it is duplicated so that the dermal autograft width is 1/3 of the tendon diametre, and underrun lengthwise by nonabsorbable uninterrupted sutures.

EFFECT: method allows restoring full range of motion.

3 dwg

Description

This invention relates to traumatology and orthopedics. The scope affects the surgical treatment of tendon ruptures during plastic surgery of the damaged tendon diastasis.

A known method of repairing tendons (Grechko V.N., Anisimov V.N., Lunin S.A., Korolev D.V. “Method for lengthening tendons using a polypropylene mesh”, patent for invention No. 2286737), taken as a prototype, when which in the projection of the tendon make a skin incision, the distal and proximal ends of the tendon are freed from scar tissue in case of chronic traumatic injuries. The size of the diastasis between the ends of the tendon is measured.

A rectangular flap is cut from a polypropylene mesh 3.0 cm longer than the diastasis between the ends of the tendon, folded in the form of a duplicate so that the width of the polypropylene graft is equal to 1/3 of the diameter of the tendon, and the length of the incision is sutured with a continuous suture from a non-absorbable suture material.

At one end of the tendon, a longitudinal incision is made by a depth of 2/3 of the tendon diameter, 1.5 cm long, into which a portion of the polypropylene graft is immersed, and fixed with interrupted sutures from a non-absorbable suture material to the tendon with restoration of the integrity of the sliding surface of the tendon. Similarly, a polypropylene graft is sutured to the other end of the tendon with restoration of its required length. The disadvantages of this method include: 1) restriction of use due to the high cost of the polypropylene mesh; 2) low elasticity of the restored tendon.

There is a way to repair Achilles tendon ruptures (A. Imamaliev, S. Osipova, S. P. Tishin, G. A. Imamalieva “A method for treating Achilles tendon rupture according to A. S. Imamaliev”, patent for invention No. 2125849) , along which longitudinal sections along the outer edges of the fragments of the Achilles tendon expose its torn ends. From the aponeurosis of the calf muscle, a flap is cut out that is connected with the bed in the distal section. A longitudinal tunnel is cut under the base of the flap, into which the flap is pulled, which, like the defect of the calf muscle, is sutured with rare sutures, and the wound is sutured tightly layer by layer. Among the disadvantages of this method, it is worth highlighting: 1) its application does not allow to restore a shortened tendon and does not guarantee sufficient strength in the area of the tendon suture, which can lead to its eruption and divergence of the ends of the stitched tendon; 2) long periods of disability of patients.

The purpose of this invention is the prosthetics of a damaged tendon, in the presence of diastasis between its ends, to restore range of motion, a more physiological use of an autoderm graft, compared with plastics with synthetic materials.

The above goal is achieved by compensating for the shortening of the injured tendon with a dermatograft, which is cut out from the skin.

Figure 1 shows a duplicate of a dermatograft.

Figure 2 shows the immersion of the dermatograft site and fixing it with interrupted sutures to the tendon.

Figure 3 presents the stitching of a dermatograft at the other end of the tendon with the restoration of its required length.

The method is as follows.

A skin incision is made in the projection of the tendon, the distal and proximal ends of the tendon are freed from scar tissue in case of chronic traumatic injuries. The size of the diastasis between the ends of the tendon is measured.

A rectangular flap is cut from the skin (for example, thigh skin), 3.0 cm longer than the size of the diastasis between the ends of the tendon. The flap is immersed in 96% ethanol for 10 minutes. Then they are folded in the form of a duplicate (Fig. 1) so that the width of the dermatograft is equal to 1/3 of the diameter of the tendon, and it is stitched along the length with a continuous suture from non-absorbable suture material.

At one end of the tendon, a longitudinal incision is made by a depth of 2/3 of the diameter of the tendon, 1.5 cm long, into which the autoderm graft section is immersed, and fixed with interrupted sutures from non-absorbable suture material to the tendon (Figure 2). Similarly, a dermatograft is sutured to the other end of the tendon with restoration of its required length (Figure 3). The wound is sutured in layers.

The experimental tests of the proposed method on laboratory animals revealed such advantages of the method as:

1) the availability and physiology of the autoderm graft, which allows the widespread and widespread use of this method,

2) this method, in comparison with prosthetics with synthetic materials, does not require additional economic costs.

Claims (1)

A method for prosthetics of the tendons, including dissection of the tendon, insertion of the graft, its stitching with the tendon, characterized in that the tendons perform longitudinal cuts with a depth of 2/3 of the diameter of the tendon and a length of 1.5 cm, into which the autograft section is immersed, which is a rectangle of length 3 cm larger than the diastasis between the ends of the tendon, previously placed in 96% ethanol for 10 min, folded in the form of a duplicate, 1/3 of the diameter of the tendon and stitched with a continuous suture of a non-absorbable suture, and then fix the graft interrupted sutures of non-absorbable suture tendon ends to the restoration of its desired length.

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