RU2631045C1 - Method for hand finger extensor tendons reconstruction - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: finger is directed to the zero position. A month later, an autologous fat transplant is taken from the subcutaneous fat tissue. The inspiratory fluid is removed. Fan-shaped 2-3 microppassages of adipose tissue are performed with a volume of at least 20.0 ml in the recipient bed of the finger with an interval of 2-3 months between procedures. A diamond shaped transplant is taken from the wide fascia of the femur. Tenolysis, mobilization of lateral bundles and the central bundle of the tendon are performed. The transplant is sutured to the tendon stumps, to the legs of the lateral bundles and to the base of the middle phalanx.

EFFECT: method restores the lost volume of soft tissues and the tendon function.

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Description

The present invention relates to medicine, namely to reconstructive and plastic surgery.

A known method of reconstruction of the extensor tendons of the fingers of the hand, including the mobilization of the lateral bundles with their subsequent stitching together (VV Azolov, GI Dmitriev et al. "Reconstructive surgery and reconstructive treatment of the effects of thermal injury of the hand", 2004: 58).

However, this method limits finger flexion.

As a prototype, a method of extensor extensor tendon reconstruction was selected, including the removal of the finger to the zero position by knitting in the preoperative period for 3-4 weeks, tenolysis of the proximal end of the central extensor bundle and mobilization of the lateral tendon bundles, the formation of a free skin autodermal graft from the inner surface of the middle third of the shoulder, hemming of one end to the proximal cult of the middle portion of the extensor, and the second to the base of the middle phalanx, and hemming of the lateral portions of the ra of the extensor to the lateral corners of the autodermal transplant (D. A. Bondaruk “Treatment of patients with long-term consequences of injuries of the extensors of the fingers of the hand.” Bulletin of Orthopedics, Traumatology and Prosthetics, 2011 No. 4: 13-18).

However, the known method in the case of incomplete epidermization of the skin graft leads to the formation of epidermal cysts and frequent relapses of the scar-adhesion process. In addition, in conditions of soft tissue deficiency, it is impossible to restore an adequate sliding surface for a tendon graft, which leads to restriction of movements.

The objective of the proposed invention is the improvement of the method.

EFFECT: restoration of the lost volume of soft tissues necessary for adequate sliding function of the tendon.

The presented technical result is achieved due to the fact that in the method, including the removal of the finger to the zero position, tenolysis and mobilization of the lateral and central bundles of the tendon, the selection of the diamond-shaped graft with subsequent hemming, after the removal of the finger to the zero position, fat is taken from the fatty tissue layer, removed inspiratory fluid and perform fan-like 2-3 micropassages of adipose tissue with a volume of at least 20.0 ml each in the recipient bed of the finger with an interval between procedures of 2-3 months.

The method is as follows. At the first stage, with a transosseous device, the finger is brought to the zero position. After a month, the Body Jet Lipocollector-3 hardware complex performs fat sampling from a layer of adipose tissue in the hypogastric region. The fat is packed in syringes, decanted in an upright position and the inspiratory fluid is removed. The remaining adipose tissue is packed in 3 and 5 ml syringes and, using a needle, fan-shaped is introduced into the recipient bed of the finger with a volume of at least 20.0 ml. Perform 2-3 micropassages with intervals between procedures for 2-3 months. After that, a diamond-shaped transplant is taken from the wide fascia of the thigh corresponding to the size of the tendon defect. A wave-like incision, tenolysis and mobilization of the lateral and central bundles of the extensor tendon are made on the back surface of the finger of the hand. The transplant is sutured distally and proximal to the corresponding tendon stumps, on the sides to the legs of the lateral bundles, to the base of the middle phalanx is fixed transossally. The wound is sutured, fixation is carried out with a plaster span in the zero position for up to 28 days.

Clinical example

B-th Shch-s VN, 17 years old, was in the Department of Reconstructive and Plastic Surgery of the Nizhny Novgorod Research Institute with a diagnosis of scar-teno-arthrogenic flexion contracture of 3, 4, 5 fingers of the right hand. Upon admission, the patient has extensive skin scars on the back surface of the right hand, 3, 4, 5 fingers in the flexion position, active extension to the zero position is impossible. At the first stage, a transosseous device is placed on the 3rd finger of the right hand. Fat was taken using the BodyJetLipocollector-3 hardware complex, followed by micropassage into the decipient bed. The postoperative period without complications. Discharged for the inter-stage period. At the third stage, access to the tendon of the flexor of the 3rd finger was made, the central and lateral bundles were mobilized. A graft was taken from the wide fascia of the thigh; plastic defect of the central beam was produced. The postoperative period without complications. The patient was examined after 6 months - the 3rd finger in the correction position, active extensor movements are possible.

The method makes it possible to restore the lost volume of soft tissues necessary for adequate sliding function of the tendon, provides stabilization of the fingers in the correction position and restores the function of the tendons of the extensors of the fingers of the hand using autologous tissue. Autologous adipose tissue sampling and passage for the formation of a soft tissue skeleton is performed using minimally invasive tissue-saving technologies, which contributes to minimal traumatic effect on cellular structures and, as a result, their maximum engraftment in the recipient bed. The method eliminates the damage to remote donor areas.

Claims (1)

A method of reconstruction of extensor tendons of the fingers of the hand, including the removal of the finger with the transosseous device to the zero position, tenolysis and mobilization of the lateral and central bundles of the tendon, the use of a diamond-shaped graft with subsequent stitching it to the stump of the tendon, middle phalanx, characterized in that one month after the finger is removed to zero position, fat is taken from the layer of fatty tissue, the inspiratory fluid is removed, the remaining adipose tissue with a volume of at least 20.0 ml is introduced fan-shaped into the recipient The finger bed is 2-3 procedures with an interval of 2-3 months between them, after which a rhomboid graft from the patient’s wide fascia is sutured.