MD1047Z

MD1047Z - Method for plasty of infected tissular defect in the calcanean region with vascularized flap

Info

Publication number: MD1047Z
Application number: MDS20150101A
Authority: MD
Inventors: Григоре ВЕРЕГА; Леонид ФЕГЮ; Михаил РУДЕЙ; Анна Мария ФЕГЮ
Original assignee: ОП ГОСУДАРСТВЕННЫЙ МЕДИЦИНСКИЙ И ФАРМАЦЕВТИЧЕСКИЙ УНИВЕРСИТЕТ им. НИКОЛАЯ ТЕСТЕМИЦАНУ РЕСПУБЛИКИ МОЛДОВА
Priority date: 2015-07-17
Filing date: 2015-07-17
Publication date: 2017-01-31
Also published as: MD1047Y

Abstract

The invention relates to medicine, in particular to traumatology and orthopedics, and can be used for plasty of infected tissular defect in the calcanean region with vascularized flap.Summary of the invention consists in that it is performed the Doppler graphical examination to detect the projections of perforated musculocutaneous vessels of the posterior tibial artery, are removed the devitalized tissues in the defect region, is performed a longitudinal cutaneous incision on the posteromedial surface of the leg, behind the rear edge of the tibia to detect the perforated vessels, after determining the dimensions of the defect it is prepared a flap, which includes soft tissues, including a portion of the deep fascia, and a bone graft from the tibia of a dimension of 2 x 5 cm with the perforated vessel, then the flap is rotated by 180° with the bone fragment located in the calcaneum defect and is fixed with the help of 1…2 screws, the Achilles tendon is sutured to the bone fragment, then the wound is sutured in layers, is drained and is applied a plaster immobilization.

Description

Invenţia se referă la medicină, în special la traumatologie şi ortopedie şi poate fi utilizată pentru plastia defectelor infectate tisulare din regiunea calcaneană cu lambou vascularizat. The invention relates to medicine, in particular to traumatology and orthopedics and can be used for the plasty of infected tissue defects in the calcaneal region with a vascularized flap.

Este cunoscută metoda chirurgicală de tratament al defectelor infectate de os calcanean prin distracţie cu aparat extrafocar Ilizarov, denumită calcaneogeneză [1]. The surgical method of treating infected calcaneal bone defects through distraction with the Ilizarov extrafocal apparatus, called calcaneogenesis, is known [1].

Metoda cunoscută prezintă neajunsuri, cum ar fi: numărul mare de etape chirurgicale efectuate cu implicarea specialiştilor din ramuri diferite, termen lung de formare a noului os pentru suplinirea defectului, nu permite rezolvarea defectului cutanat în aceeaşi etapă, iar în caz de defect necesită o intervenţie suplimentară de plastie cutanată sau plastie cu lambou, spre final este necesară artrodeza subtalară pentru cuparea sindromului dolor. The known method has shortcomings, such as: the large number of surgical stages performed with the involvement of specialists from different branches, long term of formation of the new bone to replace the defect, does not allow the skin defect to be resolved in the same stage, and in case of a defect it requires an additional skin plasty or flap plasty intervention, towards the end subtalar arthrodesis is necessary to control the pain syndrome.

Problema pe care o rezolvă invenţia propusă este elaborarea unei metode pentru tratamentul defectelor infectate tisulare din regiunea calcaneană, care are scopul de a rezolva într-o singură etapă defectul osos, cel tegumentar şi dezinserţia de tendon. The problem solved by the proposed invention is the development of a method for the treatment of infected tissue defects in the calcaneal region, which aims to resolve the bone defect, the skin defect and the tendon detachment in a single step.

Esenţa invenţiei constă în aceea că se efectuează examenul doplerografic pentru stabilirea proiecţiei vaselor perforante musculocutanate ale arterei tibiale posterioare, se debridează ţesuturile devitalizate în regiunea defectului, se efectuează o incizie cutanată longitudinală pe suprafaţa posteromedială a gambei, posterior de marginea posterioară a osului tibial pentru identificarea vaselor perforante, după determinarea dimensiunilor defectului se prepară un lambou, care include ţesuturi moi, inclusiv o porţiune din fascia profundă, şi o grefă osoasă din osul tibial cu dimensiunile de 2 x 5 cm cu vasul perforant, apoi lamboul se roteşte la 180° cu amplasarea fragmentului osos în defectul de os calcanean şi fixarea lui cu ajutorul a 1…2 şuruburi, tendonul ahilian se suturează de fragmentul osos, după care plaga se suturează pe straturi, se drenează şi se aplică imobilizare ghipsată. The essence of the invention consists in performing a Doppler examination to establish the projection of the musculocutaneous perforating vessels of the posterior tibial artery, debride the devitalized tissues in the defect region, perform a longitudinal skin incision on the posteromedial surface of the calf, posterior to the posterior edge of the tibial bone to identify the perforating vessels, after determining the dimensions of the defect, a flap is prepared, which includes soft tissues, including a portion of the deep fascia, and a bone graft from the tibial bone with dimensions of 2 x 5 cm with the perforating vessel, then the flap is rotated 180° with the placement of the bone fragment in the calcaneal bone defect and its fixation using 1…2 screws, the Achilles tendon is sutured to the bone fragment, after which the wound is sutured in layers, drained and a plaster cast immobilization is applied.

Avantajul metodei constă în rezolvarea defectelor infectate tisulare din regiunea calcaneană într-o singură etapă cu un lambou vascularizat de către o singură echipă medicală, rezolvarea unimomentană a defectului de ţesuturi moi şi osos cu dezinserţia tendonului ahilian, fără aplicarea fixatoarelor externe, cu obţinerea unui rezultat funcţional precoce. The advantage of the method is the resolution of infected tissue defects in the calcaneal region in a single stage with a vascularized flap by a single medical team, the simultaneous resolution of the soft tissue and bone defect with the disinsertion of the Achilles tendon, without the application of external fixators, with the achievement of an early functional result.

Realizarea metodei conform invenţiei propuse contribuie la obţinerea unei capacităţi funcţionale a membrului în termene obişnuite consolidării grefei osoase şi tendonului de pe ea şi, respectiv, un rezultat funcţional şi estetic final satisfăcător. The implementation of the method according to the proposed invention contributes to obtaining a functional capacity of the limb within the usual terms of consolidation of the bone graft and the tendon on it and, respectively, a satisfactory final functional and aesthetic result.

Metoda se efectuează în modul următor. The method is performed in the following way.

Se efectuează examenul doplerografic pentru stabilirea proiecţiei vaselor perforante musculocutanate ale arterei tibiale posterioare, se debridează ţesuturile devitalizate în regiunea defectului, se efectuează o incizie cutanată longitudinală pe suprafaţa posteromedială a gambei, posterior de marginea posterioară a osului tibial pentru identificarea vaselor perforante, după determinarea dimensiunilor defectului se prepară un lambou, care include ţesuturi moi, inclusiv o porţiune din fascia profundă, şi o grefă osoasă din osul tibial cu dimensiunile de 2 x 5 cm cu vasul perforant, apoi lamboul se roteşte la 180° cu amplasarea fragmentului osos în defectul de os calcanean şi fixarea lui cu ajutorul a 1…2 şuruburi, tendonul ahilian se suturează de fragmentul osos, după care plaga se suturează pe straturi, se drenează şi se aplică imobilizare ghipsată, fiind recomandat mersul în cârje fără sprijin pe piciorul operat timp de 3 luni. Doppler examination is performed to establish the projection of the musculocutaneous perforating vessels of the posterior tibial artery, devitalized tissues in the defect region are debrided, a longitudinal skin incision is performed on the posteromedial surface of the calf, posterior to the posterior edge of the tibial bone to identify the perforating vessels, after determining the dimensions of the defect, a flap is prepared, which includes soft tissues, including a portion of the deep fascia, and a bone graft from the tibial bone with dimensions of 2 x 5 cm with the perforating vessel, then the flap is rotated 180° with the placement of the bone fragment in the calcaneal bone defect and its fixation with the help of 1…2 screws, the Achilles tendon is sutured to the bone fragment, after which the wound is sutured in layers, drained and a plaster cast immobilization is applied, it being recommended to walk on crutches without support on the operated leg for 3 Monday.

Exemplu Example

Pacientul G., 23 ani, a fost spitalizat în secţia nr. 5 a Spitalului Clinic de Ortopedie şi Traumatologie cu diagnosticul de osteită posttraumatică a osului calcanean drept, defect de os şi defect de ţesuturi moi pe partea posterioară a călcâiului, dezinserţia tendonului ahilian. Pacientul a fost operat folosind metoda propusă, s-a efectuat examenul doplerografic cu stabilirea proiecţiei vaselor perforante musculocutanate ale arterei tibiale posterioare, s-au debridat ţesuturile devitalizate în regiunea defectului, s-a efectuat o incizie cutanată longitudinală pe suprafaţa postero-medială a gambei, posterior de marginea posterioară a osului tibial cu identificarea vaselor perforante, după determinarea dimensiunilor defectului s-a preparat un lambou, care include ţesuturi moi, inclusiv o porţiune din fascia profundă şi o grefă osoasă din osul tibial cu dimensiunile de 2 x 5 cm cu vasul perforant, apoi lamboul s-a rotit la 180° cu amplasarea fragmentului osos în defectul de os calcanean şi fixarea lui cu ajutorul a 2 şuruburi, tendonul ahilian s-a suturat de fragmentul osos, după care plaga s-a suturat pe straturi, s-a drenat şi s-a aplicat imobilizare ghipsată, fiind recomandat mersul în cârje fără sprijin pe piciorul operat timp de 3 luni. Patient G., 23 years old, was hospitalized in ward no. 5 of the Clinical Hospital of Orthopedics and Traumatology with the diagnosis of post-traumatic osteitis of the right calcaneal bone, bone defect and soft tissue defect on the posterior side of the heel, Achilles tendon detachment. The patient was operated using the proposed method, a Doppler examination was performed with the establishment of the projection of the musculocutaneous perforating vessels of the posterior tibial artery, the devitalized tissues in the defect region were debrided, a longitudinal skin incision was performed on the posteromedial surface of the calf, posterior to the posterior edge of the tibial bone with the identification of the perforating vessels, after determining the dimensions of the defect, a flap was prepared, which included soft tissues, including a portion of the deep fascia and a bone graft from the tibial bone with dimensions of 2 x 5 cm with the perforating vessel, then the flap was rotated 180° with the placement of the bone fragment in the calcaneal bone defect and its fixation with the help of 2 screws, the Achilles tendon was sutured to the bone fragment, after which the wound was sutured in layers, drained and applied Cast immobilization, with walking on crutches without support on the operated leg recommended for 3 months.

Metoda a fost efectuată în cadrul IMSP SCTO şi a Catedrei Ortopedie şi Traumatologie a USMF "N. Testemiţanu”, obţinţndu-se rezultate funcţionale şi estetice satisfăcătoare. The method was performed within the IMSP SCTO and the Department of Orthopedics and Traumatology of the "N. Testemiţanu" USMF, achieving satisfactory functional and aesthetic results.

1. Brinker M.R., Loncarich P.P., Melissinos E.G., O'Connor P.P. Calcaneogenesis. J. Bone Joint Surg., 2009, p. 662-665 1. Brinker M.R., Loncarich P.P., Melissinos E.G., O'Connor P.P. Calcaneogenesis. J. Bone Joint Surg., 2009, p. 662-665

Claims

Method of plasty of infected tissue defect in the calcaneal region with vascularized flap, which consists in performing a Doppler examination to establish the projection of the musculocutaneous perforating vessels of the posterior tibial artery, debridement of devitalized tissues in the defect region, a longitudinal skin incision is made on the posteromedial surface of the calf, posterior to the posterior edge of the tibial bone to identify the perforating vessels, after determining the dimensions of the defect, a flap is prepared, which includes soft tissues, including a portion of the deep fascia, and a bone graft from the tibial bone with dimensions of 2 x 5 cm with the perforating vessel, then the flap is rotated 180° with the placement of the bone fragment in the calcaneal bone defect and fixed with 1…2 screws, the Achilles tendon is sutured to the bone fragment, after which the wound is sutured in layers, Drain and apply plaster cast immobilization.