MD709Z - Method of plasty after amputation of forefoot - Google Patents
Method of plasty after amputation of forefoot Download PDFInfo
- Publication number
- MD709Z MD709Z MDS20130099A MDS20130099A MD709Z MD 709 Z MD709 Z MD 709Z MD S20130099 A MDS20130099 A MD S20130099A MD S20130099 A MDS20130099 A MD S20130099A MD 709 Z MD709 Z MD 709Z
- Authority
- MD
- Moldova
- Prior art keywords
- bones
- flap
- skin
- plantar
- stump
- Prior art date
Links
- 238000000034 method Methods 0.000 title claims abstract description 10
- 238000002266 amputation Methods 0.000 title claims description 6
- 210000004744 fore-foot Anatomy 0.000 title 1
- 210000000988 bone and bone Anatomy 0.000 claims abstract description 16
- 210000001872 metatarsal bone Anatomy 0.000 claims abstract description 12
- 210000002683 foot Anatomy 0.000 claims abstract description 11
- 210000001367 artery Anatomy 0.000 claims abstract description 10
- 210000004872 soft tissue Anatomy 0.000 claims abstract description 7
- 208000037273 Pathologic Processes Diseases 0.000 claims abstract description 4
- 239000002729 catgut Substances 0.000 claims abstract description 4
- 230000023597 hemostasis Effects 0.000 claims abstract description 4
- 210000003205 muscle Anatomy 0.000 claims abstract description 4
- 230000001575 pathological effect Effects 0.000 claims abstract description 4
- 230000009054 pathological process Effects 0.000 claims abstract description 4
- 238000007790 scraping Methods 0.000 claims description 2
- 238000002316 cosmetic surgery Methods 0.000 claims 1
- 208000027418 Wounds and injury Diseases 0.000 abstract description 4
- 239000003814 drug Substances 0.000 abstract description 3
- 238000001356 surgical procedure Methods 0.000 abstract description 3
- 206010059245 Angiopathy Diseases 0.000 abstract description 2
- 208000001034 Frostbite Diseases 0.000 abstract description 2
- 206010029098 Neoplasm skin Diseases 0.000 abstract description 2
- 208000000453 Skin Neoplasms Diseases 0.000 abstract description 2
- 206010068771 Soft tissue neoplasm Diseases 0.000 abstract description 2
- 208000014674 injury Diseases 0.000 abstract description 2
- 230000000771 oncological effect Effects 0.000 abstract description 2
- 230000008733 trauma Effects 0.000 abstract description 2
- 238000007631 vascular surgery Methods 0.000 abstract description 2
- 230000003137 locomotive effect Effects 0.000 abstract 1
- 210000003141 lower extremity Anatomy 0.000 description 4
- 206010028980 Neoplasm Diseases 0.000 description 2
- 230000002980 postoperative effect Effects 0.000 description 2
- 208000006735 Periostitis Diseases 0.000 description 1
- 206010039509 Scab Diseases 0.000 description 1
- 210000003484 anatomy Anatomy 0.000 description 1
- 230000015572 biosynthetic process Effects 0.000 description 1
- 230000008468 bone growth Effects 0.000 description 1
- 238000003745 diagnosis Methods 0.000 description 1
- 229940079593 drug Drugs 0.000 description 1
- 238000010562 histological examination Methods 0.000 description 1
- 210000001165 lymph node Anatomy 0.000 description 1
- 239000000463 material Substances 0.000 description 1
- 210000002346 musculoskeletal system Anatomy 0.000 description 1
- 210000005036 nerve Anatomy 0.000 description 1
- 210000003460 periosteum Anatomy 0.000 description 1
- 230000002093 peripheral effect Effects 0.000 description 1
- 201000000849 skin cancer Diseases 0.000 description 1
- 201000008261 skin carcinoma Diseases 0.000 description 1
- 206010041823 squamous cell carcinoma Diseases 0.000 description 1
- 238000011477 surgical intervention Methods 0.000 description 1
Landscapes
- Surgical Instruments (AREA)
Abstract
Description
Invenţia se referă la medicină, în special la chirurgia oncologică a aparatului locomotor, traumatologie şi chirurgia vasculară şi poate fi utilizată în tratamentul tumorilor pielii şi ale ţesuturilor moi cu concreşterea oaselor, traumelor, angiopatiilor, congelaţiilor şi al combustiilor de grade avansate. The invention relates to medicine, in particular to oncological surgery of the musculoskeletal system, traumatology and vascular surgery and can be used in the treatment of skin and soft tissue tumors with bone growth, trauma, angiopathies, frostbite and advanced burns.
Este cunoscută metoda de amputare a părţii anterioare a labei piciorului după Sharpe, care constă în incizia tuturor ţesuturilor moi ale părţii dorsale a labei piciorului la 2 cm distal de baza oaselor metatarsiene; lamboul plantar este croit de lungime şi lăţime suficientă pentru acoperirea tăieturii oaselor metatarsiene. Lamboul plantar se separă de la oase prin mişcări de răzuire a cuţitului de amputare, scheletând astfel oasele metatarsiene. Eliberând oasele metatarsiene de ţesuturile moi, periostul pe fiecare din ele se taie circular şi se prelucrează cu răzătorul distal. Oasele metatarsiene sunt tăiate strict perpendicular în partea lor proximală, iar marginile lor sunt netezite cu răzătorul. Artera dorsală plantară şi arterele plantare sunt legate şi cusute; nervii lamboului dorsal şi celui plantar se taie. Marginile cutanate ale lambourilor formate sunt suturate cu mătase [1]. The Sharpe method of amputation of the anterior part of the foot is known, which consists in the incision of all soft tissues of the dorsal part of the foot 2 cm distal to the base of the metatarsal bones; the plantar flap is cut to a length and width sufficient to cover the cut of the metatarsal bones. The plantar flap is separated from the bones by scraping movements of the amputation knife, thus skeletonizing the metatarsal bones. Having freed the metatarsal bones from the soft tissues, the periosteum on each of them is cut in a circular manner and processed with the distal rasp. The metatarsal bones are cut strictly perpendicularly in their proximal part, and their edges are smoothed with the rasp. The dorsal plantar artery and the plantar arteries are tied and sutured; the nerves of the dorsal and plantar flaps are cut. The skin edges of the formed flaps are sutured with silk [1].
Dezavantajul acestei metode constă în faptul că nu întotdeauna este posibilă prepararea lamboului plantar de lungimea şi lăţimea necesară, luând în consideraţie suprafaţa afectată, şi amputarea plantei la acest nivel cu păstrarea funcţiilor statico-dinamice ale membrului inferior, şi anume a funcţiei de sprijin. The disadvantage of this method is that it is not always possible to prepare the plantar flap of the required length and width, taking into account the affected area, and to amputate the plantar at this level while preserving the static-dynamic functions of the lower limb, namely the support function.
Problema pe care o soluţionează invenţia constă în elaborarea unei metode chirurgicale de amputare anterioară a labei piciorului cu păstrarea funcţiei de sprijin a membrului inferior. The problem solved by the invention consists in developing a surgical method for anterior amputation of the foot while preserving the supporting function of the lower limb.
Conform invenţiei revendicate, se croieşte un lambou dorsal prin incizia pielii corespunzător după lungimea şi lăţimea procesului patologic răspândit, se efectuează incizia ţesuturilor moi la nivelul capetelor distale ale oaselor metatarsiene cu păstrarea arterei dorsalis pedis, se decolează lamboul de la oase, apoi sub un unghi se taie şi se prelucrează oasele la acest nivel, după care se croieşte un lambou plantar cu înlăturarea radicală a focarului patologic şi se formează bontul, se ligaturează arterele pe partea plantară, se răzuiesc şi se prelucrează capetele oaselor la 2 cm în direcţie proximală, iar marginile se prelucrează cu bisturiul electric, se efectuează hemostaza definitivă, se drenează plaga, după care se formează bontul prin suturarea muşchilor cu catgut, apoi se suturează tegumentele. According to the claimed invention, a dorsal flap is cut by incising the skin corresponding to the length and width of the widespread pathological process, an incision is made in the soft tissues at the level of the distal ends of the metatarsal bones while preserving the dorsalis pedis artery, the flap is lifted off the bones, then the bones are cut and processed at this level at an angle, after which a plantar flap is cut with the radical removal of the pathological focus and the stump is formed, the arteries are ligated on the plantar side, the ends of the bones are scraped and processed 2 cm in the proximal direction, and the edges are processed with an electric scalpel, definitive hemostasis is performed, the wound is drained, after which the stump is formed by suturing the muscles with catgut, then the skin is sutured.
Rezultatul constă în aceea că are loc tăierea maximal economă din lungimea oaselor metatarsiene, care contribuie la păstrarea funcţiei de sprijin a membrului inferior şi la reabilitarea precoce a pacienţilor, iar ca material pentru acoperirea capetelor oaselor metatarsiene amputate serveşte lamboul dorsal al labei piciorului. The result is that the most economical cutting of the length of the metatarsal bones takes place, which contributes to preserving the supporting function of the lower limb and to the early rehabilitation of patients, and the dorsal flap of the foot serves as the material for covering the ends of the amputated metatarsal bones.
Avantajul metodei revendicate constă în aceea că se păstrează funcţia de sprijin a membrului inferior în cazul amputării anterioare a labei piciorului, ceea ce îmbunătăţeşte viaţa ulterioară a pacientului. Utilizând metoda revendicată au fost trataţi 23 de pacienţi cu rezultate satisfăcătoare. The advantage of the claimed method is that the supporting function of the lower limb is preserved in the case of anterior amputation of the foot, which improves the patient's subsequent life. Using the claimed method, 23 patients were treated with satisfactory results.
Metoda se efectuează în modul următor: se croieşte un lambou dorsal prin incizia pielii corespunzător după lungimea şi lăţimea procesului patologic răspândit, se efectuează incizia ţesuturilor moi la nivelul capetelor distale ale oaselor metatarsiene cu păstrarea arterei dorsalis pedis, se decolează lamboul de la oase, apoi sub un unghi se taie şi se prelucrează oasele la acest nivel, după care se croieşte un lambou plantar cu înlăturarea radicală a focarului patologic şi se formează bontul, se ligaturează arterele pe partea plantară, se răzuiesc şi se prelucrează capetele oaselor la 2 cm în direcţie proximală, iar marginile se prelucrează cu bisturiul electric, se efectuează hemostaza definitivă, se drenează plaga, după care se formează bontul prin suturarea muşchilor cu catgut, apoi se suturează tegumentele. The method is performed as follows: a dorsal flap is cut through the skin incision corresponding to the length and width of the spread pathological process, a soft tissue incision is performed at the distal ends of the metatarsal bones while preserving the dorsalis pedis artery, the flap is lifted from the bones, then the bones are cut and processed at this level at an angle, after which a plantar flap is cut with the radical removal of the pathological focus and the stump is formed, the arteries on the plantar side are ligated, the ends of the bones are scraped and processed 2 cm in the proximal direction, and the edges are processed with an electric scalpel, definitive hemostasis is performed, the wound is drained, after which the stump is formed by suturing the muscles with catgut, then the skin is sutured.
Exemplu de realizare: Example of implementation:
Bolnavul P., 59 ani, a fost internat cu diagnosticul: recidivă a carcinomului pielii plantei drepte cu concreşterea oaselor. La internare acuza prezenţa unei neoformaţiuni ulcerate a pielii părţii plantare a labei piciorului drept. Din anamneză: este bolnav timp de 3,5 ani. A fost operat de mai multe ori (excizia tumorii, electroexcizia recidivelor, electroexcizia recidivei cu autodermoplastie + TGT postoperatorie) - în total 7 ori. Status localis: pe pielea plantei drepte se determină o formaţiune 8,0 cm, ulcerată, multinodulară, alocuri acoperită cu cruste, imobilă, dureroasă. Ganglionii limfatici periferici nu se palpează. La examenul radiografic se determină concreşterea tumorii în oasele metatarsiene. Intervenţia chirurgicală a fost efectuată după metoda revendicată. Perioada postoperatorie a decurs fără complicaţii. Plaga cicatrizată per primam. La examenul histologic Nr 67986-91/12 - carcinom pavimentos keratinizat, care infiltrează ţesuturile moi adiacente şi ţesutul osos. Patient P., 59 years old, was admitted with the diagnosis: recurrence of skin carcinoma of the right sole with bone concretion. Upon admission, he complained of the presence of an ulcerated neoformation of the skin of the plantar part of the right foot. From the anamnesis: he has been ill for 3.5 years. He has been operated on several times (tumor excision, electroexcision of relapses, electroexcision of relapse with autodermoplasty + postoperative TGT) - a total of 7 times. Status localis: an 8.0 cm formation is determined on the skin of the right sole, ulcerated, multinodular, in places covered with crusts, immobile, painful. Peripheral lymph nodes are not palpable. The radiographic examination determines the tumor concretion in the metatarsal bones. The surgical intervention was performed according to the claimed method. The postoperative period was without complications. The wound healed per primam. Histological examination No. 67986-91/12 - keratinized squamous carcinoma, which infiltrates adjacent soft tissues and bone tissue.
1. Кованова В. В. Оперативная хирургия и топографическая анатомия. Москва, Медицина, 1978, р. 274 1. Кованова В. В. Operative surgery and topographical anatomy. Moscow, Medicine, 1978, р. 274
Claims (1)
Priority Applications (1)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| MDS20130099A MD709Z (en) | 2013-06-04 | 2013-06-04 | Method of plasty after amputation of forefoot |
Applications Claiming Priority (1)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| MDS20130099A MD709Z (en) | 2013-06-04 | 2013-06-04 | Method of plasty after amputation of forefoot |
Publications (2)
| Publication Number | Publication Date |
|---|---|
| MD709Y MD709Y (en) | 2013-12-31 |
| MD709Z true MD709Z (en) | 2014-07-31 |
Family
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Family Applications (1)
| Application Number | Title | Priority Date | Filing Date |
|---|---|---|---|
| MDS20130099A MD709Z (en) | 2013-06-04 | 2013-06-04 | Method of plasty after amputation of forefoot |
Country Status (1)
| Country | Link |
|---|---|
| MD (1) | MD709Z (en) |
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2013
- 2013-06-04 MD MDS20130099A patent/MD709Z/en not_active IP Right Cessation
Non-Patent Citations (1)
| Title |
|---|
| Кованова В. В. Оперативная хирургия и топографическая анатомия. Москва, Медицина, 1978, р. 274 * |
Also Published As
| Publication number | Publication date |
|---|---|
| MD709Y (en) | 2013-12-31 |
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| KA4Y | Short-term patent lapsed due to non-payment of fees (with right of restoration) | ||
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