RU187276U1 - DEVICE FOR FORMING SKIN RESERVE ON THE SOIL SURFACE OF THE FOOT FOR CLOSING EXTRAORDINARY WOUNDED DEFECTS - Google Patents

Abstract

The utility model relates to medical equipment, and in particular to devices used in surgery, traumatology and orthopedics for plastic-plastic reconstruction of extensive skin defects.

A device for forming a reserve of skin on the plantar surface of the foot to cover extensive wound defects is made in the form of a round plate made of titanium alloy, with four through holes made on the surface of the plate, designed to hold and fix the pulling thread, and rounded edges.

The technical result is manifested when using the device and is to reduce trauma to the skin. f-ly, 2 ill.

Description

The field of technology.

The utility model relates to medical equipment, and in particular to devices used in surgery, traumatology and orthopedics for plastic-plastic reconstruction of extensive skin defects.

The property of the skin to lengthen under the influence of constant tension is known and is used in case of dermatotension, when the skin is pulled out, the necessary supply of skin is created to close the vast defects of the skin resulting from mechanical, thermal, trophic injuries, pressure sores and fistulas.

Restoring the integrity of the skin on the plantar surface of the foot is of great importance, since the foot performs a supporting function and provides the person with the ability to move.

A known method of autodermoplasty (Source [1]: patent SU 1147363) is performed by applying a compression-distraction apparatus to the limb, fixing the skin to the rods, fixing the rods on the movable adjustable supports of the compression-distraction apparatus, stretching the skin and moving it towards the skin defect, followed by its substitution. In order to replace extensive skin defects and prevent maceration and trophic changes in the area of the donor skin area, an implant is inserted into the subcutaneous tissue, the axis of which is aligned with the axis of the limb segment, fixed by traction and moved in the direction perpendicular to the longitudinal axis of the limb, then after the necessary skin elongation two semicircular and parallel to each other sections according to the size of the defect. To fix the skin to the rods, an implant is used, for example, a resected segment of a rib, fibula, an elongated plastic block in the form of a bar of circular or oval cross-section with through holes. The biograft has a smooth surface, smooth edges, a rounded or ellipsoidal shape, an optimal cross section of 10 ... 15 mm. Its length should correspond to the length of the elongated skin area. Metal spokes fixed on the compression distraction apparatus with the possibility of dosed movement are carried out into the holes.

However, the spokes used as rods significantly injure the skin. When the skin is stretched and moved to the side of the skin defect in places of the greatest pressure of the implant inserted under the skin, the risk of formation of ischemia and necrosis zones is high, due to the shape of the implant. An implant in the form of a bar (an oblong cross-section of 10 ... 15 mm) cannot be used on the foot, due to the thickness of the skin and adjacent tissues.

A known method of hardware dermotension with extensive scar defects on the limbs (Source [2]: patent RU 2449754). After the external fixation apparatus is applied near the scar defect, the needles are carried into the subcutaneous fat layer, a strong suture material is percutaneously around the needles, which are fixed in the device with the possibility of alternating movement in different directions, and stretched and grown is carried out using dosed distraction for this suture material skin, then the device is removed, knitting needles and suture material are removed and skin plastic surgery is performed with local grown tissues.

However, the spokes used as an implant have a small abutment surface and, when the skin is stretched and moved toward the skin defect in places of greatest pressure, cause the formation of ischemia and necrosis zones. The skin on the plantar surface of the foot, although it has a structure in common with the rest of the skin (epidermis, dermis, hypodermis), but has significant differences from other parts of the body. On the foot, there is a large thickness of the epidermal layer up to 0.9 mm, the dermis has the largest thickness up to 5 mm, nocireceptors with a low threshold of perception are located in the plantar skin. These differences allow the skin of the plantar surface of the foot to withstand high physical exertion, and moreover, for traction, it is necessary to apply great traction in comparison with the dermotension of other parts of the skin of the human body. The spokes have a small supporting surface and in the zone of contact with soft tissues, high mechanical stresses occur, leading to cell death.

A device for dermatotension with extensive defects of soft tissues on the human body is known (Source [3]: patent RU 2563364). The device contains a corset with a lining, mounted on both sides on the patient’s body, the edges of which are located along the scar wound, plates with ribs are installed and fixed on the edges of the corset, there are tension nodes, including screws installed in the holes made in the ribs, wing nuts, screwed on the screws on one and the other sides of the ribs and threads, one end of which is fixed to the end of the screw, the other to the skin, on the opposite side of the wound.

The device for traction uses threads that are directly fixed to the skin. The threads have a small supporting surface and are able to cut through the skin with an increase in traction. Fixing the skin with threads is not acceptable for the plantar surface of the foot, the skin is cut through, since considerable effort is required to stretch the skin.

A device for dermatotension is known (Source [4]: RU 27473 patent) containing supports interconnected by means of threaded rods and beams with holes and threaded shanks, provided with holes made along their perimeter, fixed to the supports of the spokes, as well as skin fixators, brackets, straps and fastening elements, characterized in that the skin retainers are made in the form of rods, provided at one end with a threaded thread and a hook-shaped gripper - at the working end, fixed with the possibility of axial displacement in the hole Rep beams and one of the supports, the latter has a size and shape corresponding to the perimeter of the end of the residual limb.

Skin detents with a hook-shaped grip are able to cut through the skin with the efforts necessary to stretch it and are not acceptable for dermotension of the plantar surface of the foot.

A device for skin plastics is known (Source [5]: RU 517417 patent) containing an external support with bone fixation elements, traction nodes with hook-shaped skin fixators connected to the support, connecting and fastening elements, characterized in that the traction nodes are made in the form of mutually perpendicular the planes of the rods with a handle, threaded threads at the end and at the base of the handle, a corrugated working part, and hook-shaped leather clips are equipped with flexible rods attached to the working part of the rods.

Hook-shaped skin fixators are able to cut through the skin when applying the efforts necessary to stretch it and are not applicable on the plantar surface of the foot.

A known method of replacing an extensive defect of the skin located near the skin, which was previously stretched using an expander (expander dermatotension, Skin expansion). (Source [6]: “Skin Growth: Tissue Expansion in Reconstructing a Children's Forehead.” Alexander M. Zolner, Adrian Buganza Tepol, Arun K. Gosain, Ellen Kuhl. Journal of Biomechanics and Modeling in Mechanobiology. 2012 July; 11 (6): 855-867. Published online November 2011 4. doi: 10.1007 / si0237-011-0357-4 / Growing skin: Tissue expansion in pediatric forehead reconstruction. Alexander M. Zollner, Adrian Buganza Tepole, Arun K. Gosain, Ellen Kuhl. Biomech Model Mechanobiol. 2012 Jul; 11 (6): 855-867. Published online 2011 Nov 4. doi: 10.1007 / s10237-011-0357-4). (Source [7]: “Tissue expansion: concepts, methods, and adverse outcomes” Milind S. Wag, Varun Dixit. Indian J Plast Surg. 2013 May-August; 46 (2): 333-348. Doi: 10.4103 / 0970- 0358.118612. “Tissue expansion: Concepts, techniques and unfavorable results” Milind S. Wagh, Varan Dixit. Indian J Plast Surg. 2013 May-Aug; 46 (2): 333-348. Doi: 10.4103 / 0970-0358.118612). Pre-select the implantation zone and the type of expander. Before the operation, the boundaries of the expander are outlined. Perform an incision or puncture for implantation of the expander outside the tissue stretch zone. Form a bed for the expander. Form a tunnel for the location of the expander valve tube. To expand the expander, physiological saline is injected into the expander cavity through an injection needle. The expander stretches the skin, which is subsequently used for plastics.

This method [6; 7] is practically not applied to the plantar surface of the foot due to the thickness of the skin. For the skin of the plantar surface of the foot, there is a high risk of developing ischemia of the formed flap, the expander (balloon) stretching the skin rests on adjacent tissues and squeezes them, deprives blood supply and violates trophism.

Thus, existing devices do not allow for safe metered stretching of the skin on the plantar surface of the foot and provide the necessary supply of skin for plastic defect.

The essence of the technical solution.

The problem solved by this utility model is to provide a metered stretch of the skin of the plantar surface of the foot.

The technical result is manifested when using the device and is to reduce trauma to the skin.

The technical result is achieved by the fact that the device for forming a stock of skin on the plantar surface of the foot for closing extensive wound defects is made in the form of a round plate made of titanium alloy with four through holes made on the surface of the plate, intended for holding and fixing the pulling thread, and rounded edges.

The specified technical result, reducing trauma to the skin of the plantar surface of the foot during dosed stretching is ensured, manifested due to the fact that the round shape of the plate provides an even distribution of the distraction load from the pulling thread over the surface of the skin adjacent to the plate, and four holes in the plate allow you to transmit forces from the apparatus external fixation to the plate through a flexible and thin thread passing through the skin. Thus, the load passes through the thin threads and is distributed over a large area from the inside of the skin, without causing skin eruption or fatal compression of adjacent soft tissues.

The technical solution is illustrated by the following graphic materials:

FIG. 1 - photograph, device, general view;

FIG. 2 - photograph, three devices mounted on the plantar surface of the foot and connected by traction threads to the external fixation apparatus.

Implementation of a utility model.

The device (Fig. 1) for forming a stock of skin on the plantar surface of the foot to cover extensive wound defects is made in the form of a round plate made of titanium alloy with a diameter of 10 mm, 2 mm thick, with four through holes 1 (Fig. 1) made on the surface of the plate, designed for holding and fixing the pulling thread, and rounded edges. The surface roughness of the plate should not exceed 0.63 Ra. There are no sharp edges. The diameter of the holes can be in the range from 2 to 4 mm.

Use of utility model.

For implantation of the device, at a distance of at least 1 cm from the skin defect, a bed is formed between the plantar aponeurosis and subcutaneous fat. The implanted device is connected using a strong surgical traction thread 2 (Fig. 2) with the base of the Ilizarov apparatus 3 (Fig. 2) on the foot. The threads 2 are carried out in the holes on the support of the apparatus and are fixed to the distraction rod-rod. In the postoperative period, on the 5-7th day, using the Ilizarov apparatus, a metered distraction of the skin cover begins in the distal direction in a mode that allows you to stretch the skin until you get some excess in the localization area of the pathological process. When performing metered stretching, due to the fact that the round shape of the plate ensures uniform distribution of the distraction load from the pulling thread over the surface of the skin adjacent to the plate, and the four holes in the plate allow the force to be transmitted from the external fixation apparatus to the plate through a flexible and thin thread passing through skin. Thus, the load passes through the thin threads and is distributed over a large area from the inside of the skin, without causing skin eruption or fatal compression of adjacent soft tissues. For additional fixation of the device, it is sutured to the skin with surgical sutures held through holes 3. In the area of the created distraction efforts, an excess of integumentary tissues is formed. The device can be installed minimally invasively, through one incision 10 mm in size, while two, three, four or more devices can be installed in one row to stretch a large skin flap, also through one incision 10 mm long. The installation of two, three, four or more devices allows you to create a metered distraction effort to form the necessary supply of skin on the plantar surface of the foot, for suturing a large skin defect.

The proposed device was implemented by the authors, a prototype was made, which is used at the Ilizarov Center, Kurgan, when performing a double shortening osteotomy of the thigh.

Claims (2)

1. A device for forming a stock of skin on the plantar surface of the foot to cover extensive wound defects, characterized in that it is made in the form of a round plate of titanium alloy, with four through holes made on the surface of the plate, designed to hold and fix the pulling thread, and rounded the edges. 2. The device according to p. 1, characterized in that it is made with a diameter of 10 mm, a thickness of 2 mm

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