RU2026647C1 - Method of plasty of infected osteal cavities - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: this method prescribes cutting out graft from donor segment muscular tissue so that its dimensions will be smaller than those of osteal cavity defect, dissecting it at its base after making necessary exercises with leaving it free at other segment until its width grows twice, splitting it by axis into several grafts, embedding these in remaining osteal cavity, and finally suturing wound. EFFECT: encouraging results.

Description

 The invention relates to medicine, namely to traumatology in the treatment of infected bone cavities.

 There is a method of plasty of bone cavities, limbs by forming a muscle flap from another segment, isolating it with split own skin and training on its bed, subsequent excretion, cutting off the distal leg and filling the bone cavity with the free end of the muscle flap.

 The disadvantage of this method is the inability to close extensive infected bone cavities due to a deficiency of muscle tissue. When a large amount of muscle tissue is taken, the functions of the donor segment are disrupted, the operation is so traumatic.

 The purpose of the invention is the closure of extensive bone cavities and reducing the invasiveness of surgery.

 The essence of the method is that a muscle flap cut and transplanted into the bone cavity after excision from the donor segment is left outside until its hypertrophy and after an increase in diameter of 2-3 times (within 3-4 weeks), it is split along the axis into several flaps and placed in the remaining bone cavity, after which the wound is sutured.

 In contrast to the known methods, the minimum amount of primary muscle material due to hypertrophy of the free flap on one feeding leg and its subsequent splitting creates the possibility of closing vast infected bone cavities.

 The method is as follows.

 For plasty of extensive bone cavities located in the non-muscular zone, a muscle flap is formed from the opposite segment.

 The length of the flap depends on the distance between the segments. The muscle flap is separated from the surrounding tissue. A thorough hemostasis is performed. The maximum thickness of the flap reaches 3-4 cm.

 A muscle flap on 2 feeding legs is removed from the wound and wrapped with insulating material (a cerebral cloudy buchina, a plastic sheet, etc.). Then immersed in its place and the wound is sutured. At the same time open the osteomyelitis focus. Necrotic tissue is removed and mechanical, chemical treatment of the wall of the bone cavity is performed. The cavity is filled with an ointment swab.

 After 3-4 weeks, re-open the muscle flap. One leg is cut off and the bone cavity of the opposite segment is partially filled with the free end of the muscle flap. A muscle flap is fixed on the wall of the bone cavity with sutures. The limb is fixed with a plaster cast for 3 weeks. After 3 weeks, remove the plaster cast. From the side of the donor segment, the muscle flap is cut off at the base and left on the same feeding leg originating from the bone cavity. In the first week, the color of the muscle flap becomes anatomical. At the beginning of 2 weeks, granulation appears on the muscle flap and the flap becomes pink. At the end of 3-4 weeks due to hypertrophy, the flap increases in diameter by 2-3 times.

 Under general anesthesia, the bone cavity is re-opened. The muscle flap is split longitudinally into several tapes. Split muscle tapes cover the remaining bone cavity around the muscle flap. The wound is sutured.

 PRI me R. Patient H., 21 years old, was admitted on 31.X.90 with a diagnosis of chronic post-traumatic osteomyelitis of the upper third of the right lower leg. Suffers from this disease for 10 years. Prior to admission, he received surgical treatment for chronic osteomyelitis many times. Objectively, in the upper third of the lower leg there are multiple extensive scars soldered to the bone tissue. In the middle of the scars are multiple fistulous wounds. On the P-gram visible extensive bone cavities located on the upper third of the tibia.

 14. XI.90, the operation was performed - sequestro-necroectomy of the right tibia. As a result, a bone cavity of 15x7x5 cm in size was formed. At the same time, a muscle flap was formed from the left tailor muscle.

 12. XII.90, the muscle flap is brought out, the distal leg is cut off and inserted into the bone cavity of the right lower leg, while it filled only 1/5 of the bone cavity. The limb is fixed with a plaster cast.

 5. I. 91, the plaster cast was removed, under local anesthesia, the muscle flap was cut off at the base from the side of the donor segment. Hemostasis. In the future, ointment dressings for muscle flap were performed. Starting from 2 weeks, the muscle flap hypertrophied due to granulation, and by the end of 3 weeks it increased by 2 times.

 3. II.91, the bone cavity is re-opened, the muscle flap is longitudinally split into two parts and laid in the remaining part of the bone cavity. The skin wound is partially sutured. Subsequently, the wound is sutured by secondary intention. 20. II.91, the patient was discharged with recovery.

 Thus, in this method, the property of hypertrophy of the free muscle flap on the feeding leg was used, which subsequently allowed it to split into several flaps and cover them with extensive infected bone defects without the need for a large collection of donor muscle tissue and trauma to the donor segment.

Claims (1)

 METHOD FOR PLASTIC INFECTION OF INFECTED BONE CELLS by cutting a muscle flap from the donor segment, isolating and training it in the mother’s bed, then cutting it off at the base and transferring it to the defect and closing it, characterized in that the flap is cut from a smaller amount of muscle tissue of the donor segment, than a defect in the bone cavity, increase the flap width by 2 times after cutting off the proximal leg, split along the axis into several parts and lay in the bone cavity.