RU2132647C1 - Surgical method for treating trophic ulceration of the lower extremities - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves cutting out a fascial flap possessing blood supply from chest. The split skin autotransplant taken from outer femoral surface is transplanted on the fascial flap. 7 days later, the so created blood-supplied tissular complex is to be transplanted to the place earlier occupied by the removed trophic ulcer. EFFECT: prevented contracture of humeral articulation.

Description

 The invention relates to medicine, in particular to traumatology and orthopedics, and can be used for the surgical treatment of trophic ulcers of the lower extremities.

 A known method of surgical treatment of trophic ulcers of the lower extremities (authors Mathes SJ, Nahai F., "Classification of the vascular anatomy of muscles: exprimental and clinical correlation. - Plast. Reconstr. Surg., 1981, Vol. 67 N 2, p. 174 - 187), where transplantation of free blood-supplied muscle-skin flaps is proposed to close trophic ulcers of the lower extremities.

 There is also a method of reconstructing various defects of the lower extremities, including trophic ulcers, by transplantation of blood-supplied various tissue complexes. Serafin D., Vociv. E. "Reconstruction of the lower extremiti. Microsutgical compostite tissue transplantation." - Clin. plast. Surg., 1983, Vol. 10. N 1, p 55 - 72.

 Closest to the claimed technical solution relates to the method proposed by the authors Ding chem, M.B. Jesse B. - jupiter M.D., and Shiq., Lsi M.D.

 "The Parascapular flap for treament of lower extremity disorders". Plast. Reconstr. Surg. Vol. 84, N 1, 1989.

 The authors propose a transplantation of a blood-supplied, free skin-fascial peri-scapular flap to close the defect formed on the lower limb after excision of the trophic ulcer.

 The disadvantages of this method are as follows.

 1. Due to the collection of a large size of the skin-fascial flap, a significant trauma to the donor bed occurs, leading to the formation of gross postoperative scars and the formation of a cosmetic defect.

 2. Rough postoperative scars in the area of the donor bed often lead to leading contracture of the shoulder.

 3. The inability to simultaneously perform contour plastic surgery of the foot during transplantation of a skin-fascial flap, since the transplanted flap has a significant thickness, which prevents the wearing of ordinary shoes and the occurrence of repeated trophic disorders.

 The goal is to reduce the morbidity of the operation and the prevention of postoperative complications.

 This goal is achieved by the fact that the blood supply of the fascial fascial flap of the chest is mobilized, on which a split skin autograft is taken, taken from the outer surface of the thigh. After 7 days, only a fascial blood supply flap with a split autograft that has survived is taken.

 This technique allows you to save the skin of the chest, reduce the invasiveness of the operation, and prevent cosmetic defects. Transplantation of even fascial flaps of considerable size does not lead to the development of a leading contracture of the shoulder. The fascial blood supply flap with an accustomed split skin autograft has a small thickness, which allows simultaneous contour plasty of the foot and lower leg in patients with trophic ulcers of the lower extremities.

 When wearing ordinary shoes, a satisfactory contouring allows to prevent the formation of repeated trophic disorders (abrasions, hyperkeratosis, trophic ulcer grafts) in the postoperative period.

 The method is as follows. The operation is performed 2 times.

 1st stage. A linear incision is made on the chest along the rear axillary line, parallel to the outer edge of the latissimus dorsi. The fascia of the chest, which feeds its lateral artery and its 2 veins, is exposed. A fascial flap is cut out corresponding to the size and shape of the trophic ulcer, together with the vessels supplying it and is laid in place. Using a dermatome, a fissile skin autograft is taken on the outer surface of the thigh, which is laid and sutured to the cut fascial flap. Next, the surgical wound is sutured.

 2nd stage. It is carried out in 7 days. Postoperative sutures are removed, the wound edges are divorced. A fascial flap with an engrafted skin splitting autograft is exposed. The vascular leg of the created skin-fascial flap is highlighted. Simultaneously with the rise and fence of the created skin-fascial flap, the trophic ulcer of the foot or lower leg is excised and the recipient vessels are distinguished. After that, the created tissue complex is transferred to the site of the trophic ulcer, hemmed, microvascular anastomoses are performed.

 Clinical example N 1. Patient T., 32 years old, N case history 220722, was admitted to the Department of Microsurgery KuzNIITR 09.16.94. In the summer of 1992, while working in the face, he was hit by a lump of rock on his right foot. The injury was accompanied by an open fracture of the metatarsal bones, tarsal bones, extensive damage to the skin. At the place of residence, primary surgical treatment of the wound of the foot, plaster immobilization was carried out. In the postoperative period, soft tissue necrosis developed. Repeatedly performed necrectomy, wound repair with split skin grafts. Healing did not occur.

 Location: on the dorsum of the foot there is a trophic ulcer measuring 3 by 5 cm. Extensive scars, soft tissue induction.

 Clinical diagnosis: Trophic ulcer, vicious scars of the right foot.

 On angiograms: Thrombosis of the anterior tibial artery in the distal third of the leg. Patency of the posterior tibial artery is preserved.

 10/14/94. completed the first stage of the operation. The fascia of the chest is exposed, a fascial flap on the supply vessels is formed, on which a split skin autograft is taken, taken from the outer surface of the thigh.

 10.21.94. the second stage of this operation is completed. The trophic ulcer and the adjacent scarred skin were excised. A defect of size 8 by 12 cm was formed, which was covered by the skin-fascial blood-supply autograft that was formed by the first stage from the fascia of the chest. The flap has taken root, healing proceeded by primary intention. The patient was last examined 8 months after surgery. There is no recurrence of trophic disorders. Uses regular shoes. There are no cosmetic and functional disorders in the area of the donor bed.

 Clinical example N 2. Patient E., 31 years old, medical history N 212614. He entered the Department of Microsurgery KuzNIITR 01/12/94. In 1990, as a result of a road injury, he received an open fracture of the calcaneus of the right foot with extensive damage to soft tissues. The primary surgical treatment of the wound was carried out at the place of residence. Despite repeated attempts to plasty the resulting wound in the calcaneal region with split skin autotranslates, healing did not occur, a trophic ulcer formed.

 Location: On the back surface of the right calcaneal region there is a deep trophic ulcer 4 by 5 cm (Fig. 1). The bottom of the wound is lined with gray granulation.

 Clinical diagnosis: trophic ulcer of the right calcaneal region. On angiograms, the patency of the main vessels is preserved, but there is an avascular zone in the area of the trophic ulcer.

 02/10/94. completed the first stage of the operation. The fascia of the chest is exposed. Formed fascial flap on the supply vessels. The flap is covered with a split skin graft.

 02/17/94. performed the second stage of the operation. The trophic ulcer was excised, a 5 by 6 cm defect was formed, which was covered by the skin-fascial flap formed by the first stage. The graft has taken root, healing proceeded by primary intention. Examined 15 months after the operation, there are no trophic disorders in the autograft area. The contours of the foot are correct, it uses ordinary shoes (Fig. 2).

Claims (1)

 A method of surgical treatment of trophic ulcers of the lower extremities by excision and transplantation of a free blood-supply fascial and skin-fascial flap to the place of the defect formed, characterized in that a split skin graft is cut from the hip, transplanted onto a mobilized blood-supply fascial chest flap and after 7 days the created complex is transplanted tissues to the site of excised trophic ulcers.

Images