RU2186540C2 - Method for restoring a damaged tendon of finger deep flexor - Google Patents

Abstract

FIELD: medicine, traumatology, orthopedics. SUBSTANCE: after accomplishing a proximal end of a deep flexor between separated stems of a surface flexor and its fixation a damaged stem of a surface flexor is completely detached in diagonal direction at bifurcation level, not leaving its stump. This prevents the development of scars in area of tendon's suture. EFFECT: higher efficiency of restoration. 2 dwg

Description

 The invention relates to medicine, in particular to surgery for damage to the hand. It is used to repair a damaged deep flexor tendon in a critical area in combination with damage to one of the legs of a superficial flexor.

 Known are traditional methods of finding and holding the central end of the tendon of the deep flexor to the level of damage, passing the conductor from the primary wound on the finger into the operating (additional) wound in the palm and back (1). But when using this method, certain difficulties arise in conducting the central end of the damaged tendon of the deep flexor between the legs of the superficial flexor with isolated damage to the deep flexor on the finger.

 For the prototype selected method N.M. Vodyanova (2), the closest in its technical solution to the claimed one. This method consists in the fact that the proximal end of the deep flexor tendon is held between the legs of the superficial with the bent position of the hand and the bent position of the corresponding finger. The disadvantage of this method is great technical difficulties in carrying out the damaged central end of the deep flexor in combination with damage to one of the legs of the superficial flexor between the preserved (whole) leg of the superficial flexor and the damaged leg, displaced in the proximal direction along the tendon sheath. Due to the displacement of the surface flexor leg, the tendon sheath clearance and the space between the legs of the surface flexor are narrowed, especially with the bent position of the hand and the half-bent position of the corresponding finger, which makes it even more difficult to hold the central end of the damaged tendon of the deep flexor. The preservation of the damaged legs within the tendon sheath in the postoperative period will necessarily lead to the formation of a scar block at the site of the suture.

 The aim of the invention is to facilitate the Central end of the tendon of the deep flexor and to prevent the formation of a scar block in the area of its suture.

 The essence of the invention consists in a combination of distinctive features and consists in the fact that after the proximal end of the deep flexor is held between the legs of the surface flexor spread to the sides and fixed, the damaged leg of the surface flexor is completely cut off obliquely at the level of the bifurcation, without leaving its stump.

 The operation diagram is presented in the drawings. Figure 1 shows the position of the ends of the damaged tendons after the proximal end of the deep flexor and the dashed line shows the cutoff level of the Central part of the damaged legs of the superficial flexor. Figure 2 shows the position of the tendons after surgery.

 The method is as follows. After the bayonet-shaped expansion of the wound on the finger, the distal end of the deep flexor and the central end of the damaged leg of the superficial flexor are isolated by pulling the undamaged leg of the latter in the distal direction. The central end of the damaged legs of the superficial flexor is taken to the clamp, pulled in the distal direction, taken to the side. At the same time, the intact leg of the tendon of the superficial flexor is pulled up and it is also taken away with a single-tooth hook to the side. With the semi-oval cut on the palm of the hand, the central end of the deep flexor is isolated into the wound, stitched with a Bennel type suture and a button probe between the legs of the surface flexor spread apart to the side and carried out freely from palm to finger. The damaged leg of the superficial flexor, taken to the clamp, is pulled as far as possible in the distal direction and, without leaving a stump, completely cut it off in an oblique direction at the bifurcation level while maintaining the intact leg of the surface flexor. At the ends of the deep flexor, a Bennel blocking removable suture is applied with a dermal fixation of the threads on the finger on the gauze ball. A plaster cast for 3 weeks is applied to the brush.

 Clinical example; B. S., 39 years old, Eastball. N 782 at the Scientific and Technical Center "WTO" was received on October 13, 1997 with a diagnosis of a cut wound of the 5th finger of the right hand with damage to the tendon of the deep flexor at the level of the proximal interphalangeal joint, the legs of the superficial flexor and digital nerve along the elbow edge. On the 4th day after PHO, the patient was treated with the initially delayed suture of the deep flexor of the 5th finger according to Bennel and the suture of the digital nerve along the elbow edge. Under intravenous anesthesia, the sutures are dissolved, the wound is sanitized and bayonet-shaped. The distal end of the deep flexor of the 5th finger and the ends of the damaged digital nerve are highlighted. By pulling with a single-tooth hook in the distal direction and towards the undamaged leg of the tendon of the surface flexor, the central end of the damaged leg is taken to the clamp and laid aside. The central end of the deep flexor was found from an additional semi-oval incision in the palm of the hand, stitched with Bennel’s suture and a button probe was held between the legs of the surface of the flexor tendon spread from side to side from palm to finger. The central end of the damaged leg of the superficial flexor, taken to the clamp, is completely cut off without leaving the stump in an oblique direction at the bifurcation level while maintaining the intact leg of the surface flexor. At the ends of the deep flexor, Bennel’s blocking removable seam is applied. After refreshment, the ends of the damaged digital nerve are sewn along the elbow edge with thread 7/0. On the 5th finger of the right hand, a back gypsum splint is applied. Conducted postoperative rehabilitation treatment. Examined a year after the operation. No complaints, the function of 5 fingers is fully restored.

Sources of information
1. Rozov V.I. - Damage to the tendons of the hand and fingers and their treatment. Medgiz, L., 1952, 192 pp.

 2. Vodyanov N.M. - Primary suture of the tendons of the hand. Prokopyevsk, 1973, Methodological recommendations. 23 p.

Claims (1)

 A method of repairing a damaged tendon of a deep flexor of the finger, including the allocation of the central and distal ends of the tendon of a deep and damaged leg of the superficial flexor, applying a blocking removable suture to the damaged deep flexor, end to end, characterized in that after the proximal end of the deep flexor is located between the legs of the superficial flexor of the flexor and its fixation, the damaged leg of the surface flexor is completely cut off in an oblique direction at a level e bifurcation, leaving her stump.

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