RU2209596C2 - Method for preventing venous deficiency of radial fragment with retrograde circulation - Google Patents

Abstract

FIELD: medicine, orthopedics, traumatology. SUBSTANCE: one should form fragment including cephalic vein and subcutaneous veins of lesser diameter. Cephalic vein should be crossed being proximally against commissure vein connecting with rear subcutaneous veins of forearm. Fragment should be replaced. Then it is necessary to anastomose proximal part of cephalic vein with its distal part. Proximal parts of subcutaneous veins are withdrawn outwards. The suggested innovation enables to remove risk of anastomosis' thrombosis and fragment's venous deficiency. EFFECT: higher efficiency of prophylaxis. 6 dwg

Description

 The present invention relates to medicine, in particular to methods for the prevention of venous insufficiency of a radiation graft with retrograde blood flow. Plastic surgery with a radiation flap with reverse blood flow is often accompanied by the development of venous insufficiency of a tissue complex, for the prevention of which there is a known method for restoring venous outflow from a flap by anastomosing the head vein included in the flap with one of the veins of the recipient bed, described in the article “Skin-bone flap on foot taken from the forearm ", I. Matev, The Journal of Hand Surgery, 1985, V.10B, 2, p. 179-182.

 However, with the consequences of frostbite and pronounced cicatricial changes in the skin, obliteration of many saphenous veins occurs, and therefore there is a problem of a mismatch in the diameters of the stitched veins, and this significantly increases the risk of thrombosis of the anastomosis and the progression of venous insufficiency. In addition, this method allows you to restore the outflow of blood through only one of the veins, which may be insufficient to prevent the occurrence of severe forms of venous insufficiency.

 The objective of the invention is to eliminate the risk of thrombosis of the anastomosis and the progression of venous insufficiency of the flap.

 This problem is solved due to the fact that the flap includes saphenous veins of small diameter, the head vein is intersected proximal to the commissural vein connecting to the dorsal saphenous veins of the forearm, and after the flap is moved, the proximal part of the head vein is anastomosed with its distal part, and the proximal parts of the saphenous veins take out.

 The essence of the clinical decision is illustrated by drawings, where in Fig. 1 a formed radiation flap with veins included in it; figure 2 - formed flap with draining veins with the preservation of the commissural vein; figure 3 - transferred to the recipient region of the flap with the restoration of the head vein and the removal of other saphenous veins.

 The proposed method is as follows.

 The radial artery with its accompanying veins is isolated and a skin or skin-bone radial flap 1 of the required size is formed in its projection (Fig. 1). The composition of the flap 1 include the radial artery with its accompanying veins, the head vein 2, as well as one or two saphenous veins 3 of the lower arm. Before entering the flap, the head vein 2 is ligated and cut proximal to its commissural branch 4, which connects to the dorsal saphenous veins of the forearm 5, and the remaining veins 3 are located at the distal edge of the flap 1 (Fig. 2). Further, the incision continues proximal to the plank in the projection of the head vein to the ulnar fossa. The head vein 2 and veins of smaller diameter are mobilized, which intersect at the level of the ulnar fossa, their proximal ends are ligated. The radial artery is ligated and intersects proximal to flap 1. Flap 1 on the distal vascular pedicle is transferred to the recipient region (Fig. 3). In the area of the “anatomical snuff box”, the initial section of the head vein 2 is distinguished. The peripheral end of the part of the head vein included in the flap 1 is carried out in the subcutaneous canal to the “anatomical snuff box”, where the end-to-end anastomosis with the initial section of the head vein is anastomosed 6. Peripheral the ends of the veins 3 of smaller diameter lead outward between the skin sutures of the flap 1 (Fig.3). As a result of this, the main outflow of venous blood from the flap will be carried out into the head vein channel 6, and the additional one will take place in a bandage. As the venous hypertension of flap 1 decreases, the external bleeding from the veins gradually decreases and disappears on average on the second or third day after the operation. At the same time, the veins 3 of the flap 1 pulled out are pulled out, bandaged at its edge and cut off.

 Thus, when implementing the method, internal and external drainage of venous blood occurs, which is especially important in cases where there are no suitable recipient vessels for anastomosis with all veins included in the flap.

 Clinical example. B-th Ananicheva O.S., born 1950, I.B. 188676, was in Nizhny Novgorod NIITO about the stump of the first metacarpal bone at the level of the head, the stumps of the second, third metacarpal bones at the level of the distal third, the stump of the fourth finger at the base of the middle phalanx on the right. Upon admission, there is a complete absence of grip of the right hand, pronounced cicatricial changes in the skin on its back surface as a result of frostbite (Fig. 4). 10.10.99g. the patient underwent skin-bone reconstruction of the first finger of the right hand by plastic surgery with a radial skin-bone flap with retrograde blood flow. In order to prevent venous insufficiency of the flap, the outflow of blood from it was restored according to the developed method. Swelling and cyanosis of the displaced flap was stopped during the operation. In the postoperative period, there were also no signs of venous stasis in the flap. Bleeding from the veins removed outside stopped on the third day. The vessels were bandaged at the base and cut off. The displaced tissue complex has completely taken root. The performed operation with adequate prophylaxis of vascular complications made it possible to restore bilateral grip of the hand already by the time the patient was discharged from the hospital (Figs. 5, 6). The method has been successfully implemented in 8 patients.

 Thus, the method allows to stitch the largest veins of the same diameter related to one permanent collector, which significantly reduces the risk of thrombosis of the anastomosis.

 The method involves the inclusion in the flap of all saphenous veins located in its projection.

 In cases where the head vein, due to the peculiarities of its topography and the structure of the vascular network, does not provide sufficient venous outflow from the flap, blood drainage will be carried out through other veins included in it.

 Combined external and internal drainage of blood from a flap through several veins provides almost 100% engraftment.

 The method can be applied in conditions of obliteration of the majority of saphenous veins of the hand and forearm, since the head vein will most often remain after the consequences of burns and frostbite.

 The method is simple enough for a specialist who owns precision technology.

Claims (1)

 A method for the prevention of venous insufficiency of a radial flap with retrograde blood flow by forming a flap with the inclusion of the head vein with its subsequent mobilization and intersection, moving the flap and anastomosing the proximal part of the head vein, characterized in that the flap includes saphenous veins of small diameter, the head vein is crossed proximal to the commissural vein, connecting with the dorsal saphenous veins of the forearm, and after moving the flap, the proximal part of the head vein with an anastom ziruyut with its distal portion and the proximal portion of the saphenous veins is discharged outside.

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