RU2242931C2 - Surgical method for treating the cases of webbed fingers - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method involves zigzag cuts to finger end. Triangular skin flaps are moved to meet each other, covering defect with local tissues.

EFFECT: avoided marginal necrosis occurrence; forming flexion contractures.

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Description

The invention relates to medicine, namely to surgery, and can be, in particular, used for surgical treatment of the skin form of syndactyly.

From practical medicine for the treatment of the skin form of syndactyly, a method is known (Dzhanelidze Yu. Yu. Skin grafting using long tubular strips. - New. Archive. - 1924. - 3., P.22), which consists in the following: after linear finger separation in order to prevent wrinkling of the skin, its free transplantation is performed. However, the disadvantage of this method is that it is necessary to take the skin from a certain part of the body, causing additional trauma to the patient, the skin does not always take root as a result of its necrosis.

There is also a method of separating fingers with triangular incisions (Cronin T.D. Syndactylism: results of zig-zag incision to prevet postoperative contracture. - Plastic reconstr. Surg. - 1956. - 18, P.460). At the same time, triangular flaps are formed to separate the fingers, then the defect of one of the fingers is closed with the skin of this finger, and a free skin graft is used to eliminate the defect on the other finger. A serious drawback of this method is also an additional trauma for the patient, as well as the risk of developing skin necrosis.

The closest in technical essence and the achieved result is a method for surgical treatment of the skin form of syndactyly, including the mutual exchange of multiple pairs of triangular flaps (i.e., sawtooth incisions with the subsequent movement of triangular skin flaps towards each other), and the skin defect is closed with local tissues (Limberg A.A. Planning of local plastic surgeries on the body surface. - L .: publishing house of medical literature, 1963, p. 457-459).

However, the known method has the following disadvantages: involves the combination of the plate with local tissues with a free skin transplant, which is technically more difficult; not always providing sufficient cosmetic and functional results due to the formation of flexion contractures of the fingers; development of regional necrosis is possible due to severe skin tension and a violation of the blood supply to the finger.

The technical result, the achievement of which the creation of this invention is directed, is to prevent the formation of marginal necrosis in the early postoperative period and flexion contractures of the fingers in the future.

The technical result is achieved by the fact that in the method of surgical treatment of the skin form of syndactyly, including sawtooth incisions, the subsequent movement of the triangular skin flaps towards each other with the closure of the skin defect by local tissues - when forming triangular flaps, the incisions are made to the edge of the finger.

The method is as follows. At first, two injection needles drawn through the joint between the fingers indicate the base of the triangular flaps. Then, as shown in the diagram (Fig. 1), two triangular flaps are cut out on each finger, so that when they move counter, it is possible to close the skin defect on the next finger, and the incisions are not carried out until the middle, as in the previous methods, and to the edge of the finger, which provides greater extensibility of the flaps. Greater compliance of the skin flaps is also achieved due to the fact that the triangular flaps of the interdigital gap are cut out more proximally than was previously accepted, and due to the better displacement of the skin of the back of the hand, which allows you to close a large area of the defect between the fingers. The back and palm triangular flaps are stitched according to the “dovetail” type (Fig. 2).

Clinical example 1. Patient I., b. 1996 (2 years 5 months) was admitted to the clinic with a diagnosis of cutaneous syndactyly of the II and III fingers of the right hand. In connection with this disease, on March 23, 1999, the second and third fingers of the right hand were separated, followed by zigzag skin repair with local tissues. The operation was performed under intravenous anesthesia. A tourniquet is applied to the middle third of the forearm. Through the fusion between the fingers, 2 injection needles were drawn to indicate the bases of the triangles. Then, on each finger, 2 triangular flaps were cut, the incisions were made to the edges of the fingers. The fingers are disconnected. Excess fat was excised. The flaps on each finger are moved towards each other, sewn along the edges of the defects. The interdigital gap is sutured like a dovetail. An aseptic dressing is applied. Immobilization with a plaster cast. The postoperative period was uneventful. The wound healed by primary intention.

One year after the operation, the patient has no complaints. A good cosmetic and functional effect was noted - the brush function in full, contracture and rough scars did not form.

Clinical example 2. Patient K., born in 1978 (21 years) January 22, 1999 was admitted to the hospital with a diagnosis of syndactyly of the II and III fingers of the left foot. Regarding this pathology, on January 25, 1999, the second and third fingers of the left foot were separated, followed by zigzag plastic with local tissues. A tourniquet is applied to the middle third of the lower leg. Two injection needles were drawn through the joint between the fingers to indicate the bases of the triangles. Then, on each finger, two triangular flaps were cut, the incisions were made to the edges of the fingers. fingers are disconnected. Excess fat was excised. The flaps on each fingers are moved towards each other, sewn along the edges of the defects. The interdigital gap is sutured as a “swallow tail”. An aseptic dressing is applied. Immobilization with a plaster cast. The postoperative period was uneventful. The wound healed by primary intention.

One year after the operation, the patient has no complaints. A good cosmetic and functional effect was noted - the full function of the foot, contractures and rough scars did not form.

The significant advantages of the proposed method are:

1) The ability to lay skin flaps without tension, while closing large skin defects;

2) The possibility of dosed tension of skin flaps, which reduces the risk of developing regional necrosis in the early postoperative period and the formation of flexion contractures in the future;

3) It is not supposed to cause additional injury to the patient while taking skin from another part of the body:

4) A good cosmetic and functional result is provided;

5) No special training of the surgeon and special tools are required.

Claims (1)

A method for surgical treatment of the skin form of syndactyly, including sawtooth incisions, the subsequent movement of triangular skin flaps towards each other with the closure of the defect by local tissues, characterized in that during the formation of triangular flaps, the incisions are made to the edge of the finger.

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