RU2324438C2 - Method of plastic surgery of anterior abdominal wall with use of transferred oncoming flaps from aponeurosis of rectus abdominal muscles - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: flap is cut out of the external aponeurosis leaf off the medial margin of the rectus abdominal muscle. The similar flap is cute out on the internal surface of the opposite side. The aponeurotic flap from the external surface is brought to the internal part of the cut out opposite area and sutured continuously. The rectus abdominal muscles are connected by separate interrupted suture. The internal aponeurotic leaf of the rectus abdominal muscle is taken out to the anterior surface of the cut out opposite area and sutured continuously.

EFFECT: method allows preventing rough scar and increases fixation strength.

1 tbl, 3 dwg

Description

The invention relates to surgery, in particular abdominal, designed to restore the anatomical and physiological structure of the anterior abdominal wall with ventral hernias.

There are many previously proposed methods for strengthening the anterior abdominal wall with ventral hernias (Sapezhko K.M., 1900; Martynov A.V., 1932; Shpakovsky N.I., 1980; Stolyarov E.A., 1993; Zagirov U.Z. et al., 1994). However, these methods do not fully manage to strengthen the anterior abdominal wall. Tension of the tissues leads to their ischemia, atrophy of the rectus abdominis muscles, the volume of the abdominal cavity decreases, which contributes to the rise and decrease of the diaphragm excursion, and the vital capacity of the lungs is limited. An increase in intra-abdominal pressure stimulates the formation of repeated hernias, which requires prompt correction. This is especially true for cases with extensive and giant ventral hernias.

As an analogue, the method of Zagirov U.Z. attracts attention. et al. (Zhebrovsky V.V. Surgery of abdominal hernias. M., Medical News Agency, 2005, p.135-136), which was involved in plastic surgery of the anterior abdominal wall using an original technique. This technique of plastic surgery of the anterior abdominal wall with ventral hernias gives good clinical and functional morphological indicators, but a coarse scar along the sagittal line is formed, as layer-by-layer suturing is performed in one plane.

The objective of the invention is to provide a method for plastic surgery of the anterior abdominal wall by displaced oncoming flaps from the aponeurosis of the rectus abdominis muscles, devoid of the above disadvantages.

The technical result of the proposed method is to increase the strength of the anterior abdominal wall due to the restoration of the anatomical structures and the method of suturing.

Suture technique: bordering incision of the skin over the hernial protrusion, the allocation of the hernial sac to the hernial portal, excision of the hernial sac after preliminary placement of the contents of the hernial sac into the abdominal cavity. The hernial sac is excised along the border with the muscle-aponeurotic structures, the edges of the aponeurosis of the rectus abdominis muscle are distinguished (1). Retreating from the medial edge of the rectus abdominis muscle (Figure 1) by 2-3 cm, from the outer leaf of the aponeurosis (1) longitudinally dissecting (7), a U-shaped flap (5) is cut out. The same flap from the aponeurosis is cut out from the opposite side only from the inner surface (3, 6). Summing the aponeurosis flap from the outer surface (5) to the inner portion of the field to be cut out on the opposite side (3), the suture (4) is sutured with a continuous suture, and along with this, an inner sheet of aponeurosis of the rectus abdominis is formed (Figure 2). Separate interrupted sutures (4) connect the rectus abdominis muscles (2). On the opposite side, the inner leaf of the aponeurosis (6) of the rectus abdominis muscle is displayed on the front surface (6, 1) of the field to be cut on the opposite side and is fixed with a continuous suture (4). Formed anterior leaf of the aponeurosis of the rectus abdominis muscles (Figure 3). Layered suturing.

The technique developed by us for plastic surgery of the anterior abdominal wall by displaced oncoming flaps from the aponeurosis of the rectus abdominis differs from the method of Zagirova U.Z. et al. in that:

1. A U-shaped flap is cut out from the anterior wall of the aponeurosis of the rectus abdominis muscle on one side (in Zigirov U.Z. on both sides, the sections are semi-oval).

2. The second flap is cut out from the opposite side, but already from the inner leaf of the aponeurosis.

3. The cut leaf of the aponeurosis from the front wall of the rectus muscle is transferred to the opposite side and is fixed with a continuous suture to the cut field along the posterior surface of the rectus abdominis muscle (a continuous back sheet of rectus muscles has been created, the back wall has been strengthened).

4. The flap cut from the inner leaf of the aponeurosis is transferred to the front surface of the cut field of the rectus abdominis muscle on the opposite side and is also fixed with a continuous suture (a continuous front leaf of the rectus abdominis muscles has been created, the anterior wall has been strengthened).

5. The stitched seams do not create a rough scar, as they are in different planes with respect to the sagittal line.

The result of the proposed method is to increase the strength of the anterior abdominal wall due to the restoration of the anatomical structures and the suturing technique.

The data obtained are presented in Table 1. In total, 30 patients aged 20 to 60 years with a hernia size of 10 to 35 cm were operated on using the above method. Patients operated on using standard methods of anterior abdominal wall plasty were used as a control group. Patients are comparable in size to the ventral hernia, but in patients operated on by our method, complications were 2, 3 times less common, and healing by primary intention was more frequent (86%) and significantly shorter, while secondary intention was 14 % of observations and 3.3 days earlier, regardless of age.

Table 1 The effectiveness of plastic surgery of the anterior abdominal wall by displaced oncoming flaps from the aponeurosis of the rectus abdominis muscles. The total number of patients (n = 60) I group (n = 30) II group (n = 30) Age: 20-30 years 7 pax 5 pax 30-40 years old 10 pax 9 pax 40-50 years old 8 pax 11 pax 50-60 years 5 pax 5 pax Hernia Size: less than 20 cm 14 pax 10 pax 20-25 cm 9 pax 12 pax more - 25 cm 7 pax 8 pax Complications (hematomas, seromas, suppurations, ligature fistulas) 11 people (36%) 5 people (16%) Primary intention healing 19 people (63%) 26 people (86%) The timing on 12.1 ± 1.62 day at 9.4 ± 1.05 * day Secondary healing 6 people (20%) 4 people (14%) The timing on 16.2 ± 1.98 days at 12.9 ± 1.58 * day Note: * - indicated reliability (p <0.05) when comparing group II with group I Group I - a control group using standard plastic methods Group II - the study group using plastics of the anterior abdominal wall, displaced by the oncoming flaps from the aponeurosis of the rectus abdominis.

Claims (1)

The method of plasty of the anterior abdominal wall, including cutting oncoming flaps from the aponeurosis of the rectus abdominis muscle on opposite sides, characterized in that, departing from the medial edge of the rectus abdominis muscle, a flap is cut from the outer leaf of the aponeurosis, the same flap is cut from the opposite side on the inner surface, the flap is brought down from the aponeurosis from the outer surface to the inner portion of the field to be cut out on the opposite side and sutured with a continuous suture, the rectus muscles are connected with separate nodal sutures s of the abdomen, the inner sheet of the aponeurosis of the rectus abdominis is brought to the front surface of the cut out field of the opposite side and fixed with a continuous suture.

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