RU2355348C1 - Therapy of total congenital webbed fingers - Google Patents

Abstract

FIELD: medicine; orthopaedics and traumatology.

SUBSTANCE: skin, subcutaneous fatty tissue and bones are dissected between webbed fingers at nail bones and distal interphalangeal joints to heads of proximal phalanxes. Finger deformation is removed by wire fixation of nail bones and middle phalanxes of separated fingers. Skin defect is closed with a skin mesh graft thereafter applying a splint.

EFFECT: arrangement of conditions for correct finger growth without disturbing a normal anatomic axis, completely preserved flexion and extension functions, prevented postoperative cicatricial deformity of separated fingers, reduced injuries.

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Description

The invention relates to medicine, namely to traumatology, orthopedics, and can be used in the treatment of syndactyly.

With total syndactyly of the third, fourth and fifth fingers of the hand, due to the difference in their length, as the child grows, ulnar deviation of the third and fourth fingers and flexion contracture of these fingers in the interphalangeal joints develop.

A known method of surgical treatment of syndactyly using local skin grafting with oncoming triangular flaps [1].

The disadvantage of this type of treatment is the often occurring necrosis of the tops of the flaps due to their insufficient blood supply.

A known method of combined skin grafting in congenital syndactyly [2], which consists in the fact that for the formation of the interdigital gap, local skin grafting is used with counter rags, and the wound defects are covered after separation of the fused fingers by free skin transplantation. With the elimination of syndactyly by this method, partial grafting of free transplants, their retraction or rejection is possible. The use of the back M-shaped flap allows you to form only the bottom of the interdigital gap, but does not allow you to close the lateral surfaces of the divided fingers and does not prevent necrosis of the apex of the oncoming triangular palmar flap.

As a prototype, the method of treating syndactyly with skin grafting using free autografts according to Yu.Yu. Janelidze [3] was adopted, along which sutures are held through the nails of the fused fingers for more convenient stretching of the fingers. The commissure is cut longitudinally to the palmar-palmar fold, and on the rear, to the heads of metacarpal bones. The flap according to Tirsch is fixed at four points to the edges of the wound surface, after which it is sutured with the edges of the skin wound throughout and pierced in many places with the tip of a scalpel. The flap is covered with gauze with ointment, between the fingers in full length, lay a strip of rubber sponge.

However, the known method has a significant drawback. In the postoperative period in children, transplantation of a full-layer skin flap from the fingertips to their base due to linear scars formed on the back and palmar surfaces when a free skin flap is sutured, leads to an arcuate curvature of the divided fingers towards each other. This is due to the lag in the regeneration of the transplanted skin area and the scar line from the growth rate of the fingers, which subsequently leads to the appearance of flexion contracture of the divided fingers.

The invention consists in a combination of distinctive features sufficient to achieve a technical result, consisting in low injuries, creating conditions for the normal development of the anatomical axes of the fingers exposed to total syndactyly, and preventing cicatricial deformities of divided fingers in the postoperative period.

The essence of the invention lies in the fact that a method of treating total congenital syndactyly of the fingers includes dissection of adhesions and closing of a skin defect between the fingers separated by skin plasty with a perforated flap. Cut the skin, subcutaneous fat and bones between the fused fingers at the level of the nail phalanges and distal interphalangeal joints to the heads of the main phalanges. The deformation of the fingers is fixed by fixing the nail and middle phalanges of the dilated fingers with knitting needles, the skin defect is covered with a full-layer perforated skin flap, and a splint is applied.

Treatment of total congenital syndactyly in early childhood ensures the creation of conditions for the correct growth of fingers without disturbing the normal anatomical axis while maintaining the functions of flexion and extension in full.

The fixation of the divided fingers by the introduction of thin knitting needles and the subsequent application of a plaster cast in young children in the postoperative period is more comfortable compared with the use of an external fixation device.

The dissection of the skin, subcutaneous fat and bone between the fused fingers at the level of the nail phalanges and distal interphalangeal joints to the heads of the main phalanges is less traumatic and makes it possible to delay a more complex surgical treatment for the final elimination of syndactyly.

Elimination of deformations of the divided fingers by fixing their nail and middle phalanges with knitting needles provides further proper growth of these fingers.

The method is illustrated by photographs: figure 1 shows a view of the brush before surgery; figure 2 - x-ray before surgery; figure 3 is a view of the fingers, divided to the heads of the main phalanges, from the palm; figure 4 is a view of the divided fingers from the rear of the palm; figure 5 is a view of the brush after eliminating deformation with fixation of the phalanx of the fingers with needles; figure 6 - cutting a full-layer skin flap on the forearm; figure 7 - x-ray of the brush after surgery; on Fig - view of the brush after surgery. The method is as follows.

After processing the surgical field, under anesthesia, the skin and subcutaneous tissue are dissected along the back surface of the fused fingers with the separation of the nail plates to bone fusion from their tips to the heads of the main phalanges. Next, a linear incision is made on the palmar surface from the tip of the finger to the heads of the main phalanges in the central direction, after which the bone synostosis is separated, the divided fingers are spread apart, the formed deformation is removed until the normal anatomical axis is reached and the phalanges of these fingers are fixed with thin knitting needles. In this case, the diameter of the spokes should be the smallest, for this purpose injection needles can also be used. For the subsequent closure of the formed defects of the lateral surfaces of the divided fingers, a full-layer skin flap is cut out on the forearm, perforated and sutured to the edges of the skin wound of the divided fingers. Aseptic dressing. Plaster cast.

Clinical example: Jagf. A.A., date of birth 11.27.2006. Received treatment 18.06.2007. Case history No. 3159. After preliminary preparation of the patient under anesthesia, the skin and subcutaneous tissue were dissected along the back of the fingers with the separation of the nail plates. After that, a linear incision was made on the palmar surface from the tip of the finger to the heads of the main phalanges in the proximal direction. Next, bone synostosis was divided, the divided fingers were spread apart, the formed deformation was eliminated until the normal anatomical axis was reached, and the phalanges of these fingers were fixed with thin injection needles. For the subsequent closure of the formed defects of the lateral surfaces of the divided fingers, a full-layer skin flap was cut out on the forearm, it was perforated and sewn to the edges of the skin wound of the divided fingers. An aseptic dressing and a plaster cast were applied.

Information sources

1. Benoit N.I. Combined skin grafting in congenital syndactyly. Gorky, 1968, Methodical letter, p.13.

2. Limberg A.A. Planning for locally plastic surgeries on the surface of the body. - M., Medicine, 1963, p. 593.

3. Surgery of the upper limb, book 1. - M., Medgiz, 1960, p. 87.

Claims (1)

A method of treating total congenital syndactyly of the fingers, including dissection of the adhesion and closing of the skin defect between the fingers separated by skin plasty with a perforated flap, characterized in that they cut the skin, subcutaneous fat and bones between the fused fingers at the level of the nail phalanges and distal interphalangeal joints to the heads of the main phalanx, eliminate the deformation of the fingers by fixing the nail and middle phalanx of the dilated fingers with knitting needles, close the skin defect with a full-layer skin flap and apply ongetu.

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