RU2474391C1 - Method of skin grafting for circular defect of soft tissues of phalangette - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, specifically to hand surgery. Vascularised grafting of an injured phalangette with two flaps. The first flap from an ulnar surface of the injured finger is used to cover a palmar surface of the phalangette. A nerve in the flap is transected in the distal direction from its dorsal branch origin and sutured together with a digital nerve of the radial side. The cross pedicle flap is used to cover the dorsal surface of the phalangette.

EFFECT: method provides tissue reconstruction of the phalangette in its circular defect with preserved discrimination sensitivity.

1 ex, 5 dwg

Description

The invention relates to medicine, specifically to brush surgery, and is used for a circular soft tissue defect of the distal phalanx of the finger of the hand.

A known method of combined skin grafting with two cross flaps from adjacent fingers. At the level of the middle phalanx of the adjacent finger, a flap is raised on a temporary feeding leg of a length and width sufficient to cover the palmar surface of the nail phalanx. The flap is raised while maintaining paratenon. To shelter the back surface, a similar flap is lifted from another, neighboring finger. Donor wounds are covered with full-layer skin grafts from the front surface of the forearm. Three weeks later, the feeding legs are cut off. The disadvantage of this method is the lack of sensitivity of the formed finger, which reduces its functional activity.

The closest to the proposed invention, in its technical solution, is the prototype method of defect skin repair by a free back flap of the middle phalanx of the other finger. A graft of the dorsal surface of the middle phalanx on the dorsal branch of the digital artery is raised on one of the fingers of the damaged hand. The transplant is transferred to the recipient area, an anastomosis with the finger artery of the damaged finger is applied, anastomoses with the back veins, the flap is reinnervated by applying an epiperineural suture between the finger nerve of the recipient area and the back branch of the finger nerve in the graft. The donor area is covered with a full-layer skin graft. The disadvantage of this method is the duration of the operation, the possibility of thrombosis of vascular anastomoses.

The essence of the invention is expressed by a combination of essential features sufficient to achieve the desired technical result, which consists in a complete reconstruction of the nail phalanx of the finger, without excess soft tissue, with a discriminatory sensitivity of up to 10 mm, with a reduction in treatment time.

The essence of the method of skin plasty with a circular soft tissue defect of the distal phalanx of the finger includes vascularized plastic of the distal phalanx of the damaged finger with a flap, moving the flap to the recipient area and fixing it, covering the donor area with a skin graft. Two flaps. The first flap is raised on the palmar-lateral surface of the main phalanx of the ulnar side of the damaged finger, on the retrograde blood flow of the digital artery in the neurovascular bundle, to cover the palmar surface of the nail phalanx, and the digital nerve is crossed 3-4 mm proximal to the posterior branch of the posterior branch. the borders of the flap. The flap is reinnervated by means of an epiperineural suture between the digital nerve in the flap and the digital nerve of the radial side of the damaged finger. A second, cross flap on the temporary feeding leg from the next finger covers the back surface of the nail phalanx. Three weeks later, the temporary supply leg is cut off.

The first flap, on the retrograde blood flow of the finger artery with the finger nerve, used to cover the palmar surface of the damaged finger, allows you to bring in the recipient area a sufficient amount of soft tissue, similar in structure to the lost tissue.

The second flap, on the temporary feeding leg from the next finger, allows you to close the defect of the back surface of the nail phalanx with a vascularized flap, without excess subcutaneous fat.

The intersection of the digital nerve distal to the departure of its dorsal branch, 3-4 mm proximal to the border of the flap, makes it possible to reinnervate the flap with the digital nerve of the radial side of the finger, while maintaining the sensitivity of the back surface of the finger.

Reinnervation of the flap by means of an epiperineural suture between the digital nerve in the flap and the digital nerve along the radial side of the damaged finger allows the discrimination sensitivity to be restored to 10 mm.

The use of two flaps provides a complete reconstruction of the nail phalanx with a discriminatory sensitivity of up to 10 mm.

The method is illustrated by the accompanying illustrations, where:

figure 1 presents a photo of a brush with a damaged 2 finger;

figure 2-3 is a view of the brush after combined vascular plastic surgery;

figure 4-5 - long-term result - two weeks after cutting off the supply legs.

The method is carried out in the following way.

Measure the area of the skin of the distal phalanx on an intact finger for more accurate planning of the size of the required flaps. Further, on the palmar-lateral surface of the finger, on the ulnar side, at the level of the main phalanx, a flap is raised with an area sufficient to cover the palmar surface of the damaged finger, on the retrograde blood flow of the digital artery, with the digital nerve, and the digital nerve is crossed distal to the posterior branch, 3-4 mm proximal to the border of the flap. The flap is moved to the recipient area, hemmed. The donor area is covered with a full-layer skin graft. The flap is reinnervated by means of an epiperineural suture between the finger flap as part of the flap and the finger nerve of the damaged finger along the radial side. A cross flap is raised on the back surface of the adjacent finger, on the temporary feeding leg, with the area required to close the back surface of the nail phalanx. The flap is sutured to the recipient area, and the donor area is covered with a full-layer skin graft. Immobilization of the donor and recipient fingers - for 10 days. Three weeks later, the feeding leg of the cross flap is cut off.

Clinical example.

Patient S., 22 years old, October 2, 2002, when working on a machine, he received a soft tissue detachment of the distal phalanx of 2 fingers of the left hand. On October 2, 2002, a necrectomy was performed, combined vascularized skin grafting with a flap on the retrograde blood flow of the digital artery with reinnervation and a cross flap from a neighboring finger. For this, the first flap was raised on the palmar-lateral surface of the main phalanx of the ulnar side of the damaged finger on the retrograde blood flow of the digital artery in the neurovascular bundle, the digital nerve being crossed distal to the posterior branch, 3-4 mm proximal to the border of the flap, and covered with it Palmar surface of the nail phalanx. The flap was reinnervated by means of an epiperineural suture between the digital nerve in the flap and the digital nerve of the radial side of the damaged finger. The second, cross, flap on the temporary feeding leg from the next finger covered the back surface of the nail phalanx. The feeding leg of the cross flap was cut off after three weeks. After 2 weeks, the sutures were removed, a set of physiotherapeutic procedures was started. When viewed after 6 months, the discriminatory sensitivity on the palmar surface of the formed distal phalanx, of the formed finger, was 10 mm. The patient with the achieved result is satisfied.

Claims (1)

The method of skin plasty with a circular soft tissue defect of the distal phalanx of the finger of the finger, including vascularized plastic of the distal phalanx of the damaged finger with a flap, moving the flap to the recipient area and fixing it, covering the donor area with a skin graft, characterized in that there are two flaps, the first one is lifted by palm the lateral surface of the main phalanx of the ulnar side of the damaged finger, on the retrograde blood flow of the digital artery as part of the neurovascular bundle, to cover the palmar the surface of the nail phalanx, and the digital nerve is intersected distal to the posterior branch, 3-4 mm proximal to the border of the flap, the flap is reinnervated by means of an epiperineural suture between the digital nerve and the digital nerve of the radial side of the damaged finger, the second, cross, flap on a temporary the back surface of the nail phalanx is covered with a feeding leg from a neighboring finger; after three weeks, the temporary feeding leg is cut off.

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