RU2482803C1 - Method of osteocutaneous reconstruction of finger - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, in particular to traumatology. Bone butt end is exposed by skin cut above stump and hollow to joint cartilage is formed in it. Sharp end of bone transplant is introduced into hollow. Place of bone connection is fixed with pin. Bone basis is covered with two cutaneous-subcutaneous flaps from neighbouring healthy fingers, with one flap being cut out from rear-lateral finger surface, the second being cut out from palm-side surface. After four weeks after operation fingers are separated.

EFFECT: claimed is method of osteocutaneous reconstruction of finger.

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Description

The invention relates to medicine, in particular to hand surgery, and can be used in the reconstruction of missing fingers.

A known method of reconstruction of the fingers of the hand by transplanting fingers from the foot, including the fence as a transplant of the second or third toes. Fingers are transferred to the stump of the finger, performing osteosynthesis between the metacarpal bone of the hand and the bones of the transplanted finger and suturing blood vessels, digital nerves and tendons [1]. However, with all the advantages of this method, it requires special skills in vascular microsurgery and expensive equipment from a surgeon and therefore, in the current socio-economic situation, it is practically inaccessible to the vast majority of patients. Fence as a graft of a finger from the foot leads to a violation of the supporting function of this foot. Many patients who have suffered traumatic loss of fingers are psychologically unprepared for transplantation of a finger from the foot and impaired function of the lower limb associated with this transplantation, categorically refuse surgery.

There is also known a method of reconstruction of the fingers of the hand with a reversible radial flap, including cutting a skin-bone flap on an isolated vascular pedicle on the middle third of the radial surface of the forearm and forming an absent finger from it [2]. However, to perform this method also requires expensive microsurgical equipment. In this way, you can reconstruct only the first finger of the brush. Possible flap necrosis due to torsion or compression of the vascular pedicle. In the long term, fractures of the radius due to a decrease in its diameter associated with the collection of a bone graft are possible.

The method of reconstruction of a finger of a brush [3] is accepted by us as a prototype. In this method, the formation of a finger from the skin of the anterior abdominal wall and a bone autograft is performed in stages. In the inguinal region above the iliac crest, a tubular flap is formed on one feeding leg with the inclusion of a bone graft from the iliac crest. The formed flap is sutured to the finger stump, performing osteosynthesis between the bone graft and the metacarpal bone of the finger. After 4 weeks - cutting off the feeding leg from the abdomen and the final formation of the finger. A prolonged 4-week immobilization of the upper limb leads to a restriction of movements in the joints of the upper limb with the subsequent development of contractures. The skin of the formed finger does not have sensitivity, its color differs from the color of the skin of other fingers.

The objective of the invention is the creation of a highly effective method of skin-bone reconstruction of a finger of the hand, which allows to reduce treatment time and prevent possible complications.

The essence of the invention lies in the fact that the method of skin-bone reconstruction of the fingers of the hand includes the formation of a finger from a bone graft and closing it with skin flaps. By cutting the skin over the stump of the phalanx of the finger, the end of the bone is released and a depression is formed in it to the articular cartilage, into which the pointed end of the bone graft is implanted, the junction of the bones is fixed with a spoke. The bone base is covered with two skin-subcutaneous flaps from neighboring healthy fingers, with one flap cut out from the back-side surface of the finger, and the second from the palm-side surface. Four weeks after surgery, the fingers are separated.

The introduction of the pointed end of the bone graft into the groove formed in the end of the stump of the finger to the articular cartilage allows you to tightly match the graft with the mother’s bed.

Fixation of the junction of the bones by the knitting ensures the strength of this connection.

Sheltering the bone base of the newly formed finger with two skin-subcutaneous flaps cut one from the back-lateral and the other from the palmar-lateral surface of adjacent healthy fingers ensures restoration of the full sensitivity of the formed finger.

The method is illustrated by illustrations, where:

figure 1 shows x-rays of the hand before surgery;

figure 2 - x-rays after connecting the graft to the mother's bed;

figure 3 - photographs of a brush with artificially created syndactyly;

figure 4, 5 is a view of the brush after separation of artificially created syndactyly;

figure 6 - x-ray of the brush after separation of the fingers;

Fig.7 - radiographs of the brush one year after the operation;

Fig. 8 is a view of a brush one year after surgery.

The method is as follows.

After processing the surgical field under intravenous regional anesthesia with 2% novocaine by cutting the skin over the stump of the phalanx of the finger, the butt-end of the bone is released and a recess is formed in it to the articular cartilage to insert the pointed end of the bone graft into it. After the graft is firmly connected to the donor bed, the phalanges are inserted into each other, the junction of the bones is additionally fixed with a spoke. Two skin-subcutaneous flaps are cut out from neighboring healthy fingers to cover the bone base of the formed finger - the back-side flap from the 3rd finger, and the palm-side flap from the 5th finger. The length of the flaps is equal to the length of the newly formed bone "finger". After suturing these flaps, an artificial syndactyly of three fingers is formed. Two weeks after the day of surgery, after removal of skin sutures, active-passive therapeutic exercises are performed in the joints of healthy neighboring fingers. Simultaneously with these fingers will be forced to make movements in the proximal interphalangeal joint and the stump of the reconstructed finger.

After 4 weeks, artificial finger syndactyly is separated. Active-passive therapeutic exercises are carried out against the background of physiotherapy.

Information sources

1. Belousov A.E. Plastic reconstructive and aesthetic surgery. - SPb. 1998).

2. Belousov A.E., Pinchuk V.D., Yurkevich V.V. // Vestn. chir. - 1990. - T.144, No. 1. - S.85-89.

3. RF patent No. 2297804, A61B 17/56, BI No. 12, 2007

Claims (1)

A method of skin-bone reconstruction of a finger of a hand, including the formation of a finger from a bone graft and closing it with skin flaps, characterized in that by cutting the skin over the stump of the phalanx of the finger, the butt of the bone is released and a recess is formed in it to the articular cartilage into which the pointed end of the bone graft is implanted, the junction of the bones is fixed with a spoke, the bone base is covered with two skin-subcutaneous flaps from neighboring healthy fingers, and one flap is cut from the back-side surface of the finger, and the second oh from the palmar-lateral surface, four weeks after the operation, the fingers are separated.

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