RU2544100C1 - Method for vascularised skin grafting of distal fingers with insular axial pedicle graft - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method involves forming an artificial symphalangia, measuring a defect area, forming an axial fascial flap of the forearm, fixing it to the involved distal fingers, covering the flap with a split skin graft. The artificial symphalangias are formed with fixing full-thickness skin grafts in interfinger spaces; the pedicle is covered with the split skin graft by wrapping, leaving it free.

EFFECT: method reduces the length of treatment, improves the clinical outcomes by forming the artificial symphalangias, creating a combined wound surface, separating the symphalangias with forming no defects on the side surfaces on the fingers.

1 ex, 4 dwg

Description

The invention relates to medicine, specifically to reconstructive surgery. It is used to replace the integumentary tissues of the distal part of the fingers with traumatic defects with exposure of the underlying structures.

With combined damage to the fingers of the hand with a defect in the skin in 50% of cases, vascularized skin plastic is required. In case of damage to several fingers, it becomes necessary to use vascularized flaps on a temporary or permanent feeding leg [1].

A known method of vascularized skin grafting using a flap on a temporary feeding leg with an inguinal flap [2]. After necrectomy and the creation of artificial syndactyly, the soft tissue defect is covered with an axial inguinal flap on the superficial artery surrounding the ilium. The feeding leg is cut off after three weeks. The disadvantage of this method is the need for a forced limb position for three weeks before cutting off the feeding leg. The flap always has an excess of subcutaneous fat, which requires further excision [2].

The closest to the proposed method in its technical solution is vascularized skin grafting with an islet graft of the forearm. After necrectomy and the creation of artificial syndactyly of damaged fingers, the skin defect is covered with an axial islet flap of the forearm: a radial, ulnar or posterior forearm flap. In this case, the feeding leg is placed under the skin along the back or palmar surface of the hand [3]. The disadvantage of this method, in the case of isolated damage to the distal part, is trauma to the intact proximal part of the fingers due to the placement of the vascular pedicle in the channel after dissection of the skin of the finger. The excess soft tissue of the feeding leg of the flap is covered with a full-layer skin flap at the level of the finger, causing deformation of the finger.

The essence of the invention lies in the combination of essential features sufficient to achieve the desired technical result, consisting in reducing treatment time while improving treatment results by preserving the intact part of the fingers and the absence of excess soft tissue.

This essence lies in the fact that the method of vascularized skin plasty of the distal fingers of the fingers with an islet axial flap on a temporary feeding leg includes the formation of artificial syndactyly, measuring the area of the defect, the formation of an axial fascial flap of the forearm, fixing it to the damaged distal parts of the fingers, covering the flap with a split skin graft . Artificial syndactyly form with fixation in the interdigital spaces of full-layer skin grafts, the feeding leg of the flap is covered with a split skin graft by wrapping, leaving it free.

The formation of artificial syndactyly of fingers with hemming in the interdigital spaces of full-layer skin grafts allows you to create a single wound surface, including with defects in the skin of non-adjacent fingers, to further divide syndactyly without the formation of defects on the lateral surfaces of the fingers.

The formation of a temporary feeding leg of the axial fascial flap free by wrapping with cover with a split skin graft avoids skin-scar deformations of the intact proximal fingers.

The method is illustrated in the photographs, where:

figure 1 presents a view of the brush with combined damage, a defect in the soft tissues of the distal 2, 4, 5 fingers;

figure 2 shows the stage of formation of artificial syndactyly 2, 4, 5 fingers; with fixation in the interdigital spaces of a full-layer skin graft;

figure 3 is a view of a brush with fascial islet ulnar flap, fixed in the recipient region;

figure 4 is a view of the brush after covering the flap with a split skin graft.

The method is as follows. The hand is placed with the palm of the palm up with straightened fingers in a dilution state, the area of the interdigital spaces is assessed at the level of the damaged distal parts of the fingers. On the inner surface of the shoulder, a full-layer skin graft of the required area is selected, the donor site is sutured. Artificial syndactyly is formed with fixation of full-layer skin grafts in a state of finger breeding. The area of the formed single wound surface of the distal fingers is measured.

According to the size of the defect, an islet fascial flap (posterior flap of the forearm, ulnar or radial) is raised on the forearm with the length of the feeding leg necessary for transfer to the recipient area. The flap is covered with a split skin graft. The feeding leg is covered with a split skin graft by wrapping, leaving it free.

Three weeks after surgery, the feeding leg is cut off. Conduct a course of anti-scar treatment. For a period of five weeks, artificial syndactyly is divided.

The advantages of this method:

- the creation of artificial syndactyly with fixation in the interdigital spaces of a full-layer skin graft allows you to create a single wound surface, including with non-adjacent fingers;

- vascularized skin plastic of the distal parts of the fingers with a fascial axial flap on the temporary feeding leg allows you to restore the skin of the fingers without excess soft tissue, without traumatizing the intact proximal fingers.

Clinical example.

Patient K., 43 years old, 06/30/12, when working on a summer cottage received an injury to his right hand with an electric jug. After the examination, the diagnosis was made in the traumatology department No. 2 of the State Health Institution “RKB MZ RT”: Torn wounds with soft tissue defects along the plane of the middle and nail phalanges of 2, 4, 5 fingers with damage to the flexor tendons, finger nerves, lacerations of the nail phalanx of 3 fingers.

On the same day, an operation was performed: Vascularized plastic islet islet ulnar fascial flap on a temporary feeding leg. After assessing the area of the interdigital spaces at the level of the soft tissue defect of the distal fingers, a full-layer skin graft was isolated on the shoulder. In the dilution state of the fingers, artificial syndactyly were formed with full-layer skin graft stitching between 2-4 and 4-5 pp.

The size of a single wound surface on the front surface of the forearm raised an elbow fascial flap in retrograde blood flow. The flap is fixed in the recipient area. A split graft was isolated on the front surface of the right thigh. The flap and the feeding leg are covered with a distinguished split skin flap, the feeding leg being wrapped in the form of a “suitcase handle”. 07/21/12 cut off the supply leg. After removing the sutures, the patient underwent a course of anti-scar treatment. Two months after the injury, after preliminary ischemic training, artificial syndactyly were dissected. The formed skin allowed in the future to conduct a two-stage tendon plastic.

The patient with the achieved result is satisfied.

Information sources

1. Nelsin, Z.F. Emergency surgery of open injuries of the hand and fingers / Z.F. Nelsin. - M.: Medicine, 1980. 184 p.: Ill. - Bibliogr. - p. 181-183.

2. Obydennov, S.A. Fundamentals of reconstructive plastic microsurgery / S.A. Obydennov, I.V. Frauchi. - St. Petersburg: Man, 2000.142 p.: Ill. - Bibliography: - p.134-142.

3. Laoulakos, D.H. The dorsal reverse adipofascial flap for fingertip reconstruction / Laoulakos D.H., Tsetsonis C.H., Michail A.A. // Plast Reconstr Surg. - 2003. - Jul; 112 (1). - P.121-125.

Claims (1)

The method of vascularized skin plasty of the distal fingers of the hand with an islet axial flap on a temporary feeding leg, including the formation of artificial syndactyly, measuring the area of the defect, the formation of an axial fascial flap of the forearm, fixing it to the damaged distal parts of the fingers, covering the flap with a split skin graft, characterized in that it is artificial syndactyly form with fixation in the interdigital spaces of full-layer skin grafts, the feeding leg of the Ukrainian flap they are washed with a split skin graft by wrapping, leaving it free.

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