RU2548517C1 - Method for forming nail phalanx of thumb - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: cutaneo-subcutaneous flap is formed on a thumb stump by an arched incision, separated from the thumb stump with exposing a stump end face. A pedicle cutaneo-subcutaneous flap with its bed facing a back surface is cut out on the side surface of the third finger of the same hand at the level of the middle phalanx by an arched incision. The flap is mobilised; the formed defect is closed by a free skin graft. A bone or cartilage graft shaped after the nail phalanx is inserted into a deepening on the end face of the thumb. The cut out flaps are sutured together, and the formed nail phalanx is covered completely. The skin sutures are removed 2 weeks after the operation. The flap pedicles are dissected away on the third finger 4 weeks later.

EFFECT: method forms the nail phalanx by acceptance of the bone or cartilage graft to the nail phalanx stump.

6 dwg

Description

The invention relates to medicine, namely to reconstructive surgery.

In case of injuries of the fingertips of the hand, methods for plastic surgery by a skin-subcutaneous flap from the palm of the hand and from finger to finger are known today. These operations are intended only to close the traumatic defects of the skin of the fingertips [1] and are not suitable for the formation of the nail phalanx of the first finger of the hand.

The prototype of this invention is a method of skin-bone reconstruction of a finger of a hand [2]. In this method, the formed bone base of the finger is covered with two skin-subcutaneous flaps from neighboring healthy fingers, with one flap being cut from the back-side surface of the finger, and the second from the palmar-lateral surface. After 4 weeks, artificial finger syndactyly is separated.

This method cannot be used to form the nail phalanx of the first finger.

The invention is in the aggregate of essential features sufficient to achieve the desired technical result, consisting in the restoration of the nail phalanx of 1 finger of the brush.

The essence of the invention lies in the fact that the method of forming the nail phalanx of the first finger of the hand involves the formation of a finger from a bone graft and closing it with skin flaps. On the cult of the first finger, a skin-subcutaneous flap is cut out by an arcuate incision, it is separated from the stump of the finger with exposure of the end of the stump. On the lateral surface of the 3 fingers of the same brush, at the level of the middle phalanx, a skin-subcutaneous flap on the leg with the base on the back surface of this finger is cut out with an arc-shaped incision, and it is mobilized with the skin plasty of the defect formed with a free skin graft. After implantation of a graft from the bone, or cartilage, in the shape of the nail phalanx into the recess at the end of the finger, the cut flaps are sutured together with complete cover of the formed nail phalanx. Skin sutures are removed 2 weeks after surgery, cutting off the feeding legs of the flap on the 3rd finger is carried out after 4 weeks.

Cutting out an arched incision of a skin-subcutaneous flap on the stump of the first finger and separating it from the stump with exposure of the stump end is necessary to create a complete sensitive flap on the palmar surface of this stump.

Cutting out an arched incision of a skin-subcutaneous flap on a leg on the lateral surface of 3 fingers of the same brush, at the level of the middle phalanx, with a base on the back surface of this finger and mobilizing it with skin grafting of the resulting defect with a free skin graft, allows you to close the skin defect on the back of the stump and bone graft forming a fingertip.

The introduction of a graft of bone or cartilage in the shape of the nail phalanx into the recess at the end of the finger creates optimal conditions for the graft to grow together with the mother bed of the phalanx.

Stitching the cut flaps together with complete shelter of the formed nail phalanx ensures engraftment of the bone graft to the nail phalanx.

The method is illustrated by the drawings, where

figure 1 shows a view of the stump of a finger before surgery;

figure 2 - marking cut flaps on the end of the stump and on the side surface of the third finger of the brush;

figure 3 is a diagram of the cutting of the flap 1 on the cult of the finger;

figure 4 is a diagram of the cutting of the flap 2 on the side surface of the third finger of the brush;

figure 5-6 is a view of the brush 10 years after surgery.

The method is as follows.

After processing the surgical field, under intravenous regional anesthesia, an arc-shaped incision on the stump of the first finger cut out a skin-subcutaneous flap, which is separated from the stump of the finger with exposure of the end of the stump. A recess is formed at the end of the stump for implantation of a bone or cartilage graft. On the lateral surface of the 3 fingers of the same brush, at the level of the middle phalanx, a skin-subcutaneous flap on the leg with the base on the back surface of this finger is cut out with an arc-shaped incision, and it is mobilized with the skin plasty of the defect formed with a free skin graft. After implantation of a graft from the bone, or cartilage, in the shape of the nail phalanx into the recess at the end of the finger, the cut flaps are sutured together with complete cover of the formed nail phalanx. Skin sutures are removed 2 weeks after surgery. Clipping the feeding leg of the flap on the 3rd finger is carried out after 4 weeks.

Information sources

1. Z.I. Nelsin, T.I. Chudakov. Emergency surgery for open hand injuries. Minsk, 1994, p. 85.

2. RF patent No. 2482803, А61В 17/56, BI No. 27, 2013.

Claims (1)

A method of forming the nail phalanx of the first finger of the hand, including the formation of a finger from a bone graft and closing it with skin flaps, characterized in that a skin-subcutaneous flap is cut out on the stump of the first finger by an arcuate incision, it is separated from the stump of the finger with exposure of the end of the stump, on the lateral surface 3 finger of the same brush, at the level of the middle phalanx, with an arcuate incision cut out a skin-subcutaneous flap on a leg with a base on the back surface of this finger, and mobilize it with skin plastic axis of the defect with a free skin graft, after the graft is inserted from the bone, or cartilage, in the shape of the nail phalanx into the recess at the end of the finger, the cut flaps are sutured together with complete cover of the formed nail phalanx, skin sutures are removed 2 weeks after the operation, cutting off the feeding leg of the flap on the 3rd finger is carried out after 4 weeks.

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