RU2647332C1 - Dupuytren's contracture treatment - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to surgery, traumatology and orthopedics. Incisions passing through the superficial tissues to the strand are about 1 cm long: one – in the area of the base of the strand, and the second – along the distal palmar crease. Proximal opening is inserted with a tenot, they grip the cord, and circulating in the direction of the attachment point of the strand in the distal part, cut off and remove it.

EFFECT: method prevents traumatization of the skin of the hand, which allows you to carry out rehabilitation in the early period after the operation.

1 cl, 1 ex, 8 dwg

Description

The invention relates to medicine, namely to methods for treating the musculoskeletal system, and is intended for the treatment of patients with Dupuytren's contracture.

Currently, surgical operations with a wide excision of tissues are performed to treat Dupuytren's contracture, which leads to significant trauma to the hand, with complications in the form of skin necrosis.

A known method of treating Dupuytren's contracture [1], where using the needles to produce mechanical destruction of the chords of scar-modified palmar palmar aponeurosis at several levels, using the results of a high-frequency Doppler study of the affected palm performed before surgery. Needle insertion points are indicated in places free of blood vessels, outside zones of ischemia of white color, outside folds and nodes in the palm, as well as areas of skin tightly welded with palmar aponeurosis; with the introduction of the anesthetic, hydrotreating is carried out, the skin is exfoliated from the scar-modified ray of the palmar aponeurosis, the points of anesthetic administration correspond to the ports intended for the introduction of needles; when dissecting cords of the palmar aponeurosis, the ends of the needles are moved in three planes - vertical, horizontal and sagittal, the needle movements do not exceed 2-3 mm. To intersect thin and flat cords, pendulum-like movements are made by the needle; when dissecting thick cords and knots, frequent needle movements in the vertical plane are used. After surgery, at night, they are immobilized with a palmar plaster cast. During the day, immobilization is stopped and active flexion and extension in the joints of the fingers of the hand is performed. Patients begin self-care and daily activities the next day, and heavy physical exertion and return to work is carried out five days after the operation. Since the method of needle aponeurotomy does not remove existing cords, in some cases relapses of contracture are possible. Dupuytren.

A known method for the surgical treatment of Dupuytren's contracture [2], in which the pathologically altered palmar aponeurosis is excised through transverse incisions along the flexion folds. Connect the opposite corners of the transverse sections with oblique sections, forming triangular flaps. Sew cross sections with a bent position of the fingers. Sew oblique incisions with fingers as wide as possible. The operation is long, with great trauma to the skin and soft tissues, which is why rehabilitation begins in the later stages.

The essence of the invention is expressed by a set of essential features sufficient to achieve the desired technical result, which consists in eliminating Dupuytren's contracture with minimal trauma to the soft tissues of the hand, with a reduction in the time of surgery and the prevention of relapse.

The essence of the method of treating Dupuytren's contracture involves excising pathologically altered palmar aponeurosis through transverse incisions on the palmar surface of the hand. Cuts are made about 1 cm long: one in the region of the base of the cord, and the second along the distal palmar fold, introduced into the proximal opening with tenot, grab the cord with it and, making circular movements in the direction of the cord attachment in the distal part, cut it off and remove it.

Performing small transverse incisions on the palmar surface of the hand reduces tissue trauma when a pathologically altered palmar aponeurosis is achieved.

Performing two cuts: one in the region of the base of the cord, and the second along the distal palmar fold, provides complete excision of the cord.

The introduction of a tenotome into the proximal opening provides the only possible position for mounting the instrument,

The seizure of the cord by the tenotome and the implementation of circular motions in the direction of the attachment point of the cord in the distal part allow the cord to be separated from the surrounding tissues.

The method is illustrated in the illustrations, where:

in FIG. 1 - view of the brush before surgery;

in FIG. 2 - the introduction of a tenotome into a transverse incision of the skin on the palmar surface of the hand in the region of the base of the cord;

in FIG. 3 - capture of the strand with a tenotome and its advancement in the direction of the distal section;

in FIG. 4 - the selection of the cord in a circular motion;

in FIG. 5 - clipping the cord at the attachment point in the proximal part of the palm;

in FIG. 6 - cut off strands on the palm. Pictures for a period of 3 days from the date of operation:

in FIG. 7 - view of the brush;

in FIG. 8 - brush functionality.

The method is as follows.

The operation is performed under local infiltration anesthesia, for which 30 ml of a 2% lidocaine solution is used. Small, about 1 centimeter, transverse skin incisions are made on the palmar surface of the hand: one in the region of the base of the cord, the other in the distal palmar fold. With the help of a tenotome, the strand is captured, performing circular motions in the direction of the distal incision, is isolated, and upon reaching the attachment point in the distal part of the palm, the proximal part is cut off and removed. If there are several strands, the procedure is repeated from the same incision at the base of the hand and to additional incisions in the distal palmar fold. In the presence of contracture of the III-IV degree, a reduction is carried out in the joints of the fingers of the hand in order to eliminate contracture. Stitches are placed on the wounds. Dressings are carried out every other day. Sutures are removed for a period of 10 days from the time of surgery.

Clinical example

Patient S. - was treated in the Department of Microsurgery of the TC of the Clinical Hospital in Kazan, with a diagnosis of Dupuytren's contracture of the right hand of the II-III art with bands to 4-5 p.p. The patient underwent an operation according to the described method: under local infiltration anesthesia using 30 ml of a 2% lidocaine solution. Small, about 1 cm, skin incisions were made on the palmar surface of the hand in the region of the base of the cord and in the region of the distal palmar folds of 4-5 fingers of the hand over palpable cords. With the help of a tenatom, the strands were isolated, cut off and removed. They sutured the wounds. Aseptic dressing, palm plaster cast. Bandaging was carried out every other day. Sutures were removed for a period of 10 days from the time of surgery.

Information sources

1. RF patent No. 2570769, A61B 17/56, Bull. No. 34, 2015

2. RF patent No. 2170549, А61В 17/00, 17/322, Bull. No. 20, 2001

Claims (1)

A method for treating Dupuytren's contracture, including excising a pathologically altered palmar aponeurosis through transverse incisions on the palmar surface of the hand, characterized in that the cuts are performed through the surface tissue to a strand about 1 cm long: one in the region of the base of the strand, and the second in the distal palmar fold, into the proximal opening is introduced by tenot, grab the cord by it, and performing circular movements in the direction of the attachment point of the cord in the distal part, cut it off and remove it.

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