RU2797355C2 - Method for autoplasty of bone and soft tissue osteomyelitic defects of nail phalanes - Google Patents

Abstract

FIELD: medicine; reconstructive plastic surgery; traumatology; orthopedics.

SUBSTANCE: invention can be used for autoplasty of bone-soft tissue osteomyelitic defects along the lateral surface of the nail phalanges of the fingers. Radical surgical treatment of the osteomyelitic focus is carried out along the lateral surface of the nail phalanx of the finger, removal of purulent granulations and sequesters, treatment of the wound with an antiseptic solution, followed by tamponing with a gauze napkin. On the lateral surface of the nail phalanx of the finger affected by the osteomyelitis defect, a non-free distal skin flap is cut out with the base on the apical part of the finger on the distal vascular pedicle. A flap with a common palmar digital artery and its own palmar digital artery is used on the hand. The epidermis is cut from the distal part of the non-free skin flap and the napkin is removed. The flap is fixed to the nail phalanx with a deviation along the axis of not more than one hundred and fifty degrees. The wound is restored with the mobilization of local tissues and sutured in the form of a "chevron", and the site of the excised defect is sutured in a line.

EFFECT: method ensures the elimination of a purulent-destructive focus along the lateral surface of the nail phalanges, prevents the recurrence of the osteomyelitis process and preserves the aesthetic shape and functionality of the finger due to the use of a flap with a common palmar digital artery and the palmar digital artery.

1 cl, 5 dwg, 1 ex

Description

The invention relates to medicine, in particular reconstructive plastic surgery, traumatology and orthopedics, and is intended for the treatment of osteomyelitis of the lateral surfaces of the nail phalanges of the fingers.

Closest to the proposed and taken as a prototype is a method of plasty of bone-soft tissue osteomyelitic defects of the nail phalanges (Patent No. RU 2634421, dated October 26, 2017, Authors: Pavlyuchenko S.V., Zhdanova A.I., Orlova I.V.) .

The method of plasty of bone-soft tissue osteomyelitic defects of the nail phalanges includes radical surgical treatment of the osteomyelitic focus, formation of a skin rotational flap with an axial type of blood supply, while on the foot a flap is used on the own plantar digital artery, and on the hand - on the palmar digital artery, bone cavity plasty and replacement of soft tissue defects of the nail bed with the help of a de-epidermised distal part of the flap.

The disadvantage of this method is the inability to form a bone-soft tissue osteomyelitic defect along the lateral surface of the nail phalanges of the fingers.

The technical result (purpose) of the proposed method consists in the formation of a distal non-free skin flap along the lateral surface of the nail phalanx of the finger affected by the osteomyelitis process, the elimination of the purulent focus of the nail phalanx of the finger, the preservation of the aesthetic shape and functional ability of the finger.

The technical result of the proposed method is achieved by radical surgical treatment of the osteomyelitic focus along the lateral surface of the nail phalanx of the finger, removal of purulent granulations and sequesters, treatment of the wound with an antiseptic solution, followed by plugging with a gauze napkin, along the lateral surface of the affected nail phalanx of the finger with an osteomyelitic defect, a non-free distal skin is cut out. the flap with its base on the apical part of the finger on the distal vascular pedicle, while on the hand a flap with a common palmar digital artery and its own palmar digital artery is used, the epidermis is cut from the distal part of the non-free skin flap and the napkin is removed, the flap is fixed to the nail phalanx of the finger with a deviation along the axis no more than one hundred and fifty degrees, the wound is restored with the mobilization of local tissues and sutured in the form of a "chevron", and the site of the excised defect is sutured in a line.

The claimed invention is illustrated with the help of drawings.

In FIG. 1 shows the lateral surface of the nail phalanx of the finger with an osteomyelitis focus.

In FIG. 2 shows the lateral surface of the nail phalanx of the finger with a raised distal non-free skin flap.

In FIG. 3 shows the blood supply to the nail phalanx of the finger.

In FIG. 4 shows the stage of fixation of the distal non-free deep-epidermal skin flap to the nail phalanx of the finger.

In FIG. 5 shows the final view of the sutured postoperative wound.

1 - nail phalanx.

2 - finger affected by osteomyelitic process.

3 - osteomyelitic defect along the lateral surface of the nail phalanx.

4 - non-free distal de-epidermised skin flap.

5 - place of anastomosis of own palmar digital arteries.

6 - donor site, sutured in the form of a "chevron".

7 - postoperative suture in the area of osteomyelitic defect.

Treatment of a wound affected by the osteomyelitis process, located on the lateral surface of the nail phalanx of the finger, is carried out as follows: radical surgical treatment of the soft tissue osteomyelitic defect is performed along the lateral surface of the nail phalanx (1) of the finger (2) and the wound (3) affected by the osteomyelitis process (Fig. 1), resection of the site of destruction of the nail phalanx is performed. Sequesters and purulent granulations are removed with a bone spoon, the border of the resection of the nail phalanx is treated with a spherical cutter until a healthy bleeding tissue is reached. The defect cavity is treated with an antiseptic solution and temporarily covered with a gauze napkin. On the lateral surface of the nail phalanx of the finger (2), a distal non-free skin flap (4) (Fig. 2) is cut out with its base on the apical part of the finger on the distal vascular pedicle. The skin flap (4) includes the common palmar digital artery (5), own palmar digital artery 6 (Fig. 3). The epidermis is cut from the distal part of the skin flap (4), the napkin is removed from the wound. The distal part of the skin flap is sutured with absorbable suture material. The flap (4) is fixed to the resected nail phalanx 1 (Fig. 4) on the bone surface from the opposite side, with a maximum deviation along the axis of not more than one hundred and fifty degrees. The wound after radical surgical treatment of the osteomyelitic focus is restored by mobilizing local tissues. The wound in the donor area is sutured in the form of a "chevron", and in the place of the excised soft tissue osteomyelitic defect in a line.

The essence of the proposed method lies in the formation of a distal non-free skin flap along the lateral surface of the nail phalanx of the finger affected by the osteomyelitis process, the elimination of the purulent focus of the nail phalanx of the finger, the preservation of the shape and functional ability of the finger. This is achieved by the fact that the method includes radical surgical treatment of the osteomyelitic focus along the lateral surface of the nail phalanx of the finger, removal of purulent granulations and sequesters, treatment of the wound with an antiseptic solution, followed by tamponing with a gauze napkin, along the lateral surface of the affected nail phalanx of the finger with an osteomyelitic defect, a non-free distal skin flap is cut out the base on the apical part of the finger on the distal vascular pedicle, while on the hand a flap with a common palmar digital artery and its own palmar digital artery is used, the epidermis is cut from the distal part of the non-free skin flap and the napkin is removed, the flap is fixed to the nail phalanx of the finger with a deviation along the axis not more than one hundred and fifty degrees, the wound is restored with the mobilization of local tissues and sutured in the form of a "chevron", and the site of the excised defect is sutured in a line.

Patient N. was hospitalized in the "Surgical Department of Purulent Infection" with a diagnosis of primary chronic osteomyelitis of the nail phalanx of the third finger of the right hand. Fistulous form. An.morbi: the injury was received 14 days ago, later she noted the appearance of pain, swelling, hyperemia of the soft tissues of the 3rd finger of the right hand. On the radiograph, the destruction of the bone tissue of the nail phalanx 1/3. St.Localis: osteomyelitic focus on the lateral surface of the nail phalanx of the third finger on the right with a soft tissue deficit of 1.0×0.5 cm, the bottom of the wound is the bone of the nail phalanx. On the radiograph, there is a destruction of the bone measuring 0.5×0.3 cm. Antibacterial therapy was carried out taking into account the microflora. The operation was performed by the proposed method. The postoperative period proceeded without complications. The wound healed by first intention. The function of bending the nail phalanx of the finger is preserved. The sutures were removed on the twentieth day after the operation.

Claims (1)

SUBSTANCE: method for autoplasty of bone-soft tissue osteomyelitic defects along the lateral surface of the nail phalanges of the fingers includes radical surgical treatment of the osteomyelitic focus along the lateral surface of the nail phalanx of the finger, removal of purulent granulations and sequesters, treatment of the wound with an antiseptic solution, followed by tamponing with a gauze napkin, along the lateral surface of the affected osteomyelitic defect of the nail phalanx of the finger, a non-free distal skin flap is cut out with the base on the apical part of the finger on the distal vascular pedicle, while a flap with a common palmar digital artery and its own palmar digital artery is used on the hand, the epidermis is cut from the distal part of the non-free skin flap and the napkin is removed, the flap is fixed to nail phalanx of the finger with a deviation along the axis of not more than one hundred and fifty degrees, the wound is restored with the mobilization of local tissues and sutured in the form of a "chevron", and the site of the excised defect is sutured in a line.

Images