SU1616620A1 - Method of surgical treating of brachial plexia injury - Google Patents

Abstract

The invention relates to medicine, namely to neurosurgery. The method allows to reduce the invasiveness of the operation and postoperative complications, which is achieved by enveloping the damaged trunks of the brachial plexus and graft with a flap, which is formed from the fiber and fascia of the lateral surface of the neck, using the superficial artery and vein of the neck as feeding vessels.

Description

The invention relates to medicine, namely to neurosurgery.

The purpose of the invention is to reduce the trauma of surgery and postoperatively. complications.

The method is carried out as follows.

After the patient has been put into anesthesia and the treatment of the operative field, access according to Yakubovsky Pussep is used. By blunt and acute dissection of income m to the third fascial leaf of the neck and dissect it. Identify the superficial cervical arteries and veins, mobilize them before entering the fat flap and take on the taped. From the leg in the distal direction, the fat flap is mobilized, which is enveloped in wet wipes moistened with warm saline, and moved out of the surgical floor. Next, brachial plexus trunks are isolated, reconstructive surgery is performed, after which the fatty flap is transferred to the surgical area. The scar-reborn bed in the area of the plexus trunks is excised, careful hemostasis is performed and a fat-flap is covered with a maximum envelopment of the nerve trunks and grafts. At the end of the operation, the wound is sutured in layers.

Example. Patient Y., 30 years old. He entered the department of microsurgery KNIKIECH with complaints about the lack of movement and sensitivity in the right upper limb, muscle atrophy of the forearm and hand. The patient has not previously operated.

 From the anamnesis, it is known that a year ago, during the catastrophe, I received a direct blow to the right shoulder. During initial treatment, a fracture of the clavicle and signs of paralysis of the brachial plexus were revealed. The patient was given a Deso dressing and underwent kypc conservative restorative therapy.

On examination, the absence of sensitivity and movement in the right upper limb with muscle atrophy of the forearm and

ABOUT

oh oh

hO

ABOUT

brushes, positive sim Tinnel in the right supraclavicular region.

According to the electromyography data, the electrical activity of the muscles of the right upper extremity was completely absent. X-ray revealed a clavicle deformity in the middle third with the formation of a false joint.

The operation was performed under anesthesia. After extended access along Yakubovich-Pussep with the transition to the deltoid-bosom sulcus, the second cellular space, superficial cervical arteries and vein, which were mobilized and held on the taped, were separated in layers. A typical collection of a fat flap measuring 5–6 cm in size was made, with a feed leg length of 6 cm. The diameter of the artery was 2.5 mm, veins - 3 mm. The flap is lined with wet wipes with warm saline and carved from the surgical floor. Then the clavicle is highlighted and dissected through the false joint. The ends of it are divorced and the splints into a single connective tissue conglomerate and secondary trunks of the brachial plexus are separated from them with great technical difficulties. The trunks throughout their body retain anatomical integrity. With the help of microtechnology, exoendonevrolysis of primary and secondary plexus trunks was performed. The ends of the clavicle are excised within the limits of healthy bone tissue and made of metal and metal synthesis with Kirschner spokes and wire stitches. Rough scars of the primary bed and parts of the secondary trunks of the brachial plexus are excised and a thorough geytosis is performed. The fatty flap is transferred to the surgical field, placed under the trunks of the plexus with their subsequent wrapping. The wound is sutured in layers.

The postoperative period was uneventful. Discharged from the clinic 10 days after removal of sutures. In the postoperative period, conventional restorative therapy, massage, exercise therapy, and electrical stimulation of muscles are prescribed.

During follow-up examinations, after 6, 8, and 12 months, a positive recovery dynamics was observed. At the control examination after 12 MEC, a sharply attenuated Tinnel symptom is noted. The restoration of the function of the deltoid, triceps, and biceps muscles to the degree M5, as well as the muscles of the flexors and extensors of the hand and fingers to the degree M4, was noted. Restoration of sensitivity on the shoulder and forearm to degree 4, and in the innervation zone of the median nerve on the hand to the base of the main phalanges of 1-3 fingers - to

degree 3.

According to the EMG, the electrical activity of the muscles of the deltoid, triceps, and biceps did not differ from the healthy limb, and the muscles of the flexors and extensors of the hand and fingers differed only slightly.

Claims (1)

Invention Formula A method for the surgical treatment of brachial plexus injuries, including envelopes. injured brachial plexus trunks and grafts with a flap of fatty tissue on the vascular pedicle, differing from the fact that, in order to reduce the trauma of j operation and postoperative complications, the flap is formed from the tissue and fascia of the lateral surface of the neck using the superficial artery as feeding vessels and vein of the neck.