SU1697775A1 - Method for muscle transfer - Google Patents

Abstract

The invention relates to medicine, namely to orthopedics and reconstructive surgery, and can be used with free muscle autoplasty. In order to prevent atrophy and denervation of muscle tissue while providing motor function, move the muscle with the neurovascular bundle, and leave the stump of the motor nerve at least 6 cm long, impose an anastomosis between the vessels and motor nerves of the muscle and the recipient zone, additionally enter the motor nerve of the recipient zones in the area of entry into the muscle of the neurovascular bundle.

Description

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The invention relates to medicine, namely to orthopedics and reconstructive surgery, and can be used for free muscle transplantation.

The purpose of the invention is the prevention of atrophy and denervation of muscle tissue while ensuring the motor function,

The method is carried out as follows.

A muscle is selected that is suitable for the replacement of an existing tissue defect by its morphofunctional characteristics. This muscle (or its fragment) of the appropriate size is selected. At the same time, a neurovascular bundle with a motor nerve of at least 6 cm in length is separated. If there are two neurovascular legs in the muscle, it is possible to use two motor nerves.

The muscle is transferred to the month of the defect, arterial and venous anastomoses are performed with the vessels of the recipient zone. Then fix its proximal area to the bone or muscle, and the distal - to the tendons of the flexor muscles or extensor muscles. Motor nerve The muscles are connected to the motor nerve of the recipient zone. After that, another motor nerve of the recipient zone is isolated and its branches are located on the surface of the transplanted muscle in the area of entry into the muscle of the neurovascular bundle (muscle gate).

To increase the contact of the neural and muscular tissues, the ends of the motor nerve neurotizer are cut at an angle of 40-50 °, the branches are divided into individual fasciacles, on the lateral surfaces of which they open the perineurium and cross

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the fascicles and axons located on the periphery are 1/6 of their diameter, then the fascicles are immersed in the muscle.

Example. Patient K., 36 years old, was admitted to the clinic because of an extensive defect in the muscles - the flexors of the right forearm, which appeared after electric burn and necrosis of soft tissues. Active flexion of the fingers and hand is absent. Operated under combined anesthesia by two teams of surgeons. On the right, in the elbow bend and at the level of the upper third of the forearm, the elbow arteries are divided about the zone of division into the ulnar and radial, median nerve and its interosseous motor, ulnar nerve and its motor branches to the ulnar flexor of the hand, the flexor of the fifth and fourth fingers.

On the left tibia, from the club-shaped incision, the vascular-nerve pedicle of the medial gastrocnemius muscle was extracted. The gates of the muscle, i.e. the entry point of the neurovascular bundle is located in the proximal part of the muscle along the anterior-lateral surface. The length of the nerve of the muscle from its gate to the place of discharge from the tibial nerve is 5.1 cm. To obtain a nerve no less than 6 cm long, its intramural preparation is made in the main trunk against 1.5 cm. After collecting the muscle and crossing the neurovascular bundle, the nerve length of the graft is 6.6 cm. The graft is transferred to the site of the defect. The muscle is fixed proximally to the fibrous structures in the area of the elbow joint distal - to the tendons of the deep flexors of the II-V fingers, the long flexor of the first finger. The arteries and veins of the recipient zone and the graft are stitched, the latter is inserted into the bloodstream. Next, the seam of the own nerve of the muscle and the interosseous branch of the median nerve was made. Then the motor branches of the ulnar nerve are divided into individual fascicles, which are immersed in the thickness of the muscle in the region of its gate, i.e. in the area of the nerve of ju-muscular synapses. Moreover, before immersion on the side surfaces

the submerged part of the fasciculum has lateral incisions on 1/6 of their diameter.

Wounds sutured. The state of the transplanted muscle in the postoperative period was monitored electromyographically. Credible M - the answer was received on the 74th day. Active flexion at M3 was recorded by 170 days. The flap has come down completely. The results of microsurgical muscle transplantation using the proposed method in 14 patients have been studied to date. In 13 of them, a reliable complete restoration of the function of the transplanted muscle (i.e. muscle contraction with the restoration of the grip of the hand) was achieved by an average of 185 days from the moment of surgery. M - response from the transplanted muscle was obtained in the interval of 75-90 days.

Taking a donor muscle with a nerve length of 6–9 cm allows preventing the onset of atrophy and degeneration for 10–15 days due to the neurotrophic effect of the nerve stump on muscle fibers. Additional neuroticism in

in the zone of neuromuscular synapses, after 20-30 days, the formation of neuromuscular contacts causing trophic and motor innervation of the muscle ensures.

The application of the method helps to reduce the time needed for restoring the motor function of the muscle by preventing the processes of atrophy and degeneration of muscle tissue.

Claims (1)

The invention of the method of muscle transplantation by moving the muscle with the vascular nerve bundle with the imposition of anastomoses between the vessels and the motor nerves of the muscle and the recipient zone, characterized in that, in order to prevent atrophy and degeneration of the muscle tissue while ensuring the motor function, the stump is left the motor nerve is not less than 6 cm long; the motor nerve of the recipient zone is additionally introduced into the region where the neurovascular bundle enters the muscle.