SU976965A1 - Method of testing patients ill with osteomyelitis accompanied with limb soft tissue defects - Google Patents

Description

The invention relates to medicine, namely to surgery, and can be used in reconstructive traumatology and orthopedics ..

A known method of treating patients with osteomyelitis, accompanied by defects in the soft tissues of the limbs, by closing with a skin flap £ 1J.

The disadvantages of this method are the limited plastic material, the duration of the movement (the need to use the torso, arms or legs to approach the defect) and the possibility of exacerbation of the infectious process, especially when it is active.

The closest way to treat patients with osteomyelitis, accompanied by defects in the soft tissues of the limbs, which involves cutting a flap on the leg, forming a stalk, moving it to the lesion, followed by the replacement of deep tissue defects £ 2].

However, the known method is traumatic and the treatment time is long.

The purpose of the invention is to reduce treatment time and reduce trauma.

This goal is achieved by the fact that in the implementation of the method of treating patients with osteomyelitis accompanied by defects in soft tissues of the extremities, which involves cutting a flap on a leg, forming a stem, moving it to the lesion, followed by replacing deep tissue defects, the flap is cut out in the thoracoabdominal region, a defect of the distal part of the body replaces it with the proximal end, and a defect of the proximal part of the body with prolonged intra-arterial infusion of antibiotics replaces it.

For the treatment of patients with post-traumatic osteomyelitis of the extremities, accompanied by extensive soft tissue defects, a set of techniques is performed.

Intra-arterial infusion of antibiotics of the affected limb needed to eliminate 25 infectious lesions is established and sequestration and necrectomy are performed.

At the same time, a long skin flap is cut out in a ratio of 1: 5 (its length depends on the patient's height).

scapulae from back to navel in front parallel to the course of ribs obliquely downward from back to front, the flap is sutured into the tube. ¹

After wound healing and healing of the stem, i.e. in 10-14 days one of the clamping is carried ^{concentration>} ATC stem (planned to move) intestinal zhomom for 5-10 minutes to exercise stem circulation.

Then cut off the trained end and with. it replaces the area of the limb defect.

After engraftment of the transplanted end (after 4 weeks), cut off its second end - the feeding leg and refresh the wound and · replace the defect with the free end of the stem.

An example. Patient A., 22 years old, while cleaning a grain drum fell with his left foot between two moving shafts. As a result of their action, for 20 minutes, until the mechanism was stopped, the inner surface of the soft tissues and 2/3 of the tibia diameter were weathered over 2/3 of the length.

He entered the central district hospital, where the primary surgical treatment of the wound. Osteomyelitis of the left tibia with common septic manifestations developed. In serious condition, transferred to the regional hospital, the leg was at risk of amputation.

Due to the failure of the conservative therapy, intra-arterial infusion of antibiotics into the femoral artery has been established. The condition began to improve, acute inflammatory phenomena stopped. The inner surface of the foot, ankle joint, lower legs began to be cleaned of necrotic tissue and covered with granulations.

To close the defect of the foot, leg _{<of the} ankle joint and lower leg in the left half of the chest and abdomen, a skin flap of 9 x 45 cm was cut and a long Filatov stem formed.

After the wound of the stem healed, the sutures were removed and the training of its proximal end was begun. After a month and a half from the moment of cutting, the proximal end of the stem is cut off and partially spread on the defect of the foot and ankle joint, which was fissured after excision of scar and granular tissues and necrotic bone tissue without any intermediate steps. Gypsum fixation.

After engraftment of the transplanted end of the stem, i.e. after 1 month, excision of the scar tissue of the lower leg was performed, sequestrectomy of the tibia was performed (10 removed 4 sequestra up to 2 cm long).

The distal end of the stem is cut off from the mother base and spread over the entire defect of the lower leg. The flap took root completely, and after 5 months 15 from the moment of admission · the patient was discharged home and started to work.

Intraarterial infusion continued for 20 days.

The proposed method allows to “reduce the number of surgical interventions and the length of stay of the patient in the hospital by more than 2 times, as well as save the limb or limb segment, which in turn prevents the patient’s disability.

Claims (1)

Claim A method for treating patients with osteomyelitis accompanied by defects in 30 soft tissues of the extremities, which involves cutting a flap on a stalk, forming a stem, moving it to och> agu lesion, followed by replacing deep tissue defects, characterized in that in order to reduce. terms of treatment and reduce the invasiveness of the operation, the flap is cut out in the thoracoabdominal region, 40 with the proximal end is replaced by a defect in the distal part of the body, and the distal end is replaced by a defect in the proximal part of the body with prolonged intra rterial infusion of antibiotic otikov.