RU2083175C1 - Method of fasciotomy at severe compression of foot - Google Patents

Abstract

FIELD: medicine, foot surgery. SUBSTANCE: method deals with dissecting ligaments of tarsal and anterior tarsal tunnels that leads to lower pressure for vascular-nervous formations, improved blood supply and foot innervation. EFFECT: improved decompression, higher efficiency.

Description

 The invention relates to medicine, namely to foot surgery. Known methods of fasciotomy with compression of the foot (G.Ya. Epstein. Extensive damage to the foot with simultaneous destruction of bones. Amputation (Experience of Soviet medicine in V.O.V. 41-45), v. 18, Ch. 5).

 The author uses longitudinal sections of the foot to reduce tension subfascial tissue pressure. But the book does not have clear guidelines on the topography of sections.

Closest to the claimed solution relates to a method of fasciotomy for compression of the foot (Peter M. Bonuti Cordon R. Bell. Compartment Syndrome of the foot. "The Journal of Bone and Joint Surgery". Vol. 68-A, N 9, December, 1986, pg. 1449-1451). A fasciotomy of the directly affected muscle stocks of the foot is performed. The author gives clear guidance on the topography of sections. The disadvantages of this method are as follows:
1. No attention is paid to the state of neurovascular formations, which can lead to impaired circulation and innervation.

 2. No decompression at the level of the tarsal and anterior tarsal tunnels.

 3. There is no prevention of the development of tunnel syndromes.

 The aim of the invention is to increase the effectiveness of treatment. This goal is achieved by the fact that they dissect the ligaments of the tarsal and anterior tarsal tunnels, which leads to a decrease in pressure on the neurovascular formations, the outflow of blood and lymph, as well as the innervation of the foot, are improved. For complete decompression of the neurovascular formations, they are revised, eliminating the remaining compression elements.

 Thus, the above distinguishing features can avoid trophic disorders in the tissues and achieve the goal.

 The method is as follows. Cuts are made along the dorsal and plantar surface of the foot with dissection of the own fascia of the foot and decompression of the subaponeurotic space of the rear of the foot, as well as three-muscle foot beds from 2 sections. In this case, the incisions continue to the ankle joint along its front surface, where the anterior tarsal tunnel is located, and on the inner surface of the ankle joint border with the calcaneal region, where the tarsal tunnel is located. Ligaments of the anterior tarsal tunnel dissected, i.e. the supporting ligament of the extensor foot tendons and the transverse ligament of the lower leg with the release of the anterior neurovascular bundle (anterior tibial vessels), continuing into the dorsal vessels of the foot and deep peroneal nerve.

 The tarsal tunnel ligament (the supporting ligament of the flexor of the foot) is dissected with the posterior tibial vessels extending into the medial and lateral arteries and veins, as well as the tibial nerve and its branches. Nerves are exempted from hematomas, including by dissecting epineuria, i.e. endoneurolysis is performed, which requires a magnifying technique (a binocular magnifier is sufficient). The operation ends with hemostasis, suturing of the skin.

 At the level of the anterior tarsal tunnel, its ligament is restored with lengthening. At the end of the operation, the tunnels are drained by semi-tubes for the subsequent outflow of edematous fluid.

Case Studies
Patient Z. 40 years old. He was treated in the Department of Hand and Foot Surgery 07/13/91, 08/29/91, with a diagnosis of compression of the left lower leg and foot with extensive damage to the soft tissues. Open fractures of the external ankle of the left lower leg, calcaneus, middle phalanges of 1-2-4 fingers of the left foot.

 Traffic injury 1 hour before admission, collision with a wheel. On admission, a fasciotomy was performed with dissection of the ligaments of the tarsal canals of the left foot, and primary surgical treatment of wounds. Under conduction anesthesia of the left lower limb, wounds were washed with antiseptics.

 Cuts in the projection of the tarsal and anterior tarsal canals with extension to the rear of the foot and the sole surface with an additional cut of the sole parallel to the outer edge of the foot. Dissection of the own fascia of the foot (along all sections), as well as ligaments of the tarsal and anterior tarsal canals. Neurovascular bundles were isolated, hemostasis was performed. The tibial nerve is freed from hemorrhages, the epineurium is dissected. The wounds were sutured, semi-tubular drainage inserted along the neurovascular bundles and muscle sheaths of the foot. In the postoperative period, neuroses were noted on the back of the foot (the site of the primary crushing of tissues), 08/14/91, skin autoplasty. The patient was discharged for outpatient treatment with healing wounds. After 2.5 months. after the injury, he began to work.

 2. Patient V., 40 years old, was treated in the Department of Hand and Foot Surgery 07/23/92, 08/29/92, with a diagnosis of compression of the right foot with extensive damage to soft tissues, open fractures of the proximal phalanx of the 1st finger of the base 1-2 -4 metatarsal bones.

 Traffic accident 25 minutes before admission, hit by a car wheel. Upon admission, primary surgical treatment of foot wounds was performed. 3 days after admission under conduction anesthesia of the lower limb, a fasciotomy of the right foot was performed with dissection of the ligaments of the tarsal and anterior tarsal canals. Cuts were made in the projection of the tarsal and anterior tarsal canals with continuation to the rear of the foot and plantar surface. An additional cut was made on the sole parallel to the outer edge. Dissected own fascia of the foot (along all sections), as well as ligaments of the tarsal and anterior tarsal canals.

 Neurovascular bundles are highlighted. Conducted hemostasis. Epineuric dissection was not performed, because there were no subepineural hemorrhages. The wounds were sutured, leaving semi-tubular drainage along the neurovascular bundles and muscle sheaths of the foot. In the postoperative period, a necroectomy was performed. 08/14/91, skin autoplasty. The patient was discharged for outpatient treatment with healing wounds.

 I started to work after 3 months. after an injury.

 When using the method there is a positive effect, which consists in preventing the development of post-traumatic trophic disorders of the foot, as well as tunnel syndromes. Using this method promotes faster healing of wounds and reduce postoperative complications. The functional results of treatment are improving, the treatment time is shortened and the number of disability exits reduced. The method was tested on 12 patients and is widely used in the department of trauma to the wrist and foot.

Claims (1)

 The method of fasciotomy for severe compression of the foot by dissecting the fascia over the fascial stocks of the foot, characterized in that they cut the ligaments of the tarsal and anterior tarsal tunnels, then revise the neurovascular formations with their subsequent decompression in these tunnels.