RU2192175C2 - Method for cutaneous plasty at ringtype scalping the skin of the fourth finger - Google Patents

Abstract

FIELD: medicine, surgery. SUBSTANCE: one should conduct amputation of distal phalanx of the fourth finger. Plasty of volar surface of the fourth finger is carried out with an islet flap from lateral surface of adjacent finger upon volar finger vascular-nervous bundle. Rear- lateral surfaces of the fourth finger are covered with an islet flap from rear surface of the wrist which is taken in projection of the third intermetacarpal space at a perforated branch coming from volar intermetacarpal artery by saving subcutaneous vein of the wrist oriented along the flap. The method enables to precisely model the form of the finger and restore its sensitivity. EFFECT: higher efficiency of plasty. 4 dwg

Description

 The invention relates to medicine, specifically to hand surgery, and is used for skin plastics of 4 fingers of a brush when it is scalped by a ring with damage to the neurovascular bundles.

 A known method of restoring the skin of a scalped finger according to Blokhin - Converse [1]. On the front-side surface of the abdomen, two subcutaneous-fascial flaps are cut out. After mobilization of the flaps, a part of the subcutaneous fat layer is excised, the flaps are brought together and a tube is formed from them into which the scalped finger is sutured. After three to four weeks, the feeding leg is cut off. However, the disadvantage of this method is its two-stage, which lengthens the duration of treatment, and the result of the treatment is a thickened finger with limited movement and lack of sensitivity.

 The closest in technical solution to the proposed one is the method of skin plastics adopted by us for the prototype using the temporal fascia, in which the temporal fascia is collected on the temporal vascular bundle [2]. The fascia is transferred to the recipient area, the naked stump of the finger is wrapped, and vascular anastomoses are superimposed. Fascia is covered with its own free full-layer skin flap. The disadvantage of this method is the duration of the operation, the inability to accurately simulate the shape of the finger, the subsequent lack of sensitivity.

 The essence of the invention is expressed in the aggregate of essential features sufficient to achieve the desired technical result, which consists in improving results and reducing treatment time. It consists in the fact that the back-lateral surfaces of the 4 fingers are closed with an islet reversible flap from the back surface of the hand, which is taken in the projection of the 3rd intercarpal gap on the perforating branch, extending from the palmar intercarpal artery with preservation of the saphenous vein of the hand, oriented along the flap.

 The method is carried out in the following way.

 Amputation of the distal phalanx of 4 fingers is performed. On the ulnar side of the 3 fingers, an islet flap is cut out on the palmar finger neurovascular bundle with a width of up to 0.5 of the diameter of the donor finger. The flap through the subcutaneous tunnel is transferred to the palmar surface of the scalped finger. On the back surface of the hand, in the projection of the 3rd intercarpal gap, an islet flap is raised on a perforating branch extending from the palmar intercarpal artery while maintaining the saphenous vein oriented along the flap. The latter is reversed and the rear-side surfaces of the finger are closed. Wounds are sutured. Plaster immobilization for 12 days. For a period of 10-14 days, the development of finger joints is possible.

Clinical example:
Patient I., 48 years old, 10/23/98. caught on the ring, dressed on the 4th finger of the left hand, over the side of the truck, resulting in a typical injury with circular damage to the skin, neurovascular bundles, separation of the nail phalanx, 27.10. A necrectomy was performed, plastic of the palmar surface of the stump of 4 fingers with an insular lateral flap with 3 fingers on the digital neurovascular bundle, and the back surface with a flap from the back surface of the hand on a perforating branch extending from the palmar intercarpal artery with preservation of the saphenous vein oriented along the flap. After 2 weeks, the sutures were removed, a set of physiotherapeutic procedures was started. After 1.5 months, the flexion function in the proximal interphalangeal joint was achieved in a volume of 10 to 40 (amplitude 30). Discriminatory sensitivity on the palmar surface of the stump 6-7 mm. The patient with the achieved result is satisfied.

 The proposed method is displayed in the accompanying illustrations, where Fig. 1 shows a photo of a brush after damage to 4 fingers by a ring; FIG. 2 shows a raised flap of the back surface of the hand on a perforating branch extending from the palmar intercarpal artery while maintaining the saphenous vein oriented along the flap, in FIG. 3 - photo brush on the second day after surgery and figure 4 - long-term outcome of treatment for a period of 2 months.

Sources of information
1. Nelbzina Z. F. Emergency surgery of open injuries of the hand and fingers. Medicine, M., 1980, p. 72.

 2. Hiras Y., Kojima T., Bang H-H: Secondary reconstruction by temporoparietal free facsial flap for ring avulsion injury; Ann Plast Surg 1990., vol. 25, p. 312.

Claims (1)

 Method of skin plastics when scalping a skin with 4 fingers of a hand, including amputation of the distal phalanx of 4 fingers, plastic of the palmar surface of 4 fingers with an islet graft from the lateral surface of an adjacent finger on the palmar finger neurovascular bundle, characterized in that the back-side surfaces of 4 fingers close the islet reversible flap from the back surface of the hand, which is taken in the projection of the 3rd intercarpal gap on the perforating branch, departing from the palmar intercarpal artery while maintaining dkozhnoy veins brush oriented along the flap.

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