RU2118515C1 - Method for elongation of short stump of femur by skin-muscle-rib transplant with axial blood supply - Google Patents

Abstract

FIELD: medical technology. SUBSTANCE: according to method, for elongation of stump, separated is fragment of 8-th rib with attaching straight muscle and skin of abdomen. On vessel cluster feeding straight muscle of abdomen, fragment of rib is broken by halves in underperiosteum. One fragment is inserted into marrow passage, and other fragment is fastened outside. Elongated bone fragment is covered with muscle. Skin part is used to close stump tissue defect. Application of aforesaid method improves functioning of femur stump. EFFECT: higher efficiency. 1 ex, 1 dwg

Description

 The invention relates to medicine, namely to plastic surgery and prosthetics.

 A known method of reconstructive surgery, which consists in the autotransplantation of the heel-plantar part of the foot at the end of the thigh stump with the connection of their arteries and nerves.

 The disadvantages of the proposed method include the fact that the operation is possible only while maintaining the heel-plantar part of the foot, there is no possibility of restoring a defect in muscle tissue of the stump.

 The closest way to lengthen the short stump of the thigh should be attributed to the movement of a musculoskeletal flap using a muscle straining a wide fascia of the thigh with axial blood supply (prototype).

 The disadvantages of the method include the fact that the length of the bone fragment of the iliac crest and the size of the muscular part of the flap are insufficient to fully lengthen the vicious thigh stump.

 The aim of the invention is to increase the functionality of a short stump of the thigh by moving the musculoskeletal-rib flap with the shelter of a defect in the tissue of the stump.

 This goal is achieved by initially isolating the vascular bundle that feeds the rectus abdominis muscle, exposing it to attachment to the 8th rib, then reserving the rib fragment, rotating it together with the muscle and skin so that the bone fragment of the rib is easily comparable with the distal section of the truncated the bones of the thigh, a fragment of the rib subperiosteal is broken in half and the main fragment is inserted into the bone marrow canal, and the second is attached externally, the elongated bone fragment is covered with the flap muscle, the skin part of the flap is closed ayut stump tissue defect after excision scars.

 The advantages of the proposed method over the base object are as follows.

 1. The proposed autograft is preferable over others in that it is located close to the defect of the femoral stump, which allows preserving neurovascular connections.

 2. The completeness of the autograft is due to the fact that the musculoskeletal conglomerate can be transplanted of any size.

 3. An increase in the functionality of the hip prosthesis is associated with an increase in the bone lever and the integrity of the full tissue of the stump with the receiving cavity of the thigh sleeve.

 Clinical example. Kokin V.V. Born in 1948, he was admitted to the hospital with a diagnosis of a short stump of the right thigh with a deficit of muscle tissue and bad scars that prevented rational prosthetics.

 On the operating table with the gradual isolation of the rectus abdominis muscle and the neurovascular bundle in the epigastric region, starting from the navel and gradually continuing to isolate the muscle to the point of attachment to the VII-X ribs, a fragment of the 8th rib 10 cm long is cut with a cutter, which is subperiostally fractured, with this, the main fragment is inserted into the bone marrow canal of the thigh, the second fragment is fixed from the outside, fastening them with metal pins (see operation diagram of Fig. 1), the deficit of soft tissues and skin of the stump is covered with muscular-skin area scooter.

 The postoperative course is smooth, the wound healed by primary intention. After 3 months, the disabled person was prosthetized with a functional hip prosthesis and was discharged home in satisfactory condition.

Literature
1. Materials of the VI Congress of Orthopedic Traumatologists, Yaroslavl, 1993, p. 214 (prototype).

Claims (1)

 A method of lengthening a short stump of the thigh with a musculoskeletal graft with axial blood supply by introducing an autograft stump into the bone marrow canal, characterized in that the vascular bundle that feeds the rectus abdominis is initially isolated, exposed before attachment to the 8th rib, then a fragment of the rib is resected rotate it along with the muscle and skin so that the bone fragment of the rib is easily comparable with the distal section of the truncated bone of the thigh, the fragment of the rib is sub-superficially broken in half and the main fragment of the whole ulation in the medullary canal, and the second is fixed outside, muscle flap fragment harboring elongate bone, skin flap part closed stump tissue defect after excision scars.