RU2246277C1 - Method for restoring functions of lost muscles of fibular group - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method involves making injured fibula segment resection as single block with fibular group muscles adjacent to it. Musculotendinous flap is cut out from lateral head of triceps muscle of calf and Achilles tendon fragment with vascular pedicle being retained. The vascular pedicle flap is descended laterally and distally with proximal end sutured to lateral intermuscular partition and the Achilles tendon fragment to fibular muscle group tendons. The wound is sutured. Immobilization with plaster splint is carried out.

EFFECT: enhanced effectiveness in restoring muscle group function.

6 dwg

Description

The invention relates to medicine, and specifically to traumatology and orthopedics.

The problem of treating malignant tumors of long tubular bones remains one of the leading ones in traumatology and orthopedics. As a rule, surgical interventions for this pathology consist in an extensive resection of the affected bone segment and adjacent soft tissues, which often leads to the loss of whole muscle groups and, accordingly, partial loss of limb function. The use of combined treatment methods did not affect the functional results, since the requirements for the surgical stage of treatment remained the same.

The most common methods of treatment for loss of function of muscle groups, depending on the severity of dysfunction, are arthrodesis, tenodesis of a distal segment of the limb, free muscle transplantation on vascular and nerve anastomoses (Movshovich I.A. Operational orthopedics. M .: Medicine. 1983. -C.276-283; Belousov A.E., Tkachenko S.S. Microsurgery in traumatology and orthopedics. L .: Medicine. 1988. - P.123-130).

However, the main task of the reconstructive stage of the operation is the plastic closure of the postoperative defect after extensive resection of the tissues affected by the tumor process. Moreover, it is often not possible to simultaneously solve the problem of restoring the function of lost muscles, even in the case of transplantation of muscle transplants. This is explained by the peculiarity of their anatomical structure and the possibility of transplantation without nerve restoration (m.gastrocnemius), insufficient contractility (m.latissimus dorsi), and small graft size (m.gracilis).

However, with a certain localization of the tumor, simultaneous surgical intervention is possible, involving extensive resection of the tissues affected by the tumor, plastic replacement of the postoperative tissue defect and restoration of the function of the lost muscle group.

Closest to the proposed technical solution is the method proposed by Feldman J.J. (Feldman JJ, Cohen BE, May JW The medial gastrocnemius myocutaneous flap.// Plast.Reconstr. Swg. - 1978 - V.60 - P.531-539), which, for the purpose of plastic replacement of extensive soft tissue defects, provides for a free skin graft transplant. -muscular flap of the triceps muscle of the leg. However, the task of restoring the function is not solved.

The objective of the proposed technical solution is simultaneous plastic replacement of a soft tissue defect and restoration of the function of muscles lost during resection, in particular of the peroneal group. This problem is solved due to the fact that they perform a single block resection of the fibrous segment of the fibula and adjacent muscles of the fibula, cut out a muscle flap consisting of the lateral head of the sole and the Achilles tendon fragment, preserving the vascular pedicle, on which it is distally and laterally reduced. with hemming part of the Achilles tendon to the tendons of the peroneal muscles, and the proximal end to the lateral intermuscular septum, followed by suturing of the wound and immobilization her plaster cast.

The essence of the proposed technical solution is illustrated by drawings, where Fig. 1 shows a resection of a single segment of a fibular segment of a fibula and adjacent muscles of a fibular group, fig. 2 - cutting a muscular-tendon flap, Fig. 3 - moving a muscle flap to a position peroneal group.

The proposed method is as follows.

Resection is performed with a single block of the fibular segment of the fibula (Fig. 1) and the muscles of the fibula adjacent to it. The muscle-tendon flap 1 is cut out (Fig. 2), consisting of the lateral head of the calf muscle and the Achilles tendon fragment 2, and the neurovascular leg 3 of the flap 1 is mobilized.

The formed muscle-tendon flap is brought down on the neurovascular leg 3 in the distal and lateral directions and its proximal end is sutured to the lateral intermuscular septum 4, and the distal to the tendons 5 of the fibular muscle group. The wound is sutured in layers tightly. In the postoperative period, they are immobilized with a plaster cast for three weeks.

Clinical example

Patient B., born in 1950, and b / w No. 201236, was treated at the Nizhny Novgorod Research Institute of Osteopathy for osteogenic sarcoma of the fibula (Fig. 4). On April 3, 2002, the affected bone segment was resected in a single block with the adjacent fibula the muscles. According to the developed technique, the replacement of the resulting tissue defect was performed. The postoperative period was uneventful. Immobilization for three weeks. A satisfactory functional result was achieved (FIGS. 5, 6). The position of the foot is correct.

The method is simple, affordable, its implementation does not require complex operational equipment.

When implementing the method there is no likelihood of thrombosis of the vascular pedicle, because no need for vascular anastomoses. Preservation of innervation and blood supply provides contractile capabilities of the flap. This allows not only to replace a muscle defect, but also to restore the function of a muscle group lost as a result of a tumor resection.

Claims (1)

A method of restoring the function of the lost muscles of the peroneal group with extensive resection of the tumor by cutting out a muscle flap from the triceps muscle, characterized in that they perform a single block resection of the tumor segment of the fibula and adjacent muscles of the fibula, cutting out the lateral head of the triceps muscle of the leg and fragment Achilles tendon muscle-tendon flap with preservation of the vascular pedicle, on which it is reduced distally and laterally with hemming of proxime nogo end to the lateral intermuscular septum, and part of the Achilles tendon - to the peroneal muscle tendons, followed by suturing of wounds and immobilization of gypsum splints.

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