RU2269962C2 - Method for carpal reconstruction in children at thumb's hypoplasia - Google Patents

Abstract

FIELD: medicine, orthopedics, traumatology.

SUBSTANCE: along with pollicization of the second finger one should dissect thumb's soft tissues to remove its skeleton and form blood-supplied skin-fascial fragment under innervation by its shape and size being correspondent to wound defect of the foundation of newly developed thumb which is necessary to cover this defect for preventing cicatricial development that deteriorates thumb's function.

EFFECT: higher efficiency of carpal reconstruction.

5 dwg, 1 ex

Description

The invention relates to the field of medicine, namely to orthopedics and traumatology.

A known method of reconstruction of the hand with congenital hypoplasia of the first finger, consisting in the reconstruction of the first finger using pollicization of the second finger. At the same time, the second finger of the hand is transposed to the position of the first on the neurovascular bundles, and the hypoplastic first finger of the hand is removed (abstract of the dissertation of the doctor of medical sciences I.V. Shvedovchenko, 1993).

The disadvantage of this method in most cases is the lack of sufficient skin at the base of the newly created first finger after moving the skin flaps. This deficiency is eliminated by plasty with a thick split skin graft, borrowed from the donor area, for example, from the thigh. However, in the area of engraftment of a thick split skin graft, there is a high probability of developing a deforming scar that impedes the normal functioning of the first finger, which in some cases leads to repeated surgical interventions.

The objective of the invention is to increase efficiency and reduce treatment time due to the formation of a full-fledged skin cover from the soft tissues of the hypoplastic first finger after removing its skeleton.

The therapeutic effect of the task is achieved by the fact that in the method of reconstruction of the brush in children with hypoplasia of the first finger, consisting in pollicization of the second finger of the brush, it is proposed to simultaneously dissect the soft tissues of the first finger, remove its skeleton and form an innervated blood-supply skin-fascial fascial a flap in shape and size corresponding to a wound defect.

Figure 1 presents a diagram of the brush of patient O., 2 years old, with a diagnosis of hypoplasia of the first finger of the right hand during the formation of a wound defect, item 1 - hypoplastic first finger of the hand; pos.2 - wound soft tissue defect at the base of the first finger; Pos. 3 - neurovascular bundles to the skin-fascial flap and to the second finger of the hand.

Figure 2 - diagram of the brush patient O., 2 years old, with a diagnosis of hypoplasia of the first finger of the right hand, pos.2 - wound soft tissue defect at the base of the first finger; pos.4 - innervated skin-fascial flap with an axial type of blood supply, formed from the first hypoplastic finger of the hand; 5 - moved the second finger of the brush to the position of the first.

Figure 3 presents illustrations of the surgical intervention of patient O., 2 years old.

Figure 4 - brush before surgery.

Figure 5 - brush after surgery.

The method of reconstruction of the brush in children with hypoplasia of the first finger is as follows.

A Blout incision is made at the base of the second finger of the hand. On the radial surface of the first finger (Fig. 1, pos. 1), a tongue-like flap is cut out. The first finger (figure 1, position 1) is skeletonized, after which its bone part is removed. Thus, the remaining skin-fascial flap remains on the neurovascular bundle. The neurovascular bundles (Fig. 1, pos. 3) of the second finger and tendons of the flexors are distinguished. Extensor tendons are dissected, short interosseous muscles are attached, attached to the second metacarpal bone. An osteotomy of the second metacarpal bone is made under the growth zone, the remaining part of the growth zone is resected by 2/3 and rotated to the palm of the hand. The second finger (figure 2, position 5) on the neurovascular bundles moves to the proximal portion of the second metacarpal bone and is fixed in the position of opposition and abduction with two knitting needles in relation to the long fingers of the hand. The extensor tendons are sutured with shortening, after which the abdomen of short muscles is fixed to their lateral surfaces. After moving the flaps and excising excess skin, sutures are applied. The wound defect at the base of the newly created first finger is closed with a cutaneous fascial and skin flap with an axial type of blood supply (Fig. 2, item 4). An aseptic dressing is applied. The limb is fixed in the gypsum splint for 4 weeks - until the consolidation of bone fragments.

Execution example.

Patient G., 3 years old, with a diagnosis of hypoplasia of the first finger of the right hand, grade 3. The brush is five-fingered, the first finger (figure 3, pos. 1) is represented by the nail and vestigial of the main phalanx. The first finger is "dangling", its connection with the hand is due to a thin skin bridge, in the thickness of which there is a neurovascular bundle that feeds the first finger (Fig.3, pos.3). Long fingers are normal.

The child underwent the following surgery.

Blaut section at the base of the second finger of the right hand. The tongue-like flap is cut on the radial surface of the first finger. The hypoplastic first finger (Fig. 3, pos. 1) is skeletonized and its bone part is removed, the remaining skin flap is saved on the neurovascular bundle (Fig. 3, pos. 4). The neurovascular bundles of the second finger and flexor tendons were distinguished, the extensor tendon was dissected, and short interosseous muscles that were attached to the 2 metacarpal bone were cut off. An osteotomy of the second metacarpal bone was made under the growth zone, the remaining part of the growth zone was resected by 2/3 and rotated to the palm of the hand. The finger on the neurovascular bundles is moved to the proximal portion of the second metacarpal bone and fixed in the opposition position and retracted by two knitting needles (Fig. 3, item 5). The extensor tendons are sewn, to the lateral surfaces of which the abdomen of short muscles is hemmed. After moving the flaps and excising excess skin suture with hair. Thus, the wound defect at the base of the first finger is closed with a previously cut innervated blood supply flap from the hypoplastic finger (Fig. 3, item 4). An aseptic dressing is applied, immobilization is carried out by a gypsum palm tire.

Thirty days after surgery, an X-ray control is performed, according to the results of which the spokes are removed. The plaster cast is removed after another week. A course of rehabilitation treatment. Figure 4 presents the brush before surgical treatment of patient G., 3 years old, with a diagnosis of congenital hypoplasia of the first finger (Fig. 4, item 1). Figure 5 - the long-term functional and cosmetic result of the same patient G., 3 years old: figure 5, pos. 5 - moved the second finger of the hand to the position of the first, figure 5, pos. 4 - innervated blood-supplied skin-fascial flap, formed from a hypoplastic removed first finger of the hand and used in plastic surgery of a wound defect at the base of the moved second finger to the position of the first finger of the hand.

The positive effect is to improve the functional and cosmetic condition of the hand, as well as to shorten the treatment time.

Claims (1)

A method of reconstructing a brush in children with hypoplasia of the first finger, including pollicization of the second finger of the brush, characterized in that simultaneously with pollicization of the second finger of the brush, the soft tissues of the first finger are dissected, the skeleton is removed, the skin-fascial flap is preserved on the neurovascular bundle, the wound defect in the bases of the newly created first finger are closed with a cutaneous fascial-skin flap.

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