RU2290144C2 - Method for substituting posttraumatic defects of supporting foot surface - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method involves substituting soft tissue defect of supporting foot surface. Preformed tissue complex based on radial blood-fed fascial flap is used as donor flap. The flap is transferred under skin of internal foot arch with end-to-end anastomosis being created on radial artery of the fascial flap and anterior tibial artery and on corresponding comitant veins. Three weeks later, soft tissue defect of supporting foot surface is closed with transferred cutanofascial flap on recreated vascular pedicle.

EFFECT: enhanced effectiveness in creating graft with axial blood supply type in any favorable donor zone.

3 dwg

Description

The invention relates to medicine, in particular to traumatology and orthopedics, and can be used for plastic soft tissue defects of the supporting surface of the foot.

The closest analogue to the prototype is a method of plasty, in which a fascial and skin flap on the vascular pedicle is cut out by an arcuate incision along the inner arch of the foot and is turned to the side of the defect, closing it, and the donor defect is replaced by a full-layer skin graft (Serafin D. Atlas of microsurgical Composite Tissue Transplantation. Philadelphia etc., WBSaunders Co., 1996).

The disadvantage of this method is the impossibility of its use in cases where, as a result of an injury or other pathological process, the topographic and anatomical relationships in the donor zone change, as well as in the case of individual anatomical features, with a loose type of blood supply.

Our proposed method allows to improve the quality of baking by applying the plastic defect "prefabricated" flap.

The result of the invention is achieved by the fact that as a donor flap, a pre-formed tissue complex based on a radial blood-supplied fascial flap is used, which is moved under the skin of the inner arch of the foot with end-to-end anastomoses applied to the radial artery of the fascial flap and the anterior tibial artery, as well as the corresponding committing veins, and after three weeks, the soft tissue defect of the supporting surface of the foot is closed by the displaced “prefabricated” skin -fastsialnym flap created on the vascular pedicle.

I Stage of operation. The formation of the vascular pedicle of the flap.

1. Preparation of the foot. On the back surface with the transition to the inner arch of the foot, a skin-fat flap is cut out with a curly cut, detached and lifted. Allocate the anterior tibial artery with commuting veins.

2. The formation of fascial flap. On the palmar surface of the forearm curly section reveals the fascia of the forearm. A fascial flap is cut out with the radial artery and Kimantine veins included in it, with a skin buoy flap measuring 4 × 5 cm. After raising the flap on the proximal vascular pedicle and perfusion, it is ligated and the vascular pedicle intersected after it is selected in the proximal direction to provide the necessary lengths. The length of the required vascular pedicle is measured on the injured foot from the distal edge of the defect to the recipient vessels (anterior tibial artery and veins). Then the flap is transferred to the foot, and the donor wound is sutured in line.

3. The formation of the vascular pedicle of the flap. The fascial flap is placed in place of the flap that is separated on the inner arch of the foot to the depth of the wound and sutured to the edges of the defect, and the skin-subcutaneous flap is laid with a wound surface on the fascial flap. The wound is sutured. The vascular pedicle is brought out to the selected vessels and, using microsurgical technique, an end-to-end anastomosis is applied to the radial artery of the flap and the anterior tibial artery. Anastomose commit veins "end to end" (figure 1). Hemostasis is performed, the wound is sutured, an aseptic dressing and posterior plaster cast are applied from the fingertips to the upper third of the leg in a functional position for three weeks.

II stage of the operation. Plastic defect displaced "prefabricated" flap.

1. Preparation of the recipient bed. The wound is abundantly washed with antiseptic solutions, the edges of the wound and non-viable-looking tissues are excised.

2. Moving the "prefabricated" flap. Figured incision with excision of the postoperative scar is cut and raised "prefabricated" skin-fascial flap on the vascular pedicle (figure 2). The flap is moved in the distal direction with the closure of the defect. The edges adapt, suture the skin. The donor defect is closed with a full-layer skin flap taken from the inner surface of the thigh (figure 3). An aseptic dressing is applied, a back plaster cast for one week.

The advantages of the invention are the ability to create a flap with an axial type of blood supply in any favorable donor area, in particular, to restore the supporting surface of the foot, the skin of the sole surface of the foot of the unloaded area is identical in structure and supportability.

Example. Patient S., 25 years old, East. illness number 8200, accident, the car moved to the left foot. As a result, the patient had an open fracture of the main phalanx of the first finger, a closed fracture of the main phalanx of the second and fourth fingers, a fracture of the nail phalanx of the fifth toe of the left foot, traumatic detachment of soft tissues, compression of the left foot. As a result of treatment, the fractures were consolidated, a granulating wound 4 × 6 cm in size was formed on the plantar surface of the foot in the projection of the first or third metatarsal bones. The first stage was the “prefabrication” of the flap along the inner arch of the left foot. On the front surface of the left forearm, a fascial flap with a “buoy” skin island of appropriate sizes on a vascular pedicle (16 × 8 cm) was cut out. The flap is raised. After removing the tourniquet, the radial artery and veins were bandaged, and the medial cutaneous nerve of the forearm was crossed. Performed hemostasis, the wound is sutured in line, drained. An aseptic dressing is applied. On the dorsum of the left foot, the anterior tibial neurovascular bundle is laid-out in layers in a curly section. A cut-fat incision was cut and severed with a skin-fat flap in the area of the inner arch of the foot. The fascial part of the radial flap is hemmed at the edges to the separated flap of the foot. Using microsurgical technique, end-to-end anastomoses were applied to the radial artery and the anterior tibial artery with 9/0 thread, as well as to the committing veins with 9/0 thread, an epineural suture of the medial cutaneous nerve of the forearm and the medial dorsal nerve of the foot was applied. After removing the clips, the blood flow in the flap is restored, the flap is pink, the outflow is compensated. Performed hemostasis, the wound is sutured in line, drained. An aseptic dressing was applied, the posterior plaster cast was applied from the toes to the upper third of the leg. The postoperative period without features. Sutures were removed after 12 days.

Three weeks later, the next stage of the operational manual was completed - plastic defect with a “prefabricated” flap. The edges of the wound and non-viable-looking tissue are excised. A fascial “prefabricated” flap corresponding to a defect of size was cut in a figured incision with excision of the postoperative scar along the inner plantar surface of the left foot. The flap is raised and moved with the closure of the defect. The edges of the flap adapted, sutured to the skin. The vascular response of the displaced flap is satisfactory. The resulting donor defect in the inner arch of the foot is closed with a full-layer skin flap taken from the outer surface of the upper third of the left thigh. Hemostasis was performed, sutures were applied to the skin, aseptic dressing, posterior plaster cast from the fingers to the upper third of the leg for five days. The postoperative period without features. Sutures were removed after 12 days, the flap had completely taken root.

Literature

1. J.-N. Li - Y. Hu (2001) A review of the experimental study and clinical application of the prefabricatated flap. Eur. J. of Plastic Surgery. 24: 271-274.

2. Abbase EA, Shenaq SM, Spira M, et al. (1995). Prefabricated flaps: experimental and clinical review. Plast Reconstr Surg 96 (5): 1218-1225.

3. Shen Z, Wan NZ, Shen YM, et al. (1996). Free transfer of prefabricated expanded vascularized skin flap Chinese J Reparative and Reconstructive Surgery, 10 (2): 70-71.

4. Ouyang TX, Guo ET, Zhang M, et al. (1996). Experimental study on vascularized area of the prefabricated axial skin flap after implantation of vascular bundles. Chinese J Plast Surg Burns 12: 326-328.

5. Tark KS, Khouri RK, Shin KS, et al. (1991). The fasciovascular pedicle for revascularization of other tissues. Ann Plast Surg 26: 149-155.

6. Serafin D. Atlas of microsurgical Composite Tissue Transplantation. Philadelphia etc., W.B. Saunders Co., 1996.

Claims (1)

A method for replacing post-traumatic defects in the tissues of the supporting surface of the foot, which consists in replacing the soft tissue defect of the supporting surface of the foot with a flap, characterized in that a preformed tissue complex based on a radial blood-supplied fascial flap is used as a donor flap, which is moved under the skin of the inner arch of the foot with the application of anastomoses " end-to-end ”on the radial artery of the fascial flap and the anterior tibial artery, as well as on the corresponding commits e veins, and after three weeks, the soft tissue defect of the supporting surface of the foot is closed by a displaced skin-fascial flap on the newly created vascular pedicle.

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