RU2231989C2 - Method for skin plasty at combined lesions of fingers - Google Patents

Abstract

FIELD: medicine, traumatology, orthopedics.

SUBSTANCE: the present innovation is suggested to be applied in case of closing cutaneous defects of patient's wrist. Axial fragment at retrograde circulation should be formed at rear-lateral surface of donor's finger by performing incisions from the level of metacarpo-phalangeal articulation by including the rear branch of finger artery into the fragment after ligation and crossing it at the site of branching against finger artery at the level of the main phalanx. Incision should be continued distally up to the level of average third of middle phalanx, then fragment's bottom should be sutured as a tube, fragment should be spread on recipient's surface.

EFFECT: higher efficiency of skin plasty.

7 dwg, 1 ex

Description

The invention relates to medicine, specifically to hand surgery, and is used for skin plastic surgery of the fingers with their combined injuries.

With defects in the skin of the fingers of the hand, usually free skin grafting with an unvascularized skin graft is used [1]. However, this method is not applicable for combined injuries, when deep structures are exposed (neurovascular bundles, tendons, bone tissue), since the flaps do not take root during such injuries.

There is a method of restoring the skin with combined damage to the fingers of the hand with a cross grafting with a flap from an adjacent finger [2], in which a flap is taken with a ratio of length and width 2: 1 without taking into account the direction of the vessels in the flap. The flap is sutured to the recipient area, and the donor site is covered with a free full-layer flap. The disadvantages of this method are often the forced flexion position of the damaged finger, as well as the inability to conduct early development in the joints of the fingers, the length of the period between the first and second stage. All this makes it impossible to use it in people older than 50 years due to the development of persistent restriction of movement in the joints of the finger in the postoperative period.

The closest in technical solution to the proposed one is the method of skin plasty we adopted for the prototype as an insular dorsum-lateral flap on the dorsal branch of the digital artery [3]. However, the maximum length of the legs and the flap itself is such that they can be used only for plasty of skin defects at the level of the main and proximal half of the middle phalanx of the damaged finger.

The essence of the invention is expressed in the set of distinctive features sufficient to achieve the desired technical result, which consists in improving the results and reducing the treatment time. This essence consists in the fact that a flap in retrograde blood flow is formed on the dorsal-lateral surface of the donor finger, making incisions from the level of the metacarpophalangeal joint with inclusion in the flap of the dorsal branch of the digital artery after ligation and its intersection at the point of departure from the digital artery at the level of the main phalanges, continue the incision in the distal direction to the level of the middle third of the middle phalanx, after which the base of the flap is sutured in the form of a tube, and the flap is flattened on the recipient surface.

Illustrations are given in a clinical example.

The method is as follows.

On the dorsal-lateral surface of the adjacent (donor) finger at the level of the distal third of the middle phalanx, the level of the base of the leg of the flap is determined. In the proximal part of the finger, starting from the level of the spot-phalangeal joint, cuts in the distal direction, preserving the paratenon, raise the flap, sufficient in width and length to rotate and cover the skin defect. The base of the legs of the flap is sutured in the form of a tube. The donor site is covered with a full-layer skin flap. Then the flap on the feeding leg is sutured to the recipient area. A gypsum splint is applied for two days, and from the third day, movements in the joints of the fingers of the hand are developed to prevent contractures. Flap training by clamping the feeding legs is carried out from the second day. The second stage - cutting off the supply leg - is carried out after 10-12 days.

The flap has the following advantages:

1. The axial type of blood supply allows you to cut out flaps with a ratio of width and length of 1: 8.

2. The long, mobile leg of an axial flap allows:

a) cover the defect of the skin on any part of the finger;

b) to carry out at the first stage of treatment the prevention of contractures of the fingers.

Clinical example:

Patient X., 34 years old, medical history No. 3266, 10/18/01, working on a circular saw, received combined damage to 2 fingers of the right hand. He asked for help on 10.21.01. At the initial examination, a wound with a skin defect of 1.5 × 4.5 cm, covered with fibrinous plaque, is determined. The bottom of the wound is the lateral surface of the bones of the main and middle phalanges. The primary surgical treatment of a finger wound with plastic defect of the skin with an axial flap on retrograde blood flow, 1.6 × 7.4 cm in size, was performed on the feeding leg from the dorsum-lateral surface of 3 fingers with the inclusion of the dorsal branch of the finger artery. The donor site is covered with a free full-layer flap. Plaster cast was applied for two days. From the second day, the flap training was started by squeezing the feeding leg, and from the third day, the development of movements in the joints of the fingers of the hand.

The second stage - cutting off the supply leg - was carried out after 12 days. Two weeks after cutting off the feeding leg, the patient received the full range of movements of the fingers.

The proposed method is shown in the accompanying illustrations, in which Fig. 1 shows the second finger of the right hand on the third day after the injury, Fig. 2 shows a raised flap on retrograde blood flow formed on the dorsum-lateral surface of 3 fingers with the inclusion of the dorsal branch of the digital artery, figure 3 - the second and third fingers of the hand on the second day after the operation, in figure 4 and figure 5 - the range of motion in the joints of the fingers of the hand on the 11th day after the operation, and in figure 6 and figure 7 - the long-term outcome of treatment on the term 6 months.

Sources of information

1. Gubochkin N.G., Shapovalov V.M. Selected issues for hand surgery. - St. Petersburg, LLC "Interline", 2000, - p. 81.

2. Nelsin Z. F., Chudakova T. N. Emergency surgery for open hand injuries. - Mn .: Navuka i tehnika, 1994, - pp. 91-92.

3. Russell RC, Van Beek AL, Wavak P et al, Alternative hand defects for amputations and digital defects. J Hand Surg (1981) 6: 399-405.

Claims (1)

The method of skin plastics with combined injuries of fingers, including the transplantation of an axial flap on the feeding leg from an adjacent finger, characterized in that the axial flap on the retrograde blood flow is formed on the back-side surface of the donor finger, making incisions from the level of the metacarpophalangeal joint with inclusion in the flap the back branch of the digital artery after ligation and crossing it at the place of departure from the digital artery at the level of the main phalanx, continue the incision in the distal direction to the level of the middle third middle phalanx, after which the base of the flap is sutured in the form of a tube, and the flap is spread on the recipient surface.

Images