RU2626267C1 - Method for installing the immobilant - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: dissect the skin in the popliteal fossa along the natural fold medial to the median line. The fascia's own fascia is dissected longitudinally. Access is carried out from the medial edge of the medial head of the gastrocnemius muscle (MHGM), for which the MHGM traction is performed laterally. The dissector creates a container for the implant, bounded from the front by the soleus muscle, from behind - MHGM, medially - by the fascia's own fascia. Place the implant and cover it with MHGM, the wound is sutured layer by layer.

EFFECT: method allows to prevent damage to the small saphenous vein, the medullary nerve, and to prevent the implant from moving.

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Description

The present invention relates to medicine, namely to plastic and reconstructive surgery, and can be used to improve the shape of the legs, namely the restoration of the volume and contour of the legs with muscle hypotrophy and hypoplasia.

Unilateral or bilateral hypotrophy or hypoplasia of the muscles of the legs causes an aesthetically unacceptable violation of the contour of the legs, mainly its inner part, which causes persistent socio-psychological discomfort for most women and many of them are prompted to seek help from plastic surgeons.

The most stable and predictable result of an increase in the volume of the lower leg is achieved when silicone implants are placed in the soft tissues. The following methods are known for installing lower leg implants: under the superficial fascia of the lower leg (under the skin), under the own fascia of the lower leg, under the muscle.

Placing a silicone implant under the superficial fascia of the tibia (under the skin) is the simplest method described back in 1972. This technique continues to be used to date by some surgeons [1]. In this case, the cavity for the implant is formed by the gradual expansion of the space under the superficial fascia of the lower leg using Hegar dilators. The disadvantage of this method is the very high risk of capsular contracture and implant displacement [2].

The generally accepted method of installing the implant under its own fascia of the lower leg (Fig. 1). In this case, a transverse skin incision is performed (1) in the natural fold of the popliteal fossa 3-4 cm long. The fascia of the popliteal fossa is separated, and, stepping 1-2 cm lower from the skin incision parallel to it, the own fascia of the tibia (2) is dissected above the medial the head of the calf muscle (3). Under the fascia and above the medial head of the gastrocnemius muscle, a cavity for the implant is formed in a blunt way within the limits of the previously performed marking. Place the implant (4) and suture the own fascia of the lower leg over the implant. The wound is sutured in layers [3].

A diagram of the operation and placement of the implant is shown in FIG. one.

The described method has the following disadvantages:

1. With a transverse section of the own fascia of the lower leg, there is a risk of damage to the medial cutaneous nerve and small saphenous vein (5).

2. If the fascia is sutured directly above the implant, there is a risk of damage to the implant membrane by the needle.

3. There is a risk of lateral displacement of the implant during the formation of a cavity larger than the size of the implant.

4. Implants from silicone blocks are tactilely determined when installed under the shin's own fascia [4].

M.A. Kalixto and R. Vergara noted an unnaturally high density of the lower leg tissues when implants made of silicone blocks were placed under the fascia, therefore, they suggested forming a cavity for the implant under the medial head of the calf muscle (Fig. 2). Why cut the skin (1) and the own fascia of the lower leg (2) as in the previous method. Then, at a distance of 4 cm from the inner edge of the medial head of the gastrocnemius muscle (3), as far as possible from the neurovascular bundle (5), its blunt dissection is performed (6). First, they are diluted with a Kelly clamp, then expanded using Hegar dilators, the final cavity for the implant (4) is formed by a blade dissector under the medial head of the calf muscle [4].

The disadvantages of the method are its complexity and invasiveness, due to the need to breed muscle fibers for access under the medial head of the gastrocnemius muscle and the need to perform the expansion of the intermuscular canal for several introductions of the dilator. In addition, according to the authors of the method, the completely axillary location of the implant causes a prolonged pain syndrome.

The aim of the invention is to eliminate the disadvantages of existing methods of surgical intervention. The goal is achieved in that the own fascia of the tibia above the medial head of the gastrocnemius muscle is cut longitudinally and the cavity for the implant is formed above the medial part of the soleus muscle by moving the medial head of the gastrocnemius muscle, the implant is partially placed 2/3 under the muscle and 1/3 under its own fascia .

The method is as follows (Fig. 3). Before the operation, the calf is measured, on the basis of which a silicone implant is selected. In accordance with the selected implant, skin marking of the future position of the implant and skin incision is performed. The operation is performed in the patient’s position on the abdomen. Within the marking along the natural fold in the popliteal fossa medially to the midline, a transverse skin incision (1) of 3.5 cm length exposes its own popliteal fascia. 2 cm away from the midline, they cut their own popliteal fascia with a longitudinal incision of 3.5 cm in the caudal direction, continuing to the shin's own fascia (2). Longitudinal dissection of the own fascia of the tibia 2 cm from the midline completely eliminates the risk of damage to the small saphenous vein and medial cutaneous nerve (5). The index finger performs subfascial dissection above the medial head of the gastrocnemius muscle (3) to its medial edge. Next, the medial head of the gastrocnemius muscle is pushed laterally with the index finger and with the same finger simultaneously lifts it above the soleus muscle. In this way, a cavity is obtained that is bounded in front by the soleus muscle, medially by the own fascia of the lower leg, and behind the medial head of the calf muscle. Refusal to use surgical instruments allows you to perform this stage of the method as atraumatic and bloodless as possible. After isolation of the medial head of the gastrocnemius muscle, it is retracted and lifted with a Farabeuf plate hook (6). Further, a Reynolds dissector can be used with a special dissector, the formed cavity is expanded in the caudal direction within the preliminary marking along the length of the implant. A silicone implant (4) is inserted into the expanded cavity. During implant placement, make sure that the implant does not go out from under the edge of the medial head of the gastrocnemius muscle. The medial head of the calf muscle is released and the implant is covered with it. Thus, the medial head of the gastrocnemius muscle covers the silicone implant by 2/3, which prevents its displacement and protects during the following manipulations. The defect of the own fascia is sutured over the muscle. The skin wound is sutured in layers. Drainage is not used.

The method was tested on 102 patients.

Example. Patient U., 28 years old, was admitted to the hospital with complaints of dissatisfaction with the shape of her lower legs. Diagnosed with congenital hypoplasia of the medial heads of the calf muscles. An increase in calf volume with silicone implants is recommended. Under epidural anesthesia in the patient’s position on the abdomen, a 3 cm skin incision was made along the natural fold in the popliteal fossa on the right. Exposed own popliteal fascia. Retreating 2 cm from the midline, the fascia is dissected longitudinally with a continuation of the tibia into its own fascia. The index finger in the medial direction under the own fascia bluntly marks the edge of the medial head of the calf muscle. The muscle is laterally displaced, raised on a Farabef hook. A cavity for the implant is formed by a special dissector under the medial edge of the head of the calf muscle. The implant is installed, 2/3 covered by the medial head of the calf muscle. The fascial defect is sutured with Vikril 2-0 thread, the skin wound is sutured in layers Vikril 4-0, Prolen 4-0. Control of hemostasis during surgery. Similarly on the left side. The duration of the operation is 24 minutes. Photos before and after surgery are shown in FIG. four.

The application of the proposed method allows you to save the advantages of existing methods and eliminate their disadvantages. Eliminates the possibility of damage to the small saphenous vein and medial cutaneous nerve during longitudinal dissection of their own fascia. Partial coating of the implant with the medial head of the gastrocnemius muscle prevents its displacement in the lateral direction and protects the implant shell from accidental damage when the fascia is closed. Preserving 1/3 of the subfascial position of the implant reduces pressure on the calf muscle and reduces pain. The proposed method eliminates interference in the calf muscle.

Information sources

1. Cavalcanti T.O., Pitanguy I., Ribeiro B.L. Inclusion of calf implants for the correction of lower limb amyotrophy // Rev. Bras. Cir. Pla'st. - 2011 .-- Vol. 26 (3) - p. 518-524.

2. Valnicek V. Erfahrungen mit Glicenstein-wademprothesen // Annual congress of the Swiss society of plastic and reconstructive surgery. - Switzerland, Nyon - 1983.

3. Pena-Salcedo J.A., Soto-Miranda M.A., Lopez-Salguero J.F. Calf implants: a 25-year experience and an anatomical review // Aesthetic Plast. Surg. - 2012. - Vol. 36 (2). - p. 261-270.

4. Kalixto M.A., Vergara R. Submuscular calf implants // Aesth. Plast. Surg. - 2003. - Vol. 27 (2). - p. 135-138.

Claims (1)

A method of increasing the volume of the lower leg with a silicone implant, including dissecting the skin in the popliteal fossa along the natural fold medial to the midline, placing the implant under the medial head of the gastrocnemius muscle (MGIM), characterized in that the own fascia of the lower leg is dissected longitudinally, access is from the medial edge of the MGIM, for why they perform the MGIM traction laterally, the dissector creates a container for the implant, bounded in front by the soleus muscle, behind - MGIM, medially - by the own fascia of the lower leg, ayut implant and cover it MGIMO, the wound is sutured in layers.

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