RU2626271C1 - Method for hip implant installation - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: implant is placed in the facial tissue of the thin muscle from the inside through the deep sheet of the hip own fascia, for which access is made to the medial hip muscle with dissection of the posterior intermuscular septum through the posterior facial hip tissue and through skin dissection in the hypogynous fold.

EFFECT: method prevents the implant from shifting in anterolateral direction.

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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 hips, namely the restoration of the volume and contour of the hips with muscle hypotrophy and hypoplasia.

Unilateral or bilateral hypotrophy, or hypoplasia of the muscles of the thighs causes an aesthetically unacceptable violation of the contour of the legs, mainly its inner part, which causes persistent socio-psychological discomfort in 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 inner thigh surface is achieved when silicone implants are placed in soft tissues. The following methods for installing hip implants are known:

1. The method described by J. Anger [1].

2. The method described by R. Gonzales [2].

In the method of J. Anger (Fig. 1), in the patient’s position on the abdomen, a transverse skin incision is made in the sublingual fold (1), the own fascia of the thigh (2) is exposed, and subcutaneously secrete it medially in the anterior direction to the small muscle (3). A backlit retractor is used to detect the thin muscle. Directly along the posterior edge of the thin muscle, the fascia is dissected and a finger is separated from the major adductor muscle (4). Then, with a special dissector, carefully divide the space between the muscles, adhering to the medial border of the thigh. After dissection, an implant is inserted into the formed cavity through a subclinical incision (5). The postoperative wound is sutured in layers.

The disadvantage of this method is the complexity of the dissection stage of the own fascia of the thigh, the dissection is performed in a limited space, almost "blindly". To visualize the muscle requires a special expensive retractor with a light source. In cramped conditions, it is inconvenient to form a cavity for the implant. We tested the method on three patients; six implants were installed. In one case, the implant after placement was displaced through the defect of the intrinsic fascia of the thigh under the superficial fascia, which led to asymmetry in the postoperative period and required surgical correction after 3 months. Due to the complexity of the operation, we refused the method of J. Anger.

R. Gonzales altered the operative approach for implant placement according to the method of J. Anger (Fig. 2). In the patient’s position on the abdomen, a transverse skin incision is made in the sublingual fold (1), the own fascia of the thigh (2) is exposed and dissected directly under the skin incision. Through the incision, they enter the posterior fascial case of the thigh (6) and half-tendon and semi-membranous muscles contained in it are laterally moved away. Directly below them, the posterior intermuscular septum (7) is isolated and dissected, under which there is a large adductor muscle (4). The cavity for the implant is formed on the medial surface of the muscle (5). After implant placement, the fascia and wound are sutured in layers.

The method allows direct access to the space for the formation of the cavity and does not require a special retractor with backlight. The disadvantage of this method is the high frequency of displacement of the implant in the anterolateral direction (indicated by the arrow in Fig. 2), due to the large size of the fascial case into which the implant is installed. We tested the method on seven patients; 14 implants were installed. In four cases, the implant shifted forward between the large and long adductors, which led to asymmetry in the postoperative period and required surgical correction.

The aim of the invention is to eliminate the disadvantages of existing methods of surgical intervention. This goal is achieved by the fact that the implant is placed in the fascial sheath of the thin muscle from the inside through the deep leaf of the thigh fascia, for which access to the medial sheath of the thigh muscles is performed with dissection of the posterior intermuscular septum through the posterior fascial sheath of the thigh and through dissection of the skin in the sublingual fold, which limits displacement of the implant in the anterolateral direction.

The method is as follows (Fig. 3).

The operation is performed in the patient’s position on the abdomen. In the sublingual fold, as medially as possible, a transverse skin incision (1) of 4 cm length exposes the femoral fascia (2). Own thigh fascia for access to the posterior fascial sheath (6), unlike the R. Gonzales method, is cut longitudinally over the semi-tendon and semi-membranous muscles (the reference point is the sciatic tubercle, from which these muscles begin). After isolation, the semi-tendon and semi-membranous muscles are laterally pushed back and the posterior intermuscular septum is exposed (7). It is cut longitudinally under the control of vision. Then, the major adductor muscle (4) is also laterally pushed back. On the released medial surface of the wound, a fascial case of the thin muscle (3) is formed from the inside, formed by the leaves of the thigh's own fascia. The deep, thinner sheet of the fascial case of the thin muscle is bluntly opened by diluting the branch of scissors. A cavity for the implant is formed on the outside between the opened deep leaf of the own fascia of the thigh and the thin muscle from the outside (5). The implant is inserted into a cavity bounded externally by a thin muscle, from the inside by a deep leaf of its own fascia of the thigh. Fascias and skin wounds are sutured in layers. Drainage is not used.

The method was tested on 28 patients.

Example. Patient N., 28 years old, was admitted to the clinic complaining of dissatisfaction with the shape of her hips. Diagnosed with congenital hypoplasia of the adducting muscle group of the thigh. An increase in the volume of the inner thigh surface with silicone implants is recommended.

Under epidural anesthesia in the patient’s position on the abdomen, a skin incision was made as medially as possible in the sublingual fold 4 cm long on the right. Naked thigh fascia exposed. Retreating 3 cm lower from the sciatic tubercle, the fascia is dissected longitudinally. Under the fascia, the semi-tendon and semi-membranous muscles are laterally displaced on the Farabef hook. At that hour, the posterior intermuscular septum was isolated and dissected under the muscles. The laterally large adducting muscle is isolated on the Farabef hook. On the medial surface of the wound cavity revealed fascial case containing a thin muscle. The fascial case is opened from the inside by blunt dilution of the deep leaf of the femoral fascia. A cavity for the implant is formed by a special dissector under the thin muscle. The implant is installed. Fascial defects are sutured with Vicryl thread 2-0, skin wound sutured in layers Vikril 4-0, Prolen 4-0. Control of hemostasis during surgery. Similarly on the left side. 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. The implant is placed in a limited fascial case of the thin muscle, which excludes its displacement in the anterolateral direction. The implant is completely covered with a thin muscle from the outside, and installing it from the inside of the muscle eliminates damage to the surface sheet of the thigh fascia above the thin muscle, its displacement to the outside. All stages of surgical intervention are controlled by vision.

Information sources

1. Anger J. Thigh augmentation: submuscular placement of a silicone gel-filled prosthesis // Aesthet. Surg. J. - 2005. - No. 1. - Vol. 25. - p. 44-48.

2. Gonzalez R. Thigh Implant // Buttocks reshaping / ed. books by R. Gonzalez. - Rio de Janeiro: Indexa Editora LTDA, 2006.

Claims (1)

A method of increasing the volume of the thigh with a silicone implant, characterized in that the implant is placed in the fascial sheath of the thin muscle from the inside through a deep leaf of her own fascia of the thigh, for which they access the medial sheath of the thigh muscles with a dissection of the posterior intermuscular septum through the posterior fascial sheath of the thigh and through dissection of the skin into subglottic fold.

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