RU2626274C1 - Method of surgical access for installing the shin implant - 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 over the medial head of the gastrocnemius muscle (GM). Access to the subfascial space above the lateral head of the GM is carried out from the medial head of the IM under the Pirogov canal, containing a small subcutaneous vein and medial cutaneous nerve. Place the implant over the lateral head of the GM.

EFFECT: method prevents damage to the medial and lateral cutaneous nerves and a small saphenous vein.

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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.

It is generally recognized as a way to increase the volume of the medial and posteromedial contour of the lower leg by installing an implant under the own fascia of the lower leg. In this case, a transverse skin incision is made in the natural fold of the popliteal fossa 3-4 cm long. The own fascia of the popliteal fossa is isolated, and stepping 1-2 cm lower from the skin incision in parallel, the own fascia of the tibia is dissected above the medial head of the calf muscle. 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. After placement of the implant, its own fascia is sutured directly above the implant. The wound is sutured in layers [1].

In some cases, it is not enough to increase the volume of the lower leg only in the medial and posteromedial direction. The available literature describes the possibility of increasing the shin volume in the posterolateral direction by installing a silicone implant over the lateral head of the calf muscle [2]. A diagram of the operation and placement of the implant is shown in FIG. one.

To do this, perform a transverse skin incision (1) in the natural fold of the popliteal fossa 4 cm long. Separate the fascia of the popliteal fossa, and retreating 1-2 cm lower from the skin incision, parallel to it, cut the fascia of the tibia (2) above the lateral head of the calf muscle (3). Under the fascia and above the lateral head of the gastrocnemius muscle, a cavity (4) for the implant is formed in a blunt manner within the previously performed marking. After placement of the implant, its own fascia is sutured directly above the implant. The wound is sutured in layers.

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 passing in the Pirogov canal (5), and the lateral cutaneous nerve (6).

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

The aim of the invention is to eliminate the disadvantages of the existing method of surgical intervention. This goal is achieved in that the access to install the implant over the lateral head is formed through a vertical incision of the own fascia of the tibia above the medial head of the gastrocnemius muscle, and then in a blunt way under the Pirogov canal containing a small saphenous vein and medial cutaneous nerve, which prevents them from damage, and also from damage to the lateral cutaneous nerve.

The method is as follows (Fig. 2).

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 its future position 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, the medial fascia is exposed by a transverse incision of the skin (1) 4 cm long, more medially than the midline, into the popliteal fascia. 2 cm away from the midline by a longitudinal section of 3.5 cm, the own popliteal fascia is dissected in the caudal direction with the extension of the lower leg to its own fascia (2). Longitudinal dissection of the own fascia of the tibia 2 cm from the midline parallel to the Pirogov canal, containing a small saphenous vein and medial cutaneous nerve, completely eliminates the risk of damage. Next, a subfascial dissection above the medial head of the calf muscle is performed with the index finger. Dissection is continued in the lateral direction, above the place of fusion of the heads of the calf muscles under the Pirogov channel (5), formed by leaves of the tibia own fascia. The listed formations are lifted with a Farabeuf plate hook and enter the subfascial space on the lateral head of the calf muscle (3). Then, within the preliminary marking, the cavity above the lateral head of the gastrocnemius muscle is expanded caudally with a special dissector; the Reynolds dissector can be used. Thus, a cavity (4) is obtained, bounded in front by the lateral head of the calf muscle, behind its own fascia of the lower leg. A silicone implant is placed in the expanded cavity. The defect of the own fascia is sutured over the muscle. The skin wound is sutured in layers. Drainage is not used.

Typically, the proposed method is used simultaneously with an increase in the volume of the medial or posteromedial surface of the lower leg. With the simultaneous installation of implants in the lateral and medial position, the method is used as follows.

Before the operation, the calf is measured, on the basis of which silicone implants are selected. In accordance with the selected implants, skin marking of their future position 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, the medial fascia is exposed by a transverse incision of the skin 4 cm in length medially to the midline; 2 cm away from the midline by a longitudinal section of 3.5 cm in the caudal direction above the medial head of the gastrocnemius muscle, their own popliteal fascia is cut with continuation to the shin's own fascia. 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. In a known manner, a cavity is formed for the implant above or below the medial head of the gastrocnemius muscle. The implant is not installed. Further, by the proposed method, subfascial dissection is performed in the lateral direction, under the Pirogov channel, and a cavity is formed above the lateral head of the calf muscle. Silicone implants are installed: first in a cavity formed laterally, then medially. 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 8 patients.

Example. Patient I., 37 years old, was admitted to the hospital with complaints of dissatisfaction with the shape of the legs. Diagnosed with congenital hypoplasia 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 3.5 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. Next, a subfascial dissection in the lateral direction is performed with the index finger. A fascia leaf with a Pirogov canal containing a small saphenous vein and medial cutaneous nerve was raised on a Farabef hook. A cavity for the implant is formed by a special dissector under the fascia above the lateral head of the calf muscle. An implant is installed above the lateral head, then the implant is medially installed, partially covered by 2/3 of 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. Photos before and after surgery are shown in FIG. 3 and 4.

The application of the proposed method allows from one subfascial access:

- install implants to increase the volume of the lower leg in both the medial and posterolateral direction;

- exclude the possibility of damage to the small saphenous vein and medial cutaneous nerve during longitudinal dissection of their own fascia;

- to exclude the possibility of damage to the lateral cutaneous nerve in the absence of manipulations with the fascia above the lateral head of the calf muscle.

Information sources

1. 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.

2. Felicio Y. Calfplasty // Aesthetic Plast. Surg. - 2000 .-- Vol.24 (2). - p. 141-147.

Claims (1)

Surgical access method for increasing the volume of the lower leg with a silicone implant in the posterolateral direction, including dissecting the skin in the popliteal fossa along the natural fold medial to the midline and placing the implant above the lateral head of the calf muscle (MI), characterized in that the own fascia of the lower leg is cut longitudinally above the medial head of the MI , access to the subfascial space above the lateral head of the MI is carried out from the side of the medial head of the MI under the Pirogov channel containing a small hydrochloric vein and the medial cutaneous nerve that prevents damage to the lateral cutaneous nerve.

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