WO2011084112A1

WO2011084112A1 - Intramedullary venous drainage system in distal tip amputations

Info

Publication number: WO2011084112A1
Application number: PCT/TR2010/000131
Authority: WO
Inventors: Husrev Purisa
Original assignee: Individual
Current assignee: Individual
Priority date: 2010-01-11
Filing date: 2010-06-30
Publication date: 2011-07-14
Anticipated expiration: 2012-07-11
Also published as: TR201000166A2

Abstract

The invention particularly relates to a tube with hole (1) developed for providing bone fixation and venous blood circulation and for transferring the compartment internal pressure to another cavities, in fingertip replantations.

Description

INTRAMEDULLARY VENOUS DRAINAGE SYSTEM IN DISTAL TIP

AMPUTATIONS

The Related Art

The invention relates to a tube developed for providing venous drainage from medullary cavity of distal phalanx to medullary cavity of middle phalanx.

The invention particularly relates to a tube developed for providing bone fixation and venous blood circulation and for transferring the compartment internal pressure to another cavity, in fingertip replantations.

The Prior Art

The most frequently seen hand injury region is fingertip. Replantation of amputations formed in distal of distal interphalangeal joint (DIP) is difficult as technical due to the narrowness of artery diameter and the difficulties of venous circulation. Replantations at the level of fingertip together with development of microsurgical techniques have become doable. Replantation means that any part such as finger, hand, arm separated completely from body of anybody is replanted surgically. Aim of this surgery process is to replant the lost part in providing a function as near as possible to its prior location.

The most common classification for distal phalanx amputations is a classification described by Tamai. Distal phalanx is divided in two parts in this classification. Distal part extends from nail bed to fingertip; proximal part from nail bed to distal interphalangeal joint.

Hirase has classified the distal tip amputations and has determined the treatment regimes. Hirase has divided the level of nail bed in three parts. The first part is the fingertip where digital artery terminates in branches. A composite graft is recommended for amputations of this region. The second part includes distal palmar arch of the digital artery. For amputations at this level, bone fixation is not recommended for not obstructing the venous drainage from medullary cavity. Central digital artery anastomosis is recommended, however, it is reported that any treatment is not applied for venous return. The third part is proximal of the nail bed. For venous drainage after replantation made in this part, heparinized gauze and leech application is recommended for nail bed (*). In replantations at this level (fingertip replantations), finding and anastomosis of vein tips take a long time since veins are thin and the skin in the dorsal part is not mobile. Even sometimes vein cannot be found. Microsurgical repair of veins at this level is technically difficult to achieve since vein diameters are too narrow and the nail bed and the skin in the dorsal part are not flexible enough. While dorsal veins are prominently wider than volar veins at the level of proximal phalanx, volar veins are wider than dorsal veins at the level of distal interphalangeal joint (***).

In distal interphalangeal joint and its distal, vein anastomosis is preferred for an anastomosis since volar veins are wider than dorsal veins. Heparinized gauze over holes opened by pin in the nail bed in fingers which cannot be made vein anastomosis or have a venous drainage defect even though vein anastomosis can be made is placed and provided to be wetted by heparin every two hours (**, ****).

Since the processes performed for providing venous drainage by making continuously finger bleed through applying of leech to finger, applying of heparinized gauze by opening many holes in nail bed, making of fish mouth-like incision in fingertip and dropping of heparinized serum physiologic sometimes cause an excessive blood loss, blood transfusion is required to the patient. Despite all these applications, sometimes losses of fingertip can also occur.

When all published articles and present applications associated with fingertip replantations are analysed, it is observed a prolongation in operation time in case that making of anastomosis is not possible since veins are too thin for replantations at this level or that making of two veins anastomosis is necessity in the event that suitable vein thickness is present. However it is not encountered a venous drainage system providing the completion of operation in a short time.

As a result, requirement of a venous drainage system, which decreases the finger losses due to venous drainage defect, which increases the operation success rate by shortening the operation time, and insufficieny of the present solutions have necessitated a development in the related art.

References belonging to the prior art,

* Hirase Y. Salvage of fingertip amputated at nail level: new surgical principles and treatments. Ann Plast Surg 1997;38:151-157. ** Ozcelik IB, Purisa H, Sezer I, Mersa B, Aydin A. The results of digital replantations at the level of the distal interphalangeal joint and the distal phalanx. Acta Orthop Traumatol Turc 2006;40:62-6.

*** Smith DO, Oura C, Kimura C, Toshimori K, Miyazaki K.The Distal Venous Anatomy Of The Finger . J Hand Surg 1991 ;16A:303-307.

**** Allen DM, Levin LS. Digital replantation including postoperative care. Tech Hand Up Extrem Surg 2002;6:171-7.

Brief Description of the Invention

The present invention relates to a tube developed for providing bone fixation and venous blood circulation and for transferring the compartment internal pressure to other cavities, in fingertip replantations, meeting the above said requirements, eliminating all the disadvantages, and bringing some additional advantages.

Pressure and hematoma in interstitial tissues at the injury region are prevented by system which is the subject of the invention. Finger losses due to venous drainage defect are decreased. It is not possible that blood flows into needle since there is not an introduced opening by system which is the subject of the invention in body of fixation pins used in the present applications.

From the known status of the art, the purpose of the invention is to decrease operation time since vein anastomosis to be made is not required.

Another purpose of the invention is to prevent blood accumulation in interstitial tissues by rapidly removing bleeding in interstitial tissues when tourniquet is opened.

Another purpose of the invention is to eliminate blood transfusion requirement by allowing venous blood to flow into the circulation again from middle phalanx.

Another purpose of the invention is to prevent the occurrence of compartment syndrome.

In order to perform the above said purposes, the invention is a tube with hole developed for providing bone fixation and venous blood circulation and for transferring the compartment internal pressure to another cavities, in fingertip replantations; comprises holes formed over for carrying of blood to medullary cavity of distal phalanx through digital artery after replantation, taking of blood from medullary cavity to needle lumen, carrying of blood to middle phalanx lumen through the said needle lumen, and providing of blood to flow into the venous system by intramedullary perfusion.

In order to achieve all advantages which is said above and will be understood from the below detailed description, the present invention brings about many facilities through its said characteristics.

The structural and characteristic features of the invention and all its advantages will be better understood in detailed descriptions with the figures given below and with reference to the figures. Therefore, the assessment should be made taking into account the said figures and detailed explanations.

Description of the Figures

For better understanding of the embodiment of the present invention and its advantages with its additional components, it should be evaluated together with below described figures.

Figure 1 is the perspective view of injector needle (tube with hole) opened many holes over, which is the subject of the invention.

Figure 2 is the perspective view of all materials used for venous drainage system.

Figure 3 is the view associated with use of injector needle opened many holes over, which is the subject of the invention, in fingertip replantation.

Figure 4a is the view of application associated with fingertip replantations.

Figure 4b is the representation of components to be used during application associated with fingertip rep\antations.

Reference Numbers and Abbreviations

1. Needle with hole/Tube

1.1 Needle lumen

1.2 Needle tip

1.3 Hole

2. Needle without hole U ube

2.1 Needle lumen

2.2 Needle tip 3. K-wire

4. Digital artery

5. Distal phalanx

6. Digital vein

7. Middle phalanx lumen

8. Amputation line

DIP (Distal Interphalangeal Joints)

Detailed Description of the Invention

In this detailed description, in fingertip replantations, the preferred embodiments of tube (1) developed for providing the bone fixation and venous blood circulation and for transferring the compartment internal pressure to another cavities are only disclosed as example for better understanding of the subject.

It is given the perspective view of needle with hole (tube with hole (1)) opened many holes (1.3) over, which is the subject of invention, in Figure 1. Blood enters through these holes into the needle lumen (1.1) with the help of the said holes (1.3).

It is given the perspective view of all materials used for venous drainage system, in Figure 2. While normal needle (without hole) (2) is only used for fixation, needle with hole (1) carries blood to the needle tip (1.2) by taking it to the lumen (1.1) with the help of holes (1.3) over. K-wire (3) helps the operation technique since it complies with two needle lumens (1.1 , 2.1 ). K-wire (3) functions guide in order to send the needle tip (1.2, 2.2) to middle phalanx lumen (7).

In Figure 3, it is given the detailed view associated with use of the needle with hole (1) opened many holes (1.3) over, which is the subject of the invention, in fingertip replantations. Digital artery (4) carries blood to medullary cavity of the distal phalanx (5) after replantation. Blood in the medullary cavity is carried from holes (1.3) over the needle (1) to the needle lumen (1.1), and then through the needle lumen (1.1) to the middle phalanx lumen (7). Blood drainage in the middle phalanx lumen is made by intramedullary perfusion to the venous system (6).

It is given the representation of the needle with hole (1) and other components, which is the subject of the invention, will be used during application associated with fingertip replantations, in Figure 4b. Figure 4a is the view of the fingertip replantation application. Normal needle (2) is sent from retrograde amputee finger bone medulla. K-wire (3) is attached to this needle lumen (2) and the needle with hole (1) is placed from the tip of the amputee finger lumen by the said k-wire (3) guide. The same k- wire (3) is sent to the middle phalanx medulla by control of scopy. K-wire (3) guides that the needle with hole (1) over the amputee is sent to the middle phalanx medulla. After amputee is replanted by the needle with hole (1), k-wire (3) is removed.

Alternative application fields of the needle with hole, which is the subject of the invention, are available. In order to gain intramedullary bleeding to outer space or venous system in other bone fractures of body, large modules of the said needle (1) is able to be made and in order to prevent the coagulation and adhesions within the tube (1), it can be benefited from nanotechnology.

In different alternative applications of the invention, by taking into account possible that holes (1.3) over the tube (1) can cause the metal weakness, locations of the holes (1.3) and distances of each other can be arranged. In addition, holes (1.3) can be opened not only in round shape but also in different shapes on the needle (1).

In alternative applications of the invention, venous drainage defect can be prevented by draining blood through tube to a blood bag. It is to be transfusible in a dorsal venous circulation of the hand by a serum set.

The protection area of this application has been specified under claims and cannot be limited to the descriptions only given as sampling above. It is clear that any innovation can be provided by a person skilled in the related art by use of the similar embodiments and/or can also apply this embodiment in other areas for similar purposes used in the related art. Therefore, it is also clear that such embodiments will be lack of innovation criteria.

Claims

The invention particularly is a tube (1) developed for providing bone fixation and venous blood circulation and for transferring the compartment internal pressure to another cavities, in fingertip replantations, and it is characterized in that; it comprises holes (1.3) formed over for carrying of blood to distal phalanx medullary cavity (5) through digital artery (4) after replantation, taking of blood from medullary cavity (5) to the needle lumen (1.1), carrying of blood to middle phalanx lumen (7) through the said needle lumen (1.1), and providing of blood to flow into the venous system (6) by intramedullary perfusion.

A tube with hole (1) according to claim 1 , wherein; the holes (1.3) which allow blood to be taken to the needle lumen (1.1) can be in different geometric shapes.

A tube with hole (1) according to claim 1 , and it is characterized in that; venous drainage defect can be prevented by draining blood through tube to a blood bag and It is to be transfusible in a dorsal venous circulation of the hand by at least a serum set.