The method of reconstruction of the first finger brush

 

(57) Abstract:

The invention relates to medicine, namely to orthopedics, traumatology. Entity: form two skin-subcutaneous flap in the first pipestem interval, excised the first dorsal interosseous muscle, move the bracket causes the muscles to the base of first metacarpal bone, produce compactcom in the area of the diaphysis of the stump of the first metacarpal bone with subsequent dosed distraction osteotomies fragment that provides two-way grip.

The invention relates to medicine, namely to orthopedics.

There is a method of lengthening the metacarpal bones and phalanges using a distraction device (1).

The closest analogue is the way talangsari first metacarpal bone at the expense of deep cleavage Megastore gap and skin-muscle plastics (2).

However, the known methods provide a small length of the first finger and the lack of function of bilateral grip of the brush.

The invention is directed to solving objectives: increase the efficiency of the method by restoring a sufficient length of the first finger and ensure adequate bilateral grip.

STI with her distraction lengthening.

Distinctive features in comparison with prototype: incomplete (superficial, partial) breakdown Megastore period, which increases the strength of the formed finger; concurrent mobilization I Metacarpals with compactata (repression and nadumivayem) and overlay distraction device; increasing the depth and strength of bilateral coverage due to the formation of the finger of sufficient length (4.0 to 4.5 cm).

The method is as follows. In the first pipestem between form two skin-subcutaneous flap excised the first dorsal interosseous muscle. The place of attachment causes the muscles move after the cut-off from the top of the stump near the base of the first metacarpal bone and fix removable seam. From the same incision in the area of the diaphysis are compactcom with the imposition of the distraction device. The wound closed by plastics opposing flaps of skin. Formed finger extend to 4.0 to 4.5 cm by fractional distraction, started from the 5th day after the operation.

Examples of specific performance.

Example 1.

Patient S., aged 45. Diagnosis: the Defect of the first finger of the right hand at the level of the metacarpophalangeal joint. Conducted operaista. Adductor cut off from the place of attachment to the first metacarpal bone, moved to its base and fixed removable seam. From section pipestem gap executed compactline conducted in diapycnal zone. Then two pairs of parallel spokes, one pair in proximal the second distal fragments of the metacarpal bones. The wound defect is closed due to a cut on two opposite triangular flaps imposed distraction device. Fractional distraction in the office started with the 5th day after surgery to 0.5 mm per day. After 6 weeks of distraction is finished, the stabilization apparatus is continued for another 4 weeks. Long-term results of treatment after 2 years is good. Restored function of the capture of the brush. The patient continues to work with former profession. The length of the generated finger 4,0 see

Example 2.

Patient M., 35 years. Diagnosis: the Defect of the first finger of the right hand at the level of the metacarpophalangeal joint.

Surgery was performed. In the first interdigital gap cut two skin-subcutaneous flap. Cut the first dorsal interosseous muscle. Adductor cut off from the place of attachment to the first metacarpal bone, moved to its base and fixed removable seam. From nasrany two pairs of spokes, one pair of spokes in proximal the second distal fragments of the metacarpal bones. The wound defect is closed due to a cut on two opposite triangular flaps imposed distraction device. Fractional distraction in the office started with the 5th day after surgery to 0.5 mm per day. After 7 weeks of distraction is finished, the stabilization apparatus is continued for another 5 weeks. Long-term results after 1.5 years - good. The length of the finger 4.0 cm, restored the snapshot function. The patient, a resident of rural areas, actively uses the right hand. New thumb has sufficient mobility and strength.

Example 3.

Patient C. , 32 years. Diagnosis: the Defect of the first finger of the right hand at the level of the metacarpophalangeal joint.

Surgery was performed. In the first pipestem gap cut two skin-subcutaneous flap. Cut the first dorsal interosseous muscle. Adductor cut off from the place of attachment to the first metacarpal bone, moved to its base and fixed removable seam. From section pipestem gap executed compactline conducted in diapycnal zone. Then two pairs of parallel spokes, one pair in proximal the second distal metacarpal fragments to the drugs. Fractional distraction in the office started with the 5th day after surgery to 0.5 mm per day. After 6 weeks of distraction is finished, the stabilization in the apparatus for 5 weeks. Long-term results after 2 years is good. The length of the finger 4,5 see the Power of coercion and capture quite sufficient to meet the practical needs of the patient. The patient continues to work at your previous job.

The proposed method of operation is particularly shown in an isolated defect of the first finger, and even in combination with a partial defect I Metacarpals, and, unlike the prototype, you can restore the finger of sufficient length, with increased strength and depth of bilateral grip.

Sources of information

1. Ilizarov, A., I. Kataev A., murasca Century. And. etc.//Experimental-theoretical and clinical aspects in the KSRIECOT method of transosseous osteosynthesis: proc. Vsesojuz. the Symposium. - Barrow, 1984, - S. 162-163.

2. Shushkov, D. Reconstructive surgery on the stumps of the upper extremities. HP: Medgiz, 1956, S. 79-98.

The method of reconstruction of the first finger brush by splitting Megastore gap and skin-muscle plastics, characterized in that it consists of two skin-subcutaneous flap in the first pipestem promo first metacarpal bone, make compactcom in the area of the diaphysis of the stump of the first metacarpal bone with subsequent dosed distraction osteotomies fragment.

 

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