RU2556616C1 - Method of metacarpophalangeal articulation transplantation for substitution of third finger defect - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: own finger artery, dorsal vein and own finger nerve of the fifth finger are cut and bandaged. A common finger artery of the transplant is sutured with own finger artery of the third finger stump. The dorsal vein of the transplant is sutured with the dorsal vein of the stump. Own finger nerve of the transplant is sutured with own finger nerve of the stump.

EFFECT: method improves results of treatment due to the correspondence of dimensions of the transplanted finger vessels to the dimensions of the vessels of the recipient area.

5 dwg

Description

The invention relates to medicine, namely to traumatology and orthopedics, and can be used to replace defects of the third finger.

A known method of transplantation nekrovosnabzheniya bone autograft to replace the bone defect of the victim. The graft is formed from the bone of the patient himself and transplanted into the area of the bone defect. The limb is immobilized with a plaster cast until the graft merges with the recipient bone bed (VD Chaklin. Bone grafting. - M .: Medicine, 1971. - Chapter 4. Bone grafting with fresh fractures, delayed consolidation and pseudarthrosis. - P.37 -63). However, the described method has significant disadvantages. The transplanted bone autograft resolves and secrete necrohormones that activate osteogenesis. This requires prolonged immobilization with a plaster cast. Complications such as fracture of a transplanted graft or its resorption, which leads to failure of the surgical intervention, can occur.

Closest to the proposed method according to the technique of performing the operation is a method of transplanting the big toe to replace the amputated first toe. Arteries, veins, nerves, and also tendons of the transplanted finger cross. A recipient bone bed is prepared - an edge resection of the finger stump is performed to obtain contact between the stump and the graft. Allocate vessels, nerves and tendons of the stump of the finger of the hand. Bandage the vessels of the stump. The graft is transferred from the foot to the stump of the finger of the hand and fixed with their needles. JR Cobbet Free digital transfer: report of a case of transfer of a great toe to replace an amputated thumb. J. Bone Joint Surg. - 1969 stitch vessels, nerves and tendons of the stump of the finger of the hand with vessels, nerves and tendons of the transplanted toe. - Vol. 51, No. 4. - P.677-679).

The published method has the following disadvantages. The shape of the transplanted finger does not match the shape of the fingers of the hand. The size of the vessels of the transplanted toe does not correspond to the size of the vessels of the fingers. A transplanted toe violates the jerking function and the function of the roll of the foot. All this negatively affects the results of the engraftment of the transplanted toe.

The technical result of the invention is to improve the results of treatment of patients due to the fact that the shape of the transplanted finger corresponds to the shape of the remaining fingers, the size of the vessels of the transplanted finger corresponds to the size of the vessels of the remaining fingers. Do not transplant the toe, in connection with which the jog function and the function of rolling the foot are preserved. Do not use the laborious and traumatic operation of the transplantation of the toe to the brush.

The solution to this problem is provided by the fact that in the method of transplanting the fifth metacarpophalangeal joint to replace a defect of the third finger of the hand, including the intersection of arteries, veins, nerves, as well as tendons of the transplanted finger, placing the graft in a bone defect, fixing the transplanted finger to the cultured finger, a suture of vessels, nerves and tendons, cross and bandage your own digital artery and dorsal vein, cross your own digital nerve, and also suture the common digital trans artery Tata with its own finger artery stump of the third finger, the back of a vein graft from the back of the vein stump as well as your own finger nerve graft with its own digital nerve stump.

Improving the results of treatment is achieved by matching the shape of the transplanted finger to the shape of the fingers of the hand and matching the size of the vessels of the transplanted finger to the size of the vessels of the recipient area.

The invention is illustrated in figures 1-5. The figures depict:

Figure 1. View of the left hand before surgery. The projection of blood vessels and nerves.

Figure 2. The projection of the veins of the rear of the hand.

Figure 3. Radiographs of the left hand of patient E. before surgery.

Figure 4. Type of brush 2 months after surgery.

Figure 5. Radiographs of patient E. 2 months after surgery.

The method was performed as follows. One of the main veins of the rear of the hand 5-7 cm long was isolated with a cut of 10-12 cm along the back surface of the hand in the fourth intercarpal space. A second cut along the palmar surface of the hand with a length of 8-10 cm was allocated to the own and common digital arteries to the place of their departure from the superficial arterial arcs. The own palmar digital nerve was isolated by dissecting it under a microscope from the trunk of the common digital nerve of the IV-V finger to the base of the palm. Worm-shaped and interosseous muscles were cut off from the fifth metacarpal bone. Crossed obliquely fifth metacarpal bone at its base. Bandaged and crossed the back veins of the hand and digital arteries. The donor wound was sutured and drained. A recipient bed was prepared: two skin-fascial flaps were formed on the cult of the third finger to close the graft. The distal part of the main phalanx of the third finger was resected so that the transplanted joint was in the orthotopic position — five millimeters distal to the proximal interphalangeal joint of the second finger of the hand. They sawed the proximal part of the graft and fixed it to the stump of the main phalanx with two crossed knitting needles. The arteries and veins of the graft were sutured with the arteries and veins of the stump of the third finger. The restoration of blood flow was monitored with a Siemens MicrO ₂₊ JPX1 micropulse oximeter measuring percent oxygen saturation of the transplant tissue (saturation). After restoration of blood flow, nerves were sutured. Defects in the integumentary tissues were replaced by fascial-skin fascial flaps formed on the cult of the third finger. The tendons of the graft and third finger of the hand were sutured. The brush was immobilized with a plaster long. The spokes were removed after the fusion of the metacarpophalangeal joint of the fifth finger with the stump of the main phalanx of the third finger.

CLINICAL OBSERVATION

E., 26 years old, IB 56537 was admitted to the hospital for post-traumatic stumps of the III, IV, V fingers of the left hand at the level of the proximal interphalangeal joints (Figs. 1, 2, 3). Mechanical injury by a cable occurred on 10/04/13. An operation was performed according to the proposed method on 06/12/13. The postoperative course is smooth. Inspected January 27, 2014 (figure 4). The standing of the fragments is correct (figure 5). There is a gap between the transplanted graft and the main phalanx of the third finger. Immobilization continued.

According to this technique, 5 patients were operated on. Everyone has achieved a positive result.

Claims (1)

 The method of transplanting the fifth metacarpophalangeal joint to replace the defect of the third finger of the hand by forming a graft including the metacarpophalangeal joint, placing the graft in the defect of the finger located through one, followed by fixation, characterized in that it crosses and bandages its own digital artery, the back vein and the fifth finger’s own nerve nerve, cross-link the common digital graft artery with the third finger’s own stump artery, the back vein of the graft with the back a stump vein, as well as a transplant's own digital nerve with a stump's own digital nerve.

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