RU2440057C1 - Method of heteroplastic transplantation of finger flexor tendon - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely traumatology and orthopaedics. Injured finger flexor tendons are replaced within a fibrous synovial canal. For the purpose of the plastics, a graft made of a xenopericardial plate in the form of a twisted cylinder with cuffs on its ends and with ligatures along its length is used. The graft is attached to the tendon by ligaturing the graft inside the tendon stem; the ligatures are exteriorised on an external surface and tied together. A suture area is covered and reinforced with the cuffs to be anchored by separate interrupted suturing.

EFFECT: method provides adequate recovery of the lost function of the finger flexor tendons, prevention of potential complications, reduced injures.

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Description

The invention relates to medicine, namely to traumatology - orthopedics.

There are various methods of surgical treatment of injuries of the tendons of the flexors of the fingers. The main one is plastic tendons. The principle of plastic surgery of the flexors of the fingers of the fingers is to remove the ends of the damaged tendon and replace it with a tendon graft with the removal of the tendon suture beyond the fibro-synovial canals.

Among the known methods for treating injuries of tendons of the flexors of the fingers of the hand when they are damaged in the zone of the fibro-synovial canal, autoplasty of the tendons with replacement of the deep flexor along the canal by the autograft of the tendon of the long palmar muscle, tendons of the extensors of the fingers of the foot, tendons of the superficial flexors of the fingers, and the tendon of the extensor extensor 2 finger brush. Attempts to restore tendons often lead to unsatisfactory results [1]. The frequency of unsatisfactory results according to various authors reaches 17.9% -60.8%. The main cause of failure is the fusion of restored tendons with surrounding tissues [3].

The most used method is the excision of the damaged tendon of the deep flexor within the synovial vagina and the replacement of the defect due to the tendon autograft from the superficial flexor of the same finger, the tendon of the long palmar or plantar muscles, the tendons of the long extensors of the toes [4].

The main disadvantage of the known methods of tendon grafting is a violation of the function of the donor organ, due to the operative access and extraction of the tendon graft, as well as the possible congenital absence of the tendon of the long palmar muscle [2, 5].

Of the known closest in technical essence is the method of autoplasty of the tendons of the deep flexors of the fingers when they are damaged in the zone of the fibro-synovial canal [3], according to which during the operation, the damaged flexor tendon of the finger is replaced in the area of the fibro-synovial canal by the tendon of the long extensor of the toe . This method of plastics allows you to replace damaged tendons of the flexors of the fingers.

However, with plastic surgery according to the above method, a number of disadvantages are noted. Autografts are taken without paratenon, which increases the likelihood of their fusion with surrounding tissues on the finger. Finger extensor tendon harvesting from the foot entails impaired toe function.

The aim of the invention is the creation of a highly effective way to restore the tendons of the fingers of the hand, which allows you to fully restore the lost function of flexion of the finger and prevent possible complications. The technical result of the proposed method is the restoration of a deep flexor tendon using xenopericardium as a prosthesis.

The essence of the proposed method lies in the fact that as a plastic material a graft is used, which is a rectangular plate 0.5 mm thick made of enzymatically treated cattle pericardium (xenopericardium). The xenopericardial plate is rolled into a roll with a diameter of 5 mm, along the length of which inside there are two ligatures with a length of up to 200 mm (Figure 1). At both ends of the graft, rectangular equal-sized cuffs are cut 15 mm wide and 10 mm long. The connection of the graft to the tendon is carried out by carrying out the ligatures of the graft inside the trunk of the tendon to a length of 10 mm (Figure 2), bring them to the outer surface and tie them together. The seam area is covered and strengthened by cuffs that are hemmed with separate interrupted sutures (Figure 3).

This method of surgical treatment allows you to perform tendon plastic without taking plastic material and thereby does not violate the function of donor organs.

The proposed method of plastics tendon deep flexor is illustrated by drawings. Figure 1: 1 - xenograft; 2 - xenograft cuff; Figure 2: 3 - fixing ligatures. Figure 3: 4 - tendon; Figure 4: 5 - individual nodal joints on the cuff of the xenograft.

Information sources

1. Golubev I.O. Tendoplasty with blood-supplied tendon grafts // Annals of plastic, reconstructive and aesthetic surgery. 1998. No. 1. S.38-47.

2. Demichev N.P. Unresolved issues of reconstructive surgery of the tendons of the hand // Orthopedics, traumatology, prosthetics. 1975. No5. S.75-81.

3. Klyukvin I.Yu., Miguleva I.Yu., Okhotsky V.P. Hand injuries / - M .: GEOTAR-Media, 2009.192 p.

4. Kolontay Yu.Yu., Panchenko MK, Andruson M.V. // Open brush damage. Kiev: "Health". 1983. S. 115-117.

5. Miguleva I.Yu. Treatment of complications of plastic surgery on the flexor tendons // Surgery im. N.I. Priorova. - 1996. No. 2. - S. 92-96.

Claims (1)

Method of xenopericardial plastic surgery of the flexors of the fingers of the fingers, including prosthetics of damaged tendons of the flexors of the fingers in the area of the fibro-synovial canal, characterized in that the plastic material used is a transplant, which is a rectangular plate 0.5 mm thick from enzymatically treated cattle pericardium fixed with glutaraldehyde, rolled up into a roll with a diameter of 5 mm, along the length of which inside there are two ligatures up to 200 m long m, and at both ends rectangular rectangular cuffs were cut 15 mm wide and 10 mm long, the graft is connected to the tendon by means of graft ligatures inside the tendon trunk for a length of 10 mm with their exit to the outer surface and tying together, after which the seam area is covered and strengthened by cuffs that are hemmed with separate interrupted sutures.

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