Patent RU-2739693-C1 (RU)
Inventor: Kozhevnkov Oleg Vsevolodovich
IPC: A61B17/56
Filed: 2020-06-19
Granted: 2020-12-28
Abstract: FIELD: medicine. 
     SUBSTANCE: invention refers to medicine, namely to traumatology and surgery and can be used for surgical correction of congenital flat-valgus foot deformities in children. In the preoperative period prior to the surgical management, spatial visualization of the congenital flat-valgus deformation of the patient's foot is determined by multilayer helical computed tomography. Method of magnetic resonance tomography is used to assess the condition of surrounding soft tissues, vascular and nerve structures that are not visualized when multilayer helical computed tomography is performed. After the anesthesia is performed, a patient's back is presented with an arcuate skin incision 6-7 cm long on the posterior surface of the shin in a projection of an Achilles tendon. Base of the incision is oriented to the lateral part of the shin, the Achilles tendon is accessed, and the paratenon is opened. Achilles tendon is lifted on narrow elevators and the scalpel is incised in lengthwise direction of the Achilles tendon for 4-5 cm. Medial portion of the dissected Achilles tendon is used to isolate a longitudinal flap over the entire incision length, the medial portion of the Achilles tendon and the medial flap are proximally dissected away. Lateral flap is distally distal to Z-shaped elongation of Achilles tendon. Deep fascia of shin is opened and access to ankle and subtalar joints is opened. Ankle and thresher arthropathy capsulotomy is performed. Second incision 3-4 cm long is made on the lateral foot surface in the projection of the insertion point of the tendon of the short fibular muscle into the tuberosity of the fifth metatarsal bone. Tendon of the short fibular muscle is separated, cut off from the attachment point and sutured. In the wound of the first incision on the posterior surface of the shin one differentiates the tendon of the short fibular muscle and leads it to the wound along the posterior surface of the shin with traction on the elevator. Billroth’s clamp is used to form a canal in the tibiofibular syndesmosis on an anterior shin surface, where third linear 1, 5 cm incision of the skin at the clamp top is performed. Tendon of the short fibular muscle is delivered through the formed canal in the tibiofibular syndesmosis onto a front surface of the shin and brought into the third skin incision. Then the fourth arc-shaped skin incision is made along an internal surface of the foot with length of 6-7 cm; the base of the incision is oriented towards the rear, in a projection of the talonavicular joint. In the direction of the tarsal canal, the approach to the talonavicular and talocalcaneal joints is performed, the talonavicular and talocalcaneal joints are dissected by dissecting their capsules in a horizontal plane. Talus bone is sharply mobilized from a capsule in the neck area. From the back approach, the first fixing pin is delivered through a talus bone from behind-ahead, from the outside to the inside in the direction of the neck and head of talus bone. Foot is given a correction position with recovery of the height of the internal longitudinal arch and holds the forefoot in the correction position. First fixing wire is taken further into the navicular bone with fixation of an talus bone with navicular bone with one fixing wire in the position of midfoot correction. Calcaneal tubercle is brought up using a single-tooth crochet with restoration of the anatomical relationship between a heel, an ankle and a tibia. From the plantar surface of the foot through the calcaneal bone in the direction of the shin bone, two additional wires in the sagittal plane are additionally provided with fixation of the calcaneal, ankle and shin bones in an anatomically correct position. Billroth’s clamp is carried out from the medial surface of the ankle neck through the joint capsule under the extensor tendon holder in the direction of the third incision. Tendon of the short fibular muscle is grasped, held under the extensor tendon holder and brought out into the projection of the collar of the talus, then into ankle neck from medial side, as close as possible to the facet joint facet of the head, anchor fixation anchor with threads is introduced, to which tendon of short fibular muscle is fixed in tension position. Distal portion of the tendon of the short fibular muscle is transossally sutured with a suture to a back-medial surface of the navicular bone, closer to its tuberosity, with creation of an additional talonavicular ligament. Longitudinal flap is made from a medial part of an Achilles tendon along a medial foot surface by means of a Billroth’s clamp above a foot flexor tendon holder and anchored to the distal part of the tendon of the short fibular muscle in the region of the tuberosity of the navicular bone with creating an additional calcaneonavicular ligament. Talonavicular ligament is restored by suturing with creation of duplicate. Achilles tendon is sutured in a moderate end-to-end position. Postoperative wounds are closed in layers, aseptic wound dressings, immobilized with plaster bandage from metacarpophalangeal joints to upper third of shin. 
     EFFECT: method provides anatomical recovery of the foot shape and support function due to the sequence of the method steps. 
     1 cl, 3 ex