Patent RU-2747694-C1 (RU)
Inventor: Karyakin Nikolaj Nikolaevich
IPC: A61B17/15
Filed: 2020-07-17
Granted: 2021-05-12
Abstract: FIELD: medicine. 
     SUBSTANCE: method of skin and bone reconstruction of the finger of the hand consists in using the following guide and cortical-spongy avascular allograft. In the projection of the radial artery, a skin-fat flap of the required size is formed, taking into account the length of its vascular pedicle, with the preservation of the intermuscular septum and septal vessels throughout its entire length, as well as its connections with the radial artery and the periosteum of the radial bone. Then the radial artery is mobilized distal and proximal to the flap, maintaining vascular connections with the periosteum in the area of the proposed border osteotomy of the radial bone. Then the tissues are mobilized along the back and palmar surface of the radial bone in the area of graft collection. In the area of the proposed osteotomy, the palmar part of the guide is applied along the palmar surface of the radial bone in such a way that its central axial hole coincides with the palmar surface of the radial bone, while the intermuscular septum is located in a continuous slot of the palmar part of the guide. Then, in the same way, the back part of the guide is applied to the bone along the back surface, combined with the first one and connected with the help of retainers. The proximal end of the guide is fixed temporarily to the bone with spokes. The radial artery is located on the lateral surface of the guide. Next, with an oscillatory saw, by tightly pressing its blade to the groove of the guide to ensure the prevention of damage to the intermuscular septum with septal and periosteal vessels, connecting cuts of the palmar and back cortical plates are performed, forming a border blood-supplied bone autograft of the navicular shape, connected by septal and periosteal vessels with the radial artery and skin flap. The length of the blood-supplied autograft corresponds to the length of a similar finger of a healthy hand minus the length of the nail plate, the width corresponds to 1/3 of the diameter of the radial bone at the site of its collection, and the thickness is similar to the thickness of the radial bone in the donor area. Then the radial artery is bandaged and crossed proximal to the guide. After that, the spokes are removed, and the parts of the guide are separated from the radial bone in turn, which allows one to preserve the integrity of the intermuscular septum. Then, on the cortical-spongy allograft, a flat platform is formed for the installation of the guide, after which the guide is applied in assembled form and fixed to the allograft platform with spokes. Then, an allograft corresponding to the blood-supplied autograft in shape, direction of the cut plane, length, thickness, but exceeding it in width by 0.5 cm, taking into account the subsequent partial resorption of the avascular graft, is cut out of the cortical-spongy allograft with an oscillatory saw through the guide groove. After that, the avascular bone allograft is transferred to the border defect of the radial bone, completely combining the planes of the cutouts of the allograft and the radial bone. Then preventive bone osteosynthesis of the radial bone is performed with a plate with screws proximal and distal to the border defect and the location of the plate on its palmar surface. After that, the blood-supplied radial bone graft, together with the skin flap, is transferred on the vascular pedicle, represented by the distal part of the radial artery, to the position of the lost finger. Then osteosynthesis of the stump of the finger and the blood-supplied graft is performed with spokes. Next, the soft tissues of the finger are formed from the skin ray flap, after which the donor wound on the forearm is sutured. The guide for longitudinal shaped osteotomy during the collection of the autograft of the radial bone and during the formation of a cortical-spongy non-vascular allograft to replace the resulting border defect of the radial bone contains a groove for installing the saw blade and a central axial hole and consists of two equal combined separable parts, the palmar and back. The guide is made individually according to computed tomography data using 3D printing, depending on the planned size of the graft, so that the guide is at least 1 cm longer than the planned graft at the distal end, and at least 2.5 cm longer at the proximal end. The axial hole precisely corresponds to the external surface of the radial bone in the area of formation of the planned graft. The groove for the saw blade is made of a navicular shape. In the middle, in the area of the distal end of the guide, a continuous slot with a width of 2 mm is made to accommodate the intermuscular septum and the vessels contained therein. At its proximal end, a connecting element of the “protrusion-groove” type and two holes for the spokes are made.  
     EFFECT: inventions make it possible to achieve a precise correspondence of the blood-supplied graft to the specified dimensions of the bone skeleton of the reconstructed finger of the hand, to minimize the donor bone defect of the radial bone and to reduce the risk of its pathological fracture.  
     2 cl, 4 dwg