METHOD FOR RECTIFYING AN ANTERIOR THORACIC WALL WITH A RECTUS ABDOMINIS MUSCLE FLAP Russian patent published in 2020 - IPC A61B17/00 

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to thoracic surgery. Flap is formed with preservation of the feeding vessel, it is moved and fixed to the tissues of the anterior chest wall. Skin-subcutaneous flap is mobilized after an intersection of skin and subcutaneous fat along the median line of the body with the incision extension laterally at angle of 90° to the external border of the rectus abdominis muscle to an external leaf of the abdominal rectus aponeurosis. External leaf of sheath of abdominal rectus is dissected from a median line of a body and separated from muscular fibers. In lower part of wound external leaf of sheath of rectus muscle is dissected laterally along skin incision. At the same level, the abdominal rectus muscle is transected on the clamps in two stages with the caudal portion piercing with non-absorbable ligatures, and the cranial portion with absorbable ligatures. Inferior epigastric vessels are clamped, crossed and ligatured with non-absorbable ligatures. Rectus muscle flap is separated from a posterior leaf of rectus sheath to cross and ligature all perforating vessels. Method includes mobilizing a rectus muscle flap to a fixation point to a costal arch. Lateral portion of the abdominal rectus flap within its fixation to the costal arch is clamped, crossed in the medial direction for 3 cm and sutured with absorbable ligatures. Superior epigastric artery is examined under the control of color duplex mapping. Flap is moved into a defect of the anterior thoracic wall, fixed by absorbable ligatures along the perimeter of the wound to the internal thoracic fascia. Lateral edge of abdominal rectus sheath leaf in area of fixation to costal arch is dissected laterally for 5 cm and laid directly on posterior leaf of sheath of rectus abdominis muscle. Non-absorbable interrupted sutures are used to staple both leafs of rectus sheath along a median line throughout the surgical wound.

EFFECT: method allows eliminating tension during movement of the flap on anterior thoracic wall and, if necessary, increasing its length, assessing the intraoperative blood supply of the muscular flap, preventing compression of the artery feeding flaps, reducing a risk of developing postoperative ventral hernias.

1 cl, 1 ex