METHOD FOR PLASTIC CHEST WALL DEFECT WITH FULL-LAYER SKIN-SUBJECT-FASCIAL-MUSCULAR FLAP ON THE SUPERGROUND ARTERY Russian patent published in 2022 - IPC A61B17/00 A61B17/03 

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to thoracic surgery. From the lower part of the chest wall wound, an incision is made caudally with a dissection of the skin and subcutaneous tissue along the midline of the abdomen to a level of 10 cm below the navel. Then the incision is continued in the projection of the lateral edge of the rectus abdominis muscle, returning to the beginning of the incision, thereby forming an ovoid flap. The anterior leaflet of the rectus abdominis muscle is dissected, retreating 0.5 cm outward from the midline of the abdomen along the entire length of the wound. The rectus abdominis muscle is separated from the posterior leaf of its vagina, at the level of 10 cm below the level of the navel, the rectus abdominis muscle is crossed to its full thickness. The anterior sheath of the rectus abdominis muscle is dissected along its lateral edge, in the costal arch region, the lateral edge of the anterior sheath of the rectus abdominis muscle with muscle fibers is dissected for 3 cm. The formed flap is moved to the chest wall so that it turns 180°. A perforated drainage tube is placed at the bottom of the wound under the formed graft, which is led out through the skin incision under the left costal arch. The graft is freely placed in the defect, the subcutaneous fat of the graft is fixed to the subcutaneous fat of the edges of the chest wound along the perimeter. Excess skin and subcutaneous fat are excised in the region of its lower part in the projection of the costal arch, while the edges of the wound of the chest and abdominal walls are compared when suturing the skin. Interrupted skin sutures are applied along the perimeter of the graft; in the lower part of the wound of the anterior abdominal wall, the aponeurosis of the external oblique muscle is sutured with a white line of the abdomen with a continuous non-absorbable thread. The wound of the abdominal wall is drained with a perforated tube inserted into the lower part of the wound through a separate skin incision.

EFFECT: method allows eliminating an extensive defect of the chest wall after sternumectomy and resection of the ribs, ensuring the prevention of the development of postoperative ventral hernia after harvesting a full-layer cutaneous-subcutaneous-fascial-muscle flap from the anterior abdominal wall and restoring the integrity of the skin of the chest wall without tension of tissues, which prevents the development of skin necrosis.

1 cl, 1 ex