METHOD OF SURGICAL TREATMENT OF AGGRESSIVE AND LOW-GRADE NEOPLASMS OF THE METACARPAL BONES OF THE HAND WITH PLASTY WITH AN AUTOGRAFT FROM THE ILIAC CREST Russian patent published in 2023 - IPC A61B17/56 

FIELD: medicine; traumatology; orthopedics.

SUBSTANCE: invention can be used for surgical treatment of aggressive and low-grade neoplasms of the metacarpal bones of the hand with plasty with an autograft from the iliac crest. Before performing the surgical treatment, the affected bones of the hand are visualized with the location of the neoplasm, the condition of the surrounding soft tissues, vascular and nervous structures are assessed. With the patient in the supine position, an S-shaped incision of the skin and subcutaneous adipose tissue is performed in the projection of the affected metacarpal bone along the dorsal surface of the hand from the projection of the metacarpophalangeal joint to the metacarpal joint. The neoplasm is accessed by obtuse and sharp way. The tendons of the extensor fingers of the hand running in this zone are isolated and taken on the holders. A revision is performed to confirm the position of the tumor and surrounding anatomical structures, and also to determine the possibility of an intimate fit of the neoplasm to adjacent metacarpal bones. The metacarpophalangeal joint and the metacarpal joint are opened, the affected metacarpal bone with the neoplasm is isolated within healthy tissues and, without opening it, the metacarpal bone is extirpated as a single block with the neoplasm. An incision is made in the projection of the iliac crest, blunt and sharp access to the iliac crest is performed and the iliac crest is isolated from the surrounding tissues. The size of the removed metacarpal bone is determined on the iliac crest for autograft sampling. Using an oscillatory saw, a bicortically spongy autograft with a length corresponding to the removed metacarpal bone and a width of 2–3 cm is isolated. The autograft is cleaned of soft tissue fragments and modeled taking into account the parameters of the implantation zone. The autograft is placed in the area of the removed metacarpal bone ensuring the contact of the autograft with the bones of the wrist. The autograft is fixed with Kirschner wires, while the first wire is passed longitudinally through the proximal phalanx of the corresponding finger, the autograft and the bones of the wrist, then the bone material remaining after the modeling of the autograft is additionally placed between the autograft, the bones of the wrist and the nearest metacarpal bone, the laid autograft is fixed with two Kirchner wires through bone material, two metacarpal bones adjacent to it, in the distal section, fixation is carried out with two Kirschner wires through the autograft and heads of adjacent metacarpal bones. Control of the stability of the position of the autograft and the stability of its fixation, hemostasis are performed during the surgery. The wound is washed with an antiseptic solution and sutured in layers. A morphological study of the preparation of the removed neoplasm is performed.

EFFECT: method ensures reliable restoration of the patient's functional integrity and motor abilities, creates conditions for preventing dislocations of the hand bones, and also improves the patient's quality of life due to the peculiarities of performing surgical treatment.

2 cl, 3 ex