METHOD FOR MULTILAYER PLASTY OF MEDIAN CHEST WALL DEFECT AFTER ITS EXTENSIVE RESECTION Russian patent published in 2024 - IPC A61B17/00 A61B17/03 

FIELD: medicine.

SUBSTANCE: invention refers to medicine, particularly to thoracic surgery. Wound debridement, removal of nonviable soft tissues, sections of handle, body and xiphoid process, rib cartilages are performed. Peritoneum is opened in the lower part of the wound. Strand of a greater omentum on a left gastroepiploic artery is separated and mobilized. Flap of the greater omentum is moved into the defect of the chest wall. In a projection of the right rectus muscle, a full-thickness skin-subcutaneous-fascial-muscle flap is formed on the right superior epigastric artery with the length and width corresponding to the size of the defect of the chest wall. Lower epigastric vessels are separated, clamped, ligatured and transected in the lower part of the wound of the anterior abdominal wall. All perforating vessels extending from the lower surface of the full-thickness flap are transected and ligatured. Intraoperative Doppler ultrasound is used to confirm the presence of arterial blood flow in the superior epigastric artery. Full-thickness flap is moved into the defect of the chest wall and placed on the flap of the greater omentum. Perforated drainage tubes are inserted into the mediastinum under the flap of the greater omentum and under the full-thickness flap of the rectus abdominis muscle, which are brought out through separate incisions in the left hypochondrium. Peritoneal defect is closed in the lower part of the chest wound with a continuous absorbable suture. At the level of the anterior abdominal wall, a polypropylene prosthesis of the appropriate size is sutured into the diastasis between the edges of the outer sheet of the sheath of the right rectus muscle. It is fixed along the periphery in the medial part of the wound to the midline of the abdomen, in the lower and lateral parts — to the external leaf of the sheath of the right rectus muscle, in the upper part — to the posterior leaf of the sheath of the right rectus muscle. Performed laparotomy area is reinforced by fixing the prosthesis to an external leaf of the sheath of the left rectus muscle. Perforated drainage is installed on the polypropylene prosthesis and brought out in the lower part of the wound through a separate skin incision. Wound of the anterior abdominal wall is closed in layers. Strand of a greater omentum is fixed to a thoracic fascia with absorbable sutures. Full-thickness skin-subcutaneous- fascial-muscle flap of the right abdominal rectus muscle is fixed to the edges of a chest wall wound. Skin edges of the wound are matched. Skin is closed with separate interrupted sutures.

EFFECT: method enables filling the defect of the chest wall with autologous tissues without tensioning the edges of the skin wound, as well as achieving stabilization of the sternocostal frame.

1 cl, 2 ex