METHOD OF TENDON-MUSCULAR TRANSPOSITION IN OLD INJURIES OR CHRONIC NEUROPATHY OF PERONEAL NERVE Russian patent published in 2025 - IPC A61B17/56 

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to traumatology and orthopaedics, and can be used for tendon-muscle transposition in old injuries or chronic neuropathy of peroneal nerve. With the patient in the supine position and with the pneumatic cuff applied, the first incision is made along the inner surface of the foot in a projection of the medial sphenoid bone. Tendon of the posterior tibial muscle is bluntly and sharply separated, the non-absorbable polyfilament suture of thickness 0 used as a holder is stitched, and the tendon is dissected away. Tendon of a long flexor of II-V toes is separated. It is stitched with a retaining suture and cut off. Second incision of the skin is performed along the inner surface of the shin at the level of a middle one-third; an external fascia is dissected, and the muscles whose tendons are cut off on the foot are approached. They are separated in the proximal direction and the ends of the tendons are brought out into the wound. Canal is formed in the interosseous membrane at the level of a distal one-third of the shin, and a third skin incision is made on an anteroexternal surface of the distal one-third of the shin to transfer the cut tendons. Fourth wave-like incision of the skin is performed along the dorsal surface of the foot, through which the tendons of the long extensor muscle of the first toe and the tendons of the long extensor muscle of the toes are separated. From the wound of the anteroexternal surface of the distal one-third of the shin, the ends of the tendons are brought into the wound of the dorsal surface of the foot subcutaneously with the help of a forceps. Tendon of the anterior tibial muscle is separated in the wound on the back of the foot, and the dissected tendon of the anterior tibial muscle is dissected through the wound along an anteroexternal surface of the distal third of the shin and dissected at the level of tendon-muscular junction 14-15 cm long, at the level of a middle one-third of the III metatarsal bone. Canal is formed by a blunt method around the bone, and a tendon of the anterior tibial muscle is grafted around a middle one-third of the instep bone with the help of a Deschamps needle and a ligature loop. Suture of the distal end of the tendons of the posterior tibial muscle with the ends of the "loop" of the graft of the anterior tibial muscle in the foot extension position in ankle joint 90°-80° and alternate suture of distal end of long flexor muscle of toes with tendons of denervated long extensor muscle of I toe and long extensor muscle of II-V toes according to Pulvertaft. Layer-by-layer sutures on foot and shin wounds with leaving passive drains. Limb is immobilized in the posterior plaster splint in the foot extension position in ankle joint 90° from distal phalanges to proximal one-third of shin. On 3rd-4th day, the patient is verticalized with support on crutches. On 5-7th day from the moment of operation, isometric tensions of the transposed muscles are started. Limb immobilization for 8 weeks.

EFFECT: method provides restoration of active extension of foot and toes, correction of foot varus, centralization of foot axis during fixation by III metatarsal bone, as well as improved patient’s quality of life due to use and peculiarities of tendon transplantation.

1 cl, 3 ex