pedicled muscle flap filling

The disadvantage of gypsum sealing therapy is that it has a heavy odor and a long course of treatment. Patients are often reluctant to receive treatment; some patients are neither suitable for disc surgery nor gypsum sealing therapy. The pedicled muscle flap filling is based on the removal of the lesion, filled with a pedicled muscle flap near the bone cavity, destroying the dead space, and suturing the wound in one stage. This method can shorten the course of treatment, reduce the removal of normal bone and maintain the firmness of the bone. It is an ideal treatment. Treating diseases: chronic osteomyelitis Indication There is a wealth of healthy muscles around the bone cavity (such as femur, tibia and tibia, humerus, iliac crest, proximal ulna) chronic osteomyelitis, pedicle muscle flap filling is optional. The muscles lacking muscles, distal ulna, anterior medial humerus, metacarpal, phalanx, calcaneus, etc., as well as weight-bearing bones with excessive bone defects, should not be used. Excessive purulent secretions or skin defects, wounds can not be sutured in one period, and should not be used. Preoperative preparation Mainly the selection and design of the muscle flap: 1. The pedicled muscle flap should in principle be taken from the closest and largest muscle to the bone cavity in order to fill the bone cavity nearby. According to the needs, the muscle flap is generally 5 to 15 cm long and 1 to 4 cm in diameter, but its length should not be greater than 6 times the diameter to ensure sufficient blood supply of the muscle flap. 2. When taking muscle from muscles with independent functions, do not exceed 1/3 of the total muscle volume. If the bone cavity is large and one muscle flap is not enough, it can be taken partly from the other muscle. 3. Muscles are small and functionally important. They should not be used as muscle flaps to avoid functional obstruction or deformity. 4. The muscle flaps that can be taken in the bone cavity of each part are shown in Table 1. 5. The pedicled muscle flap has three types: proximal pedicle, distal pedicle and bilateral pedicle. The proximal pedicle muscle flap has the best blood supply, and this method is commonly used in clinical practice. The bilateral pedicle muscle flap is suitable for those with long bones in the bone cavity. Surgical procedure 1. Position, incision, and exposure: same as bone removal. 2. Handling the dead cavity: the removal of the dead bone and the repair of the bone cavity are the same as the removal of the dead bone. The lesion should be removed thoroughly and have an open, well-blooded bone bed. 3. Forming the muscle flap: After thoroughly washing the bone cavity and the wound, replace the gloves and surgical instruments, re-sew the sterile small surgical towel, and place the antibacterial drug in the bone cavity. Extend the skin incision and cut the fascia according to the length and width of the desired muscle flap. Fully expose the muscle abdomen, separate the muscle fibers with a hemostatic forceps, insert the finger in the direction of the muscle fiber for blunt separation, and cut the distal end of the muscle flap at the appropriate length. When taking the muscle flap, it should be noted that the muscle flap should not be too far away from the bone cavity to avoid excessive tension and affect blood supply; it is necessary to retain the nerves and blood vessels supplied to avoid damage. 4. Muscle flap filling: Fill the muscle flap into the bone cavity, and the pedicle of the muscle flap can not be flexed and twisted to avoid blood flow disorder. A number of needles can be intermittently sutured between the bone edge and the muscle flap to prevent muscle displacement. 5. Wound treatment: generally can be used for one-stage suture. If the bone cavity is not filled, the rubber sheet should be drained. If there is a large gap in the site of the muscle flap and can not be eliminated, another small skin incision can be made, and the rubber sheet is drained to avoid fluid accumulation and infection.