Myoplasty: muscle transplantation
Surgical transposition of muscle tissue is divided into two fundamentally different categories depending on its relationship to the neurovascular bundle.
Pedicled muscle transplantation The main condition for the success of such an operation is the strict preservation of the graft's original blood supply and innervation. The use of tissue flaps nourished by their own artery allows for the reliable replacement of even very extensive defects. Main indications:
- Plugging of pathological cavities: filling bone defects in chronic osteomyelitis, as well as closing bronchial fistulas.
- Regional plasty: restoration of abdominal wall integrity, closure of inguinal and linea alba hernias, and surgical correction of anal sphincter incompetence.
Free muscle transplantation Unlike pedicled flaps, free muscle fragment transplantation is used for other purposes. First and foremost, this is effective biological hemostasis — stopping bleeding from injured parenchymal organs. Free muscle fragments are also used to plug traumatized dural venous sinuses.
Tenoplasty: tendon repair
The main goal of tendon and fascia reconstruction is to restore lost limb function or compensate for the work of a paralyzed muscle group. For this purpose, an implantation technique is used: tendons of adjacent, fully functioning synergistic muscles are sutured into the paralyzed muscles.
A direct indication for tenoplasty is tendon rupture. The choice of surgical tactics depends on the nature of the injury:
- Primary suture. Applied in cases where there is no tissue defect and the ends of the tendon can be approximated without tension.
- Local plasty. Indicated in the presence of diastasis — significant separation between the ends of the ruptured tendon. To bridge the resulting defect, the surgeon creates special flaps directly from the injured tendon itself.
Fascioplasty
Plastic surgery using fascial tissues is widely demanded in reconstructive surgery due to the high strength and elasticity of this material.
Materials used:
- Free fascia lata graft (fascia lata) — harvested from the patient.
- Conserved fascial allografts — donor tissues that have undergone special processing.
Areas of application of fascioplasty:
- Strengthening weakened or damaged joint capsules.
- Replacement of dural defects (dura mater).
- Creation of an artificial rectal sphincter in case of incompetence.
- Plastic closure of tissue defects in spinal hernias (spina bifida).
- Surgical treatment of abdominal wall hernias.
For quick memorization of indications for fascioplasty, use the abbreviation SGDS: S — Joints (capsule reinforcement) G — Hernias (abdominal and spinal — spina bifida) D — Dural membrane (dura mater) S — Sphincter (rectal)
Class and exam questions
What is the difference between pedicled muscle transplantation and free muscle grafting?
A pedicled flap retains its artery and innervation, allowing it to engraft and close large defects (cavities in osteomyelitis, hernias). Free grafting involves complete detachment of the muscle fragment and is used primarily to stop bleeding from parenchymal organs.
When is a primary suture insufficient for a tendon rupture?
Primary suture is ineffective in the presence of diastasis — separation of tendon ends with a tissue defect. In such cases, local plasty with the creation of replacement flaps from the tendon itself is required.
Where is autologous material for fascia plasty most commonly harvested from?
The most popular source of the patient's own tissue is a free fascia lata graft (fascia lata).
What else to study on this topic
- Techniques for flap creation in tendon diastasis
- Technique of muscle plugging of bone cavities in chronic osteomyelitis
- Creation of an artificial anal sphincter
- Methods of harvesting and preservation of fascial allografts
- Surgical anatomy of the fascia lata
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Other topics in "CHAPTER 17. PLASTIC (RECONSTRUCTIVE) SURGERY"
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