FALANGIZATsIYa (Greek phalanx, phalangos a joint of a finger, a phalanx) — the plastic surgery consisting in splitting pyastya on interosseous intervals and mobiles -
zation of metacarpal bones for the purpose of improvement of function of a stump of a brush.
For the first time F. carried out in 1852 Mr.
of P. Ch. Huguier. However the way did not find supporters and was forgotten. In 1912 R. Klapp described F. under the name «artificial assignment of the I metacarpal bone». G. Pertes (1921) for the first time at F. suggested to close a bottom of an interdigital interval a skin rag on the temporary feeding leg, and at hems — to resect the II metacarpal bone for improvement of function of a stump of a brush.
In the USSR the first F. V. G. Shipachev (1918) by races -' Began to carry out
Fig. 1. The diagrammatic representation of a falangization of the first metacarpal bone on the first (I) and second (II) ways of Parin: and — lines
of a section of soft tissues on a palmar surface of a brush; — lines of a section of soft tissues on a dorsum of a brush; in — a type of a brush from a dorsum after suture; black painted over sites of excision of fabrics, shading showed the field of closing of wound defect with a free skin transplant; I \on palmar and back surfaces of a brush create rags 1 and 2, excise soft tissues between the first and second metacarpal bones, a rag 1 close wound defect in the first metacarpal bone, a rag 2 — a bottom of the created interdigital interval; wound defect in the second metacarpal bone is closed a free skin transplant; II \on palmar and back surfaces of a brush create rags 1, 2 and 3\rag 1 close wound defect in the mobilized first metacarpal bone, a rag 2 — a bottom of the created interdigital interval, a rag 3 — the most part of wound defect in the second metacarpal bone; the rest of wound defect in the second metacarpal bone is closed a free skin transplant.
sections of interosseous intervals pyastya that allowed it to create three - four - or a five-fingered brush. G. A. Albrecht (1921) suggested to carry out F. with formation of triangular skin rags, excision of the first back interosseous muscle and change of the place of an attachment of the muscle leading a thumb of a brush to the basis of the I metacarpal bone. In the subsequent a number of improvements by V. N. Blochin is brought in technology of operation (see t. 5, additional materials), B. V. Parin, H. N. Priorov, G. D. Shushkov, L. Kreuz, J. Zoltan, Ya. Holevi-chem, to-rye at F. used different types of skin plastics (see).
T. it is shown in the absence of fingers of a brush of any etiology.
Depending on age of the patient, extent of deformation of a stump, volume of an operative measure F. carry out under anesthetic, conduction or futlyarny anesthesia.
Special preoperative preparation is not required.
At hems in the field of top of the first interosseous interval pyastya the best functional results are provided by Parin (1939) way, at Krom apply the combined skin plastics (fig. 1). However plastic opportunities of two skin rags at F. do not allow to recover function of a stump of a brush fully. In this regard B. V. Parin in 1958 offered the second way F., based on formation in an interosseous interval of three skin rags (fig. 1,//). Substitution
by a trapezoid rag of defect on a working surface of the II metacarpal bone provides preservation of skin sensitivity, but at the same time the shift and shortening of an interdigital interval in connection with scarring of freely implanted skin is possible. To avoid this complication, V. V. Azolov (1977) offered a way F., based on movement in an interosseous interval pyastya four triangular rags. At the first option of this way find three skin rags on a palmar surface and one — on back; the second option is based on closing of wound defects with the symmetric skin rags created up to two on each party stumps. Excision by the first back interosseous and the first worm-shaped muscles, and also an angle head of an adductor is obligatory.
Insufficient length or different size of metacarpal bones reduce
FALLO the TETRAD of 183
Fig. 2. Hands of the patient working with the hammer and a chisel after a falangization of the first metacarpal bones.
functional result of F. V such cases F. it can be added with lengthening of metacarpal bones by means of skin and bone plastics or distraction, and also by change of the next metacarpal bones or free change of a finger from foot by means of the microsurgical equipment (see Microsurgery, Replantation).
After operation the extremity is fixed a plaster splint for
10 — 15 days, and the hand is given sublime situation. The active and passive movements begin after a removal of sutures. Functional results F. usually good (fig. 2).
See also Plastic surgery.
Bibliography: And z about l about in V. V. Dva spo
a soba of a falangization of 1 metacarpal bone, Vestie, hir., t. 118, No. 3, page 93, 1977; The Multivolume guide to surgery, under the editorship of B. V. Petrovsky, t. 11, book 1, page 345, M., 1960; G1 and r and B. V N. Reconstruction of fingers of a hand, M., 1944; H u g and i-e R. S. of Considerations anatomiques et physiologiques pour servir a la chirurgie du pouce, Arch. gen. Med., t. 1, p. 54, 1874 V. V. Azolov.