From Big Medical Encyclopedia

KRUKENBERG HAND (The N of Krukenberg, is mute. the surgeon, 1863 — 1935) — the stump of a forearm split by an operational method on two mobile parts (branches) adapted for prehensile movements. Operation is offered by Krukenber-g in 1917 for patients at whom both brushes with distal department of a forearm are amputated. The idea about cinematization of a prosthesis of an artificial hand which is put forward in 1889 Mr. of G. Vanghetti is the basis for operation of Krukenberg.

Krukenberg made active prehensile body which, unlike a prosthesis, has tactile sensitivity of a stump of a forearm. Krukenberg's operation is for the first time manufactured in the Soviet Union by V. H. Rozanovym in 1922

Technology of operation

the Ratio of muscles in «claw» after operation on Krukenberg (semi-schematical): 1 — a humeral muscle; 2 — a long palmar muscle; 3 — a beam sgibatel of a wrist; 4 — an elbow razgibatel of a wrist; 5 — a superficial sgibatel of fingers; 6 — a beam bone; 7 — a beam razgibatel of a wrist; 8 — the round pronator; 9 — a humeroradial muscle; 10 — an instep support; 11 — a biceps of a shoulder.

Operation was made in two stages. On the middle by palmar and a dorsum of a forearm did the H-shaped section of skin. The general razgibatel of fingers divided into two parts — beam and elbow, a superficial sgibatel of fingers — on beam and elbow speak rapidly. Elbow parts of a superficial sgibatel of fingers and an elbow sgibatel of a wrist were sewed in the form of a loop with a razgibatel of fingers and an elbow razgibatel of a wrist. Arrived also with beam parts of muscles (fig). On the ends of bones created fillets in the lokteluchevy direction in which stacked both tendinous loops. The beam branch was completely closed skin of a forearm, defect of skin on an elbow branch — a rag on a leg.

In the subsequent time, especially in days of the Great Patriotic War, the Soviet surgeons brought considerable improvements in a technique of operation of Krukenberg. Two-stage operation is turned in one-stage thanks to use skin and a myoplasty (G. A. Albrecht, 1928 — 1930; B. I. Berliner, 1946; D. I. Gritskevich, 1948; G. D. Shushkov, 1955) or to a way of closing of defect of skin of an elbow branch of a claw with a perforated rag (B. I. Parin, 1944). Ya. L. Povolotsky (1943), rationally using muscular groups, achieved improvement of kinematics of a claw. V. G. Shchipachev (1943 — 1946), V. I. Filatov and S. A. Regentov (1978) developed a number of the osteoplastic operations improving the prehensile movements. In modern practice the great value is attached to preoperative preparation and postoperative exercises on which the result of operation considerably depends. The set of exercises gives the chance, using hidden funkts, possibilities of a stump to develop the new uslovnoreflektorny bonds necessary for the fastest development by the patient of coordination of prehensile movements of claws. Massage and the persistent sparing systematic extension prepare a stump for carrying a prosthesis.

The modern method of a kineplasty of a forearm consists in the following. Operation is performed under anesthetic or a futlyarny "squirt-and-cut" technique. On a shoulder impose a ribbon yarn. The section of skin shall provide full closing with a branch with skin of a stump without tension and damage of cutaneous nerves and vessels. The pattern of a rag shall provide an arrangement of hems out of a prehensile surface with a branch at good overlapping of a crack between branches of a claw. When for closing both are not enough with a branch of skin, the section is done closer to an ulna, and for closing of defect of skin on an elbow branch replace a free perforated rag. On the line planned before operation cut skin with hypodermic cellulose. The fascia of a forearm on the flexion party is cut on edge of a palmar muscle, on the back of a stump — in the area of a skin section. As a part of a beam branch leave the following muscles: instep support, round pronator, humeroradial, beam sgibatel of a wrist, long palmar, short and long beam razgibatel of a wrist; on an elbow branch — an elbow sgibatel and a razgibatel of a wrist. All other muscles of the flexion side of a forearm exsect, without injuring elbow and beam arteries and an elbow sgibatel of a wrist. The interosseous membrane is cut under control of sight in close proximity to a beam bone.

The following stage of operation is separation and excision of muscles of the back of a stump. Razgibatel of fingers otseparovyvat from his fascial bed throughout and delete. The back interosseous artery is removed together with an elbow razgibatel of a wrist aside. The long muscle which is taking away a thumb short and long razgibatel of a thumb and a razgibatel of an index finger, cut a scalpel so that on a bone there were only traces of muscular tissue; then these muscles lump separate from an interosseous membrane and exsect together with rubtsovo the changed sinews. Branches carefully part up to 10 — 12 cm at top; at the same time the remains of an interosseous membrane are broken off. Under a superficial sgibatel of fingers allocate a median nerve and cut at the level of a proximal corner of a wound. For a good skhvatyvaniye of small objects the ends a branch create so that they deviated a little inside. After removal of a plait make a full hemostasis. Operation is finished with sewing together of skin over again formed branches. At a tension of skin do small notches. The elbow joint is fixed in the provision of bending at an angle 50 °. To the second day after operation appoint to lay down. the gymnastics directed to development of movements of claws on a direct skhvatyvaniye. The set of exercises is aimed at the development of coordination and only after achievement of full effect in the beginning — at development of force of prehensile movements. After persistent exercises the prehensile movements reach the sufficient force and big accuracy; operated completely themselves service. Irrespective of funkts, ability of a stump after splitting of a forearm of patients can supply with prostheses of hands. The active prehensile movements by prostheses are made by reduction or assignment of beam «finger».

See also Stump of an extremity , Forearm .

Bibliography: V. N. Ruk Krukenberga's rose trees, It is new. hir. arkh., t. 3, No. 3-4, page 552, 1923; Filatov V. I. and Regentov S.A. Kineplasty of a forearm, Ortop, and travmat., No. 7, page 21, 1978; Sh at sh-to about in G. D. Reconstructive operations on stumps of upper extremities, page 137, L., 1956; Krukenb erg H. t)ber plastische Umwertung von Amputationsstiimp-fen, Stuttgart, 1917; about N of e, Zur Kruken-berghand, Zbl. Chir., Bd 55, S. 222, 1928.

T. P. Bogdanov, A. A. Kurilo.