From Big Medical Encyclopedia

TIHOVA-LINBERGA OPERATION ( P. I. Tikhov , domestic surgeon, 1865 — 1917; B. E. Linberg, owls. surgeon, 1885 — 1965; synonym mezhlopatochno-chest resection) — the surgery consisting at a distance the proximal end of a humeral bone together with a clavicle, a shovel and a shoulder joint.

For the first time the basic possibility of a resection of a shoulder girdle with preservation of an upper extremity was shown Sime (J. Syme, 1856), Byrd (S. D. Bird, 1865), Estor (E. Estor, 1904). In 1914 P. K. Bauman described such operation executed by P. I. Tikhov in 1912. The resections made by V. N. Pryanishnikov (1908) and I. L. Epstein (1913), were insufficiently radical, and removal of bones of a shoulder girdle was carried out not by the uniform block, and in parts. The main idea of P. I. Tikhov consisted in preservation of distal, most functionally significant department of a hand during removal of a proximal segment of an extremity. B. E. Linberg (1922) improved this operation and reported on its results (with demonstration of patients) at the XIX Russian congress of surgeons (1927), to-ry made the decision to appropriate operations a name of Tikhov — Linberg.

T. — L. the lake is applied at patients with malignant tumors of a shovel or the proximal end of a humeral bone, and also at the echinococcosis or extensive inflammatory purulent processes extending to a shoulder joint, a shovel or the proximal end of a humeral bone.

Fig. 1. The patient who underwent Tikhov's operation — Linberg (a) and the roentgenogram (a direct projection) of her shoulder and a part of a thorax: and — the area left nadolechya is deformed, the left hand is sharply displaced from top to bottom, connected to a trunk a skin tube; — there is no shadow of a clavicle which remained after a resection a humeral bone is freely located in soft tissues of a shoulder.

Preoperative preparation of specific features has no. Operation is carried out under anesthetic. Cross a clavicle in the sternal end it, allocate the main vessels and nervous trunks from the level of their crossing with a clavicle to an upper third of a shoulder and delete with the uniform block the clavicle, a shovel, the proximal end of a humeral bone and a shoulder joint, the muscles which are beginning on a shovel and attached to the proximal end of a humeral bone, axillary, subclavial and supraclavicular cellulose. The peripheral department of an extremity remains and remains the neurovascular bunch connected to a trunk concluded in a skin tube (fig. 1). The upper part of a humeral bone freely lies in soft tissues and has no bone support in this connection the patient is not capable to manage all hand. Freely hanging down hand sinks down for a sgshna. from where usually patients bring her a healthy hand. Completely function of a brush and a forearm and satisfactory function of an elbow joint remains. It pain a noma gives the chance to perform work as two hands. At the same time T. — L. the island leads to sharp shortening of a shoulder that significantly complicates an opportunity to use the operated extremity.

Fig. 2. The patient who underwent Tikhov's operation — Linberg in Makhson (a) modification, and the roentgenogram (a direct projection) of his shoulder and a part of a thorax: and — deformation of the right shoulder girdle is insignificant; — the humeral bone which remained after a resection is suspended to the kept clavicle; anatomic ratios are close to norm.

N. E. Makhson (1965) developed modification of T. — L. the lake, the function of a shoulder significantly improving and cosmetic result of intervention. Feature of this operation is preservation of a skeletirovanny clavicle and suspension to it by means of mylar threads or tapes of a humeral bone, edges at the same time receives a support, and function of a shoulder is somewhat recovered. The form of a shoulder girdle remains that improves the cosmetic result of operation and facilitates wearing clothes (fig. 2).

The part of a humeral bone which remained after a resection can be extended by use of an endoprosthesis — a metal or polymeric pin (see. Endoprosthesis replacement ), fixed in the marrowy channel of a humeral bone and suspended on a mylar tape to a clavicle. Lengthening can be reached also by means of podnadkostnichno the allocated bone autograft taken from an akromion and an awn of the deleted shovel. The autograft turned from top to bottom connects to a humeral bone; the subsequent immobilization is carried out by means of a torakoakromialny plaster bandage on average within 3 months. The acromial and clavicular joint assumes function of a remote shoulder joint, and mobility of a shoulder in a certain volume is recovered.

To possible to complications operations belong damages of the main vessels and nerves.

Bibliography: Bauman P. K. A case of a resection of an upper extremity in a shoulder joint, Hir. arkh. Velyaminova, prince 1, "page 145, 1914; Put e-in and 3. D. K to a question about mezhlopatochno-piles-ache amputashsh at malignant new growths of humeroscapular area, Kazanek. medical zhurn., No. 8, page 916, 1926; The L and N <• r of B. E. K to a question of conservative removal of a humeroscapular belt, Is new. hir. arkh., t. 2, book 4, page 611, 1922; M and x with about N of H. E. K to a technique of boundaries - a scapular and chest resection (Tikhov's operation-..... Linberg), Ex-: per and m hir., No. 5, page 4;; 1965; Pack G. T. and. In and] d w i n J. Page of The Tikhor — - Lin-herg resection of schoulder girdle, Surgery, V. 88, p. 753, 1955.

H. E. Makhson.