Posterior tibial tendon transfer

1. The deformity of the ankle and foot caused by the total nerve injury. 2. As a kind of assisted tendon surgery to correct congenital or acquired deformity of the foot. For example, due to the flexion and inversion of the lateral leg muscles, the anterior tendon metastasis can be used to correct the deformity; however, in order to weaken the muscle strength of the posterior muscles of the lower leg and increase the muscle strength of the dorsiflexion, it can be used simultaneously. Muscle transfer surgery. Treatment of diseases: common peroneal nerve injury Indication 1. The deformity of the ankle and foot caused by the total nerve injury. 2. As a kind of assisted tendon surgery to correct congenital or acquired deformity of the foot. For example, due to the flexion and inversion of the lateral leg muscles, the anterior tendon metastasis can be used to correct the deformity; however, in order to weaken the muscle strength of the posterior muscles of the lower leg and increase the muscle strength of the dorsiflexion, it can be used simultaneously. Muscle transfer surgery. Contraindications Older, combined with severe heart, liver, kidney and other diseases and difficult to tolerate surgery. Preoperative preparation After a group or a muscle is paralyzed, the balance of muscle strength is imbalanced, which will inevitably cause deformity and a series of functional and structural changes after malformation. Therefore, detailed examination, careful analysis, and necessary preparations are required before surgery: 1. The number and degree of muscle spasm vary, due to the length of the date, the influence of gravity, the amount of use and the weight of the deformed foot can cause different deformities. Almost every patient's deformity has its own particularity, and even the same muscle tendon can often cause different deformities. Therefore, it is necessary to conduct a detailed examination and thorough understanding of the deformity, muscle spasm, and muscle strength of the abscess before surgery, and fully estimate whether a new imbalance will occur after the transfer, and a new malformation will occur. In this way, the surgical design can be tailored to the patient's specific situation and the expected results are achieved. Otherwise, it is very likely that the original deformity has not been corrected, but instead caused another deformity. 2. All soft tissue contracture deformities and deformities of the bone structure must be corrected before the metastasis, or corrected before surgery. It is not in principle and impossible to correct these deformities by relying on muscle strength after tendon transfer. Only after the deformity is corrected can the transferred muscle maintain the corrected condition and prevent the recurrence of the deformity. 3. After the muscle is paralyzed, the balance of muscle strength is imbalanced, and the limb function is affected to some extent, so that the muscles of the attempted atrophy will also shrink to varying degrees, the muscle strength will be correspondingly weakened, and the joint activity will be limited. Therefore, exercise should be strengthened before surgery, supplemented by physical therapy, etc., so that the function can be restored as much as possible, and the muscle strength reaches 4 to 5 to ensure the effect of surgery. 4. Prepare a sufficient range of skin as usual on the 2nd day before surgery. After the deformity of the foot, it often occurs in the weight-bearing part. Before the operation, it is necessary to soak the feet with warm water to make the skin soft and clean, in order to facilitate surgery. Surgical procedure 1. Position: supine position, high limbs. 2. Incision: A total of 4 incisions are required: Incision 1: slit in the inner side of the first clavicle and the scaphoid, about 2 cm long; Incision 2: longitudinally cut at 2 cm on the posterior border of the medial malleolus, about 4 cm long; Incision 3: 3 cm on the anterior aspect of the medial malleolus, longitudinal medial section of the tibialis anterior tendon, about 5 cm long; Incision 4: longitudinally cut above the second cuneiform bone of the foot, about 3 cm long. 3. Separation of the posterior tibial tendon: The posterior tibial muscle stop is revealed from the incision 1 and cut off, and the length should be retained as much as possible. The posterior tibial tendon is separated at the incision 2 and the muscle is withdrawn from the incision 2. 4. Reveal the incision of the interosseous membrane: the tibialis anterior muscle is revealed at the incision 3. The muscle and its lateral anterior tibiofibular vein, deep peroneal nerve and elongate tendon are pulled to the outside to expose the interosseous membrane, and the interosseous membrane is longitudinally cut into a small opening. When making this interosseous incision, be careful not to cut too deep to avoid damage to the posterior tibial and posterior iliac vessels. Be careful not to damage the periosteum of the tibia to avoid ossification in the future and affect the passage. 5. Transfer the tendon: use the long curved hemostat to extend from the incision 3, through the interosseous incision, the posterior aspect of the humerus is worn back to the incision 2, and the end of the tendon is clamped to the incision 3, and the anterior and posterior incisions are observed. Tendons are accessible through barriers. If the fibers pass through other muscles, they should be re-passed; if the interosseous incision is too small, it should be enlarged or a transverse incision should be added at both ends to make the tendon open in a straight line. A subcutaneous tunnel is made from the incision 3 to the incision 4, and the tendon is withdrawn. 6. Fixing the tendon: Open the incision 4, reveal the 2nd cuneiform bone, cut and peel the periosteum, expose the bone, and drill vertically with a bone drill to make a short intraosseous tunnel. The soft stainless steel wire was used, and the broken end of the tendon of the tendon was sutured by stainless steel wire, and the end of the tendon was pulled into the tunnel. The steel wire was worn out of the plantar skin and fixed by a button, and the extracted steel wire was taken out from the upper corner of the incision 4. Finally, each incision is sutured separately. complication pain.

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