• The case of application of the retrained operational up-stupe to the tumor located on the borning- interior surface of the top third diaphism of the big-tonal bone
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The case of application of the retrained operational up-stupe to the tumor located on the borning- interior surface of the top third diaphism of the big-tonal bone

Paediatric surgery.Ukraine.2019.4(65):67-71; DOI 10.15574/PS.2019.65.67

O.V. Shchokin, O.V. Spakhi
Zaporizhzhya State Medical University, Ukraine

For citation: Shchokin OV, Spakhi OV. (2019). The case of application of the retrained operational up-stupe to the tumor located on the borning-interior surface of the top third diaphism of the big-tonal bone. Paediatric Surgery.Ukraine. 4(65): 67-71. doi 10.15574/PS.2019.65.67
Article received: Jul 11, 2019. Accepted for publication: Dec 18, 2019.
Objective. To develop low-traumatic and safe operative access to the posterior surface of the tibial diaphysis in the upper third and acquaint the operating orthopedic trauma surgeons, oncologists and surgeons with it.
Materials and methods. According to the scientific literature, the study and analysis of the topography of anatomical formations of this area were conducted with respect to possible options for access to the posterior external surface of the upper third of the tibial diaphysis. Anterior, anterior and anterior internal accesses were studied. These accesses are offered by most authors in the scientific literature. Along with these approaches, many authors propose to use the posterior and posterior-external accesses, which are located closest to the posterior outside surface of the tibial diaphysis in the upper third. All these approaches are either too traumatic, or with their help it is almost impossible to reach the posterior surface of the tibial diaphysis in the upper third. The least traumatic and safest is a backward access. It is carried out as follows. An incision of the skin triad is performed, retreating 1 centimeter posterior to the posterior inner edge of the tibia and parallel to it. Medial edges of the gastrocnemius and soleus muscles are stupidly and acutely exfoliated. After removal of the muscles posteriorly, the posterior tibial and peroneal vessels and tibial nerve open, which are retracted along with the muscles. After separation of the posterior tibial muscle, access to the upper third of the diaphysis of the inner surface of the tibial bone is opened without damaging the important anatomical structures.
Clinical case. A 16-year-old child with two tumors (osteochondromas) located on the inner and posterior surface of the tibial bone in the upper third of the diaphysis from the posterior-internal access was operated on in the clinic. Anatomical structures and structures were not damaged. This confirmed the security of the back door.
Conclusion. The case of posterior-internal access, which was carried out to remove a tumor located on the posterior surface of the tibial bone in its upper third, showed that this access is less traumatic and safe.
The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the institution’s Local Ethics Committee. The informed consent of the child and his parents was obtained from the studies.
No conflict of interest was declared by the authors.
Key words: operative access, tumor, tibia, diaphysis, upper third, posterior-outer surface.

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