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The incision design for bone plate fixation surgery is of vital importance, directly affecting the surgical operation, postoperative recovery and the occurrence of complications. The following are the key points of its design:
Fully expose the fracture site
Precise positioning: Before the operation, imaging examinations such as X-rays and CT scans are conducted to clarify the location, type and displacement of the fracture, thereby determining the approximate position and direction of the incision. For instance, for femoral shaft fractures, the appropriate starting point and direction of the incision should be selected based on the specific position of the fracture line on the femur to ensure that the fracture ends are fully exposed.
Appropriate length: The incision length should be sufficient to ensure a clear surgical field of view, facilitating the placement of bone plates and the screwing in of screws. However, it should not be too long either, so as not to increase the risk of trauma and infection. Generally speaking, the incision length should be slightly longer than the bone plate length to facilitate the operation. For example, when using a bone plate with a length of 10 centimeters, the incision length can be designed to be 12-13 centimeters.
Reduce soft tissue injuries
Along the anatomical Spaces: The incision should run as far as possible along the natural Spaces of soft tissues such as muscles, tendons, nerves, and blood vessels, and avoid directly cutting off important soft tissue structures. For instance, in limb surgeries, incisions can be designed along the direction of muscle fibers. This not only reduces muscle damage but also lowers the risk of postoperative muscle adhesion and functional disorders.
Protecting blood vessels and nerves: During the incision design process, special attention should be paid to avoiding important blood vessels and nerves. The approximate locations of blood vessels and nerves can be determined by consulting the anatomical atlas and combining clinical experience, and they can be carefully separated and protected during the operation. For example, when performing bone plate fixation surgery for brachial shaft fractures, it is necessary to avoid damaging the radial nerve, and the incision should be biased towards the lateral side of the radial nerve.
Consider the postoperative functional recovery
Avoid restricted joint movement: The incision design should avoid the joint area as much as possible to prevent affecting joint movement. If it is necessary to pass through a joint, the path that has the least impact on joint function should be selected, and joint function exercises should be carried out in the early postoperative period. For instance, when performing bone plate fixation surgery for fractures near the elbow joint, the incision should not cross the joint as much as possible to minimize damage to the joint capsule and ligaments and promote the recovery of joint function.
Reduce the impact of scars: The incision location should be chosen as much as possible in areas with less skin tension and greater concealment. This can not only reduce the formation of postoperative scars but also minimize the impact of scar contracture on limb function. For instance, in a facial fracture bone plate fixation surgery, the incision should be designed in concealed areas such as within the hairline or the mouth.
It is convenient for the placement of bone plates and screw fixation
Conforming to the shape of the bone plate: Bone plates in different parts have different shapes and curvatures. The incision design should be adapted to the shape of the bone plate so that it can closely adhere to the bone surface. For example, for the bone plate at the proximal femur, the incision should be able to fully expose the anatomical structure of the proximal femur, enabling the bone plate to be accurately placed in the appropriate position.
Convenient screw operation: The cut should be able to provide sufficient space to facilitate the drilling, tapping and screwing of screws. When designing the incision, the entry point and direction of the screw should be taken into consideration to ensure that the screw fixation operation can be completed smoothly during the operation. For example, when performing bone plate fixation surgery for spinal fractures, an appropriate incision should be designed so that the pedicle screws can be accurately screwed in.
Take into account both aesthetics and the needs of patients
Aesthetic incision: Under the premise of meeting the surgical operation requirements, the incision should be made as neat and beautiful as possible. Cosmetic suture techniques can be adopted to reduce the formation of scars. For example, when performing bone plate fixation surgery for facial fractures, the design and suture of the incision should be more meticulous to achieve an aesthetic effect.
Respect the patient’s wishes: When designing the incision, sufficient communication with the patient should be conducted to understand their needs and concerns. If the patient has special requirements for the position and appearance of the incision, their wishes should be met as much as possible without affecting the surgical outcome.