RU2540497C1 - Filtration composition and method for fat excision - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention represents a composition for surgical area infiltration in liposuction or lymphedema elimination, containing normal saline, 0.5% Naropin and phosphatidylcholine in ratio 9:1:6 respectively per 10-15 cm3 fat.

EFFECT: reducing oedema, tissue injuries and blood loss volume, preventing microcirculation disorders in soft tissues and complications, reducing a risk of recurrences and promoting a faster rehabilitation of the patients.

2 cl

Description

The invention relates to medicine, namely to surgery, and can be used to eliminate postmastectomy lymphedema, in particular for the prevention of a complex of functional and cosmetic disorders resulting from radical surgical treatment of breast cancer, as well as with liposuction.

The most effective methods of medical rehabilitation of patients after surgical treatment of breast cancer include subcutaneous surgical correction of lymphedema followed by a set of conservative measures (compression and drug methods, exposure to physical factors: laser radiation, phototherapy and modern pneumatic massage) in the postoperative period.

One of the operations used to eliminate postmastectomy lymphedema is the removal of fatty tissue. A similar removal of fatty tissue is performed during liposuction. To reduce the morbidity of this operation, compounds are used that reduce the density of fiber, and simplify its excretion.

A known method for the prevention and elimination of lymphedema, which consists in the fact that through a puncture of the skin, a ligature is passed through the entire thickness of the fiber to the fascia and a ligature is brought out through the puncture. Then, through the same puncture directly under the skin, a ligature is carried out to the first puncture. Formed fiber capture loop dissect it and in the same way carry out circular subcutaneous dissection of subcutaneous fat at each level from the foot to the knee joint. Apply pressure dressings in the fiber dissection area. The method allows to exclude damage to the skin, as well as to increase the effectiveness of treatment due to the formation of lymphovenous and lymphomuscular discharge of lymph without traumatic excision of the cellular space, which provides a cosmetic effect [1].

This method does not provide a sufficient discharge of the bodice into the venous bed, since excision of the cellular space is not performed, thereby blocking the vessels and the lymph depot remains, and in this method, secondary infection is possible.

A known method of removing fatty tissue by means of tumecent liposuction [2], which allows to significantly reduce both clinical and aesthetic complications. In addition, it allows you to remove a large amount of fat and, as a result, achieve good results.

According to the method, a preliminary infiltration of the operation area is carried out with a Klein solution, which consists of a large amount of saline, lidocaine and adrenaline. Klein's solution is injected under high pressure so that it can be evenly and deeply distributed in the tissues. Klein's formula allows you to achieve several results at the same time: reduce trauma during surgery (by reducing fat density); remove fat in large quantities and carry out the operation without general anesthesia.

The disadvantage of this method is the introduction of a large volume of Klein solution, which, among other ingredients, contains lidocaine. The use of lidocaine often provokes cardiovascular problems - bradycardia, vasodilation, arterial hypotension and inhibition of the myocardium. At the same time, the addition of an exogenous hospital infection and the possibility of the formation of seromas are not excluded, serious blood loss requiring transfusion of blood components is also quite likely.

The invention is aimed at obtaining a technologically simple method for the treatment and prevention of a complex of functional and cosmetic disorders that occur, for example, as a result of radical surgical treatment of breast cancer, such as postmastectomy lymphedema, both proximal and medium, and distal, as well as liposuction due to pre-infiltration of the area of operation of the proposed solution.

The specified result is achieved through the use of the composition for the infiltration of the operation area during liposuction or elimination of lymphedema, including physiological saline, 0.5% solution of napropine and phosphatidylcholine at a ratio of 9: 1: 6, respectively, to 10-15 cm ³ of fatty tissue removed.

The method of removing fatty tissue during liposuction or eliminating lymphedema involves infiltrating the area of the operation with a composition consisting of physiological saline, 0.5% solution of napropine and phosphatidylcholine in a ratio of 9: 1: 6, respectively, to 10-15 cm ^{3 of} removable fatty tissue, which is pre-cooled to temperature of 10 ° C and injected under high pressure, sufficient so that it can evenly and deeply distributed in the tissues.

Due to the low temperature, high pressure and amount of injected fluid, as well as its diffusion, there is a significant narrowing of blood vessels, including capillaries, as well as adipocyte swelling, which facilitates subsequent aspiration. When processing fiber in this manner, thin cannulas are allowed.

Naropin promotes local anesthesia and does not cause any complications from the cardiovascular system. And phosphatidylcholine contributes to the degradation of adipocytes.

The combination of the components of the proposed solution (composition) for infiltration and thin cannulas allow: to minimize tissue trauma during surgery, reduce blood loss, safely remove fat in large quantities and carry out the operation without general anesthesia. Accordingly, rehabilitation is more comfortable, as the operation is less traumatic, which determines a lower risk of complications.

Between infiltration and immediately the beginning of the operation, a pause of 30 to 60 minutes is maintained.

To assess the effectiveness of treatment of lymphedema, a comparative analysis of case histories of 28 patients with postmastectomy lymphedema of the II-III stage was performed. To assess the effectiveness of the liposuction procedure, 15 patients were analyzed.

In 12 cases of treatment of lymphedema, subcutaneous surgical correction of lymphedema was performed, in 16 patients underwent standard treatment. The result was evaluated by comparative analysis of anthropometric studies, ultrasound of subcutaneous fat, low-frequency impedance measurement data, and the frequency of complications was also evaluated.

As a result, it was proved that the use of the proposed solution before surgery in the treatment of patients with postmastectomy lymphedema can significantly reduce edema, blood loss and reduces the risk of complications both from the cardiovascular system and from the postoperative wound and generally reduces the rehabilitation time.

The proposed method of removing fatty tissue in comparison with the tumecent method is more effective, which is proved by a decrease in anthropometric indicators of limb volume by 5%, a decrease in the thickness of subcutaneous tissue according to ultrasound by 84%, and a decrease in blood loss by 35%. According to impedanometry, the indicator increases by 25%, which indicates a decrease in extracellular edema. In patients who were treated according to this technique, no complications were observed.

Clinical example

Patient X., 54 years old, 06/05/2011 was admitted with a diagnosis of secondary lymphedema of the right upper limb III art. From the anamnesis: in 1992 - a radical mastectomy on the right according to Halsted. In mid-August 2005, after a bruise in the area of the right hand, the forearm noted the appearance and progression of edema on the hand, forearm and shoulder. Compression mode, phlebotonic administration is irregular. Erysipelas in 2010. On examination: in the region of the right breast, the postoperative scar is consistent, axillary lymph nodes are not palpable. The right upper limb is swollen. The skin is of normal color, with palpation the temperature and humidity are normal. The circumference of both upper limbs (in cm on the right / left, respectively): brush 21/17, l / s joint 20/16, n / 3 forearm 24/20, s / 3 34/25, s / 3 36/26, n / 3 shoulders 35/32, s / 3 36/33, b / 3 37/36. Fingers on the right / left I-8/6, II-7/6, III-7/6, IV-7 / 6.5, V-6/5. Ultrasound of subcutaneous fat: 2.58 cm; impedance measurement: 17 ohms. The patient performed subcutaneous surgical correction of lymphedema. After treatment: there is a decrease in edema of the limb, mainly in all departments. The right upper limb is slightly swollen, the swelling is soft, normal temperature, the size of the right and left upper limbs in cm: brush 17.5 / 17, l / s joint 16/16, forearm n / 3 21/20 cm, s / 3 26 / 25 cm, in / 3 27/26 cm, shoulder n / 3 32/32 cm, s / 3 33/33 cm, in / 3 36.5 / 36 cm. Fingers: right / left 1-6 / 6 cm, 2-6 / 6 cm, 3-6 / 6 cm, 4-5.5 / 5.5 cm, 5-5 / 5. Ultrasound of subcutaneous fat: 0.67 cm; impedance measurement: 25 ohms [3].

Since 2010, this technique has been applied to 32 patients with postmastectomy lymphedema. In all cases, accelerated positive dynamics of treatment and the absence of complications during rehabilitation of patients were noted.

In cases of liposuction in accordance with the proposed method, the following results were achieved: when 700 ml of fatty tissue was eliminated, the operation time was reduced by 15 minutes; blood loss reduced by 150 ml; hemodynamic and respiratory disorders were not observed. The postoperative period was uneventful, without features. Compared with the known methods of liposuction, a decrease in the amount of blood loss, the absence of early and late complications in the observed cases, a decrease in the rehabilitation time of patients are noted.

The results confirm the effectiveness of the proposed method of removing fatty tissue using the indicated solution for infiltration both during liposuction and in the treatment of lymphedema.

According to the data, the proposed method allows to reduce edema, reduces tissue trauma and the amount of blood loss, prevents the violation of microcirculation of soft tissues, which helps prevent the development of complications, eliminates the need for expensive materials and devices, reduces the risk of relapse and promotes faster rehabilitation of patients.

Information sources

1. RU 2423926 C1, 01/21/2010.

2. Brorson N., Svensson N. Complete reduction of lymphedema of the arm by liposuction after breast cancer. Scand J PlastReconstr Surg Hand Surg 1997; 31: 137-143.

3. O.B. Andrianov, D.B. Sidorov, D.D. Bolotov, M.V. Zabelin. An innovative approach to the problem of comprehensive rehabilitation of patients with postmastectomy syndrome: problems and reality. Ways of solving. Ambulance doctor. - 2013. - No. 4. - S. 57-64.

Claims (2)

1. Composition for infiltration of the operation area during liposuction or elimination of lymphedema, including physiological saline, 0.5% solution of napropine and phosphatidylcholine in a ratio of 9: 1: 6, respectively, to 10-15 cm ^{3 of} fatty tissue. 2. A method for removing fatty tissue during lymphedema or liposuction, including infiltrating the area of the operation with a composition consisting of physiological saline, 0.5% solution of napropine and phosphatidylcholine in a ratio of 9: 1: 6, respectively, to 10-15 cm ^{3 of} fatty tissue pre-cooled to temperature 10 ° C, which is injected under pressure to ensure distribution in the tissues to the required depth.