MD479Z - Method for plasty of large skin defects - Google Patents
Method for plasty of large skin defects Download PDFInfo
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- MD479Z MD479Z MDS20110115A MDS20110115A MD479Z MD 479 Z MD479 Z MD 479Z MD S20110115 A MDS20110115 A MD S20110115A MD S20110115 A MDS20110115 A MD S20110115A MD 479 Z MD479 Z MD 479Z
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- expander
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- 238000000034 method Methods 0.000 title claims abstract description 15
- 230000007547 defect Effects 0.000 title claims abstract description 13
- 231100000241 scar Toxicity 0.000 claims abstract description 18
- 238000002316 cosmetic surgery Methods 0.000 claims abstract description 8
- FAPWRFPIFSIZLT-UHFFFAOYSA-M Sodium chloride Chemical compound [Na+].[Cl-] FAPWRFPIFSIZLT-UHFFFAOYSA-M 0.000 claims abstract description 5
- 239000011780 sodium chloride Substances 0.000 claims abstract description 5
- 238000011049 filling Methods 0.000 claims description 11
- 239000002504 physiological saline solution Substances 0.000 claims description 4
- 239000003814 drug Substances 0.000 abstract description 2
- PLXMOAALOJOTIY-FPTXNFDTSA-N Aesculin Natural products OC[C@@H]1[C@@H](O)[C@H](O)[C@@H](O)[C@H](O)[C@H]1Oc2cc3C=CC(=O)Oc3cc2O PLXMOAALOJOTIY-FPTXNFDTSA-N 0.000 abstract 1
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- 201000004384 Alopecia Diseases 0.000 description 2
- 206010020649 Hyperkeratosis Diseases 0.000 description 2
- 206010023506 Kyphoscoliosis Diseases 0.000 description 2
- 206010023509 Kyphosis Diseases 0.000 description 2
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- 102000004127 Cytokines Human genes 0.000 description 1
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- Radiation-Therapy Devices (AREA)
Abstract
Description
Invenţia se referă la medicină, în special la chirurgia plastică şi poate fi utilizată pentru plastia defectelor mari ale pielii. The invention relates to medicine, in particular to plastic surgery and can be used for the plastic of large skin defects.
Este cunoscută metoda de plastie a defectelor mari ale pielii, ce include implantarea espanderului sub pielea adiacentă intactă, cu scopul de a obţine prin umplerea lui periodică a ţesutului pentru plastie de aceeaşi culoare, arhitectonică, număr de foliculi pieloşi, sensibilitate etc. Espanderul reprezintă un balonaş din latex, ermetizat, pereţii elastici ai căruia pot menţine un anumit volum de lichid şi exercita presiune asupra ţesuturilor adiacente cicatricei. Espanderul este umplut periodic cu ser fiziologic, acesta exercitând o tensiune permanentă şi inofensivă asupra ţesuturilor situate deasupra lui. Expandarea progresivă dirijată creează un surplus de tegument pentru acoperirea unei suprafeţe de defect din vecinătate fără a genera retracţie sau dehiscenţă de sutură [1]. The method of plastic surgery of large skin defects is known, which includes implanting the expander under the adjacent intact skin, with the aim of obtaining by its periodic filling the tissue for plastic surgery of the same color, architecture, number of hair follicles, sensitivity, etc. The expander is a latex balloon, hermetic, the elastic walls of which can maintain a certain volume of liquid and exert pressure on the tissues adjacent to the scar. The expander is periodically filled with physiological serum, which exerts a permanent and harmless tension on the tissues located above it. The directed progressive expansion creates a surplus of skin to cover a defect surface in the vicinity without generating retraction or suture dehiscence [1].
Totodată, metoda cunoscută are o serie de neajunsuri, cum este durata îndelungată de expandare pentru a obţine ţesuturi în cantităţi suficiente pentru a acoperi defectele mari ale pielii. În acelaşi context, pe perioada umplerii espanderului tegumentele suferă o subţiere considerabilă, ce poate genera premise pentru compromiterea vascularizării cupolei ţesutului expandat. Odată cu reconstrucţia arhitectonicii vascularizării acestor tegumente, ele sunt mai vulnerabile proceselor inflamatorii cauzate de suprimarea imunităţii tisulare locale. At the same time, the known method has a number of shortcomings, such as the long duration of expansion to obtain tissues in sufficient quantities to cover large skin defects. In the same context, during the filling of the expander, the skin undergoes a considerable thinning, which can generate premises for compromising the vascularization of the dome of the expanded tissue. Along with the reconstruction of the vascularization architecture of these skins, they are more vulnerable to inflammatory processes caused by the suppression of local tissue immunity.
Problema pe care o soluţionează invenţia constă în scurtarea timpului de pregătire a tegumentelor expandate pentru plastia defectelor mari ale pielii, stimularea proceselor imune locale, îmbunătăţirea caracteristicilor elastice ale tegumentului supus tensiunii dirijate. The problem solved by the invention consists in shortening the preparation time of expanded skin for the plasticity of large skin defects, stimulating local immune processes, and improving the elastic characteristics of the skin subjected to directed tension.
Conform invenţiei, metoda revendicată constă în aceea că se efectuează o incizie la nivelul cicatricei, se introduce un espander sub pielea adiacentă intactă şi se umple cu ser fiziologic la fiecare 2…4 zile, adăugând de fiecare dată în espander câte 20…50 ml de ser până la senzaţia de durere. După obţinerea extinderii suficiente a pielii pentru plastie, se excizează cicatricea, se înlătură espanderul şi se efectuează plastia, totodată pielea sub care este introdus espanderul, începând cu a doua zi, zilnic, se iradiază câte 10 min cu lumină policromatică cu lungimea de 480…3400 nm, densitatea de 2,4 J/cm2 şi puterea de 40 mW/cm2, până la 30 de zile. According to the invention, the claimed method consists in making an incision at the scar level, inserting an expander under the adjacent intact skin and filling it with physiological saline every 2…4 days, adding 20…50 ml of saline to the expander each time until the pain is felt. After obtaining sufficient skin extension for the plasty, the scar is excised, the expander is removed and the plasty is performed, at the same time the skin under which the expander is inserted, starting with the second day, is irradiated daily for 10 min with polychromatic light with a wavelength of 480…3400 nm, a density of 2.4 J/cm2 and a power of 40 mW/cm2, for up to 30 days.
Expunerea zilnică la lumină polarizată policromatică sporeşte calitatea şi viabilitatea tegumentelor expandate dirijat. S-a stabilit că efectul biostimulator este determinat de efectul biologic al fototerapiei prin sporirea activităţii funcţiei leucocitelor, reducerea cantitativă a citochinelor antiinflamatoare plasmatice, producerea factorilor de creştere, care duc la stimularea proliferării celulelor: cheratinocite, endoteliocite, fibroblaşti. Tegumentele expandate şi totodată expuse fototerapiei prezintă mecanisme adaptiv-compensatorii mai accentuate ale metabolismului tisular şi ale vascularizării lambourilor dermice. Astfel, în cazul expandării tisulare combinate cu terapie polarizantă, caracterul schimbărilor tisulare atestă reacţii compensatorii mai pronunţate de adaptare şi ameliorare a metabolismului tisular, comparativ cu expandarea tradiţională, unde sunt întâlnite manifestări de procese degenerative instabile, caracteristice dereglării proceselor metabolice. Daily exposure to polychromatic polarized light increases the quality and viability of directed expanded skin. It has been established that the biostimulatory effect is determined by the biological effect of phototherapy by increasing the activity of leukocyte function, quantitative reduction of plasma anti-inflammatory cytokines, production of growth factors, which lead to stimulation of cell proliferation: keratinocytes, endothelial cells, fibroblasts. Expanded skin exposed to phototherapy also presents more pronounced adaptive-compensatory mechanisms of tissue metabolism and vascularization of dermal flaps. Thus, in the case of tissue expansion combined with polarizing therapy, the nature of tissue changes attests to more pronounced compensatory reactions of adaptation and improvement of tissue metabolism, compared to traditional expansion, where manifestations of unstable degenerative processes, characteristic of metabolic process deregulation, are encountered.
Prioritatea metodei propuse constă în micşorarea perioadei de pregătire a tegumentului expandat util pentru plastia defectelor mari ale pielii, îmbunătăţirea calităţii lui, profilaxia complicaţiilor. Aplicarea metodei propuse de stimulare a expandării tisulare prin expunere la lumină polarizată policromatică incoerentă a ţesuturilor dermotensionale facilitează expansiunea tisulară, ameliorează suportarea procedurilor de gonflare, reduce esenţial termenele de cicatrizare, permite de a efectua mărirea suprafeţei de ţesuturi utile pentru plastie fără complicaţii vasculare din partea tegumentului, atenuează fenomenele inflamatorii locale şi generale, micşorează riscul de infecţie, exclude extruzia şi exteriorizarea expanderului cauzat de necroza tegumentară pe cupola expanderului, favorizează o reabilitare chinetoterapeutică atât pe parcursul tratamentului, cât şi în termen precoce după regenerarea ţesuturilor, are efect psihoterapeutic în aspectul complexului de tratament multidirecţional. Avantajul invenţiei propuse, de asemenea, constă în prevenirea şi excluderea complicaţiilor vasculare sau inflamatorii de pe cupola expanderului, din perimetrul ţesuturilor expandate şi a capsulei periprotetice. The priority of the proposed method is to reduce the preparation period of the expanded skin useful for the plasticity of large skin defects, improve its quality, and prevent complications. The application of the proposed method of stimulating tissue expansion by exposing dermotensional tissues to incoherent polychromatic polarized light facilitates tissue expansion, improves the tolerance of swelling procedures, significantly reduces healing times, allows for the increase of the surface area of tissues useful for plasticity without vascular complications from the skin, attenuates local and general inflammatory phenomena, reduces the risk of infection, excludes extrusion and externalization of the expander caused by skin necrosis on the expander dome, favors physiotherapeutic rehabilitation both during treatment and in the early term after tissue regeneration, and has a psychotherapeutic effect in the aspect of the multidirectional treatment complex. The advantage of the proposed invention also consists in preventing and excluding vascular or inflammatory complications on the expander dome, in the perimeter of the expanded tissues and the periprosthetic capsule.
Metoda se realizează în modul următor: se efectuează o incizie la nivelul cicatricei, se introduce un espander sub pielea adiacentă intactă şi se umple cu ser fiziologic la fiecare 2…4 zile, adăugând de fiecare dată în espander câte 20…50 ml de ser până la senzaţia de durere, după obţinerea extinderii suficiente a pielii pentru plastie se excizează cicatricea, se înlătură espanderul şi se efectuează plastia, totodată pielea sub care este introdus espanderul, începând cu a doua zi, zilnic, se iradiază câte 10 min cu lumină policromatică cu lungimea de undă de 480…3400 nm, densitatea de 2,4 J/cm2 şi puterea de 40 mW/cm2, până la 30 de zile. The method is performed as follows: an incision is made at the scar level, an expander is inserted under the adjacent intact skin and filled with saline every 2…4 days, adding 20…50 ml of serum to the expander each time until pain is felt, after obtaining sufficient skin extension for the plasty, the scar is excised, the expander is removed and the plasty is performed, at the same time, the skin under which the expander is inserted, starting with the second day, is irradiated daily for 10 minutes with polychromatic light with a wavelength of 480…3400 nm, a density of 2.4 J/cm2 and a power of 40 mW/cm2, for up to 30 days.
În calitate de sursă de lumină polarizată policromatică incoerentă a servit lampa BIOPTRON (ZEPTER, Elveţia). Lumina polarizată policromatică incoerentă folosită prezintă următoarele caracteristici: aparatul generează un fascicul de lumină cu lungimi de undă cuprinsă între 480 nm şi 3400 nm; grad de polarizare > 95% (590…1550 nm); putere de 40 mW/cm2; densitatea fasciculului de lumină pe minut este de 2,4 J/cm2. Fasciculul de lumină se aplică perpendicular pe suprafaţa tegumentului expandat de la o distanţă de 15 cm. The BIOPTRON lamp (ZEPTER, Switzerland) served as a source of incoherent polychromatic polarized light. The incoherent polychromatic polarized light used has the following characteristics: the device generates a light beam with wavelengths between 480 nm and 3400 nm; polarization degree > 95% (590…1550 nm); power of 40 mW/cm2; the density of the light beam per minute is 2.4 J/cm2. The light beam is applied perpendicularly to the surface of the expanded skin from a distance of 15 cm.
Exemplul 1 Example 1
Pacientul D., 46 ani, spitalizat în IMSP SCTO secţia leziuni termice MS cu diagnosticul „Cicatrice hipertrofă postcombustională în regiunea membrelor inferioare cu hipercheratoză în regiunea poplitee pe dreapta” a fost supus intervenţiei de implantare a unui espander de latex în regiunea coapsei drepte, pe partea posterioară, în 1/3 distală. Volumul espanderului a fost umplut cu 450 ml de ser fiziologic în decurs de 24 zile. Zona expandată a fost expusă zilnic sursei lineare de lumină polarizată incoerentă. Fasciculul de lumină a fost aplicat perpendicular pe suprafaţa tegumentului expandat de la o distanţă de 15 cm. Durata de expoziţie pentru fiecare procedură a fost de 10 min. Expunerea a fost efectuată în timpul schimbului pansamentului şi după umplerea espanderului de latex, începând cu a doua zi postoperatorie. Aplicarea luminii polarizate a fost încetată la regenerarea completă a plăgilor - după excizia şi înlăturarea cicatricei şi substituirea defectului cicatriceal de 120 cm2, cu tegument expandat. Patient D., 46 years old, hospitalized in IMSP SCTO thermal injuries department MS with the diagnosis of "Post-combustion hypertrophic scar in the lower limb region with hyperkeratosis in the popliteal region on the right" was subjected to the intervention of implantation of a latex expander in the right thigh region, on the posterior side, in the distal 1/3. The expander volume was filled with 450 ml of physiological saline over 24 days. The expanded area was exposed daily to the linear source of incoherent polarized light. The light beam was applied perpendicular to the surface of the expanded skin from a distance of 15 cm. The exposure duration for each procedure was 10 min. The exposure was performed during the dressing change and after filling the latex expander, starting with the second postoperative day. The application of polarized light was stopped upon complete wound regeneration - after excision and removal of the scar and substitution of the 120 cm2 scar defect with expanded skin.
Exemplul 2 Example 2
Pacienta V., 38 ani, a fost tratată în IMSP SCTO cu diagnosticul: „Cifoscolioză dorsolombară severă. Cicatrice hipertrofică postradiantă la nivelul toracic”. La bolnavă se determină o deformitate cifoscoliotică a coloanei vertebrale, cu unghi de cifoză de 105° şi o deformitate cicatriceală postactinică cu hipercheratoză situată median la nivelul toracelui dorsal Th5…Th12, cu dimensiunile de 30x12 cm ca urmare a radioterapiei locale efectuate cu 20 ani în urmă, din cauza unei tumori a ţesuturilor osoase la nivelul vertebrelor. Din cauza progresării cifozei a fost programată pentru o intervenţie chirurgicală de stabilizare a coloanei vertebrale, care prevede incizia ţesuturilor moi la nivelul cicatricelor postactinice. Pentru a obţine un tegument plastic util de calităţi satisfăcătoare s-a recurs la implantarea a 4 espandere de latex cu valvă încorporată, cu dimensiunile de 140x45 mm şi capacitatea de umplere maximă de 1200 ml, în zonele situate perifocal ţesuturilor cicatriceale postactinice. Espanderele au fost introduse prin incizii liniare cu lungimea de 3 cm, perpendiculare axului implantului. Inciziile au servit ca reper pentru lojele corpurilor şi valvele expanderelor. Lojele espanderelor au fost suturate în două planuri şi ulterior drenate. Iniţial în cavitatea fiecărui espander au fost injectate câte 200...250 ml de ser fiziologic. Drenajul a fost înlăturat peste două zile, pe motiv de evacuare a unor cantităţi nesemnificative de lichid serohemoragic. Umplerea a fost efectuată cu o frecvenţă de 3…4 ori pe săptămână prin punctarea periodică a valvei expanderului şi introducerea lichidului cu un volum maxim de 1/10 din capacitatea expanderului la fiecare umplere. Aportul lichidian într-o şedinţă a fost limitat de tensiunea pielii expandate, dureri prezentate de pacient, culoarea ischemică a cupolei ţesutului expandat. Zonele expandate au fost expuse zilnic sursei lineare de lumină polarizată incoerentă. Fasciculul de lumină a fost aplicat perpendicular pe suprafeţele tegumentelor expandate de la o distanţă de 15 cm. Durata de expoziţie pentru fiecare procedură a fost de 10 min. Expunerea a fost efectuată în timpul schimbului pansamentului şi după umplerea espanderelor de latex, începând cu a doua zi postoperatorie. Aplicarea luminii polarizate policromatice incoerente a fost încetată la regenerarea completă a plăgilor - după excizia şi înlăturarea cicatricei şi substituirea defectului cu tegument expandat. După umplerea volumului fiecărui espander cu câte 650…800 ml, la a 30-a zi după implantare pacienta a fost supusă intervenţiei chirurgicale finale de plastie a defectelor mari ale pielii. Lambourile au fost suturate etajat, a fost aplicat drenaj vacuumizat prin lojele espanderelor. În perioada postoperatorie pansamentele au fost schimbate zilnic, iar drenajul înlăturat la a 3-a zi. Suturile transcutane au fost înlăturate la a 12-a zi după operaţie. La examinarea repetată peste 3 luni pacienta nu prezenta acuze, iar ulterior a suportat o intervenţie de stabilizare a coloanei vertebrale. Patient V., 38 years old, was treated in IMSP SCTO with the diagnosis: "Severe dorsolumbar kyphoscoliosis. Postradiant hypertrophic scar at the thoracic level". The patient was diagnosed with a kyphoscoliosis deformity of the spine, with a kyphosis angle of 105° and a postactinic scar deformity with hyperkeratosis located medially at the level of the dorsal thorax Th5…Th12, measuring 30x12 cm as a result of local radiotherapy performed 20 years ago, due to a bone tissue tumor at the level of the vertebrae. Due to the progression of kyphosis, she was scheduled for a spinal stabilization surgery, which involves incision of the soft tissues at the level of the postactinic scars. In order to obtain a useful plastic skin of satisfactory quality, 4 latex expanders with a built-in valve, with dimensions of 140x45 mm and a maximum filling capacity of 1200 ml, were implanted in the perifocal areas of the post-actinic scar tissues. The expanders were inserted through linear incisions of 3 cm in length, perpendicular to the implant axis. The incisions served as a reference for the chambers of the bodies and the valves of the expanders. The chambers of the expanders were sutured in two planes and subsequently drained. Initially, 200...250 ml of physiological saline were injected into the cavity of each expander. The drainage was removed after two days, due to the evacuation of insignificant amounts of serohemorrhagic fluid. The filling was performed with a frequency of 3…4 times a week by periodically puncturing the expander valve and introducing the liquid with a maximum volume of 1/10 of the expander capacity at each filling. The liquid intake in one session was limited by the tension of the expanded skin, pain presented by the patient, the ischemic color of the dome of the expanded tissue. The expanded areas were exposed daily to the linear source of incoherent polarized light. The light beam was applied perpendicularly to the surfaces of the expanded skin from a distance of 15 cm. The exposure time for each procedure was 10 min. The exposure was performed during the dressing change and after filling the latex expanders, starting with the second postoperative day. The application of incoherent polychromatic polarized light was stopped upon complete wound regeneration - after excision and removal of the scar and substitution of the defect with expanded skin. After filling the volume of each expander with 650…800 ml, on the 30th day after implantation the patient underwent the final surgical intervention for plastic surgery of large skin defects. The flaps were sutured in stages, vacuum drainage was applied through the expander lodges. In the postoperative period the dressings were changed daily, and the drainage was removed on the 3rd day. The transcutaneous sutures were removed on the 12th day after the operation. At the repeated examination after 3 months the patient had no complaints, and subsequently underwent a spinal stabilization intervention.
Exemplul 3 Example 3
Pacienta A., 16 ani, spitalizată în IMSP SCTO secţia leziuni termice MS cu diagnosticul „Alopeţie postcombustională frontoparietală tip IIB” a fost supusă intervenţiei de implantare a două espandere de latex în regiunea părţii pieloase intacte, pe partea temporo-parieto-occipitală, în 1/3 distală. Cavităţile espanderelor au fost umplute în total cu 450 ml de ser fiziologic în decurs de 28 zile. Zonele expandate au fost expuse zilnic sursei lineare de lumină polarizată incoerentă. Fasciculul de lumină a fost aplicat perpendicular pe suprafaţa tegumentului expandat de la o distanţă de 15 cm. Durata de expoziţie pentru fiecare procedură a fost de 10 min. Expunerea a fost efectuată în timpul umplerii expanderelor de latex, începând cu a doua zi postoperatorie. Aplicarea luminii a fost încetată la regenerarea completă a plăgilor - după excizia şi înlăturarea cicatricei alopetice cu suprafaţa de 260 cm2 şi substituirea defectului cu tegument expandat. Patient A., 16 years old, hospitalized in the IMSP SCTO thermal injuries department MS with the diagnosis of "Postcombustion frontoparietal alopecia type IIB" was subjected to the intervention of implantation of two latex expanders in the region of the intact skin part, on the temporo-parieto-occipital side, in the distal 1/3. The expander cavities were filled with a total of 450 ml of physiological serum over 28 days. The expanded areas were exposed daily to the linear source of incoherent polarized light. The light beam was applied perpendicular to the surface of the expanded skin from a distance of 15 cm. The exposure time for each procedure was 10 min. The exposure was performed during the filling of the latex expanders, starting with the second postoperative day. The application of light was stopped upon complete wound regeneration - after the excision and removal of the alopecia scar with an area of 260 cm2 and the substitution of the defect with expanded skin.
1. Sharpe D.T. Tissue expansion. Burns. 1987, № 13, p.43-48 1. Sharpe D.T. Tissue expansion. Burns. 1987, No. 13, p. 43-48
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| MDS20110115A MD479Z (en) | 2011-06-20 | 2011-06-20 | Method for plasty of large skin defects |
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| MDS20110115A MD479Z (en) | 2011-06-20 | 2011-06-20 | Method for plasty of large skin defects |
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| MD479Y MD479Y (en) | 2012-02-29 |
| MD479Z true MD479Z (en) | 2012-09-30 |
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Cited By (1)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| MD610Z (en) * | 2012-11-08 | 2013-10-31 | Юлиан ЦУРКАНУ | Nose wing defect plasty method |
Citations (1)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| RU2364346C1 (en) * | 2008-04-14 | 2009-08-20 | Государственное образовательное учреждение дополнительного профессионального образования "Иркутский государственный институт усовершенствования врачей Федерального агентства по здравоохранению и социальному развитию" | Extensive skin defect plasty technique |
-
2011
- 2011-06-20 MD MDS20110115A patent/MD479Z/en not_active IP Right Cessation
Patent Citations (1)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| RU2364346C1 (en) * | 2008-04-14 | 2009-08-20 | Государственное образовательное учреждение дополнительного профессионального образования "Иркутский государственный институт усовершенствования врачей Федерального агентства по здравоохранению и социальному развитию" | Extensive skin defect plasty technique |
Non-Patent Citations (3)
| Title |
|---|
| Sharpe D.T. Tissue expansion. Burns. 1987, № 13, p.43-48 * |
| Авдеев А. Е. Пластика рубцовых поражений кожных покровов методом эндоэкспандерной дермотезии у детей. канд. мед. наук. Москва, 1997. с.47, 58-64 * |
| Гришкевич В. М., Мороз В. Ю. Хирургическое лечение последствий ожогов нижних конечностей. Москва. 1996, С. 41-42 * |
Cited By (1)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| MD610Z (en) * | 2012-11-08 | 2013-10-31 | Юлиан ЦУРКАНУ | Nose wing defect plasty method |
Also Published As
| Publication number | Publication date |
|---|---|
| MD479Y (en) | 2012-02-29 |
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| MM4Y | Short-term patent definitely lapsed due to non-payment of fees |