RU1806638C - Method of rhinoplasty of total and subtotal defects of nose - Google Patents

Abstract

The use of medicine, namely in reconstructive surgery. The purpose of the invention is to shorten the treatment time. SUMMARY OF THE INVENTION: A skin-fascial flap with axial blood supply is cut out in the inguinal region, from which a rhinograft with a cartilaginous skeleton is formed and, after its adaptation, it is transferred to the anatomical location with simultaneous restoration of blood supply in it using microvascular anastomoses. Advantage j of the invention is in improving functional results.

Description

The invention relates to medicine, in particular reconstructive surgery, and can be used to restore the external nose with subtotal and total defects of the nose.

The aim of the claimed method is to reduce the treatment time.

The goal is achieved in that a rhinograft containing a cartilaginous skeleton is formed in the inguinal (or other) area in the area of axial blood supply, and after 3-4 weeks, the rhinograft, with the inclusion of its axial (supply) vessels, is immediately transferred to a nasal defect, where, with the help of microvascular anastomoses in it blood supply is restored.

SUMMARY OF THE INVENTION

Rhinoplasty according to the proposed method consists of 2 stages and takes up to 1.5 months of inpatient treatment

Stage 1 - the formation of rhinotransplantate in the inguinal region. In the inguinal region 2-2.5 cm below the inguinal ligament, the projection of the discharge of the superficial ileal artery surrounding the ileum is noted

bone (PAOPK) from the femoral artery. This point is connected to the anterior superior iliac spine by a line drawn on the auger, as a result of which the axis T of the inguinal flap is obtained — the projection of its axial vessels: the superficial arteries and veins surrounding the ilium (PAPC and PAPC). On this axis from the projection of the femoral artery retreat outward to the length of the vascular pedicle of the rhinotransplant - the distance measured from the median: the line of the forehead to the outer edge of the orbit, and from | mark the inner (medial) border j of the flap to be cut out. Other flap boundaries are determined from it by a sample that corresponds to a defect in the nose. The flap length is doubled to form a duplicate. An incision of the skin, subcutaneous tissue, and underlying fascia is performed along the designated boundaries. The formed flap of tissues is lifted from the outer edge (from the periphery) to its inner border, preserving the fascia, under which the arteries and veins are located, which supply blood to this skin: fascial (L

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flap. Then the flap is folded in half - duplicated, bending the free edge 180 °, due to which the inner lining (mucous membrane) of the rhinotransplantate is created. In the region of the VII-VHI ribs of the patient (or chest cartilage), two cartilage plates are cut out, from which the nasal cartilage frame is formed by stitching. The formed cartilage frame is inserted into a duplicated fascial and fascial flap and fixed in the correct position with sutures. The wound of the inguinal region is sutured using local techniques. The edges of the duplicated flap along the lateral surfaces are sutured together, turning it into a rhinograft, which is sutured above the donor wound to the skin of the inguinal region. Modeling of the shape of the nose is carried out using tubes inserted into the nasal passages and gauze rolls fixed on the sides of the rhinograft for 3 weeks. During this period, the rhinograft is supplied by blood through its axial vessels (PAOPK and PWPOK), which are contained in its medial edge.

2nd stage - elimination of a nasal defect by the formed rhinograft is performed 3-4 weeks after the 1st operation.

The operation begins with the extraction of the axial vessels of the rhinograft. Then the edges of the nose defect are refreshed and the frontal artery and vein are secreted through the incision along the upper edge of the eyebrow, to which the rhinograft vessels will be sutured. After this, the rhinograft is cut off from the axial vessels in the places of their departure: PAPC - from the femoral artery, PAPC - from the large saphenous vein of the femur, and transferred to the area of the nasal defect, where 2-3 guiding sutures are fixed. The blood flow is immediately restored in the rhinograft by applying anastomoses between its artery and vein and the frontal artery and vein using an operating microscope, microsurgical technique and atraumatic suture material - thread 10/0. After checking the patency and consistency of microvascular anastomoses, the rim graft is sutured to the edges of the nose defect. Reuse forming tubes and rollers.

The postoperative period is 2 weeks. If necessary, nose shape is corrected after 2-3 months.

In contrast to the prototype, this solution: 1) uses a skin-fascial flap to restore the nose; 2) a skin-fascial flap having axial blood supply is used to form a rhinograft; 3) form a rhinograft in the inguinal (donor) region, where a skin-fascial flap is cut out; 4) a cartilage framework is used to form the rhinograft; 5) transplanted rinotrans-. plantate from the inguinal region to a defect in the nose in one step; 6) microsurgical anastomoses are applied between the vessels of the rhinograft and the vessels of the face,

providing restoration of blood flow in it; 7) rhinoplasty is performed in two stages for 2 months, which indicate that the claimed method meets the criterion of novelty.

The use of these signs to achieve the goal in reconstructive surgery has not been previously applied, which indicates that the claimed solution meets the criterion of significant

distinguish.

The use of these features in a rhinoplasty method will provide a lasting cosmetic effect, reduce treatment time, and reduce the number of complications.

Example 1. Patient X ,, born in 1967, the medical history of Mz 3002, was admitted to the clinic of maxillofacial surgery at the Medical University named after S.M. Kirov on 03.20.87

total defect of the nose, cicatricial deformity of the middle zone, face, including the eyelids and upper lip, of the extensive defect of the parietal-occipital region after an electric burn ,.-

After a comprehensive examination on 04/03/87, under anesthesia, the 1st stage was performed - the formation of a rhinograft in the left inguinal region. In this case, a skin-fascial flap was used.

8x17 cm in size and cartilage plates from the VII rib of the patient. Postoperative course without complications.

04.29.87t. 25 days later after the 1st stage, the 2nd stage is completed - elimination of the defect

nasal rhinograft from the inguinal region on microvascular anastomoses. The operation lasted 6 hours. Against the background of the appointment of anti-inflammatory therapy and drugs that improve the rheological properties of blood

rhinograft engraftment occurred after 10 days. A satisfactory result was obtained in the cosmetic sense, which did not change during two years of dynamic observation. The patient was discharged on the 18th day after the operation. Thus, the entire rehabilitation treatment took about 2 months.

Example 2. Patient P., born in 1942, medical history Ns 11205, drank to the clinic of maxillofacial surgery and

dentistry S.M. Kirova, 10.11.87, regarding a subtotal defect in the nose, combined with an extensive through defect in the hard palate after radiation therapy, carried out with the aim of treating a new formation of the nasal septum. Examined clinically, radiologically and laboratory. The operation of eliminating a subtotal nasal defect is indicated. Considering that the tissues surrounding the nasal defect were irradiated, a plastic technique was required that would ensure graft engraftment in such tissues. The claimed method fully met such requirements.

11.11.87, under anesthesia, an operation was performed - the formation of a rhinotransplant on the left lateral surface of the chest in the zone of axial blood supply to the chest and back vessels. This area is specially chosen to include the latissimus muscle, which was used to close the defect in the sky, in the rhinograft being formed. The 1st stage of plasty proceeded without complications.

12.22.87, the 2nd stage was completed - the elimination of the subtotal nasal defect and an extensive through palate defect by transplanting a rhinograft from the lateral surface of the chest on microvascular anastomoses. In this case, the rhinograft vessels anastomosed with the facial vessels, passing them through the subcutaneous tunnel. The operation lasted 8 hours. In the postoperative period, there was suppuration of the wound in the area of the left wing of the nose, but due to the good blood supply to the transplanted rhinograft, it did not affect the final cosmetic result of the operation. The patient was discharged 3 weeks after the second operation. The duration of treatment was 2.5 months.

Achieving a stable cosmetic result of rhinoplasty according to the proposed method is provided by the histological structure of the flap used, which includes the skin, subcutaneous tissue in a complete layer without dissection, which is important for maintaining its volume and structure, and fascia; and the absence of fiber atrophy, as well as the lack of resorption of the cartilage frame, as evidenced by morphological studies on b dogs in an experiment studying the histogenesis of rhinograft tissues.

The reduction of treatment time is ensured by the fact that the proposed method of rhinoplasty is carried out in two stages.

The reduction in the number of complications is ensured by the fact that in the proposed method the rhinograft has excess blood supply through the axial arteries and vein, thereby eliminating the possibility of inflammatory complications and engraftment of the rhinograft in areas with insufficient blood supply (scar tissue and irradiated tissue).

In addition, the proposed method relieves patients of the multi-stage rehabilitation treatment, forced, inconvenient and prolonged immobilization of the arm when transferring the stem of the stalked flap according to the prototype method. It is applicable in patients with the consequences of extensive trunk injuries, having cicatricial contractures of the elbow joint and hand or amputated upper limbs at different levels.

The proposed method allows to establish total and subtotal defects of the nose in a short time, reduces the number of complications and provides a stable cosmetic result of rhinoplasty after 2 years or more after surgery, increases the cost-effectiveness of rehabilitation treatment, while reduces the duration of inpatient treatment (bed days) and increases bed turnover in the clinic; and it is easier for patients to tolerate. In addition, the implementation of rhinoplasty according to this method in facial-facial wounded people will allow avoiding multi-stage evacuation to the rear medical facilities of the country and will ensure return to duty in a short time.

Claims (1)

The claims A method of rhinoplasty for total and subtotal nasal defects using a transplant, characterized in that, in order to reduce the treatment time, a skin-fascial flap with axial blood supply is cut out in the inguinal region, from which a rhinograft with a cartilaginous skeleton is formed, and after its adaptation it is transferred to the region of anatomical location with simultaneous restoration of blood supply in it using microvascular anastomoses.