RU2020881C1 - Method of tracheostoma plasty - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: this method prescribes making arc-like closed chord edging incision around tracheostoma, placing cut-out graft so that epiderm will contact tracheostoma, attaching it on opposite side, mobilizing skin portion also on opposite side, positioning it on fastened graft, and then suturing the whole to skin on side of cut-out graft. Sutures should be disposed outwards tracheostoma on opposite side. EFFECT: better functional results, shorter treatment period and reduced rate of relapses.

Description

 The invention relates to medicine, namely to otorhinolaryngology, and can be used in the treatment of tracheostomy.

 The aim of the invention is to reduce the treatment time and relapse of the disease.

 Operation scheme.

 After processing the surgical field, a skin incision is made around the tracheostomy, which is arched on one side of the tracheostomy and straight in the opposite direction, i.e. the arc is closed by a chord. The latter passes along the edge of the tracheostomy. The skin, limited by an arcuate incision, is separated inside the incision, leaving a leg along the edge of the tracheostomy. As a result, a flap is formed on the leg, which, after being reduced in accordance with the size of the tracheostomy, is laid inside the epidermis on the tracheostomy and is sutured to the edge of the tracheostomy on the opposite side by knotted sutures. In this case, a wound surface is formed. Subsequently, the skin is mobilized on the side of the rectilinear incision, laid on top of the hemmed flap and fixed with sutures to the skin on the side of the previously arched flap. In this case, both sutures are located outward from the tracheostomy from opposite sides at different depths.

 PRI me R 1. Patient M., 7 years old, was admitted to the hospital with complaints of the presence of a tracheostomy. Sick for 6 years. In the past, plastic surgery on the larynx has been performed repeatedly for chronic cicatricial stenosis. Last operation 8 months. back, after which the patient is unanimated.

 Upon admission on the front surface of the neck in the middle third: a tracheostomy 2.5 x 0.8 cm in size. When closing the last, breathing is preserved, the voice is sonorous. With direct laryngoscopy, the epiglottis is not changed, the vocal folds are somewhat thickened, mobile, a parietal scar in the sub-vocal cavity, the lumen of the larynx is sufficient for breathing.

 Diagnosis: tracheostomy, condition after plastic surgery of the larynx.

 Treatment. Under the general anesthesia, a fringing skin incision was made around the tracheostomy: a diagram was made of a flap of an arched shape, on the right a straight-line incision was made (an arch closed by a chord). The skin, limited by an arcuate incision, is mobilized inside, as a result of which a flap on the leg is formed. After bringing its size in accordance with the tracheostomy, the flap is laid by the epidermis on the tracheostomy and hemmed to the edge of the tracheostomy from the opposite side. Then the skin was mobilized outward from the linear incision and laid on top of the previously described flap and wound surface and sutured along the edge of the arcuate incision to the skin. As a result, the tracheostomy is closed by two flaps, and the seams are located on opposite sides of the tracheostomy at different depths. An aseptic dressing is applied. The patient took kefzol at 750,000 units. 3 times a day intramuscularly, inhalation of a decongestant mixture, desensitizing therapy. The postoperative period was uneventful. Sutures were removed after 10 days. The wound healed by primary intention. Discharged in satisfactory condition. When viewed after 6 months. free breathing, sonorous voice, postoperative scar on the site of the former tracheostomy.

 PRI me R 2. Patient Z., 8 years old, was admitted to the ENT clinic with complaints of laryngotracheostomy. In the past, he was repeatedly treated in ENT clinics for chronic cicatricial stenosis of the larynx. He underwent 5 plastic operations on the larynx, the last time - 1 year ago.

 Objectively: the general condition is satisfactory. On the front surface of the neck in the middle third of the laryngotracheostomy size 5 x 1.5-1 cm, which is located down from the edge of the thyroid cartilage. Mixed breathing: through the nasal cavity and laryngotracheostomy. When closing the last, breathing is free, the voice is sonorous.

 Ultrasound examination of the larynx preserves its lumen, echo signals from the vocal folds of a linear shape, are located at the same level, close when phonation occurs.

Claims (1)

 METHOD OF PLASTIC TRACHEOSTOMA by making incisions and forming a tracheostomy using flaps, characterized in that, in order to reduce treatment time and prevent relapse, a bordering incision is made around the tracheostomy with an arcuate shape with a closed chord on the opposite side of the tracheostomy, then the cut flap is placed under the epidermis and placed under the tracheostoma on the opposite side, and then the skin on the opposite side is mobilized, laid on top of the hemmed flap and fixed with sutures to the skin on the side cut flap, while the seams are located outward from the tracheostomy on opposite sides.