RU2134072C1 - Method of cutaneous tissue taking root in plastic operations - Google Patents

Abstract

FIELD: medicine, particularly, ophthalmology; may be used in plastic surgery for improvement of fusion of transplanted skin, both, in free plasting and pedicel graft under conditions limiting transplant taking root. SUBSTANCE: to increase probability of fusion, transplanted cutaneous graft after operation is covered with closed vessel from semipermeable membrane with pore diameter of 2.0-3.0 nm. Membrane cavity contains dialyzing solution balanced by electrolytes with blood plasma and having antibiotics, local anesthetics and hydrophilic compounds with molecular weight from 14,000 to 65,000 dalton and forming osmotic pressure within 0.9-8.0 mOsmole. EFFECT: rapid fusion of cutaneous draft. 1 cl, 1 dwg

Description

 The invention relates to medicine, in particular to ophthalmology, and can be used in plastic surgery to improve the engraftment of transplanted skin, both with free plastic surgery and when grafting skin flaps on a feeding leg under conditions limiting the engraftment of transplanted tissues.

A known method of free plasty skin flaps of certain sizes and shapes, providing normal healing of tissues and contributing to faster healing of extensive wounds or a change in deforming effects of scar tissue. Factors that increase the likelihood of engraftment of skin plates should be considered:
- giving the transplanted skin flap on the leg of geometrically defined shapes and sizes (the length should not exceed the width of more than three times);
- transplantation of a free or leg of a skin flap should be performed in a bed that does not have signs of purulent inflammation and severe scarring [1; 2; 3].

 Ignoring these rules leads to the engraftment of the skin graft with the formation of a rough scar or rejection and melting of the transplanted skin flap.

A known method of treating purulent wounds by using a closed container from a semipermeable membrane in the cavity of which the dialysis solution is circulated
[a.s. N 1050679 USSR, IPC A 61 B 17/00].

 A known method for the treatment of purulent wounds, where to reduce the time for cleansing the wound, drainage is introduced into its cavity in the form of a closed container from a semipermeable membrane with a pore diameter of 2.5-3.0 nm, filled with a drug solution based on dextran gel with a molecular weight of 60,000 dalon and concentration above 50% [a.s. N 1421312 USSR, IPC A 61 B 17/00].

 However, the use of a closed container of a semi-permeable membrane, in the cavity of which a dialysis solution is changed with desired properties to increase the efficiency of transplantation of skin flaps, has not been used.

 The aim of the invention is to increase the engraftment of the skin flap after transplantation.

 The goal is achieved by applying a comprehensive therapeutic effect on the transplanted flap by means of a closed container of a semipermeable membrane with a pore diameter of 2.5 - 3.0 nm, in the cavity of which a dialysis solution is balanced, balanced by electrolytes with blood plasma and osmotic pressure of hydrophilic polymers with a molecular weight of 14000 -60000 daltons in front of 0.9-8.0 mOsmol, which has antibiotics, local anesthetics (directed medicines).

 A semi-permeable membrane with a pore diameter in the range of 2.5-3.0 nm in dialysis mode is capable of transmitting compounds with a molecular weight of up to 12,000 daltons. Due to this, almost all known drugs used parenterally penetrate the concentration gradient from the dialysis solution through the wall of the semipermeable membrane (their molecular weight, as a rule, does not exceed 1500 daltons, and in the vast majority this figure does not exceed 500 daltons). At the same time, low molecular weight biodegradation products (inflammatory mediators) diffuse from the wound discharge into the dialysis solution according to the concentration gradient. At the same time, on the wound surface and at the junction of the transplanted skin and the skin of the transplantation zone, cellular and large-molecular compounds of the wound discharge are preserved, which contributes to the rapid development of reparative processes. The addition of large-molecular hydrophilic compounds to the dialysis solution allows the formation of osmotic flows and, thus, the regulation of colloidal osmotic pressure parameters. The balance of the main electrolytes allows all kinds of effects (dialysis of the wound discharge, regulation of colloid osmotic parameters of wound tissues) without inducing electrolyte imbalances. If there are electrolyte imbalances in the wound, they are corrected and the wound homeostasis parameters are adjusted to average levels. The osmotic pressure of large-molecular hydrophilic polymers of a dialysis solution in the range of 0.9-8.0 mOsmol is determined by the osmotic pressure of the official blood-substituting solutions, which are as close as possible to the parameters of homeostasis.

As a solution balanced by basic electrolytes with blood plasma and having an oncotic pressure in the range of 0.9-8.0 mOsmol by adding high molecular weight hydrophilic polymers with a molecular weight in the range of 14000-60000 daltons, official plasma substituting solutions can serve, for example;
hemodesis (oncotic pressure of polyvinylpyrrolidone with a molecular weight of 14,000 within 8.0 mOsmol)
polyglucin (oncotic pressure of desctran with a molecular weight of 60,000 daltons within 0.9 mOsmol).

 Directed medicines (antibiotics, local anesthetics) are added to the dialysis solution, based on the therapeutic situation. Moreover, the amount of medication in 1 kg of dialysis solution should be equal to the doses allowed by the pharmacotherapy guidelines for a single parenteral administration per 1 kg of patient weight.

 In the case of using several drugs at the same time, consideration must be given to their interoperability and individual tolerance by the patient.

As a semipermeable membrane, a cellophane film with a pore diameter of 2.5-3.0 nm is used. It is formed in the form of a tube with a diameter of 30 mm. Before use, the semipermeable membrane is sterilized by boiling for 40 minutes in distilled water. Then one end of the cellophane tube is knotted tightly (2) [Fig. 1]. A dialysis solution is poured into the cavity of the container from a semipermeable membrane and the second end of the membrane is tied (3). Thus, a closed container is formed from a semipermeable membrane (1) containing a dialysis solution
The amount of dialysis solution in the container should be 25-30% of the total capacity of the membrane bag, which allows to achieve a high degree of congruence of the membrane system and to adapt it well to the surface of the area of the transplanted skin and the receiving bed.

The implementation of the method:
After performing the operation and moving the transplanted skin flap (4) onto the receptive bed (6), the membrane container (1) containing the dialysis solution is placed on the graft, overlapping the contact area of the transferred flap (1) and surrounding healthy skin (5). It should be ensured that the nodes (2,3) of the membrane system do not fall into the area of the surgical field. The bandage membrane system is mounted on the wound surface. The membrane system is changed 1 time per day during ligation. The total length of the dialysis device is dictated by the surface of the overlapping zone. The dialysis device is fixed with a dressing using any dressing.

 The use of a dialysis tank in the treatment of the patient ensures that the dressing does not adhere to the surface of the wound, makes subsequent dressings simple and painless.

Case Studies
Example 1
Extract from the medical history N 486 \ 112
Date of receipt 01/26/94

 Date of discharge 14.02.94

 Patient Karabanov Alexander Viktorovich, born in 1976.

Diagnosis: Extensive necrosis of the skin of the upper eyelid of the left eye with a transition to the frontal and zygomatic region due to phlegmon of the upper eyelid
From the anamnesis: was beaten by unknowns, after which phlegmon of the upper eyelid developed. He was treated for a week in the surgical department at the place of residence. The methods of surgical treatment and dressings with hypertonic solution were used, as well as the general purpose of antibiotics. Due to the failure of treatment, he was admitted to the 1st eye department of the Krasnoyarsk Interregional Center for Eye Microsurgery named after P.G. Makarova.

 On admission: A sharp swelling of the eyelids of the right eye. On the upper eyelid with a transition to the zygomatic region and to the frontal purulent wound size 6x4 with a purulent necrotic bottom and copious purulent discharge. A bandage with a cellophane membrane system was applied to the wound, in the cavity of which a dialysis solution of the following composition was changed: Polyglukin-400.0 ml + gentamicin 10 mg + novocaine solution 2% - 10 ml. The dressing with the dialysis system was changed 1 time per day for 5 days. As a result of treatment, the wound partially cleared of necrotic tissue, purulent discharge was significantly reduced. 02/01/94 (5 days after the start of treatment) skin plastic surgery was performed with a flap on a leg from the temporal region (flap dimensions: length 6 cm, width 3 cm, base width 2 cm). From the first day after the operation, ligation with the membrane system and the use of a dialysis solution of the following composition were started: Polyglukin - 400.0 + gentamicin 2.0 mg + novocaine solution 2% 10 ml. The dressing with the dialysis system was changed 1 time per day. The engraftment of the skin flap is complete. No exclusion zones were noted. The surviving skin plate is elastic, normal in color, with no swelling of the tissues.

2. The medical history N 5170 \ 202008
Date of receipt 02.10.95.

 Date of discharge 18.10.95.

 Patient Parfenova Zinaida Zakharovna.

 Year of birth 1940.

 Diagnosis: gross post-burn scarring of the skin of the face, cicatricial eversion of the eyelids, xerosis of the cornea of the left eye.

 From the anamnesis. In December 1994, a thermal burn of the face. On examination, gross cicatricial deformities of the skin of the face and eyelids of the left eye. Eyelids shortened, non-closure of the eye, xerosis of the cornea.

 10/04/95, correction of insufficiency of the upper eyelid and wing of the nose on the left, blepharography.

 For the purpose of skin plasty of cicatricial insufficiency of the upper eyelid, a free skin graft was performed in its entire thickness in the projection area of the palpebral fold, in a bed with gross scar tissue changes. The size of the skin graft was 1.5x4.0 cm. In addition, a free plastic surgery of the left wing of the nose was made with a flap in the entire thickness of 3.0x1.5 cm. The graft areas were covered with a membrane system. From the first day after the operation, ligation with the membrane system and the use of a dialysis solution of the following composition were started: Hemodez - 200.0 ml + gentamicin 2.0 mg + novocaine 2% -10 ml. The dressing with the dialysis system was changed 1 time per day. The engraftment of skin flaps is complete. No exclusion zones were noted. The surviving skin plates are elastic, normal in color, with no swelling of the tissues.

 Under observation were 17 patients. Of these, 5 patients underwent skin plastic in the bed with signs of purulent infection (phlegmon of the upper eyelid 3, purulent wound of the face 2); 12 patients with free plastic and plastic with an elongated skin graft on the leg, in the entire thickness (rough bed of the skin of the eyelids 6, face skin 6). In the postoperative period, all patients underwent treatment using the proposed membrane system. In all cases, complete transplant engraftment was noted. At the same time, the graft that had survived had an elastic consistency and gathered in a fold. No complications were observed in any case.

Claims (1)

 A method of engraftment of skin tissues by moving the flap, having restrictions on the length and width, the absence of signs of severe scarring, purulent inflammation on the bed receiving the flap, characterized in that they use a therapeutic effect, using the cover of the transplanted skin flap in a closed container of a semipermeable membrane with a pore diameter of 2.5 -3.0 nm, in the cavity of which the dialysis solution is balanced, balanced by electrolytes with blood plasma and oncotic pressure of hydrophilic polymers with .m. 14000-60000 daltons in the range of 0.9-8.0 mOsmol, including antibiotics, local anesthetics.