RU2269321C2 - Method for closing defects of soft tissues - Google Patents

Abstract

FIELD: medicine, surgery.

SUBSTANCE: one should make a skin incision near defect of soft tissues to implant a silicone balloon - expander under the skin under healthy tissues followed by forcing the liquid into expander for 3-4 wk. Then expander should be removed, wounds should be sutured. The innovation enables to accelerate reparative regeneration.

EFFECT: higher efficiency.

3 dwg, 1 ex

Description

The invention relates to medicine, in particular to plastic surgery, and can be used to close soft tissue defects of various localization, formed after traumatic detachment, frostbite and burns.

Despite certain successes achieved over the past decade in the treatment of patients with soft tissue defects, the problem of traumatic and thermal lesions remains one of the difficult sections of clinical medicine. The number of patients with post-traumatic and post-burn cicatricial deformities and contractures does not decrease.

When correcting severe cicatricial deformities, contractures of the neck, upper and lower extremities, plastic is effective with mixed skin-fat and skin-fascial flaps from adjacent areas, as well as a combined method that includes a combination of small skin flaps and free skin grafting. However, the use of these methods is limited due to cicatricial damage to the integumentary tissues of nearby areas. The stalked plastic is multi-stage, it is associated with frequent complications, loss of part of the plastic material during migration, deterioration of the elastic qualities of the skin, and prolonged, forced position.

A free transplant with a split graft eliminates any deformation. However, this method has its drawbacks. Due to retraction of the autolosug, its cicatricial degeneration, loss of elasticity, hypo- and hyperpigmentation, relapse of contracture occurs in 30% of cases, and in 70% of cases there is no cosmetic effect that would satisfy both the patient and the surgeon.

The prototype of this invention is a method for closing a soft tissue defect or scarred skin of the limbs, based on the high adaptive ability of soft tissues when creating tensile stress (V.I. Shevtsov et al. "Defects of the lower limb bones. Transosseous osteosynthesis according to the methods of the Russian Scientific Center" WTO "named after academician G.A. Ilizarov. - M., IPP" Zauralie ", 1996, 58 pp.).

The technical result of the invention is the improvement of the functional and aesthetic results of the treatment of patients with soft tissue defects.

Indication for surgery - the presence of a long non-healing wound or scar scar of soft tissues of various origin.

The indicated result is achieved by the fact that in order to accelerate and stimulate regenerative processes in the area of soft tissue defect, a silicone balloon is implanted under the skin, into which liquid is introduced until tensile stress appears.

The proposed method is as follows. After treatment with a chlorhexidine solution of the surgical field, a skin incision is made next to the soft tissue defect. A silicone balloon (expander) is injected under the skin, if possible implanted under healthy tissue. Cicatricial altered tissues have an increased risk of pressure sores, and therefore they are stretched with special precautions. Within 3-4 weeks, fluid is injected into the expander, wound dressings with reparative ointments. 1 week after the start of skin stretching, the expander in the wound accelerates reparative processes in the form of granulation and epithelization and by the fourth month the wound is completely closed. The expander is removed, the wounds are sutured.

In FIG. 1 shows a photograph of a shin with a long non-healing wound along the front surface. In FIG. 2 shows a wound treatment step. In FIG. 3 - photograph with the outcome of the treatment: the silicone balloon was removed, the wound of the lower leg was epithelized.

The method is used in clinical practice in 6 patients. All patients underwent surgery for complicated shin bone fractures. The functional and cosmetic result of the treatment is satisfactory. The supporting function of the limbs has fully recovered, all patients are socially and professionally rehabilitated.

Example

Patient V., 45 years old, medical history No. 4751, was hospitalized in the orthopedic and traumatology department of the BSMP of Ufa for planned surgical treatment. History - an open fracture of the bones of the left leg. Periosteal bone osteosynthesis was performed. In the postoperative period, the phenomena of metallosis and discrepancies of the edges of the wound of the lower leg with exposure of the metal structure occurred. A wound measuring 4.0 by 3.0 cm did not heal within two months.

The operation was performed - removal of metal, closed intramedullary blocked osteosynthesis of the tibia, implantation of a silicone expander next to the defect of the soft tissues of the lower leg. For three weeks, fluid was injected into the expander, wound dressings with reparative ointments. As a result, the wound was epithelized. The patient was examined after 11 months. The supporting function of the limb is fully restored, aesthetically and functionally the skin of the lower leg meets well-known requirements.

The advantages of our proposed method are improved functional and aesthetic results and a significant reduction in the treatment time for patients with soft tissue defects due to the fact that the acceleration of granulation and epithelization of long-healing wounds is achieved by stimulation of reparative processes while creating tensile stress.

Claims (1)

A method of closing a soft tissue defect, including stretching the soft tissues for 3-4 weeks, characterized in that a skin incision is made next to the soft tissue defect, a silicone balloon - expander is implanted under the skin under healthy tissues, and is pumped into the expander for 3-4 weeks liquid, remove the expander, sutured wounds.

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