RU2295305C1 - Method for substituting postsurgical subtotal defects of oral bottom and tongue - Google Patents

Abstract

FIELD: medicine, surgery.

SUBSTANCE: it is necessary to perform autotransplantation of antebrachial radial fragment by one stage; the fragment should be applied as two cutaneous elements upon total fascial foundation; the fragment should be folded in two with its cutaneous surfaces outwards. One should dissect fragment's skin in the site of flexion up to fascial foundation, fix lateral edge of one of the cutaneous elements due to applying transossal sutures towards internal surface of mandibular body, suture median edge with edges of tongue's mucosa and oral mucosa, suture the edges of the second cutaneous element with skin edges along defect's periphery in submandibular area. The innovation enables to simultaneously compensate internal lining and external covering, provide transplant's resistance to infection.

EFFECT: higher efficiency of substitution.

8 dwg, 1 ex

Description

The invention relates to medicine, namely to surgery, and can be used to replace defects that occur after removal of malignant neoplasms of the bottom of the oral cavity and tongue.

A known method of replacing subtotal defects of the bottom of the oral cavity and tongue using a musculocutaneous flap with the inclusion of muscles lying below the hyoid bone (Restorative surgery of the soft tissues of the maxillofacial region. Manual for doctors / Arzhantsev P.Z., Vissarionov V.A., Davydov B.N. et al. / Under the editorship of A.I. Nerobeev, N.A. Plotnikov. - M .: Medicine, 1997. - 288 p.).

The disadvantages of this method are its invasiveness, a large percentage of partial necrosis of the flap, the need to use other plastic methods to restore the outer integument of the neck, the duration of inpatient treatment is 35-70 days.

The technical result of the invention is to improve the results and reduce the treatment time for patients with malignant neoplasms of the bottom of the mouth and tongue.

The technical result is achieved by the fact that the tissues of the bottom of the oral cavity and tongue are compensated by means of a microsurgical autotransplantation of a radial graft of the forearm, formed in the form of a defect in the form of two skin elements on a common fascial basis.

The method is as follows. Through the central mandibulotomy, a resection of 1/2 of the tongue and tissues of the bottom of the oral cavity is performed. Compensation of the resulting subtotal defect in the bottom of the oral cavity and tongue is performed simultaneously with the help of a radial flap of the forearm, formed according to the method of the authors, in the form of two skin elements in the form of a defect on a common fascial basis. The flap is folded in half with the skin surfaces outward, the leaves of the deep fascia along the perimeter of the flap are stitched together to prevent infection of the vascular pedicle. One of the skin elements is used to compensate for a defect in the oral mucosa and tongue and is fixed to the body of the lower jaw with transossal sutures, the other is used to compensate for the defect of the external integument of the submandibular region.

Example 1. Patient E., 56 years old, medical history No. 1347/2.

He entered the Department of Microsurgery of the Voronezh Regional Hospital with a diagnosis of Relapse of cancer of the mucous membrane of the bottom of the oral cavity after radiation treatment (SOD-70 Gy). Histological diagnosis: squamous keratinizing cancer.

04/13/03, the patient underwent surgery - upper cervical dissection, after which, through the central mandibulotomy, a resection of 1/2 of the tongue and tissues of the bottom of the oral cavity was performed. The left facial artery and the left external jugular vein were isolated. In the middle third of the left forearm, a skin-fascial radial flap is formed in the form of two skin elements of a trapezoidal shape on a common base from the deep fascia of the forearm. The dimensions of the skin elements corresponded to the sizes of defects in the oral mucosa and tongue and the external integuments of the submandibular region. The feeding leg of the flap was represented by the radial artery and the accompanying radial veins. After mobilization of the flap, there were no signs of a violation of the blood supply to the skin elements. After crossing the vascular pedicle, the flap was transferred to the defect zone and folded in half, with the skin surfaces out. The skin of the flap, at the fold, is dissected to the fascial base. The leaves of the deep fascia along the perimeter of the flap are stitched together to protect the vascular pedicle from possible infection. The lateral edge of one of the skin elements by applying transossal sutures is fixed to the inner surface of the body of the lower jaw. The medial edge is stitched with the edges of the mucous membrane of the tongue and the mucosa of the bottom of the oral cavity with separate atraumatic catgut sutures in two floors. The edges of the second skin element are stitched with the edges of the skin along the periphery of the defect in the submandibular region. The flap leg was held under the skin on the lateral surface of the neck, where end-to-end microanastomoses were applied between the radial and facial arteries, as well as between the external jugular vein and radial veins at the point of their confluence. After the start of blood flow, blood circulation in the flap was restored. After that, osteosynthesis of the lower jaw was carried out along the line of the central mandibulotomy with a titanium miniplate. Wounds in the field of recipient vessels are sutured in layers. A donor wound on the forearm is closed by split skin grafts. In the postoperative period, there were no signs of impaired blood supply to the flap and suppuration of the wound. The nasogastric tube was removed on the 9th day, after which the patient ate naturally. Split skin in the donor area has taken root completely, the function of the forearm and hand was not impaired. The patient was discharged 04/27/03, the Period of inpatient treatment was 14 bed days. A satisfactory functional and aesthetic result was noted.

Photos of patient E. at various stages of treatment are presented in figures 1-8.

Thus, the positive effect of this method is its one-stage, reliability, and transplant resistance to infection. The engraftment of the flap does not depend on the state of blood supply to the tissues of the recipient zone. The anatomical features of the radial flap make it possible to successfully use it in the form of two skin elements on a common fascial base for simultaneous compensation of both the inner lining and the external integument. The hairline of the skin at the site of the flap is slightly expressed. Taking a radiation flap does not cause significant functional and aesthetic disorders on the part of the donor forearm. The period of inpatient treatment is reduced.

Claims (1)

A method for replacing subtotal defects in the bottom of the oral cavity and tongue, including the autotransplantation of a radial graft of the forearm in one step, characterized in that the graft is applied in the form of two skin elements on a common fascial base, the graft is folded in half with the skin surfaces outward, the skin of the graft is dissected to the fascial base, the lateral edge of one of the skin elements by applying transossal sutures is fixed to the inner surface of the body of the lower jaw, the medial edge is sutured to the edges of the mucous tongue and the mucosa of the bottom of the oral cavity, the edges of the second skin element are stitched with the edges of the skin along the periphery of the defect in the submandibular region.

Images