RU2297849C2 - Method and the device for carrying out liposuction - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method involves saturating skin layer above liposuction area with ozone/NO-containing substance. Then, hydrotreated adipose tissue tunnel or near-surface dispersion and emulsification is carried out. Primarily circumscribed superficial remote pneumopulse liposuction area is treated with ozone/NO-containing gas mixture, after vacuum evacuation of dispersed and emulsified adipose tissue, suturing incisions and placing fixing flexible bandage impregnated, for example, with ozone/NO-containing solution is carried out in superposition relative to liposuction area. And then, ultrasonic low-frequency superficial contact treatment of liposuction area is carried out. The device has means for producing ozone/NO-containing gas mixtures, high pressure air compressor, reservoir containing ozonized drug solution and pneumatic hydraulic unit. Beside that, the device has pneumatic hydraulic dispersing cannulas and limiting control unit, and acoustic unit having advanced radiation-emitting end face means.

EFFECT: enhanced effectiveness of treatment; reduced risk of traumatic liposuction complications.

4 cl, 13 dwg, 1 tbl

Description

The invention relates to medicine, namely to plastic surgery and the related direction of aesthetic (cosmetic) surgery, as well as to cosmetology, and relates to methods and devices for correcting body shape by liposuction.

The search for beauty is part of human nature. Beautiful and physically attractive people have great potential for their success and self-realization in various fields of activity of the modern world. Elimination and masking of physical defects or deficiencies of patients, realized by the possibilities of modern plastic surgery and, above all, aesthetic surgery, dramatically increase the level of self-esteem, psychoemotional state and quality of life.

Liposuction, aimed at removing localized and excess subcutaneous fat from almost any part of the body, is one of the cosmetic operations that allows, within the limits of what is possible, to improve the shape of the body, and therefore the appearance of a person.

There are methods of superficial and massive tunnel liposuction with appropriate devices for their implementation (Y. Illons; P. Fournier; G. Hatter; C. Gasperoni, M. Salgarello and others) [1], most of which are associated with “wet” technology vacuum aspiration of excess subcutaneous fat in both the subdermal and deep layers of adipose tissue. Basically, they consist in hydrotreating (infiltrating) adipose tissue in a selected liposuction area by introducing an anesthetic solution with a vasoconstrictor substance (for example, a solution of sodium chloride with hyaluronidase, a solution of lidocaine with adrenaline, etc.), performing one or two skin incisions 10- 15 mm, insertion and reciprocation of the cannula (with a perforated working part at the end) in the field of liposuction, emulsification of fat cells, followed by vacuum aspiration with a dispersion electric suction device that adipose tissue into the adipose tissue receptacle, suturing incisions and applying a fixative elastic bandage.

However, the known methods of liposuction are laborious, do not provide high-quality hydrotreparation of tissues in the fat layer, which facilitates the process of local lipodystrophy and, accordingly, the removal of emulsified fat, which, as a rule, is accompanied by bleeding of tissues, requiring replenishment of blood loss. The use of devices for implementing known liposuction methods makes it difficult to treat patients with a fine tuberous skin texture due to dystrophic processes in the surface layer of adipose tissue, as well as when used in deep layers of adipose tissue. Known methods and devices for their implementation do not provide oxygenation of the postoperative liposuction region, which improves microcirculation in it, normalization of adipocyte metabolism, etc., leading to minimization of tissue repair time with improved skin structure and relief of the operated body area with the exception of postoperative complications. They cannot be used with various possible options for correcting the shape and topography of the body using liposuction, limiting the functionality of aesthetic surgery.

The closest in technical essence and the achieved effect is the method of liposuction, using the physical factor, namely the energy of ultrasound, and related to the hydrodynamic methods of dispersion of biological tissues, as well as a device for its implementation [2].

This method implements “wet” tunnel liposuction, which includes hydrotreating adipose tissue in a selected area of liposuction with an anesthetic with a vasoconstrictor substance, performing skin incisions, introducing and reciprocating movement of the working part of the dispersing cannula in the liposuction area when exposed to adipose tissue with a physical factor leading to to the dispersion and emulsification of fat cells, followed by vacuum aspiration of the adipose tissue dispersant, suturing of incisions and the application of a fixing el bandage.

However, this method of ultrasonic liposuction, implemented by an appropriate device for its implementation, is traumatic and causes bleeding of tissues, requiring replenishment of blood loss, as it is known [1, 3, 4] that even with the mastered methods of liposuction, the amount of blood in the exfusate averages about 25 % In the case of ultrasonic liposuction, this is a consequence of the occurrence of thermomechanical destruction, which can cause a contact burn of adipose tissue and thermomechanical damage to blood vessels and nerves in the liposuction region, the working end of the waveguide tool and the waveguide path forming in contact with tissues throughout its length, oscillating with ultrasonic frequency. The specified causes the danger of emulsified fat getting into the destroyed bloodstream and is often accompanied by a painful state during the tissue regeneration period, the terms of which are delayed. At the same time, high-quality hydropreparation of the fat layer and the achievement of pronounced lipodystrophy and dispersion of adipose tissue are not ensured due to the limited mass transfer conditions in the contact zone “working end of the waveguide-instrument - adipose tissue”, which impede the implementation of the cavitation regime of dispersion and emulsification of fat cells and free removal of the formed fat dispersant (emulsion) from the liposuction zone. In addition, the small "live" section of a hollow waveguide-tool, where in the zone of the working part the maximum amplitude of ultrasonic vibrations reaches 100-150 microns, cannot provide a long time of its use when performing the entire active cycle of ultrasonic liposuction lasting from tens of minutes to several hours. Moreover, uncontrolled breaking off and loss of the working part of the waveguide tool during liposuction in the thickness of dispersible adipose tissue can cause additional trauma to the tissues and vascular system of the liposuction region and complications in the further operation. The use of a waveguide tool and an additional cannula during liposuction, which separately implement the dispersion and emulsification of fat cells with their subsequent vacuum aspiration, indicates the insufficient effectiveness of the known technical solution that limits the possibilities of aesthetic operations using ultrasonic liposuction. Moreover, the known method of ultrasonic liposuction and a device for its implementation do not provide for forced oxygenation of the liposuction region in the intra- and postoperative period, which improves the cosmetic result due to the intensification of microcirculation, normalization of adipocyte metabolism, etc., leading to minimization of tissue recovery time with improved skin structure and relief the operated area of the body with the exception of postoperative complications. They cannot be used with various possible options for correcting the shape and topography of the body, as well as for improving the structure of the skin, limiting the possibilities of aesthetic operations using liposuction.

The analysis shows that when using known methods of liposuction and devices for their implementation, it is impossible to reduce the morbidity of liposuction while expanding its functionality and improving cosmetic results.

The objective of the invention is to reduce the invasiveness of liposuction, as well as expanding its functionality while improving cosmetic results.

In terms of the method, the task is achieved due to the fact that in the method of liposuction, which consists in hydrotreating adipose tissue in a selected area of liposuction with an anesthetic with a vasoconstrictor substance, performing skin incisions, introducing and reciprocating moving the working part of the dispersing cannula in the liposuction area when exposed to fat tissue with a physical factor leading to the dispersion and emulsification of fat cells, followed by vacuum aspiration of the adipose tissue dispersion, suturing ov and applying a fixing elastic bandage, the ozone / NO-containing substance is first saturated with the surface layer of the skin over the liposuction region by means of surface contact low-frequency ultrasonic treatment through an intermediate pad impregnated with ozone / NO-containing solution, then tunnel or surface dispersion and emulsification of the hydrated fat tissues are carried out by pulsed jets of an ozone / NO-containing gas mixture and ozone / NO-containing gas-liquid flow, sequentially supplied by a pneumohydraulic dispersing cannula into the liposuction zone, and after the dispersant and emulsion of adipose tissue are formed in the liposuction area, they are vacuum aspirated through the same pneumohydraulic dispersing cannula, after vacuum aspiration of the dispersant and emulsion of adipose tissue and suturing of incisions on the skin, the liposuction area is placed saturated with ozone / NO-containing solution, and then near the area of ozone / NO-pulse liposuction performed, along with manual relief ate in the field of liposuction, initially it is formed using a limited surface air-pulse treatment with pulsed jets of an ozone / NO-containing gas mixture, and then using surface contact low-frequency ultrasonic treatment through an intermediate pad impregnated with ozone / NO-containing solution.

In terms of the device, the task is achieved due to the fact that the device for liposuction, containing an infiltration syringe for hydrotreating adipose tissue with an anesthetic solution with a vasoconstrictor substance, an ultrasonic generator, an acoustic unit with a waveguide tool, a nozzle for vacuum aspiration of the dispersion of adipose tissue, an electric suction device, is equipped with a generator ozone / NO-containing gas mixture, a high-pressure air compressor or a cylinder with a compressed gas component, such as air, having pressure and flow regulator, a pneumohydraulic unit, including a working chamber-receiver, an air flow interrupter and a supply pipe connected with a container with ozonized medicinal solution, pneumohydraulic dispersing cannulas for implementing hydro-pulse tunnel disintegration and emulsification of hydrotreated adipose tissue and for performing hydro-impulse surface and emulsification of hydrotreated adipose tissue, the working ends of which have the corresponding a distal and tangential nozzle hole, and behind it drainage holes with an angle of inclination towards the outflow of a jet of ozone / NO-containing gas mixture or ozone / NO-containing gas-liquid stream, while the pneumohydraulic dispersing cannula is connected to the pneumohydraulic unit through a threaded connection, and through supply pipe - a container with an ozonized drug solution and a regulator for its supply to the pneumohydraulic unit, and a pneumohydraulic dispersing cannula through the outlet fitting Nena to elektrootsasyvatelyu dispergata adipose tissue and is equipped with a stop collar.

In addition, the device for liposuction is equipped with a delimiter, consisting of a base in the form of a delimiting hollow support element made of an elastic deformable elastic material conjugated with a cone-shaped bearing body, ending with a cylindrical nozzle including a stepped guide sleeve with a central hole allowing passage through the delimiter cavity the working end of the pneumohydraulic dispersing cannula.

In addition, the device for liposuction is equipped with an acoustic unit with a developed emitting end for surface contact ultrasonic treatment of the skin over the liposuction region, while the acoustic unit includes annular piezoceramic elements and a waveguide tool in the form of a tightening bolt and a reflective lining, and is equipped with a through capillary hole in a tightening bolt communicating on one side with the cavity for the medicinal solution, and on the other hand with the radiating end of the bolt, which is an intermittent th concentric wavy surface in the form of a labyrinth.

Analysis of the known literature and patent sources showed that at the filing date of the application for the invention, there are no known methods and devices for liposuction with the above distinguishing features.

The essence of the invention, which allows to increase the effectiveness of liposuction by reducing its invasiveness and expanding functionality while improving cosmetic results, is based on the integrated use of pulsed hydrodynamic jets with high kinetic energy and exogenous highly active ozone / NO- and ozonide / NO-containing gas and gas-liquid components supplied to adipose tissue in the field of liposuction provided by the proposed device design for the implementation of ozone / NO-pulse liposuction and.

Moreover, in the proposed method of liposuction, which provides the simultaneous prophylaxis of postoperative inflammatory complications caused by an infection represented by anaerobic and associative microflora, pathogenetically based physical and physicochemical factors such as ozone (O ₃ ) and its derivatives, nitric oxide (NO) are used. being azeotropic with respect to the body, i.e. behaving as pure and biologically compatible substances with the body, hydroimpulse effects of gas and gas-liquid jets, as well as low-frequency contact ultrasound on adipose tissue, which is a composite connective tissue in the form of fat cells (lipocytes), united into lobule groups, separated from each other and supported by partitions from the connective tissue stroma, through which blood vessels and capillaries, nerves pass into the adipose tissue [5].

Each of the listed influencing factors implements properties and indicators that are significant for the successful solution of the problem of the invention.

one). Ozone (O ₃ ) is one of the components of exogenous ozone / NO-containing substance obtained from the exogenous OZOTRON (hereinafter referred to as the OZOTRON apparatus) generated by the OZOTRON apparatus for gas ozone therapy, exogenous ozone / NO-containing gas component.

The O ₃ -allotropic form of oxygen, on the one hand, is a donor of atomic (O) and, above all, molecular (O ₂ ) oxygen, which together with arginine is a substrate for the synthesis of NO under the influence of NO synthase. Moreover, the synthesis of NO in tissues directly depends on the concentration of O ₂ (G.S. Krotovsky, 1998). On the other hand, the specific properties of ozone and its derivatives (S. Rilling, R. Viban, 1985; S.P. Peretyagin, 1992; V.V. Pedder et al. 1993-2004; V.A. Maksimov, 1998 and others .) can reduce the risk of known complications of the postoperative period after liposuction due to:

- intensification of lipocyte dispersion processes (when exposed to ozone and its derivatives on lipocytes), extraction of fat from them and emulsification of fat in an ozonized dispersion medium due to the reaction of ozone with double and triple bonds of unsaturated fatty acids (mainly triglycerides). This changes their properties and leads to the breakdown of lipid chains. Hydrophobic lipids turn into less stable hydrophilic ones - lipodystrophy occurs, which facilitates the destruction and emulsification of adipose tissue;

- pronounced local and general bactericidal, fungicidal and virucidal effects;

- stimulation of the general detoxification, immunocorrecting, oxygenating, antihypoxic and analgesic effects;

- activation of oxygen-dependent processes in the body, normalization of lipid peroxidation, the acid-base state and potential of the antioxidant system, leading to an increase in the deformability of red blood cells and an increase in the oxygen-transporting function of the blood;

- normalization of the rheological properties of blood and lymph, vasodilation and normalization of microcirculatory disorders in the blood and lymph systems, improvement of vascular trophism and tissue metabolism;

- a positive effect on the production of biologically active substances and the metabolism of biological substrates: carbohydrates, proteins, lipids, etc.

2). Nitric oxide (NO) is one of the components of an exogenous ozone / NO-containing substance obtained from the ozone / NO-containing gas component generated by the OZOTRON apparatus. The NO-endothelial relaxing factor is the endogenous signaling molecule of the cardiovascular system of the body (R. Furchgott, J. Zawadzki, 1980; R. Furchgott, L. Ignarro, F. Murad, 1998, etc.). This free radical molecule has high chemical activity and instability (G.S. Krotovsky, 1998). NO is one of the main endothelial dilatation factors that prevents tonic contraction of vessels of neuronal, endocrine or local origin. An additional exogenous introduction of NO into the liposuction area will activate the bactericidal properties of macrophages, which is extremely important for the prevention of postoperative complications of inflammatory genesis after liposuction, stimulate the cells of the nervous tissue and brain, protect the heart, and also normalize blood pressure.

3). The hydroimpulse effect on adipose tissue implements the hydrodynamic (convective) technology of tunnel or surface (subdermal) disintegration and emulsification of lipocytes of pre-hydrated adipose tissue in the liposuction area (deep or subdermal layers of adipose tissue) by applying gas pressure-dependent, flow-rate and frequency effects on adipose tissue and gas-liquid jets with high kinetic energy. The hydroimpulse effect in the jet mode on adipose tissue, which is a composite connective tissue with a wide spread of biomechanical characteristics of its constituent elements: lipocytes, connective tissue stroma (reticulin and collagen fibers), blood vessels and capillaries, nerves), promotes highly effective disintegration and emulsification, before total lipocytes in lobules as an element with the lowest strength characteristics of the main tissue and its minimal intermolecular adhesion forces and adhesion to other elements of adipose tissue. In relation to other elements of adipose tissue (connective tissue stroma, blood vessels and capillaries, nerves) that have higher biomechanical characteristics, including elastoelastic properties than lipocytes, the hydro-pulse effect in the jet mode is "gentle" and does not cause their pronounced trauma and destruction, primarily blood vessels and nerves, and therefore the manifestation of dangerous postoperative complications inherent in known liposuction methods.

In addition, the hydroimpulse effect on adipose tissue with gas and gas-liquid jets with high kinetic energy makes it possible to remove adipose tissue not only in the deep, but also in the subdermal layers, successfully solving, along with the problems of removing “trapped" fat, the problems of treating patients with a fine tuberous skin texture due to lipodystrophic processes occurring in the most superficial layer of adipose tissue. In the latter case, the surface hydroimpulse effect, carried out by removing fat directly from the subcutaneous space, stimulates the formation of subdermal scars, which contribute to improving the contractility of the skin, providing a “tightening” effect, which is important in case of reduced skin elasticity and the presence of sprains, bumps, cavities and wrinkles on surface.

At the final stage of liposuction and in the postoperative period, near the area of ozone / NO-hydroimpulse liposuction, it is possible to carry out a limited surface pneumo-impulse treatment (pneumo-impulse massage) of the liposuction region of ozone / NO-containing gas mixture (with pronounced surface irregularities in the shape and topography of the body as in liposuction area, and in the areas closest to it) for the primary correction of the body relief by moving adipose tissue and correction of wrinkles formed after liposuction due to t forces realized by pneumopulse massage, as well as stimulated lymphatic drainage.

four). Surface contact low-frequency ultrasonic treatment of the liposuction region implements contact scoring of the skin surface above the liposuction region with low-frequency ultrasound both directly and through an ozone / NO-impregnated substance impregnated with an intermediate capillary-porous pad with the following:

- at the preparatory stage of liposuction, intensification of the diffusion interaction of lipocytes of hydroprepaired adipose tissue with an ozonized dispersion medium (for example, ozone / NO-containing Klein infusion solution), which allows creating better conditions for the disintegration and emulsification of lipocytes during subsequent hydroimpulse exposure to them with gas and gas-liquid jets;

- saturation of the surface layer of the skin over the liposuction region with ozone / NO-containing substances providing tissue oxygenation, improving the structure of the skin and increasing its elasticity, including its fine-bumpy relief due to dystrophic processes in the surface layer of adipose tissue;

- at the final stage of liposuction and in the postoperative period, the best correction ("liposculpture", "fake") of the surface unevenness of the shape and topography of the body both in the liposuction region and in the zones closest to it for the formation of an optimal finished body relief due to stimulated contact ultrasound directed spatial movement and uniform redistribution and coalescence of intact volumes of adipose tissue, as well as correction of the condition formed after liposuction of wrinkles due to stimulus ozone / NO-containing substances and vibro-ultrasound massage of contact ultrasound: impregnation of ozone / NO-containing substances into the skin, oxygenation and contraction of the skin with improvement of its structure, coalescence of adipose tissue, as well as intensification of blood and lymph circulation, lymphatic drainage in the field of liposuction and other .

The implementation in the field of liposuction of surface pneumopulse treatment (pneumopulse massage) and surfaces of contact ultrasonic treatment (vibro-ultrasound massage) in combination with ozone / NO-containing substances promotes intracellular and intercellular activity with activation of a complex of biochemical reaction chains during the breakdown of fats [6].

The invention is illustrated by drawings, which depict:

figure 1 is a General diagram of the implementation of liposuction using a device for its implementation;

figure 2 - schematic representation of the main functional elements of the device for liposuction;

figure 3 is a cross section of the working end of the pneumohydraulic dispersing cannula with a distal nozzle hole for the implementation of hydro-pulse tunnel disintegration and emulsification of lipocytes of pre-hydrated fat tissue (zone I in figure 2);

figure 4 is a cross section of the working end of the pneumohydraulic dispersing cannula with a tangentially located nozzle hole for the implementation of hydroimpulse surface (subdermal) disintegration and emulsification of lipocytes of pre-hydrotreated adipose tissue (zone I in figure 2);

figure 5 is a cross section of a pneumohydraulic unit with a pneumohydraulic dispersing cannula (section aa in figure 2);

figure 6 - acoustic node with a developed emitting end for the implementation of surface contact low-frequency ultrasonic processing of the liposuction region (type B in figure 2);

Fig.7 is a cross section of an acoustic unit with a developed emitting end (section BB in Fig.6);

on Fig is a schematic representation of the initial stage of the implementation of tunnel liposuction technology (disintegration and emulsification of lipocytes in a deep layer of hydroprepaired adipose tissue of the liposuction region);

figure 9 is a schematic representation of the final stage of the implementation of tunnel liposuction technology;

figure 10 is a schematic representation of the initial stage of the implementation of surface liposuction technology (disintegration and emulsification of lipocytes in the subdermal surface layer of the hydro-prepared adipose tissue of the liposuction region);

11 is a schematic representation of the final stage of the implementation of surface liposuction technology;

12 is a schematic representation of the implementation of surface pneumo-pulsed treatment (pneumo-pulsed massage) of the liposuction region by pulsed gas-liquid jets consisting of a gas-liquid mixture of ozone / NO-containing and ozonide / NO-containing 5-10% aqueous solution of an oil-in-water oil emulsion ;

13 is a schematic representation of the implementation of surface contact low-frequency ultrasonic treatment (vibro-ultrasonic massage) of the liposuction region through an intermediate solution of a mixture of ozone / NO-containing and ozonide / NO-containing 5-10% aqueous solution of an oil-in-water oil emulsion.

When implementing the liposuction method, ozone / NO-containing or ozonide / NO-containing gas and gas-liquid components are used in the form of:

- pulsed jets consisting of an ozone / NO-containing gas mixture (ozone / NO-air gas mixture with an ozone concentration of at least 3-5 mg / l) obtained using the OZOTRON apparatus (used in the implementation of tunnel or surface stages ( subdermal liposuction), as well as the stage of superficial pneumopulse treatment (pneumopulse massage) of the liposuction region);

- pulsed gas-liquid jets consisting of an ozone / NO-containing gas-liquid mixture at an ozone concentration of at least 1-1.5 mg / l, obtained by sparging a physiological solution of ozone / NO-containing gas mixture at an ozone concentration of at least 3-5 mg / l, obtained using the apparatus "OZOTRON" (used in the implementation of the stages of tunnel or surface (subdermal) liposuction);

- pulsed gas-liquid jets, consisting of a gas-liquid mixture of ozone / NO-containing and ozonide / NO-containing 5-10% aqueous solution of an oil-in-water oil emulsion (a mixture of refined vegetable oil with physiological saline) with a peroxide number of at least 100 mmol About _asset. per 1 kg of oil obtained by bubbling the specified liquid mixture with an ozone / NO-containing gas mixture at an ozone concentration of at least 3-5 mg / l, obtained using the OZOTRON apparatus (used in the implementation of the stages of tunnel or surface (subdermal) liposuction;

- a solution of ozone / NO-containing substance in the form of a mixture of ozone / NO-containing and ozonide / NO-containing 5-10% aqueous solution of an oil-in-oil emulsion (a mixture of refined vegetable oil with physiological saline) with a peroxide number of not less than 100 mmol O _asset. per 1 kg of oil obtained by sparging the specified liquid mixture with an ozone / NO-containing gas mixture at an ozone concentration of not less than 3-5 mg / l, obtained using the OZOTRON apparatus (used at the stage of implementation of surface contact low-frequency ultrasonic treatment (vibro-ultrasonic massage ) areas of liposuction).

The device for liposuction, which is a hardware complex "HYDROTON" contains the following main blocks and elements (Figure 1-Figure 13): instrument unit 1, pneumohydraulic unit 2, an acoustic unit with a developed emitting end (AKU) 3, a container with ozone / NO-containing solution or mixture with ozone / NO-containing and ozonide / NO-containing drug solution 4, electric suction device 5, delimiter 6 with excess ozone deactivator 6.1.

The instrument unit 1 (FIG. 1 and FIG. 2) contains a supporting body 1.1 with a power supply (IP) 1.2 located in it, a control unit (BU) 1.3 connected via a cable 1.4 to an electric suction device 5, an air compressor (PC) 1.5 (air compressor) high pressure, P - from 0 to 50 kgf / cm ² or a cylinder with a compressed gas component, P - 150 kgf / cm ² , for example air). The pneumatic compressor (PC) 1.5 has a pressure and flow controller (not shown in the diagram) and is connected via a pneumatic line 1.6 to a pneumohydraulic unit (CCGT) 2, an ozone / NO-containing gas mixture generator 1.7 (for example, the OZOTRON apparatus) connected by a pneumatic pipeline 1.8 with a capacity 4 filled with ozone / NO- or ozonide / NO-containing drug solution, which, in turn, is connected to a pneumohydraulic unit (CCGT) 2 by means of a hydraulic line 1.9 with a drug flow rate regulator 1.10, an ultrasonic generator (UGS) 1.11, with 1.12 of the connections through a cable to the acoustic unit (ACU) developed with 3 radiating end 3.1, which is a discontinuous concentric undulating surface in the form of a labyrinth. The indicated geometry of the developed radiating end face 3.1 makes it possible to ensure uniform spreading and distribution, supplied under the action of ultrasound through the through capillary hole 3.2, of an intermediate solution of ozone / NO-containing substance introduced into the surface layer of the skin above the liposuction region when it is contacted with sound. This helps to intensify the impregnation of the solution deep into the skin, as well as the elimination of overheating and thermal degradation of the skin surface in contact with the emitter. The acoustic unit (ACU) 3 includes a supporting body 3.3, annular piezoceramic elements 3.4, a reflecting plate 3.5, a waveguide tool 3.6 in the form of a tightening bolt equipped with a through capillary hole 3.2, communicating on one side with the cavity of the container 3.7 for the drug solution, and on the other, with a developed radiating end face 3.1.

Pneumohydraulic unit (CCP) 2 (Fig.2-Fig.5) contains a supporting housing 2.1 with a cover 2.2, a receiver chamber 2.3 in the form of a bellows, rigidly connected through a supporting flange 2.4 with the supporting housing 2.1. At the same time, on one of the fittings 2.5 of the receiver-chamber 2.3, a flow control valve 2.6 is installed, supplied from the pneumocompressor (PC) 1.5 through the pneumatic line 1.6, and on the other nozzle 2.7, the solenoid valve (EC) 2.8 is fixed (opens or stops the air flow from the pneumatic compressor ( PC) 1.5), connected via a cable 2.9 and a control key (K-EK) 2.10 with a control unit (BU) 1.3. At the output end of the solenoid valve (EC) 2.8, a two-cone injector 2.11 is connected through a threaded connection, which is connected to the pneumohydraulic dispersing cannula 2.12 (for hydroimpulse tunnel disintegration and emulsification of hydrotreated adipose tissue) or 2.13 (for hydroimpulse surface (subdermal) emulsion disintegration and fabric) by means of their flanges 2.14, fixed in the supporting body 2.1. Moreover, the two-cone injector 2.11 is equipped with a suction nozzle 2.15, which is connected via a hydraulic line 1.9 to a container 4 filled with ozone / NO- or ozonide / NO-containing drug solution. In addition, the pneumohydraulic dispersing cannulas 2.12 and 2.13, on the one hand, are equipped with a conical and rounded at the end working end (to reduce the risk of injury to blood vessels and nerves during liposuction), which has a nozzle opening 2.16 (distal) and 2.17 (tangential), respectively, and behind the nozzle hole there are drainage holes 2.18 with an angle of inclination facing the outflow stream of an ozone / NO-containing gas mixture or ozone / NO-containing gas-liquid stream, and on the other hand, a discharge fitting 2.19, by 2.20 hydraulic line connected to elektrootsasyvatelem (EO) 5 providing vacuum suction from the region of liposuction dispergata adipose tissue. In addition, to prevent uncontrolled movement of the pneumo-hydraulic dispersing cannula 2.12 or 2.13 deep into the liposuction region during the process of disintegration and emulsification of adipose tissue, a restriction sleeve 2.21 is installed on it.

The proposed method of liposuction is carried out using the proposed device, in stages, as follows (Fig.1 and Fig.8-Fig.13). Before carrying out the proposed method of liposuction, a preparatory cycle is carried out, consisting in the implementation of the preliminary stage of generally accepted diagnostic and therapeutic measures aimed at preparing the patient for the main stage of liposuction - improving body shape by removing localized fat. Also, before liposuction, an ozone / NO-containing solution is prepared on the basis of physiological saline filling tank 4 by bubbling through it an ozone / NO-containing gas mixture generated by the OZOTRON 1.7 apparatus, as well as an ozone / NO-containing mixture and an ozonide / NO-containing 5-10% aqueous solution of an oil-in-water oil emulsion (a mixture of refined vegetable oil with physiological saline filling a container 4), by sparging said mixture with an ozone / NO-containing gas mixture generated by the apparatus Volume OZOTRON 1.7.

After preparatory procedures, the patient is immersed in a light sleep by the introduction of sleeping pills. Anesthesia is used - local, spinal or general, depending on the size, volume and location of the fat tissue removed by liposuction. The surgical field is sterilized and covered with napkins, in addition to the previously designated area of the liposuction region. Then, the conventional hydrodrug of adipose tissue is carried out in the selected liposuction region by introducing an anesthetic solution with a vasoconstrictor substance (for example, Klein infusion solution or ozone / Klein NO-containing infusion solution).

In order to saturate, at the preparatory stage, the surface layer of the skin above the liposuction region with an ozone / NO-containing substance and to create better conditions for the disintegration and emulsification of lipocytes during subsequent hydro-pulse exposure to them with gas and gas-liquid jets by intensifying the diffusion interaction of lipocytes of hydroparried adipose tissue with previously introduced into the liposuction region by the dispersion medium carries out surface contact low-frequency ultrasonic treatment (vibro-ultrasound howling massage) the area of liposuction.

Turn on the instrument unit 1 of the hardware complex "HYDROTON". Through a power source (IP) 1.2 and a control unit (BU) 1.3, at the same time they turn on (while maintaining the "standby" mode): pneumatic compressor (PC) 1.5, control key (K-EC) 2.10 of the electrovalve (EC) 2.8 located in the pneumohydraulic unit (CCP) 2, electric suction device 5, apparatus "OZOTRON" 1.7 and an ultrasonic generator (UZG) 1.11, connected to an acoustic unit (ACU) 3.

After that, fill the capacity 3.7 acoustic unit (ACU) 3 with a solution of ozone / NO-containing substance and ozonide / NO-containing 5-10% aqueous solution of an oil emulsion of the oil-in-water type. An intermediate capillary-porous (2-4-layer gauze napkin) pad (hereinafter - pad) 2.22, previously impregnated with the above solution of ozone / NO-containing substance, is placed on the skin surface in the area of the planned liposuction. The acoustic unit (ACU) 3 is applied with a radiating end face 3.1 to the gasket 2.22. They include an ultrasonic generator (UGS) 1.11 connected to an acoustic unit (ACU) 3, and perform contact sounding of the entire skin surface above the liposuction region with low-frequency ultrasound by circular or linear movement of the acoustic unit (ACU) 3 along the surface of the gasket 2.22. At the same time, through the through capillary hole 3.2, which communicates with the capacity 3.7 and the radiating end 3.1, the liner 2.22 and then the skin surface above the liposuction region are additionally saturated with an ozone / NO-containing substance during sonication. At the end of the stage of surface contact ultrasonic treatment (vibro-ultrasonic massage) of the liposuction area, the ultrasonic generator (UGS) 1.11 is turned off, and the acoustic unit (ACU) 3 and the spent gasket 2.22 are removed. After that, previously cut skin incisions are performed, through which excess fat is subsequently removed. Next, they include a pneumatic compressor (PC) 1.5, a control key (K-EC) 2.10 of an electrovalve (EC) 2.8 located in a pneumohydraulic unit (CCP) 2, an electric suction device 5 and an OZOTRON 1.7 device. The flow regulator 2.6 of the pneumohydraulic unit (CCGT) 2 sets the required flow rate of the compressed gas component (air or ozone / NO-containing gas mixture) supplied to the receiver chamber 2.3, coupled to an electrovalve (EC) 2.8, which communicates via a pneumatic line 1.6 with a pneumatic compressor (PC) 1.5.

Through one of the small skin incisions, a pneumohydraulic dispersing cannula 2.12 or 2.13 is inserted into the area of the initial area 2.23, removed by liposuction of the volume of adipose tissue 2.24, attached on one side to the electric suction device 5, and on the other hand to the pneumohydraulic unit (CCP) 2, the type of which is chosen depending on the volume and location of the intended liposuction region, as well as the type of planned liposuction - tunnel (Fig. 8, Fig. 9) or surface (subdermal) (Fig. 10, Fig. 11). The pneumatic compressor (PC) 1.5 provides the necessary supply of the original compressed gas component through the pneumatic pipeline 1.6, the flow regulator 2.6 of the pneumohydraulic unit (CCGT) 2 into the receiver chamber 2.3, which reduces (with increase) the energy of the supplied gas component. In this case, the control key (K-EC) 2.10 provides sequential periodic closing and opening of the electrovalve (EC) 2.8, respectively performing sequential interruption of the passage or passage into the two-cone injector 2.11 and then into the pneumohydraulic dispersing cannula 2.12 or 2.13 of the flow of the compressed gas component, which acquires impulse character. The pulse flow of the compressed gas component, passing further through the nozzle orifice 2.16 or 2.17, is transformed and, gaining, acquires the properties of a pulsed gas jet with high kinetic energy (other types of devices that form the pulsed nature of the flow of the compressed gas component can be used). The HYDROTON apparatus complex also allows mixing the flow of a compressed gas component with an ozone / NO-containing gas mixture supplied to a two-cone injector 2.11 through a suction nozzle 2.15 directly from the OZOTRON 1.7 apparatus.

To enhance the effect of disintegration of the volume of adipose tissue 2.24 through the suction fitting 2.15 from the hydraulic pipe 1.9 from the tank 4, through the flow regulator 1.10, an ozone / NO-containing solution (based on physiological saline) or a mixture of ozone / NO-containing solution is fed into a two-cone injector 2.11 and ozonide / NO-containing 5-10% aqueous oil-in-water oil emulsion solution, which, when mixed with the pulse stream of the compressed gas component flowing through the injector 2.11, forms, when the nozzle orifice 2.16 or 2.17 flows out, ozone / NO-containing or about he / NO- and ozonide / NO-containing mud pulse stream in a gas-liquid phase, having a still higher kinetic energy.

Further (Fig. 8, Fig. 9, and Fig. 10, Fig. 11), the reciprocating and angular movements of the pneumohydraulic dispersing cannula 2.12 or 2.13 relative to the initial portion 2.23 of their insertion, limited by the installed restrictive sleeve 2.21, are performed sequentially or separately in the targeted liposuction area, tunnel or surface ozone / NO-hydroimpulse disintegration and emulsification of lipocytes, respectively, in the volume of the deep layer or in the volume of the subdermal surface layer of the hydropreparated fat th fabric. In between the hydroimpulse effects on the hydropreparated fatty tissue with pulsed gas-liquid jets (ozone / NO-containing or a mixture of ozone / NO-containing and ozonide / NO-containing jets), successive vacuum aspiration of the adipose tissue dispersant is carried out in the receiver of the electric suction device 5, carried out through drainage holes 2.18, as well as nozzle holes 2.16 and 2.17 of the pneumohydraulic dispersing cannulas 2.12 and 2.13.

At the end of the ozone / NO-hydroimpulse disintegration and emulsification process of lipocytes in the intended area of liposuction and vacuum aspiration of the dispersant and adipose tissue emulsion therefrom, by means of the control unit (BU) 1.3, the electric suction device 5 is turned off, the OZOTRON 1.7 apparatus, the pneumatic compressor (PC) 1.5, control key (K-EC) 2.10 of the electrovalve (EC) 2.8 and, accordingly, the pneumohydraulic unit (CCP) 2 of the HYDROTON hardware complex. The sections are sutured and applied to the skin, above the liposuction area, with a 2.22 pad soaked in one of the above ozone / NO-containing solutions. After that, near the area of liposuction, along with the manual formation of the body relief, it is formed using a delimited surface pneumo-pulsed treatment (pneumo-pulsed massage) of the liposuction region by pulsed jets of an ozone / NO-containing gas mixture (Fig. 12). To do this, initially on the gasket 2.22 set the limiter 6, through the Central hole of which spend the working end of the pneumohydraulic dispersing cannula 2.12. Then, the HYDROTON hardware complex is turned on, and through the pneumohydraulic unit (CCP) 2 and the pneumohydraulic dispersing cannula 2.12, generating the pulsed nature of the compressed gas component in the form of an ozone / NO-containing gas mixture with high kinetic energy, they act on the gasket 2.22, and through it on the entire surface of the skin, sequentially moving the delimiter 6 over the entire liposuction region and adjacent to it skin surface areas having a pronounced surface roughness. This ensures the primary correction of liposuction altered by liposuction (after removal of the necessary volume of fat) by moving the intact adipose tissue and reducing the volume of discontinuities in the liposuction and wrinkles on the skin surface formed after liposuction, due to the forces realized by air-pulse massage, as well as stimulated lymphatic drainage. Then, the delimited surface pneumo-pulsed treatment is stopped by turning off the pneumohydraulic unit (CCP) 2 and the pneumohydraulic dispersing cannula 2.12, as well as by diverting them and the delimiter 6 from the liposuction area.

After that (Fig.6, Fig.7 and Fig.13) carry out the final stage, which consists in conducting surface contact low-frequency ultrasonic treatment (vibro-ultrasonic massage) of the skin surface above the liposuction area. Due to its properties, it improves microcirculation, increases the ability of red blood cells to transfer oxygen to tissues, as well as the fibrolytic property, the ozone / NO-containing substance in the postoperative period contributes to the resorption of part of the connective tissue structures surrounding adipocytes, which leads to normalization of the metabolism of the remaining fat cells in the liposuction area. On the surface of the skin above the liposuction region, a 2.22 gasket is laid, pre-impregnated with a solution in the form of a mixture of ozone / NO-containing and ozonide / NO-containing 5-10% oil-in-water oil emulsion solution and an acoustic unit (ACU) is installed for 3 s attached to it with a capacity of 3.7 with the above solution. They include an ultrasonic generator (UGS) 1.11 connected to an acoustic unit (ACU) 3, and perform contact sounding of the entire skin surface above the liposuction region with low-frequency ultrasound by circular or linear movement of the acoustic unit (ACU) 3 along the surface of the gasket 2.22. At the end of surface contact ultrasonic treatment (vibro-ultrasonic massage) of the skin surface in the liposuction region, providing additional surface skin massage and mass transfer in the liposuction region, leading to a reduction in the volume of the cavity in the intact adipose tissue, its coalescence, giving the liposuction region a new shape, etc. , the ultrasonic generator (UZG) 1.11 is turned off, and the acoustic unit (ACU) 3 and the spent gasket 2.22 are removed.

After the completion of the multi-stage technological cycle of ozone / NO-hydro-pulse liposuction, the HYDROTON hardware complex is turned off. Previously sutured incisions are covered with a surgical patch, and a tight elastic bandage or belt is applied to the liposuction area. Further patient management is carried out according to standard methods.

The applicability and effectiveness of the proposed technical solution “Liposuction Method and Device for its Implementation” was compared with the prototype sold by the Sonoca-Lipo ultrasound device manufactured by Soring Medizintechnik GmbH at the plastic surgery department of the Clinical Center LLC Ivaschenko Clinic LLC (Omsk) using identical biopsy specimens of pig tissues (the most similar in structure to human tissues) in the form of skin patches with subcutaneous fatty tissue taken from the abdominal cavity, no more than h 2 hours after slaughter.

One group of biopsy specimens (5 samples) with a size of 100 × 100 mm and a fat layer thickness of at least 15 mm was taken for a comparative study of the effectiveness of the surface liposuction of the prototype and ozone / NO-hydroimpulse disintegration and emulsification of lipocytes in the volume of the subdermal surface layer of the pre-hydrotreated adipose tissue (volume of dispersible and aspirated fat, on average, 1000 cm ³ ). Another group of biopsy samples (5 samples) with a size of 100 × 100 mm and a fat layer thickness of at least 40 mm was taken for a comparative study of the effectiveness of the tunnel liposuction of the prototype and ozone / NO-pulse disintegration and emulsification of lipocytes in the volume of a deep layer of pre-hydrated fatty tissue (volume of dispersible and aspirated fat, on average, 3000 cm ³ ).

The biopsy specimens were placed in one-sided open and transparent polymeric cases with grooves for performing surface contact low-frequency ultrasonic processing, as well as delimited surface pneumopulse processing of the biopsy specimen from the skin side and biopsy specimens were fixed in them. One part of the biopsy samples prepared for comparative analysis was influenced by technological methods that implement the process of ultrasonic liposuction using the Sonoca-Lipo ultrasonic apparatus (prototype). Another part of the biopsy samples prepared for the comparative analysis was influenced by technological methods that implement the ozone / NO-hydro-pulse liposuction process using the HYDROTON hardware complex, according to the stages of the hydro-pulse treatment of adipose tissue in the liposuction region described in the invention, sequentially performing:

- preliminary hydrotreatment of adipose tissue in the deep or subdermal layers of the adipose tissue of the biopsy specimen using ozone / NO-containing Klein infusion solution;

- surface contact low-frequency ultrasonic treatment (vibro-ultrasonic massage) of the biopsy skin above the liposuction region through a pad soaked in ozone / NO-containing substance;

- hydrodynamic (convective) technology of tunneling or surface (subdermal) disintegration and emulsification of lipocytes of hydroprepaired adipose tissue in the liposuction area (deep or subdermal layers of adipose tissue) using appropriate pneumohydraulic dispersing cannulas that provide a hydro-pulse effect on the adipose tissue with gas (ozone / NO) gas mixture) and gas-liquid jets (ozone / NO-containing or ozonide / NO-containing aqueous solutions) with high kinetic energy, and t also vacuum aspiration of the formed dispersant and fat emulsion;

- delimited surface pneumo-pulsed skin treatment (pneumo-pulsed massage) over the area of simulated liposuction of an ozone / NO-containing gas mixture (to correct the surface unevenness of the biopsy skin surface formed at the previous stage after removal of “excess” adipose tissue) using an intermediate pad, a delimiter and pneumohydraulic dispersing cannula;

- surface contact low-frequency ultrasonic treatment of the skin (vibro-ultrasonic massage) over the region of simulated liposuction through an intermediate pad saturated with ozone / NO-containing or ozonide / NO-containing aqueous solutions using an acoustic unit.

The results of a comparative analysis of the effectiveness of technical solutions - the proposed and the prototype are shown in Table 1.

Table 1. No. p / p Performance indicators and their value in points: 1 point - minimum, 2 points - significant, 3 points - maximum Liposuction methods Method for ozone / NO hydro-pulse liposuction and device for its implementation Prototype (ultrasonic liposuction method and device for its implementation) one Injury reduction: - mechanical destruction of blood vessels and nerves missing (3) takes place (1) - thermal destruction of blood vessels and nerves missing (3) takes place (2) - blood loss presence of traces of blood cells in the dispersant (3) presence of blood dispersant (1) 2. The quality of the destruction of adipose tissue: - the degree of disintegration of adipose tissue high (3) insufficient (2) - degree of emulsification of lipocytes 70-80% emulsion (3) 40-50% emulsion (2) 3. Increased functional abilities: - pneumopulse massage takes place (3) missing (1) - vibro-ultrasonic massage takes place (3) missing (1) four. Improving cosmetic results: - the degree of heterogeneity of the relief of the skin above and near the liposuction region small (2) significant (1) - tightening "effect takes place (3) missing (1)

The claimed invention that implements the method of liposuction, and a device for its implementation in comparison with the prototype allows you to:

- significantly reduce the invasiveness of the liposuction process in relation to the vascular system and nervous tissue, and therefore, reduce the risk of postoperative complications, while increasing the efficiency of dispersion and emulsification of adipose tissue;

- expand the functionality of liposuction due to the implementation of pneumopulse and vibro-ultrasonic massage in a single technological process for performing liposuction;

- improve cosmetic results by providing a "tightening" effect, as well as reduce the degree of heterogeneity of the skin topography in the liposuction region due to the initiation of pneumatic and hydroimpulse effects of the ozone / NO-containing gas mixture and solutions of ozone / NO-containing substances, volumetric tissue movement, reduction volume of the formed cavity, as well as massage of tissue structures in the area of liposuction.

The inventive method of liposuction and a device for its implementation can be used in plastic surgery and the related direction of aesthetic (cosmetic) surgery, as well as in cosmetology.

Sources taken into account

1. Belousov A.E. and others. Plastic, reconstructive and aesthetic surgery. - SPb. Hippocrates, 1998 .-- S.712-724.

2. Heden P. Encyclopedia of Plastic Surgery. - M .: ed. ASTASTREL. - 2001. - S.226-234.

3. Prospectus of the ultrasonic dissector "Sonoca-Lipo" produced by the German company "Soring Medizintechnik GmbH", 2001. - 6 p.

4. Technology of the company SORING GmBH // Business Bulletin (series "Medicine"). - 2002. - No. 3. - C.8.

5. Ham A., Cormac D. Histology. - M .: Mir, 1983.- T.2. - 254 p.

6. Prospect "The concept of electrotherapy company" Nemectron GmBH ", 2004.

Claims (4)

1. The method of liposuction, which consists in the hydrotreatment of adipose tissue in the selected area of liposuction with an anesthetic with a vasoconstrictor substance, performing skin incisions, the introduction and reciprocating movement in the liposuction area of the working part of the dispersing cannula when exposed to adipose tissue with a physical factor leading to the dispersion and emulsification of fat cells followed by vacuum aspiration of the adipose tissue dispersant, suturing the incisions and applying a fixing elastic bandage, characterized in that first, the surface layer of the skin is saturated with ozone / NO-containing substance above the liposuction region by means of its surface contact low-frequency ultrasonic treatment through an intermediate pad impregnated with ozone / NO-containing solution, then tunnel or surface dispersion and emulsification of hydrotreated adipose tissue are carried out by pulsed jets of ozone / NO-containing gas mixture and ozone / NO-containing gas-liquid flow sequentially supplied by a pneumohydraulic disperser a cannula in the liposuction zone, and after the dispersion and emulsion of adipose tissue are formed in the liposuction region, they are vacuum aspirated through the same pneumohydraulic dispersing cannula, after vacuum aspiration of the dispersant and emulsion of adipose tissue and suturing of the incisions, a gasket is placed on the skin above the liposuction region saturated with ozone / NO-containing solution, and then near the area of ozone / NO-pulse liposuction performed, along with the manual formation of a body relief in the liposuction region, initially odyat its formation with the surface delimited pnevmoimpulsnoy processing pulsed jets of ozone / NO-containing gas mixture and then with a contact surface of low-frequency ultrasonic treatment through an intermediate gasket impregnated with ozone / NO-containing solution. 2. A liposuction device containing an infiltration syringe for the hydro-preparation of adipose tissue with an anesthetic solution with a vasoconstrictor substance, an ultrasonic generator, an acoustic unit with a waveguide tool, a nozzle for vacuum aspiration of adipose tissue dispersant, an electric suction device, characterized in that it is equipped with an ozone / NO- generator containing a gas mixture, a high-pressure air compressor or a cylinder with a compressed gas component, for example, air having a pressure and flow controller, pneumohydrator an influential unit including a working chamber-receiver, an air flow interrupter and a supply pipe connected with a container with an ozonized drug solution, pneumohydraulic dispersing cannulas for implementing hydro-pulse tunnel disintegration and emulsification of hydrotreated adipose tissue and for hydro-pulse surface disintegration and emulsification of tissue and emulsification whose working ends have respectively a distal and tangential nozzle hole, and behind it drainage holes with an angle of inclination towards the outflow of a stream of ozone / NO-containing gas mixture or ozone / NO-containing gas-liquid stream, while connected to the pneumohydraulic bridle: through a threaded connection - a pneumohydraulic dispersing cannula, and through the supply pipe - a container with an ozonized drug solution and a regulator for its supply to the pneumohydraulic unit, and the pneumohydraulic dispersing cannula is connected to the dispersion electric suction device through a discharge fitting fabric and is equipped with a restrictive sleeve. 3. The device according to claim 2, characterized in that it is equipped with a delimiter consisting of a base in the form of a delimiting hollow support element made of an elastically deformable elastic material paired with a cone-shaped bearing body, ending with a cylindrical nozzle including a stepped guide sleeve with a central hole, allowing the passage through it into the cavity of the isolator of the working end of the pneumohydraulic dispersing cannula. 4. The device according to claim 2, characterized in that it is equipped with an acoustic node with a developed emitting end for surface contact low-frequency ultrasonic treatment of the skin over the liposuction region, while the acoustic node includes annular piezoceramic elements and a waveguide tool in the form of a tightening bolt and reflective lining, and is equipped with a through capillary hole in the tightening bolt, communicating on the one hand with the cavity for the medicinal solution, and on the other with the radiating end of the bolt, a discontinuous concentric wavy surface in the form of a maze.

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