RU2393787C1 - Method of preventing disturbances of venous and lymphatic outflow in distracted flaps - Google Patents

Abstract

FIELD: medicine. ^ SUBSTANCE: invention relates to surgery and can be applied for prevention of disturbances of venous and lymphatic outflow in distracted skin flaps. Expander is implanted. Dermatension and simultaneously discrete prolonged and increasing in time cross-clamping of base of distracted tissues cupula are carried out. ^ EFFECT: method allows to form directed venous outflow. ^ 1 ex

Description

The alleged invention relates to medicine, in particular to plastic and reconstructive surgery.

As a prototype, the method was chosen consisting in implanting the expander, filling it with stretching the soft tissues, subsequent surgical training of the distracted flap by stage dissection of the tissues to the original of the future flap, cutting out and moving the stretched flap to the defect after wound healing (Vaganova N.A., Sarygin P. V. On the issue of the prevention of trophic disorders in long flaps cut out from tissues stretched by an expander // Annals of plastic reconstitution and aesthetic surgery, 2005. - No. 4, p. 63).

However, the known method excludes the possibility of the development of adaptive mechanisms of venous outflow at the stage of tissue stretching, and the healing and adaptation of stretched skin after surgical training increases the overall duration of inpatient treatment.

The objective of the proposed invention is the formation of directed venous and lymphatic outflow in distracted flaps when using expander dermatensia.

The problem is solved due to the fact that in a method involving implantation of an expander, conducting stage dermatensia, at the stage of tissue stretching, simultaneously with an increase in the volume of the expander, a discrete, prolonged and time-increasing compression of the base of the dome of the tissue to be distributed is performed.

The method is as follows: make a skin incision of 5-10 mm along the axis of the implantable expander, departing 3-4 cm from the proposed zone of the base of the expander. Soft tissues are detached to a depth corresponding to the implantation zone with the formation of an expander bed. The expander is implanted, the initial volume of physiological saline is injected with the goal of hemostasis of the bed cavity and expansion of the endoexpander, and the wound around the port is sutured. After three to four days, scheduled dermatension begins in the mode of continuous injection of the solution. Given the presence of various sizes of endoexpanders, the rate of fluid injection is selected depending on the size of the base and the specified volume of the expander. In most cases, stretching of intact skin is performed in the immediate vicinity of the defect, while the venous outflow to the latter is limited by the presence of scar tissue. Then, within two weeks, the base of the dome of the degradable tissues is clamped to form a directed venous outflow. At the last stage of treatment, the expander is removed with the formation of an extensional flap and the latter is moved to the area of the scar defect.

Clinical example: B. S., 24 years old (ib. No. 271143), was admitted to the hospital with the consequence of frostbite on the right hand. Upon admission, there are stumps of II-V fingers at the level of the metacarpophalangeal joints. The end surface of the stumps is represented by a previously transplanted free skin graft and is prone to ulceration. The subcutaneous fat layer was hydrotreated in the projection of the rear of the brush with a solution of novocaine 0.5% - 20 ml. A 1.5 cm skin incision was made along the elbow edge of the brush. The edges of the wound were taken on the holders. A blunt and sharp way was performed to separate the skin-fat flap with the creation of a bed for the expander with dimensions of 90 × 40 mm. An expander with a base area of 80 × 30 mm was introduced into the cavity. The wound around the port of the implanted expander is sutured with three interrupted sutures. 20 ml of physiological saline was added to the expander. 3 days after implantation, dermatension was started in a constant mode of fluid injection using a portable infusion pump. After 7 days of planned dermatensia, parallel to the axis of the limb, clamping of the base of the dome of the degradable tissue was started. Pinching was carried out for two weeks three times a day with an increase in time from 45 minutes to 3 hours.

After reaching the necessary supply of soft tissues, an end scar change of the stump defect was excised with the latter replaced by a distracted flap. Primary wound healing, the absence of microcirculatory changes in the distal flap associated with insufficiency of the venous outflow were noted.

A method for the prevention of disorders of venous and lymphatic outflow in distracted flaps allows the formation of a directed venous outflow at the stage of tissue stretching, to reduce the time spent in the hospital.

Claims (1)

A method for the prevention of violations of venous and lymphatic drainage in distracted skin flaps, which consists in implanting an expander, conducting dermatensia, characterized in that at the stage of tissue expansion, simultaneously with an increase in the volume of the expander, a discrete, prolonged and time-increasing compression of the base of the dome of the tissue to be distracted is performed.