RU2398528C1 - Method of contour plasty - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine and can be applied for contour plasty. Sampling of patient's blood is performed. Blood is centrifuged and mass in form of three-fraction layer is obtained; upper layer representing blood plasma, middle layer - thin leukocyte-platelet layer on the border with erythrocytes and lower - erythrocyte layer. Two upper layers are separated into separate reservoir; transplanted, preliminarily washed from blood fat grafts are placed into it, adding solution of calcium chloride. Obtained mixture is shaken up and jelly-like mass is obtained. Obtained jelly-like mass is removed, wringed out and transplanted into zones of defect and/or filling.

EFFECT: method allows to reduce autolysis of transplant, accelerate revascularisation of recipient area.

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Description

Technical field

The invention relates to medicine, namely to a method for contour plastics from biological tissues, and can be used to treat contour deformities of integumentary tissues, fill in volume defects of organs and soft tissues in reconstructive and reconstructive surgery of the maxillofacial region.

State of the art

Currently, a large number of autografts are used for contour plastic surgery of the maxillofacial region (FFA): adipose tissue, dermal tissue, fascia, muscle tissue, bone tissue, cartilage, allotissue.

It is also known to use platelet-rich blood plasma for contouring and in surgical dentistry, obtained, for example, by the method of citrate deposition or by centrifugation.

A known method of contour plastics using autogyro - a method of contour liposculpture (S. S. Malakhov, L. I. Belonogov. Liposculpture. St. Petersburg, St. Petersburg, Moscow, 2001, p.3-19), a feature of which is to use the ability of adipose tissue to fill in the organism of the space, formed as a result of the loss of another tissue, to eliminate soft tissue deformations.

The disadvantages of this method are: the appearance of edema (after the introduction of a subcutaneous autograft graft), observed within 1-2 weeks, which occurs due to a violation of cell membranes in the transplantation zone; the possibility of an aseptic inflammatory reaction, as well as a large percentage (up to 50%) of transplant resorption.

A known method for the correction of volume defects of soft tissues (RU 2273458, АВВ 17/00, 2004.02.24). It is adopted as a prototype.

According to the indicated method, an aspirate solution is injected into the adipose tissue collection area and an aspirate containing an autograft graft is taken with a syringe, then it is cleaned, the reagent is added and reinjection is performed in the selected area. As a reagent, human superoxide dismutase (SOD) is used in a concentration of 0.001-0.1 wt.%. The introduction of SOD is carried out either directly in the AZT before its introduction into the recipient zone or in the solution used to take the inoculum at the stage of infiltration of the donor region before the intake of AZT.

The disadvantage of this method can be attributed to lysis, the difficulty of engraftment, due to the fact that the resorption process is little predictable and not controlled.

Disclosure of invention

Thus, the tasks to which the invention is directed, consist in reducing the processes of tissue autolysis, improving the quality and process of engraftment of autografts, increasing the speed of revascularization of the areas.

The tasks are solved as follows. The method of contour plasty by introducing fat cells and / or fat grafts into the subcutaneous fatty tissue is characterized in that each fat cell and / or graft is placed in a protein coat. To do this, a blood sampling is performed from the patient, which is then centrifuged and the mass is obtained in the form of three fractional layers, the upper of which is blood plasma, the middle is a thin leukocyte-platelet layer at the border with red blood cells and the lower is the red blood cell, then the upper two layers are separated in a separate container, transplanted blood cells washed from blood cells and / or fat grafts are placed there and a solution of calcium chloride is added, the resulting mixture is shaken slightly and obtained as a result of polymerization of protein jelly braznuyu weight, wherein said fat cells and / or grafts placed in the shell, obtained autograft extracted, drained and transplanted to the defect area and / or filling.

The use of fat for contouring has been known for a long time. Auto or allogyre is used as fat blocks for breast augmentation surgery. It partially resolves, is more encapsulated with the formation of seals or oleomas inside the capsule. Currently, the use of dermiric blocks for contour plasty of soft tissue defects in the face area has been preserved. After transplantation, adipose tissue is partially absorbed. The resorption process is unpredictable and uncontrollable.

The use of washed fatty cell suspension for contouring in the face and body has been known for a long time and is commonly called lipofilling. Adipose tissue is removed by aspiration, washed from the blood with saline, and then it is ready for use. Washed fat cells and fragments of fatty tissue are introduced into the filling zones: nasolabial sweets, lips, cheeks, under retracted scars, into other areas of soft tissue deformations by the syringe method through needles with an internal diameter of 1.5-2 mm. The volume of injected mass can be from 2 ml or more. The procedure is always performed with excess fat intake in order to achieve hypercorrection of the injection zone based on the resorption in the first month of at least 50% of the volume of fat added. Aspirated adipose tissue is not only complete fat cells, but, in a significant number, and their fragments. The surface of such a fat mass is acidic in nature, the pH ranges from 5.5-6.0. The use of sodium bicarbonate in the collection of adipose tissue leads to its alkalization. Scraps of fat cells, an alkaline or acidic environment are an excellent basis for the development of phagocytosis and significant resorption of the introduced adipose tissue.

It is obvious that fragments of fat cells and an acidic environment are an excellent basis for the development of phagocytosis and significant resorption of the introduced adipose tissue.

The authors propose a method of contour plasty (lipofilling and lipografting) by fat cells or fat grafts (a set of cells in a single block), which means that each fat cell and / or graft is wrapped in an auto-protein. Moreover, fragments of fat cells are protected by their own protein and are not exposed to such significant leukocyte aggression and autolysis. In addition, the acidity of the processed fat mass decreases, while the pH rises to 6.2-6.8 units.

The method of wrapping autogyro with auto-protein is as follows.

For the collection of 5-6 ml of blood, VACUTEST sterile tubes are used, containing 1 ml of a 3.8% sodium citrate solution. In 4-6 tubes, 20-30 ml of autologous blood is collected. The tubes are placed in a centrifuge (the make and model of the centrifuge may be different) and, if necessary, a counterweight is installed, the centrifugation time is 15-20 minutes, while the centrifugation speed depends on the centrifuge radius and relative centrifugal force, which should not exceed 40 (so as not to cause destruction erythrocyte membranes) and is calculated by the formula Vob./min = (√F / r) × 1000, where F is the relative centrifugal force, r is the radius of the centrifuge chamber.

After the centrifuge stops in test tubes, a three-fraction layer is obtained, the upper part of which is a blood plasma, the middle one is a thin leukocyte-platelet layer at the border with red blood cells and the lower one is an erythrocyte layer. The two upper layers of all tubes are collected with a syringe in a separate small glassware, where the prepared fat washed from the blood is placed. To the plasma we add a 10% solution of calcium chloride at the rate of 4 drops per 1 ml of blood plasma. For 5 minutes, shake the mixture slightly, which begins to polymerize and turns into a jelly-like mass, in the thickness of which there is a fat mass in the form of cells or grafts. After completion of the polymerization, the fat mass along with the protein is removed, squeezed and injected into the syringe, after which it is ready for use.

Morphological studies have shown that fat cells and grafts are coated on all sides with auto-protein.

The proposed method of lipofilling and lipografting using self-wrapped adipose tissue adipose tissue has significantly improved the results of soft tissue contouring. The maximum decrease in tissue volume after plastic surgery did not exceed 15-18%. The period of positive effect of contour plastics observed by autogyro observed by us has already been one year. The first results of using the method showed its high efficiency in performing contour plasty of soft tissues and the need for widespread use in plastic and reconstructive surgery.

Examples of specific embodiments of the invention

Example 1

A 65-year-old patient L. was admitted to the clinic due to age-related changes in her face, pronounced nasolabial folds. Under intravenous anesthesia, the lower, middle and upper third of the face was lifted with SMAS. Using a 200 ml tuminescent solution without soda, liposuction of the submental and submandibular regions was performed. The resulting fat in a volume of 10 ml is separated from the residual solution and blood by washing and centrifugation at low speeds. Ligature from wicker nylon performed subcutaneous dissection of the fibrous cords of the nasolabial folds. Through the resulting puncture of the skin, autogel wrapped in autogel in the amount of 5 ml on each side was introduced into the cavity formed. The procedure for wrapping fat is as follows: 30 ml of autologous blood were collected in 6 sterile test tubes of VACUTEST firm, each containing 1 ml of 3.8% sodium citrate solution. The tubes were placed in a centrifuge (make and model of the centrifuge - EVA 20 company "HETTICH", Germany). The centrifugation time was 20 minutes, the speed was 2000 in 1 min. After the centrifuge stopped in the tubes, a three-fraction layer was obtained, the upper part is blood plasma, the middle one is a thin leukocyte-platelet layer at the border with red blood cells and the lower one is the erythrocyte layer. The two upper layers of all test tubes with a total volume of 14 ml were collected by syringe into a separate small glassware. Prepared blood-washed fat was placed in it. To the plasma was added a 10% solution of calcium chloride at the rate of 4 drops per 1 ml of blood plasma. For 5 minutes, the mixture was slightly agitated, which polymerized and turned into a jelly-like mass, in the thickness of which there was a fat mass in the form of cells or grafts. After the completion of the polymerization, the protein-wrapped adipose tissue acquired a pale yellow tint. It is drawn into a syringe and injected through a 2.0 mm diameter needle into a predetermined area.

On the third day, the patient's condition is satisfactory, there is no temperature. On the tenth day there are no complaints, the contour of the nasolabial fold is smoothed, there are no signs of inflammation. At the follow-up examination after three months, the patient does not complain, the result is satisfied. The contour of the nasolabial fold is smoothed.

Example 2

Patient G., 43 years old, was admitted to the clinic due to age-related changes in the face, pronounced nasolabial folds. Under intravenous anesthesia, lifting of the lower and middle third faces was performed with SMAS plastic. Using a 100 ml Tumiscent solution, liposuction of adipose tissue in the umbilical area was performed. The resulting fat in a volume of 10 ml is separated from the residual solution and blood by washing and centrifugation at low speeds. Ligature from wicker nylon performed subcutaneous dissection of the fibrous cords of the nasolabial folds. Through the resulting puncture of the skin, autogel wrapped in autogel in the amount of 5 ml on each side was introduced into the cavity formed.

The procedure for wrapping fat is as follows: 30 ml of autologous blood were collected in 6 sterile test tubes of VACUTEST firm, each containing 1 ml of 3.8% sodium citrate solution. The tubes were placed in a centrifuge (make and model of the centrifuge - EVA 20 company "HETTICH", Germany). The centrifugation time was 20 minutes, the speed was 2000 in 1 min.

After the centrifuge stopped in test tubes, a three-fraction layer was obtained: the upper part is a blood plasma, the middle one is a thin leukocyte-platelet layer at the border with red blood cells and the lower one is an erythrocyte layer. The two upper layers of all test tubes with a total volume of 14 ml are collected by syringe into a separate small glassware. Prepared blood-washed fat was placed in it. To the plasma add a 10% solution of calcium chloride at the rate of 4 drops per 1 ml of blood plasma. For 5 minutes, slightly agitate the mixture, which polymerizes and turns into a jelly-like mass, in the thickness of which there is a fat mass in the form of cells or grafts. After the completion of the polymerization, the protein-wrapped adipose tissue acquired a pale yellow tint. It is drawn into a syringe and injected through a 2.0 mm diameter needle into the area of the nasolabial folds.

On the third day, the patient's condition is satisfactory, there is no temperature. On the tenth day there are no complaints, the contour of the nasolabial folds is smoothed out, there are no signs of inflammation. At the control examination after three months, the patient does not complain, he is satisfied with the result. The contour of the nasolabial fold is smoothed.

Example 3

Patient K., 70 years old, was admitted to the clinic due to age-related changes in the face, pronounced nasolabial folds. Under intravenous anesthesia, the lower and middle third of the face were lifted with SMAS. Using a 100 ml Tumiscent solution, liposuction of adipose tissue in the umbilical area was performed. The resulting fat in a volume of 10 ml is separated from the residual solution and blood by washing and centrifugation at low speeds. Ligature from wicker nylon performed subcutaneous dissection of the fibrous cords of the nasolabial folds. Through the resulting puncture of the skin, autogel wrapped in autogel in the amount of 5 ml on each side was introduced into the cavity formed.

The procedure for wrapping fat is as follows: 30 ml of autologous blood were collected in 6 sterile test tubes of VACUTEST firm, each containing 1 ml of 3.8% sodium citrate solution. The tubes were placed in a centrifuge (make and model of the centrifuge - EVA 20 company "HETTICH", Germany). The centrifugation time was 20 minutes, the speed was 2000 in 1 min.

After the centrifuge stopped in test tubes, a three-fraction layer was obtained: the upper part is a blood plasma, the middle one is a thin leukocyte-platelet layer at the border with red blood cells and the lower one is an erythrocyte layer. The two upper layers of all test tubes with a total volume of 14 ml are collected by syringe into a separate small glassware. Prepared blood-washed fat is placed in it. To the plasma add a 10% solution of calcium chloride at the rate of 4 drops per 1 ml of blood plasma. For 5 minutes, slightly agitate the mixture, which polymerizes and turns into a jelly-like mass, in the thickness of which there is a fat mass in the form of cells or grafts. After completion of the polymerization, the protein-wrapped adipose tissue acquires a pale yellow tint. It is drawn into a syringe and injected through a 2.0 mm diameter needle into a predetermined area.

On the third day, the patient's condition is satisfactory, there is no temperature. On the tenth day there are no complaints, the contour of the nasolabial fold is smoothed, there are no signs of inflammation. At the follow-up examination after a month, the patient does not complain, she is satisfied with the result. The contour of the nasolabial fold is smoothed.

Industrial applicability

The invention will find application in the treatment of contour deformities of integumentary tissues, filling of volume defects of organs and soft tissues in reconstructive and reconstructive surgery of the maxillofacial region.

Claims (1)

The method of contour plasty by introducing fat grafts into the subcutaneous fat, characterized in that each fat graft is placed in a protein shell, for which a patient is sampled, which is then centrifuged and the mass is obtained in the form of three fraction layers, the top of which is a plasma blood, middle - a thin leukocyte-platelet layer on the border with red blood cells and the lower - red blood cell layer, then the upper two layers are separated in a separate container, placed there before transplanted from ytye blood fat grafts and calcium chloride solution was added, the resulting mixture was lightly shaken to give a gelatinous mass, which is removed, drained and transplanted to the defect area and / or filling.