RU2398534C1 - Method of contour plasty of nose deformities - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to field of medicine, namely to plastic surgery, and can be applied for treatment of contour deformities and defects of nose. Essence of method lies in transplantation of cartilage which is placed into envelope. Said envelope is formed from patient's autoblood, which is centrifuged and from obtained mass, containing three fraction layers, upper of which represents blood plasma, meddle- thin leukocyte-platelet layer on the border with erythrocytes, and lower - erythrocyte layer; two upper layers are removed into separate reservoir. Transplanted cartilage graft is placed in the same reservoir, calcium chloride is added there, mixture is shaken and jelly-like mass, with cartilage graft in its thickness, is obtained, graft is removed, wringed out, and transplanted into deformity area.

EFFECT: application of claimed invention allows to reduce process of tissue autolysis, improve quality and process of autograft engraftment, increase rate of revascularisation of areas, level unevenness of cartilage and bone structures, created during rhinoplasty.

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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 and defects of the nose in reconstructive and reconstructive surgery of the nose and maxillofacial region.

State of the art

It is known that any operation in the outer nose is associated with exposure and work on cartilage or bone structures. Reconstructive operations in the nose are associated with the formation of a cartilaginous skeleton from its own cartilage, taken from the auricle or rib, or allo-cartilage. The skin of the nose is in direct contact with bones or cartilage, minor irregularities of which can significantly level the overall result of rhinoplasty. To eliminate this drawback, autofascation is used, the fence of which requires additional operation, or various absorbable or non-absorbable allomaterials, the use of which has a high frequency of complications.

It is known that autofibrin glue is used in maxillofacial surgery mixed with spongy bone during extensive reconstructive interventions on the lower jaw, which helps to accelerate the consolidation of fragments (Tayapongsak P., O'Brien D.A., Monteiro S.V., 1994). It is also known to use a mixture of autoplasm with artificial materials containing tricalcium phosphate (Cerasorb) to replace defects in the bone of the alveolar bone (Modina T.N., Bolbat M.V., 2004).

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 retraction.

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 of restoring the nasal septum (RU 2001131658, 2001/11/22), which is adopted as a prototype. The method consists in transplanting an autotissue on a stalk, and a mobilized autograft is moved through the widest half of the nose to the septum of the same name, inserted into the through defect and fixed on the contralateral side in the “lock”. A bone-soft tissue complex from the lower part of the nasal concha, the mucous membrane of the lower nasal passage and the bottom of the nasal cavity is used as an autograft.

A significant drawback of the known method is that the transplanted bone-soft tissue complex is not a single unit and therefore, displacements of individual protein or cartilage fragments included in its composition are possible, which negatively affects the overall results of rhinoplasty.

Disclosure of invention

Thus, the tasks to which the invention is directed are to create a new method for contour plastics of nose deformities, which will reduce the process of tissue autolysis, improve the quality and healing process of autografts, increase the speed of revascularization of areas, level the irregularities of the cartilage and bone structures created by rhinoplasty .

The tasks are solved as follows. The method of contour plastics of nasal deformities using a transplanted complex, including cartilage, is characterized in that they pre-form cartilage for transplantation, which is placed in the membrane, said membrane being formed from the patient’s blood, which is centrifuged and from the resulting mass containing three fraction layers, the upper which is a blood plasma, the middle - a thin leukocyte-platelet layer at the border with red blood cells and the lower - red blood cell layer, two upper layers are distinguished in a separate container, the cartilage transplanted graft is placed there, calcium chloride is added, the mixture is shaken and a jelly-like mass is obtained, in the thickness of which there is a cartilage transplant, the latter is removed, squeezed and transplanted into the deformation region.

Protein-platelet factors contained in the membrane stimulate the development of connective tissue, which further levels all cartilage and bone irregularities and improves the aesthetic result of rhinoplasty. While in the known contour plastics of the saddle-shaped deformities of the nose using cartilage autografts from the ear cartilage, the disadvantage is that the transplanted protein-cartilage complex is not a single whole and displacements of individual protein or cartilage fragments that make up it are possible.

The authors proposed a method for contour plastics of nasal deformities, which consists in creating a single protein-cartilaginous conglomerate by wrapping the transplanted cartilage with an auto-protein that surrounds the cartilage on all sides and binds them together.

The proposed method contains the following sequence of operations. 5-6 ml of blood is sampled from the patient, for which sterile test tubes of VACUTEST firm are used, containing 1 ml of 3.8% sodium citrate solution. The cartilages prepared for transplantation are placed in the patient’s blood plasma.

In 4-6 tubes, 20-30 ml of autologous blood is carried out. The tubes are placed in a centrifuge and, if necessary, a counterweight is installed, the centrifugation time is 15-20 minutes, while the centrifugation speed depends on the radius of the centrifuge and the relative centrifugal force, which should not exceed 40 (so as not to cause destruction of the erythrocyte membranes) and is calculated by the formula V _rpm = (√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 is blood plasma, a thin leukocyte-platelet layer at the border with red blood cells and the lower one is the red blood cell. The two upper layers of all tubes are collected with a syringe in a separate small glass dish, where the prepared cartilage complex is placed.

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, mix the mixture slightly, which begins to polymerize and turn into a jelly-like mass, in the thickness of which there is an immersed cartilage graft. The latter is removed, squeezed, after which it is ready for use.

Examples of the invention

Example 1. Patient G., 37 years old, complained of nasal deformity and respiratory dysfunction resulting from aspirgellous chondritis that developed during chemotherapy treatment of acute leukemia. At the time of admission: there is a retraction of the cartilage of the nose as a result of the absence of wing cartilage, a significant scar narrowing of the right nasal passage, defects in the soft tissues of the wings of the nose, more pronounced on the left. The patient underwent surgery - reconstruction of the cartilaginous part of the nose with restoration of the nasal skeleton by the costal cartilage, restoration of the left wing of the nose with a skin-fatty flap from the left nasolabial fold, elimination of cicatricial narrowing of the right nasal passage by a rotational skin-fatty flap taken from the right nasolabial fold. The cartilaginous skeleton of the nose was formed from plates of the costal cartilage, columellar support, septum rafters of the nasal dorsum and two lateral plates fixed rigidly with sutures to the septum rafter and resting on the base of the nose wings. A rigid cartilage construct was coated on top with a protein-platelet film that separated it from the skin and hid all the cartilage irregularities, preventing the cutting of the latter.

Method for the preparation of protein-platelet films: in six sterile tubes without a preservative, autogenous blood was taken from a cubital vein in a volume of 7 ml each. 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 stopping the centrifuge, a three-fraction clot was obtained, at the very top of which there was blood serum, a protein-platelet clot in serum at the border with red blood cells and a layer of red blood cells. After mechanical separation from erythrocytes and serum, a protein-platelet clot was placed on a sterile gauze cloth, squeezed and a membrane of 2 by 1 by 0.1 cm was obtained from each tube. The six membranes obtained were used to cover the cartilage construct. The obtained functional and aesthetic result of the performed operation and the use of protein-platelet coatings for the created cartilaginous frame of the nose was excellent.

Example 2. Patient S., 26 years old, complained of the presence of a bone-cartilage hump and deformation of the external nose and septum. Nasal breathing on the left is difficult. The skin of the nose is thin. Cartilage and bone irregularities are visible and well palpated on the back of the nose. The patient underwent an operation - rhinoseptoplasty together with ENT specialists and eliminated the deformation of the nasal septum in the bone and cartilage sections.

To eliminate the deformation of the external nose, closed surgical access was chosen along the posterior edge of the external legs of the wing cartilage. After detachment of the skin of the back and slopes of the nose, the cartilage and bone parts of the hump were cut off tangentially with a scalpel and chisel. Bone parts are treated with a rasp. Lateral osteotomy of the frontal processes of the maxillary bones was performed. The bones of the nose are set in the middle position, in the area of the back of the nose they are brought into contact. Bone fragments were easily felt through the thin skin of the nasal bridge. The smallest irregularities were felt, which could level the result of the operation performed. To eliminate irregularities and prevent adhesions between the skin and bones, two protein-platelet films are placed evenly on the section of the cut hump under the skin.

Method for the preparation of protein-platelet films: in two sterile tubes without a preservative, autogenous blood was taken from a cubital vein in a volume of 7 ml each. The tubes were placed in a centrifuge (make and model of the centrifuge - EVA 20 "NETTISN", Germany). The centrifugation time was 20 minutes, the speed was 2000 in 1 min. After stopping the centrifuge, a three-fraction clot was obtained, at the very top of which there was blood serum, a protein-platelet clot in serum at the border with red blood cells and a layer of red blood cells. After mechanical separation from erythrocytes and serum, a protein-platelet clot was placed on a sterile gauze cloth, squeezed and a membrane of 2 by 1 by 0.1 cm was obtained from each tube. The wounds of the mucosa were sutured with separate catgut nodal sutures. A plaster cast was applied to the nose, tampons were introduced into the nasal cavity. On the twelfth day, the general condition is good, the plaster cast is removed. Under the bandage, the skin is normal in color, there are no signs of inflammation, the contour of the nasal bridge is even. Nasal breathing is not impaired. At the follow-up examination after a month, the patient does not complain, the result is satisfied. The contour of the nasal bridge is even, the skin is of a normal color. The achieved esthetic result was rated as good.

Example 3. Patient S., 46 years old, complained of the presence of a saddle nose deformity that occurred many years ago as a result of an injury. The patient underwent an operation through open surgical access in the narrow part of the columella and along the edges of the wing cartilage - contour plastic of the saddle-shaped nose deformation by auto-cartilage from the auricle. The cartilage complex prepared for transplantation onto the nasal bridge consisted of three cartilaginous plates located on top of each other, the upper one measuring 2.4 cm by 0.4 cm, the middle one 1.9 cm by 0.6 cm, and the lower one 1.0 by 0 , 8 cm. Cartilaginous plates were not even. There were gaps between them. To level cartilage irregularities and eliminate gaps between them, four protein-platelet films were laid.

The method of preparation of protein-platelet films: in four sterile tubes without a preservative, autogenous blood was taken from a cubital vein in a volume of 7 ml each. 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 stopping the centrifuge, a three-fraction clot was obtained, at the very top of which there was blood serum, a protein-platelet clot in serum at the border with red blood cells and a layer of red blood cells. After mechanical separation from erythrocytes and serum, a protein-platelet clot was placed on a sterile gauze cloth, squeezed and a 2 by 1 by 0.1 cm membrane was obtained from each tube. The obtained four membranes were used to cover the cartilaginous structure from above, below, and between the cartilaginous plates. The structure created from cartilage and protein-platelet films was U-shaped with 6/0 monofilament and placed under the skin of the nose in the saddle region. The ends of the thread were brought out onto the skin of the nasal bridge and were standardly fixed with a paper adhesive plaster. The wound was sutured with separate interrupted sutures, a plaster bandage was applied to the skin of the external nose, tampons were inserted into the nasal cavity. On the twelfth day, the general condition is good, the plaster cast is removed. Under the bandage, the skin is normal in color, there are no signs of inflammation, the contour of the back of the nose is even, the stitches have been removed. Nasal breathing is not impaired. At the follow-up examination after a month, the patient does not complain, the result is satisfied. The contour of the nasal bridge is even, the skin is of a normal color. Aesthetic result achieved is good.

Example 4. Patient B., 34 years old, complained of the presence of a saddle-shaped deformation of the external nose that arose many years ago as a result of an injury. The patient underwent an operation through closed surgical access along the posterior edges of the lateral legs of the wing cartilage - contour plastic of the saddle-shaped nose deformation by auto-cartilage from the auricle. The cartilage graft prepared for transplantation onto the nasal bridge consisted of two cartilaginous plates located on top of each other, the upper one measuring 2.0 cm by 0.4 cm and the lower one 1.0 cm by 0.6 cm. The cartilaginous plates were not even. There were gaps between them. The structure created from the cartilage was U-shaped with 6/0 monofilament. In order to level the irregularities of the cartilage and to eliminate the gaps between them and to create a strong and motionless protein-cartilaginous structure, the cartilages sewn with a thread prepared for transplantation onto the nasal bridge were wrapped with autoplasma protein. Cartilage wrapping procedure: in two sterile VACUTEST tubes containing 1 ml of 3.8% sodium citrate solution, 6 ml of patient blood was collected. The tubes were placed in a centrifuge and (brand and model of the centrifuge - EVA 20, NETTICN company, 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 blood plasma, a thin leukocyte-platelet layer at the erythrocyte border and the lower erythrocyte layer. The two upper layers from all tubes were collected with a syringe into a separate small glass dish, where the prepared cartilage complex was placed. To the resulting plasma was added a 10% solution of calcium chloride at the rate of 4 drops per 1 ml of blood plasma. The mixture was shaken slightly for 5 minutes. The latter polymerizes and turns into a jelly-like mass, in the thickness of which there is an immersed cartilage complex. The complex is removed and squeezed from the serum, after which it is ready for use. In the conglomerate obtained, the cartilaginous plates are interconnected by protein and are motionless, all external irregularities and voids between them are filled with protein. The resulting protein-cartilage complex is a single autograft. A structure created from cartilage and plasma protein is placed under the skin of the nasal bridge in the saddle region. The ends of the graft fixing threads are brought out onto the skin of the nasal dorsum and are standardly fixed with a paper adhesive plaster. The mucosal wound was sutured with separate nodal catgut sutures. A plaster cast was applied to the nose, tampons were introduced into the nasal cavity. On the twelfth day, the general condition is good, the plaster cast is removed. The skin of the nose is normal in color, there are no signs of inflammation, the contour of the back of the nose is even. Nasal breathing is not impaired. At the follow-up examination after a month, the patient does not complain, the result is satisfied. The contour of the nasal bridge is even, the skin is of a normal color. Aesthetic result achieved is good.

Example 5. Patient T., 28 years old, complained of the presence of a saddle-shaped deformation of the external nose that arose many years ago as a result of an injury. The patient underwent an operation through closed surgical access along the posterior edges of the lateral legs of the wing cartilage - contour plastic of the saddle-shaped nose deformation by auto-cartilage from the auricle. The cartilage graft prepared for transplantation onto the nasal bridge consisted of three cartilaginous plates located on top of each other, the upper one measuring 1.8 cm by 0.4 cm, the middle one 1.4 by 0.6 cm and the lower one 1.0 by 0.7 see Cartilaginous plates were not even. There were gaps between them. The structure created from the cartilage was U-shaped with 6/0 monofilament. To level the irregularities of the cartilage and to eliminate the gaps between them and to create a strong and motionless protein-cartilaginous structure, the cartilages prepared for transplantation on the nasal bridge and stitched with thread were wrapped with protein from autoplasma. The procedure for performing cartilage wrapping is as follows. In two sterile test tubes of VACUTEST firm, containing 1 ml of 3.8% sodium citrate solution, 6 ml of patient blood was collected. 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 was blood plasma, the middle part was a thin leukocyte-platelet layer at the border with red blood cells, and the lower one was an erythrocyte layer. The two upper layers from all tubes were collected with a syringe into a separate small glass dish, where the prepared cartilage complex was placed. To the resulting plasma was added a 10% solution of calcium chloride at the rate of 4 drops per 1 ml of blood plasma. The mixture was shaken slightly for 5 minutes. The latter polymerizes and turns into a jelly-like mass, in the thickness of which there is an immersed cartilage complex. The complex is removed and squeezed from the serum, after which it is ready for use. In the conglomerate obtained, the cartilaginous plates are fastened together by a protein and are motionless, all the irregularities and voids between them are filled with protein. The resulting protein-cartilage complex is a single autograft. A structure created from cartilage and plasma protein was placed under the skin of the nasal bridge in the saddle region. The ends of the strands fixing the transplant are brought out onto the skin of the nasal dorsum and are standardly fixed with a paper adhesive plaster to the skin. The wound of the mucosa is sutured with separate nodal catgut sutures. A plaster cast is applied to the nose, tampons are introduced into the nasal cavity. On the twelfth day, the general condition is good, the plaster cast is removed. The skin of the nose is normal in color, there are no signs of inflammation, the contour of the back of the nose is even. Nasal breathing is not impaired. At the follow-up examination after a month, the patient does not complain, the result is satisfied. The contour of the nasal bridge is even, the skin is of a normal color. Aesthetic result achieved is good.

Industrial applicability

The invention will find wide application in contour rhinoplasty of nasal deformities, will reduce the process of tissue autolysis, improve the quality and process of engraftment of autografts, increase the speed of revascularization of areas, level the roughness of cartilage and bone structures.

Claims (1)

A method for contour plastics of nasal deformities using a transplanted complex, including cartilage, characterized in that the cartilage is preliminarily formed for transplantation, which is placed in the membrane, said membrane being formed from the patient’s autoblood, which is centrifuged and from the resulting mass containing three fraction layers, the upper which is a blood plasma, the middle - a thin leukocyte-platelet layer at the border with red blood cells, and the lower - red blood cell layer, two upper layers are distinguished in a separate tank b, are placed to the transplanted cartilage graft, calcium chloride is added, the mixture was stirred to give a gelatinous mass, which is thicker in the cartilage graft, the latter is removed, drained, and transplanted to deformation.