RU2421154C1 - Method of surgical correction of defects of face soft tissues with application of xenotransplant - Google Patents

Abstract

FIELD: medicine. ^ SUBSTANCE: invention relates to surgery and can be applied for surgical correction of defects of face soft tissues. Skin incisions on defect edges are made. Subcutaneous canal on defect area is made by means of chisel. Transplant is passed and laid by means of silk thread, fixed on one of its ends and passed through hole on working part of chisel. As transplant used is xenogenic biomaterial with predominant content of elastin, obtained from connective tissue of animal nuchal ligament, which is processed by anionic and cationic detergents for 80-90% unblocking of chemical bonds of proteoglycans and glycoproteins, structured in bundles of connective-tissue fibres, and elimination from fibre bundles of glycosaminoglycans to residual content ëÑ50%. ^ EFFECT: method makes it possible to form functionally adequate regenerate, obtain from available raw material transplant, suitable for substitution of face soft tissue defect. ^ 2 ex

Description

The invention relates to medicine, namely to reconstructive surgery and cosmetology, in particular for the correction of defects in soft tissues of the face in the form of deep folds and wrinkles, saddle nose.

It is known to use various materials for the correction of defects in soft tissues of the face.

1. The introduction under the skin of one or more threads in the deepening of the folds in order to fill it. Various types of threads are used: absorbable and non-absorbable, of synthetic and biological origin (N. A. Gvozdenko. Handbook of therapeutic cosmetology. 2004, p.203-204, Offe N. Correction of wrinkles using threads // LNE. 1998. No. 3. )

To correct involutive changes in the skin of the face, its reinforcement is applied using special surgical (gold) threads. However, the indications and results of skin reinforcement depend on the initial degree of expression of wrinkles. This method is effective for 1-2 degrees of involutional changes and as a preventive method. The following complications are possible: retracted scar, teething through the skin.

2. Contour plastics using microimplants, which by their properties and origin can be divided into biological (natural), non-biological (polymer, synthetic), combined. Complications and errors in contouring include both the absence and too pronounced effect. As a rule, this may be due to either an incorrectly selected drug, an incorrectly chosen depth of administration, insufficient quantity or its overdose, or individual characteristics of the patient. (I. Danishchuk, E. Laputin. Contour plasty with microimplants. - Cosmetics and Medicine, 2001, No. 2, pp. 63-69.)

3. Contour plasty using a biological graft - “Alloderm” based on the acellular dermis. (Evaluation of acellular dermal graft in sheet (AlloDerm) and injectable (micronized AlloDerm) forms for soft tissue augmentation. Clinical observations and histological analysis / APSclafani, T. Romo 3 ^rd , AAJacono [et al.] // Arch. Facial Plast. Surg. - 2000. - Vol.2, No. 2. - P.130-136. Clinical experience with Alloderm: a one-staged composite dermal / epidermal replacement utilizing processed cadaver dermis and thin autografts / RACalicut, MJSchurr, M.Sloan, LDFaucher // Burns. - 2006. - Vol.32, No. 5. - P.583-588.)

The disadvantage of this method is the high likelihood of developing a bacterial and herpetic infection in the area of replanting Alloderm biomaterial, as well as the origin of this material (cadaver human tissue) and its high cost.

Closest to the proposed is a method of surgical treatment of deep grooves and skin using an allograft for facial contouring (RF Patent No. 2317025, IPC A61B 17/00, published on 02.20.2008). According to the known method, skin incisions are made at the ends of the defective fold, a subcutaneous canal is made to the length of the fold with a width corresponding to the expected size of the expansion of the fold, an allograft for ophthalmic surgery is cut along the length and width of the canal, which is laid into the canal by means of a silk thread fixed at one end of the allograft after which the thread is pulled through a skin incision and sutured skin incisions.

This method allows the formation of a full-fledged regenerate at the defect site, which is not subject to wrinkling and deep scarring, but it has a drawback associated with the source of allograft production - these are donor tissues of a deceased person, requiring strict morphological and biomechanical selection and testing at the sampling stages. In addition, in recent years, social problems have become a serious obstacle to the use of these tissues.

The objective of the invention is the creation of an effective method for the surgical correction of defects of soft tissues of the face using an affordable transplant material, providing a high degree of standardization, manufacturability at the stages of processing and sterilization, guarantee compliance with medical and technical requirements.

The problem is solved by the method of surgical correction of defects of soft tissues of the face using a graft, which is injected subcutaneously into the area of the defect, for which skin incisions are made along the edges of the defect, a subcutaneous canal is made with a chisel to the area of the defect, into which the pre-modeled graft is made and placed using silk a thread fixed at one of its ends and drawn through an opening on the working part of the bit, after which skin incisions are sutured, in which, unlike the proto IPA, a xenogenic biomaterial with a predominant elastin content is used as a graft, obtained from the connective tissue of the animal excretory ligament, which is treated with anionic and cationic detergents to unlock 80-90% of the chemical bonds of proteoglycans and glycoproteins structured in bundles of connective tissue fibers, and elimination from bundles of glycosaminoglycan fibers to a residual content of ≥50%, moreover, the transplant is modeled using laser cutting.

The main difference of the proposed invention is the use as a transplant of xenogenic biomaterial obtained from the connective tissue of the excretory ligament of animals. A feature of this tissue is the predominant content of elastin protein in its structure, which contributes to the formation of a functionally adequate regenerate in the recipient. This is due to the morphogenetic properties of this connective tissue graft.

The advantage of the proposed method is prolonged in comparison with the prototype cosmetic effect due to the low rate of transplant replacement with a predominant content of elastin.

The method is as follows.

From a pre-prepared xenogenic biomaterial processed according to known technology (RF Patent No. 2189257, IPC A61L 27/00, publ. September 20, 2002), the graft is modeled using laser cutting to determine the defect size. The choice of laser cutting is determined by the structural features of the graft tissue. The laser has a minimal thermal effect on biological tissues adjacent to the cutting zone, and ensures maximum preservation of the structure and properties of the biomaterial during the cutting process (Utility model No. 23402, IPC B23K 26/00, published on June 20, 2002).

The area of the skin where the surgery is to be treated is treated with an antiseptic. Ultracain and others are used as painkillers. Premedication is not required. Using a syringe, an infiltration anesthesia is performed in the area of transplant administration. A knife with a width of 5 mm produces skin incisions in two places along the edges of the defect. On a natural fold, for example, nasolabial, make a strictly subcutaneous or intradermal canal for a fold length of 0.5-1.0 cm wide. In this case, a bit with a hole in the working part is used. A silk thread is fixed at one end of the prepared graft, a thread with a graft is grasped through a hole made on the working part of the bit, passed through a skin notch and placed subcutaneously in the area of the defect. Skin incisions are sutured with atraumatic threads. Apply cold for 10-15 minutes. After 1-3 months, the transplant begins to be replaced by a dense, formed connective tissue. The complex of glycosaminoglycans contained in the graft gives the skin firmness, elasticity, healthy color.

Clinical examples.

Patient V., 27 years old, congenital saddle deformity of the nose, III degree.

Under local anesthesia, a transverse incision was made of a columella at the tip of the nose along the front edge of the deformity with a length of 4-5 mm, the skin was separated with a chisel over the area of deformation. An additional incision 2-3 mm long was made on the back of the nose along the edge of the deformity. A xenograft pre-modeled by laser cutting is fixed over the edge with a silk thread-conductor, with the help of which the graft is carried out subcutaneously and laid in the area of deformation. After that, the thread is removed through an additional incision on the back of the nose. Skin incisions are sutured with atraumatic suture 5-0. An aseptic dressing is applied to the back and tip of the nose. An inconspicuous anterior nasal tamponade with 2% protargol solution was produced. Tampons are removed the next day. Seams from the columella and wings were removed on the 4th day, with the exception of anchor joints at the junction of the transverse section of the columella and the vertical marginal section, which were removed on the 7th day. A complete aesthetic correction of saddle nose deformation has been achieved. Long-term postoperative period without complications.

Patient K., 44 years old. Pronounced nasolabial folds.

Using a syringe, an infiltration anesthesia was performed along the nasolabial folds of the skin on both sides. Skin incisions 2-3 mm long were made at the ends of the fold. A subcutaneous canal was made for a fold length of 0.5-0 cm wide on both sides. In this case, an eye chisel was used. Xenografts pre-modeled by laser cutting are fixed over the edge with a silk thread guide, with the help of which the transplants are performed subcutaneously and laid in nasolabial folds. Conductor threads removed. Cold applied for 10-15 minutes. Long-term postoperative period without complications. In the area of nasolabial folds, augmentation of the skin, a good cosmetic result was noted.

Thus, the proposed invention allows the effective correction of defects in soft tissues of the face using available xenograft material, processed to achieve low antigenic properties.

Claims (1)

A method of surgical correction of defects in soft tissues of the face using a graft, which is injected subcutaneously into the region of the defect, for which skin incisions are made along the edges of the defect, a subcutaneous canal is made with a chisel to the area of the defect, into which a pre-modeled graft is fixed and placed using a silk thread fixed at one of its ends and passed through an opening on the working part of the bit, after which skin incisions are sutured, characterized in that the transplant is used as a graft enogenous biomaterial with a predominant elastin content, obtained from the connective tissue of the excretory ligament of animals, which is treated with anionic and cationic detergents to unblock 80-90% of the chemical bonds of proteoglycans and glycoproteins structured in bundles of connective tissue fibers and to eliminate residual glycosaminoglycans from fiber bundles ≥50%, moreover, the transplant is modeled using laser cutting.