RU2473320C1 - Method of reconstructing trachea after extensive circular resections in experiment - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to field of medicine, namely to trachea surgery and experimental surgery. Essence of method lies in application for trachea reconstruction of tubular bioprosthesis, formed from loose skin-fascial flap on vascular pedicle, which is taken from dog's shin. After that, it is re-enforced with nitilon threads - semi-circles, which are passed by means of metal guides through subcutaneous-adipose cellular tissue.

EFFECT: application of claimed invention makes it possible to reduce intervention time, ensure bioprosthesis rigidity and eliminate possibility of development of inflammatory processes in bronchi and lungs.

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Description

The invention relates to medicine, namely to methods for replacing extended circular defects of the trachea.

There is a method of reconstruction of the trachea after extensive circular resections using silicone prostheses (Okumura N., Nakamura T., Natsume T. et al. Experimrntal study on a new tracheal prosthesis made from collagen-conjugated mesh. J. Thorac Cardiovasc Surg 2000; 119: 1162-1168).

The disadvantages of the method: 1) migration and displacement of prostheses due to the biological incompatibility of silicone with surrounding tissues, 2) the development of granulations and scars in the area of anastomoses, infection and stenosis; 3) arrosive bleeding from the brachiocephalic trunk.

Closest to the claimed method, the technical solution is a method for reconstructing extended circular defects of the cervical trachea with a free skin-fascial flap taken from the anterior abdominal wall of the dog and reinforced with a polytetrafluoroethylene stent and a Polymax mesh (Mengqing Zang, Keneng Chen, Peirong Yu, Reconstruction of large Tracheal Defects in a Canine Model: Lessons Learned. Journal of Reconstructive Microsurgery 2010; 26 (6): 391-399) (prototype). The method is carried out in two ways: one-stage and two-stage reconstruction. One-stage reconstruction method: the cervical trachea, common carotid artery and external jugular vein are isolated, then the skin-fascial flap of the anterior abdominal wall of the dog is taken on the vascular pedicle of the epigastric vessels 6 cm long, from which the tube is formed, it is reinforced with polytetrafluoroethylene and strips of Polymax nets. The graft is moved to the neck, microvascular anastomoses are applied between the flap vessels and large vessels of the neck. After that, a T-shaped silicone tube with a diameter of 11 mm is placed in a revascularized graft as a stent. 4 weeks after surgery, the T-shaped silicone tube is removed. In a two-stage reconstruction, a fragment of tetrapolyfluoroethylene with strips from the Polymax mesh is placed under the skin of the anterior abdominal wall of the dog on the fascia of the rectus muscle and left there for 3 weeks (prefabrication process). Then perform the fence skin-fascial free flap from the anterior abdominal wall of the dog on the vascular pedicle of the epigastric vessels and form a tubular bioprosthesis.

The prototype adopted a method of single-stage reconstruction of the trachea.

The prototype has a number of significant drawbacks: 1) lack of rigidity of the bioprosthesis, leading to respiratory collapse; 2) the occurrence of inflammatory processes in the field of anastomoses: 3) a long postoperative period, due to the need for temporary stenting of the bioprosthesis; technical complexity of execution.

The task of the invention is the development of a new method for reconstruction of the trachea after extensive circular resections using a bioprosthesis. The method consists in the fact that for the reconstruction of the trachea, a tubular bioprosthesis is used, formed from a free skin-fascial flap on a vascular pedicle, taken from a dog's leg, reinforced with nitinol-filaments-half rings. As reinforcing material, half-rings made of nitinol (intermetalide) with shape memory are used (ASTM Designation F 2063-00 Standard Specification for Wrought Nickel-Titanium Shape Memory Alloys for Medical Devices and Surgical Implants, p. 1-4; Materials with the effect of shape memory.Tutorial.A.A. Ilyin, M.Yu. Kollerov, N.A. Nochnovna, D.E. Gusev; Moscow 2009). When cooled to 10 ° C, the threads take a U-shape, at a temperature of 27 ° C to 37 ° C, the shape of the half rings is restored. The diameter of the half rings is determined by the diameter of the trachea. To this end, chest x-ray and tracheoscopy are performed.

The method is as follows.

The cervical trachea, common carotid artery and external jugular vein are isolated. Vessels are taken on a turnstile. After hair removal from the shin of the dog, a free skin-fascial flap is taken on the vascular pedicle (saphenous artery and vein). The size of the flap is determined by the extent of the defect of the resected trachea and its diameter. The formation of a tubular bioprosthesis is carried out by conducting nitinol filaments chilled to a temperature of 10 ° C through metal conductors in the subcutaneous fatty tissue of the fascial skin-fascial flap with an interval of 1 cm. At the body temperature, U-shaped filaments restore the shape of half rings. Then, a tube is formed from the skin-fascial flap with the epithelium inward using a two-row suture. The formed bioprosthesis is moved to the neck and microvascular anastomoses are applied between the flap and neck vessels using standard techniques. Then the cervical trachea is resected and a tracheostomy is performed 3 rings below the resection level. An anastomosis is formed between the stumps of the resected trachea and the bioprosthesis.

The inventive method is illustrated by figures 1-3.

Figure 1 - Nitinol thread U-shaped.

Figure 2 - Nitinol half ring at body temperature.

Figure 3 - Regenerative epithelium of the triea lining a bioprosthesis in the area of anastomoses (micropreparation).

The invention is illustrated by the following examples.

Example 1

Dog - half-breed shepherd dog, nickname Almaz, 3 years old, card No. 575/09. Clinic for Experimental Therapy N.N. Blokhina RAMS. After the examination (chest x-ray, tracheoscopy), a resection of the cervical trachea was performed using the proposed method for tracheal reconstruction.

After 2 months, the tracheostomy closed on its own. Breathing is free. During the control x-ray examination of the chest organs, there were no signs of an inflammatory process in the bronchi and lungs.

During tracheoscopic examination, the bioprosthesis is tight, has a smooth, uniform epithelial lining, and there are no inflammatory changes. Granulation in the zone of anastomoses and the lumen of the bioprosthesis was not found. The wall of the bioprosthesis is rigid. There is no respiratory collapse.

Example 2

Mongrel dog, nickname Roxy, 2 years old, card No. 598/09. Clinic for Experimental Therapy N.N. Blokhina RAMS. After the examination (chest x-ray, tracheoscopy), a resection of the cervical trachea was performed using the proposed method for tracheal reconstruction.

After 3 months, the tracheostomy closed independently. Breathing is free without signs of obstruction. During the control x-ray examination of the chest organs, there were no signs of an inflammatory process in the bronchi and lungs.

During tracheoscopic examination, the bioprosthesis is tight, has a smooth, uniform epithelial lining, and there are no inflammatory changes. Granulation in the zone of anastomoses and the lumen of the bioprosthesis was not found. The wall of the bioprosthesis is rigid.

The histological picture of biopsy material during control tracheoscopy is represented by a stratified squamous epithelium of the bioprosthesis and partially regenerative tracheal epithelium throughout. Granulation in the lumen of the bioprosthesis, zones of anastomoses are absent, there are no signs of inflammation.

The technical result.

The method of reconstruction of the trachea after extensive circular resections in the experiment, as compared with the prototype, is technically simple to perform, takes a shorter period of time, ensures rigidity of the bioprosthesis and the absence of inflammatory processes in the bronchi and lungs.

Claims (1)

A method for reconstructing the trachea after extensive circular resections in an experiment by forming a tubular bioprosthesis from a free skin-fascial flap on a vascular pedicle, characterized in that it is formed from a free skin-fascial flap taken from a shin of a dog by passing nitinol filaments-semirings through metal conductors in subcutaneous fat.

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