RU2480165C1 - Method of covering and fixation of endoprosthesis in mammary gland reconstruction - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to surgery. After skin-preserving mastectomy, silicone endoprosthesis is placed under the edge of separated pectoralis major muscle. Adipose cellular tissue of lower skin-fatty flap is sewn to lower lateral edge of pectoralis major muscle 1.5-2 cm lower than skin cut. Skin is sutured with intradermal suture.

EFFECT: method makes it possible to isolate endoprosthesis from skin wound.

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Description

The invention relates to medicine, more specifically to oncology, and can be used after a radical removal of a malignant tumor of the mammary gland.

A known method of installing and fixing an endoprosthesis in a cavity formed between the posterior sheet of the connective tissue capsule of the mammary gland and the fascia covering the pectoralis major muscle ("Plastic surgery of the mammary gland" A.A. Vishnevsky et al., Moscow, Medicine, 1987).

The proposed method for fixing the endoprosthesis significantly improves the appearance of the mammary gland. The specified method can be applied for aesthetic purposes in the presence of glandular tissue of the mammary gland. When a malignant tumor is removed, glandular tissue is also removed, which makes the application of the known method impossible.

A known method of shelter and fixation of the endoprosthesis, when it is placed under the pectoralis major and anterior dentate muscles or on the pectoralis major muscle, covering it with the mobilized latissimus dorsi muscle ("Plastic surgery of the mammary gland" A.A. Vishnevsky et al., Moscow, Medicine, 1987 )

However, this method of fixation of the endoprosthesis has disadvantages. The prosthesis located between the pectoralis major and anterior denticular muscles is deformed during muscle contraction, the closed muscle “cocoon” forms a dense, inactive gland with unnatural outlines of its lower slope and fuzziness of the inframammary fold. To cover the implant with the broadest muscle of the back, it is necessary to expose the patient to an additional long operation to mobilize this muscle with the inevitable loss of function and aesthetics of the donor zone.

The aim of the invention is to restore the natural appearance of the mammary gland after radical surgical treatment of cancer.

The goal is achieved in that after a skin-saving mastectomy in the area of the inframammary fold, the pectoralis major muscle is separated to the level of the sternum, hemostasis is performed, and active drainage is established; a silicone endoprosthesis of the appropriate size and shape is placed under the edge of the separated pectoralis major muscle; then the fatty tissue of the lower skin-fat flap is sutured to the lower lateral edge of the pectoralis major muscle 1.5-2 cm below the skin edge. Next, layer-by-layer suturing of fiber and skin with an intradermal suture is performed.

An analysis of known methods of covering and fixing the endoprosthesis after a subcutaneous mastectomy while removing a malignant tumor of the breast allows us to state the presence of novelty and differences.

The novelty of the developed method lies in the reliable fixation and shelter of the endoprosthesis without damage and impaired function of the anterior dentate and latissimus dorsi. Reliable shelter and fixation of the endoprosthesis is facilitated by suturing of the fatty tissue of the lower skin-fat flap to the lower lateral edge of the pectoralis major muscle 1.5-2 cm below the skin incision.

In the available open sources of information of Russia, the CIS countries and foreign countries, a similar method could not be found.

The inventive method is industrially applicable. It can be reproduced and repeated many times in surgical clinics of the general medical network and in specialized oncological institutions.

The method is as follows.

In the operating room under anesthesia in a patient position while lying on their backs, a skin-preserving radical mastectomy is performed, with the removal of the regional lymphatic collector in a single block, then the pectoralis major muscle is separated to the sternum level, hemostasis is performed, and active drainage is established. After that, a silicone endoprosthesis of the required shape and size is placed under the edge of the separated pectoralis major muscle, then the fatty tissue of the lower skin-fatty flap is sutured to the lower lateral edge of the pectoralis major muscle, 1.5-2 cm below the skin edge. Then the fiber is sutured with separate sutures, the skin with an intradermal suture.

An example of a specific implementation of the method can serve as an extract from the medical history.

Patient K., born in 1976, medical history No. 16364 / о, turned to the department of reconstructive plastic surgery of the Rostov Cancer Research Institute on October 27, 2010 with complaints of the presence of a tumor-like formation of the left breast. During the examination, the diagnosis was established: cancer of the left breast T2N0M0, stage II a, clinical group 2.

On October 27, 2010, an operative measure was performed, while lying under endotracheal anesthesia after a skin-preserving mastectomy in the area of the inframammary fold, the pectoralis major muscle was detached to the level of the sternum, hemostasis was performed, and active drainage was established; a silicone endoprosthesis of the appropriate size and shape is placed under the edge of the separated pectoralis major muscle; then the fatty tissue of the lower skin-fat flap is sewn to the lower lateral edge of the pectoralis major muscle 1.5-2 cm below the skin edge. Then the fiber is sutured with separate sutures, the skin with an intradermal suture.

On November 1, drainage tubes were removed; on November 7, 2010 skin sutures were removed. The patient was discharged from the hospital in satisfactory condition with a good aesthetic effect.

Technical and economic effectiveness of the method is:

- in complete isolation of the endoprosthesis muscle tissue from the skin wound;

- in the exclusion of the displacement of the endoprosthesis towards the axillary cavity;

- to reduce the time of the operation, its morbidity and blood loss, the number of postoperative complications;

- in the formation of a soft, mobile mammary gland of a natural appearance.

Claims (1)

A method of sheltering and fixing a breast endoprosthesis, including a skin-preserving mastectomy, mobilization of the pectoralis major muscle, installation of active drainage, characterized in that an endoprosthesis of the appropriate size and shape is placed under the edge of the separated pectoralis major muscle; then the fatty tissue of the lower skin-fat flap is sutured to the lower lateral edge of the pectoralis major muscle 1.5-2 cm below the skin incision; then carry out layer-by-layer suturing of fiber and skin with intradermal sutures.