RU2702152C1 - Method of treating a donor belly wound - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to surgery, combustiology, plastic surgery, and can be used for treating a donor's abdominal wound. Full-thickness skin transplant with subcutaneous fat is sampled to abdominal surface fascia, hemostasis, plastic closure of donor wound. After the transplant is taken with separate interrupted sutures, the edges of the donor wound are contracted from the periphery to the center, reducing the area of the wound defect. Performing application of dermal autofibroblasts or allofybroblasts in concentration of 1 million cells in 1 ml to bottom of donor's wound with exposure of 30 minutes. That is followed by simultaneous closure of the wound with a perforated splitter with a perforation factor of 1:2 of skin autografts 0.25 mm thick, which are closed with a meshy atraumatic coating. A vacuum bandage is applied on the donor belly for 5 days at constant pressure of 110 mm Hg with apparatus for vacuum therapy of wounds VivanoTec. On 7th postoperative day, the wound coating is removed.

EFFECT: method enables reducing the traumatism of the operation by reducing the area of the donor wound, reducing the area of the split transplant to close the donor wound, reduced volume of blood loss from soft tissues in the area of full-thickness skin transplant, faster adaptation and engraftment of split perforated skin transplants, improved functional and aesthetic results of surgical treatment.

1 cl, 26 dwg, 2 ex

Description

The alleged invention relates to medicine, namely to surgery, combustiology, plastic surgery, and can be used in patients who need to complete a full-layer skin autograft on the abdomen.

With deep burns, body parts that are important in functional and cosmetic respects are performed with whole autografts (Burns: A Guide for Doctors / Edited by B.S. Vikhriev and V.M. Burmistrov. - L .: Medicine, 1981. - P. 158) . Given that the tendency of full-layer grafts to secondary retraction compared with split ones is less (Azolov VV, Dmitriev GI Surgical treatment of burn consequences. - N. Novgorod: Dzerzhinsky Printing House OJSC, 1995. - P. 42, C 57), the use of full-layer skin grafts on functionally and aesthetically significant parts of the body is preferable. The use of skin grafts from the abdomen is traditional. Considering that the capture of a full-layer skin graft of large sizes is required, as a rule, when closing the wounds of the face, the localization of the donor site on the abdomen is optimal, because it is advisable to plan donor sites on the same surface as the wounds being closed (Burns: A Guide for Doctors / Edited by B.S. Vikhriev and V.M. Burmistrov. - L .: Medicine, 1981. - P. 156-157). In this regard, it is relevant to treat a donor wound after taking a full-layer skin graft.

An analogue of the alleged invention is a method for plastic surgery with a full-layer skin graft. (Kazarezov M.V., Koroleva A.N., Golovnev V.A. Contractures. - Novosibirsk: Novosibirsk State Medical Academy, 2002. - P. 119). Using a dermatome, a flap of the required size is taken over the entire thickness of the skin, and the resulting defect is replaced by a split flap. As a result, the engraftment of both skin flaps takes place.

The disadvantages of the method include:

1. After taking a full-layer skin graft with a dermatome, the donor wound bleeds intensively, which increases the invasiveness of the operation, and the resulting graft is insufficient in size and width.

2. When taking a full-layer skin graft to subcutaneous fat, the engraftment of split skin grafts on a donor wound is significantly worse than on connective tissue (for example, deep layers of the dermis or fascia).

3. There are technical difficulties in taking a full-layer skin graft from the abdomen, associated with the relief features of the donor region, which can lead to a decrease in width, thickness unevenness and the formation of graft perforations during collection.

4. With plastic surgery of a donor wound with split skin grafts, there is a risk of displacement of the latter in the postoperative period.

5. This method does not provide for the possibility of reducing the area of the donor wound after taking a full-layer skin graft.

As the closest analogue, we have adopted a method for picking up a skin graft and restoring a donor wound (SB Bogdanov, RF patent for invention No. 2618907, application No. 2016103837 dated February 5, 2016, published on May 11, 2017, Bull. No. 14). The method includes performing a bordering section of the transplant receiving area, taking a skin graft using a scalpel with the condition that the mosaic sections of the lower layers of the dermis are preserved in the donor site, covering the donor site with a split skin autograft from another area of the patient’s healthy skin obtained using the dermatome.

The disadvantages of the method include:

1. The risk of accidental perforation of a full-layer skin graft when it is separated at the level of the upper layers of subcutaneous fat, which will subsequently lead to the formation of a rough scar in the area of perforation and significantly worsen the aesthetic result of skin grafting.

2. After taking a full-layer skin graft while preserving the mosaic sections of the lower layers of the dermis, the donor wound bleeds intensively, which increases the invasiveness of the operation.

3. When taking a full-layer skin graft to subcutaneous fat, the engraftment of split skin grafts on a donor wound is significantly worse than on connective tissue (for example, deep layers of the dermis or fascia).

4. The method does not indicate the possibility of taking a full-layer skin graft on the abdomen with an existing navel defect, which is important in patients with a deficit of donor resources.

5. When taking a full-layer graft with a scalpel, a retraction of the edges of the donor wound is noted, which significantly increases its area and requires large resources of split skin grafts, which increases the invasiveness of the operation.

6. The method does not provide for the possibility of reducing the area of the donor wound after taking a full-layer skin graft.

Tasks:

- improve the treatment of donor abdominal wounds after taking a full-layer skin graft;

- reduce the amount of blood loss from soft tissues in the area of taking a full-layer skin graft;

- reduce the area of the donor wound in the area of taking a full-layer skin graft;

- reduce the invasiveness of the operation by reducing the area of capture of split skin grafts to close the donor wound of the abdomen;

- create optimal conditions for engraftment (reduce the risk of displacement and rejection) of split skin grafts on the donor wound;

- optimize the healing time of the donor wound of the abdomen;

- to improve the functional and aesthetic results of surgical treatment when taking a full-layer skin graft on the abdomen.

The essence of the invention, including the collection of a full-layer skin graft with subcutaneous fat to the superficial fascia on the abdomen, hemostasis, plastic closure of the donor wound, is as follows: after the graft has been taken with separate nodal sutures, the edges of the donor wound are partially pulled from the periphery to the center, and dermal autofibroblasts are applied. allofibroblasts at a concentration of 1 million cells in 1 ml to the bottom of the donor wound at the rate of at least 20 thousand cells per 1 square. see the treated surface with an exposure of 30 minutes, after which the wound is simultaneously closed with split perforated skin autografts with a perforation coefficient of 1: 2, 0.25 mm thick, then a vacuum dressing is applied to the donor area of the abdomen for 5 days with a constant pressure of 110-120 mm. Hg apparatus for vacuum therapy of wounds VivanoTec.

Technical result: this method allows to reduce the area of the donor wound of the abdomen, to reduce the amount of blood loss from soft tissues in the area of taking a full-layer skin graft, to reduce the invasiveness of the surgery by reducing the area of taking split skin grafts to close the donor wound of the abdomen, to accelerate the adaptation and engraftment of split perforated skin transplants on a donor abdominal wound, optimize the healing time of a donor abdominal wound, improve functional and esthetes The results of surgical treatment for abdominal skin graft collection.

The implementation of the method of sampling a skin graft is as follows. In the operating room, after standard preparation and processing of the surgical field on the abdomen, preoperative marking of the skin is performed, indicating the borders of the fence, taking into account the required length and width of the skin graft. A scalpel along the lines of preoperative marking produce a cut of the skin and subcutaneous fat. A full-layer skin graft with subcutaneous fat is taken to the superficial fascia, as well as hemostasis. Then, with separate interrupted sutures, the edges of the donor wound are partially pulled together from the periphery to the center, thereby reducing the area of the wound defect. Then, dermal autofibroblasts or allofibroblasts are applied at a concentration of 1 million cells in 1 ml to the bottom of the donor wound at the rate of at least 20 thousand cells per 1 square. see the treated surface with an exposure of 30 minutes. At this time, the preparation of a full-layer skin graft is performed, surgical treatment of a wound requiring plastic closure with a full-layer graft, and perforation with a perforation coefficient of 1: 2 split skin autografts, 0.25 mm thick, to close the wound of the donor site. After 30 minutes, plastic closure of the donor wound with split perforated skin grafts is performed, skin grafts are closed with a mesh atraumatic coating, then a vacuum dressing is applied to the donor area of the abdomen for 5 days with a constant pressure of 110-120 mm Hg. apparatus for vacuum therapy of wounds VivanoTec. 5 days after surgery, the vacuum dressing is removed. On the 7th day after the operation, the wound cover is removed, and the engraftment of split skin grafts is observed on the donor site of the abdomen. Donor sites after taking split skin grafts are epithelized under dry dressings and do not require a change in dressings.

According to this method, 4 patients were operated on under clinical conditions.

Example 1 (see Appendix 1). Patient A., 9 years old, was admitted to the burn department of GBUZ "Research Institute - KKB No. 1 named after prof. S.V. Ochapovsky ”with a diagnosis of thermal burn (flame) of the head, neck, trunk, buttocks, extremities of 41% I-II-III degree, thermo-inhalation injury, burn disease (Fig. 1). After performing staged necrectomy on the face on the 21st day after the injury, the patient was taken to the operating room (Fig. 2). After standard preparation and processing of the surgical field (Fig. 3), a preoperative marking of the skin was performed on the abdomen, indicating the borders of the fence taking into account the required length (Fig. 4) and width (Fig. 5) of the skin graft. Using a scalpel along the lines of the preoperative marking, the skin and subcutaneous fat were dissected (Fig. 6). A full-layer skin graft with subcutaneous fat was taken to the superficial fascia, as well as hemostasis (Fig. 7). Then, with separate interrupted sutures, the edges of the donor wound were partially pulled from the periphery to the center, thereby reducing the area of the wound defect (Figs. 8 and 9). Then, dermal allofibroblasts were applied at a concentration of 1 million cells in 1 ml to the bottom of the donor wound at the rate of at least 20 thousand cells per 1 square. see the treated surface with an exposure of 30 minutes. At this time, they prepared a full-layer skin graft (Figs. 10 and 11), surgical treatment of a wound (Fig. 12), requiring plastic closure with a full-layer graft, took on the back surface of the trunk and perforation with a 1: 2 perforation ratio of split skin autografts, 0 thickness , 25 mm, to close the wounds of the donor site. Skin plasty was performed with a full-layer skin graft (Figs. 13 and 14). After 30 minutes, the plastic closure of the donor wound was performed with split perforated skin grafts (Fig. 15), the skin grafts were closed with a mesh atraumatic wound cover (Fig. 16), then a vacuum dressing was applied to the donor abdomen (Figs. 17 and 18) for 5 days constant pressure 110-120 mm Hg apparatus for vacuum therapy of wounds VivanoTec (Fig. 19). 5 days after surgery, the vacuum dressing was removed (Fig. 20). Under reticulated atraumatic wound cover, suppuration was not observed (Fig. 21). On the 7th day after the operation, the wound cover was removed (Fig. 22), and the engraftment of split skin grafts in the donor area of the abdomen was observed (Fig. 23). Donor sites after taking split skin grafts on the rear surface of the body were epithelized under dry dressings (Fig. 24), no dressing changes were required. The patient was discharged on the 63rd day after the injury after complete recovery, damaged by a burn of the skin and the healing of donor wounds. A satisfactory condition of the restored skin on the donor abdomen was observed (Fig. 25) and complete engraftment of a full-layer skin graft on the face without a tendency to retraction (Fig. 26).

Example 2. Patient M., 26 years old, was admitted to the burn department of GBUZ. "Research Institute - KKB number 1 named. prof. S.V. Ochapovsky "with a diagnosis of thermal burn (flame) of the trunk, upper limbs of 18% I-II-III degree, burn disease. After performing staged necrectomy on the hands on the 17th day after the injury, the patient was taken to the operating room. After standard preparation and processing of the surgical field on the abdomen, preoperative marking of the skin was performed, indicating the borders of the fence, taking into account the required length and width of the skin graft. A scalpel along the lines of the preoperative marking produced a dissection of the skin and subcutaneous fat. A full-layer skin graft with subcutaneous fat was taken to the superficial fascia, as well as hemostasis. Then, with separate interrupted sutures, the edges of the donor wound were partially pulled from the periphery to the center, thereby reducing the area of the wound defect. Then, dermal autofibroblasts were applied at a concentration of 1 million cells in 1 ml to the bottom of the donor wound at the rate of at least 20 thousand cells per 1 square. see the treated surface with an exposure of 30 minutes. At this time, the preparation of a full-layer skin graft, surgical treatment of a wound of the right hand requiring plastic closure with a full-layer graft, capture on the right thigh and perforation with a perforation factor of 1: 2 split skin autografts, 0.25 mm thick, were performed to close the wounds of the donor abdomen. Performed skin plastic surgery of the wounds of the right hand with a full-layer skin graft. After 30 minutes, plastic closure of the donor wound of the abdomen was performed with split perforated skin grafts, the skin grafts were closed with a mesh atraumatic wound cover, then a vacuum dressing was applied to the donor area of the abdomen for 5 days with a constant pressure of 110-120 mm Hg. apparatus for vacuum therapy of wounds VivanoTec. 5 days after surgery, the vacuum dressing was removed. Under mesh atraumatic wound dressing suppuration was not observed. On the 7th day after the operation, the wound cover was removed, and the engraftment of split skin grafts in the donor area of the abdomen was observed. Donor sites of the right thigh, after taking split skin grafts, were epithelized under dry dressings; no change of dressings was required. The patient was discharged on the 32nd day after the injury after full recovery, damaged by a burn of the skin and healing of donor wounds.

Claims (1)

A method of treating a donor wound of the abdomen, including the collection of a full-layer skin graft with subcutaneous fat to the superficial fascia on the abdomen, hemostasis, plastic closure of the donor wound, characterized in that after the graft is taken with separate interrupted sutures, the edges of the donor wound are pulled from the periphery to the center, reducing the area wound defect, produce application of dermal autofibroblasts or allofibroblasts at a concentration of 1 million cells in 1 ml to the bottom of the donor wound with an exposure of 30 minutes, after which an instant to close the wound split perforated with perforation ratio of 1: 2 by skin autografts, 0.25 mm thick, which is closed atraumatic mesh coating is then applied to the vacuum bandage donor belly portion 5 days with a constant pressure of 110 mm Hg apparatus for vacuum therapy of wounds VivanoTec, on the 7th day after surgery, the wound cover is removed.

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