RU2749297C1 - Method for removal of scared lider elevation - Google Patents

Abstract

FIELD: medicine.SUBSTANCE: invention relates to medicine, namely to plastic surgery, combustiology, ophthalmology. Simultaneous surgery is performed on the upper and lower eyelids, dissection of scar tissue, removal of the eyelids with retainer sutures, free skin grafting, bloodless blepharorhaphy, bandaging. In this case, the upper and lower eyelids are pulled forward by the hold-down seams. Sutures for blepharorhaphy are applied retreating 3 mm from the ciliary edge, while creating a simultaneous tension of both eyelids, and bandages fix the edges of both eyelids protruding and connected by seams.EFFECT: invention allows in one operation eliminating eversion of both eyelids on one side with the creation of hypercorrection on both eyelids, restoring the integrity of the skin on the operated eyelids, reducing scarring processes in the area of free skin grafting, improving the results of surgical treatment of patients with cicatricial eversion of both eyelids on one side.1 cl, 5 dwg, 1 ex

Description

The alleged invention relates to medicine, namely to plastic surgery, combustiology, ophthalmology, and can be used in patients with emerging or formed cicatricial eversion of the upper and lower eyelids on one side.

Cicatricial eversion of the eyelids is the most frequent and typical deformity in patients who have suffered a burn injury to the face. The question of the surgical treatment of cicatricial lesions of the eyelids is decided by almost all authors as an urgent operation (Azolov V.V., Dmitriev G.I. Surgical treatment of the consequences of burns. N. Novgorod, 1995. - S. 38.).

The most common operation for the consequences of facial burns is free skin plastic surgery of the eyelids. (Burns: A Guide for Physicians. Edited by B. S. Vikhriev and V. M. Burmistrov. L .: Medicine, 1981. - S. 245.). It was noted that free skin grafts undergo wrinkling, leading to the development of recurrent eversion of the eyelids. In order to prevent this complication, fixation of the eyelids in the position of hypercorrection in the postoperative period is used (Azolov V.V., Dmitriev G.I. Surgical treatment of the consequences of burns. N. Novgorod, 1995. - S. 41-42.). At the same time, the authors believe that it is not necessary to simultaneously restore the upper and lower eyelids, since their overcorrection will be impossible (Burns: A Guide for Physicians. Edited by B.S.Vikhriev and V.M. Burmistrov. L .: Medicine, 1981. - P. 245. Yudenich V.V., Grishkevich V.M.

An analogue of the alleged invention, we adopted a method for eliminating cicatricial eversion of the eyelids (Burns: A Guide for Physicians. Edited by B. S. Vikhriev and V. M. Burmistrov. L .: Medicine, 1981. - S. 245.). The method involves surgical intervention on one cicatricial-changed eyelid. To do this, the incision of the scar-altered skin is made parallel to the ciliary edge, departing from it by 1.5-2 mm, stitching stitches are applied through the edges of the resulting wound. Cutting the scars, stupidly and sharply separating the skin of the eyelid, it is brought to the position of hypercorrection (to the opposite edge of the orbit), positioned over the other eyelid. A free skin graft is sutured onto the resulting wound and sutured without tension. For uniform tight pressing to the wound bed, gauze balls are applied to it, which are fixed with a bandage.

The first dressing is done in a week, the sutures are removed after 7-10 days.

The disadvantages of this method include:

1. Correction of cicatricial eversion is performed only on one eyelid.

2. The need for two stages of surgical treatment for simultaneous lesions of the upper and lower eyelids of one eye.

3. Overcorrection of the operated eyelid is carried out by traction on the retainer sutures, which must be additionally fixed.

4. The operated eyelid is positioned over the other eyelid, which leads to inflammation of the conjunctiva of the stretched eyelid due to contact with the eyelashes of the underlying eyelid.

The closest analogue of the alleged invention we have adopted a method of surgical treatment of deep total burns of the face (Bogdanov SB. Method of surgical treatment of deep total burns of the face. Patent RU 2632776. Application 2016128423 dated 12.07.2016. Published: 09.10.2017. Bull. No. 28). According to this method, for deep burns of the face, after cleansing the wound from necrosis, the upper layers of granulation tissue are excised to the lower layers of granulation tissue parallel to the skin surface up to 1-2 mm deep. Free skin grafting is performed with a full-thickness autograft, while the eyelids are fixed by performing bloodless blepharorhaphy to prevent eversion.

The disadvantages of this method include:

1. Blepharorrhaphy is performed by comparing the edges of both eyelids without eyelid hypercorrection.

2. When a slit is formed in the graft, the graft is circularly fixed around the palpebral fissure, which contributes to the formation of cicatricial epicanthus in the postoperative period, requiring additional surgical correction.

Tasks:

- to improve the methods of surgical correction of cicatricial eversion of the eyelids;

- to create conditions for performing one-step intervention on the upper and lower eyelids on one side with the creation of hypercorrection on both eyelids;

- to reduce the scarring processes in the area of free skin grafting;

- to improve the results of surgical treatment of patients with cicatricial eversion of the eyelids on one side.

The essence of the invention, including simultaneous surgery on the upper and lower eyelids, dissection of scar tissue, taking the eyelids with stitches, free skin plastics, bloodless blepharorrhaphy, bandaging, is the following: the upper and lower eyelids are pulled forward by the stitches, the stitches are blepharorrhaphy is applied, retreating 3 mm from the ciliary edge, while creating a simultaneous tension of both eyelids, and bandages are used to fix the forward-facing and seamed edges of both eyelids.

EFFECT: this method allows in one operation to eliminate eversion of both eyelids on one side with the creation of hypercorrection on both eyelids, to restore the integrity of the skin on the operated eyelids, to reduce scarring processes in the area of free skin plastic surgery, to improve the results of surgical treatment of patients with cicatricial eversion of both century on the one hand.

The implementation of the method for eliminating cicatricial eversion of the eyelids is performed as follows. In the operating room, after processing the operating field, the scar tissue is dissected simultaneously on the upper and lower eyelids, and hemostasis is performed. Both eyelids are taken with retainer stitches. Bloodless blepharorrhaphy is performed, while the sutures are applied, retreating 3 mm from the ciliary edge, while creating a simultaneous tension on both eyelids. After that, free skin grafting is performed with free skin grafts, 0.7-1.0 mm thick. After that, apply aseptic dressings moistened with 0.02% aqueous solution of chlorhexidine, which fix the edges of both eyelids protruding forward and connected by seams. The first dressing is performed 5-7 days after the operation. Full adaptation of skin grafts is observed 10-12 days after surgery.

According to this method, two patients with cicatricial eversion of the eyelids were operated on in a clinical setting.

Clinical example. Patient N., 53 years old, was admitted to the burn department of GBU3-NII KKB No. 1 named after prof. S.V. Ochapovsky with a diagnosis of post-burn granulating wounds of the face, cicatricial eversion of both eyelids on the right (Fig. 1). In the operating room, after the treatment of the operating field, the scar tissue was dissected simultaneously on the upper and lower eyelids, and hemostasis was performed. Both eyelids were taken with retainer sutures (Fig. 2). Surgical treatment of wounds, hemostasis and bloodless blepharorrhaphy were performed (Fig. 3), while sutures were applied, retreating 3 mm from the ciliary edge, while creating a simultaneous tension of both eyelids. After that, free skin grafting was performed with free skin grafts, 0.7-1.0 mm thick (Fig. 4). After that, aseptic dressings were applied, moistened with 0.02% aqueous solution of chlorhexidine, which fixed the edges of both eyelids protruding forward and connected by sutures. The first dressing was performed 7 days after the operation. Complete adaptation of skin grafts was observed 11 days after surgery (Fig. 5).

Claims (1)

A method for eliminating cicatricial eversion of the eyelids in patients with burns, including a one-stage surgical intervention on the upper and lower eyelids, dissection of scar tissue, taking the eyelids with stitches, free skin plastic surgery, bloodless blepharorhaphy, bandaging, characterized in that the upper and lower eyelids for the holding sutures are pulled forward, the sutures for blepharorhaphy are applied retreating 3 mm from the ciliary edge, while creating a simultaneous tension of both eyelids, and the edges of both eyelids protruding and connected by seams are fixed with bandages.

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