RU2791005C2 - Method for removing alae defects after surgical treatment of skin malignant neoplasms - Google Patents

Abstract

FIELD: medicine, oncology.

SUBSTANCE: invention can be used to eliminate defects of the wings of the nose after surgical treatment of skin malignant neoplasms (MN) of the corresponding area. Trapezoidal flaps are formed on the right and the left side on the proximal vascular pedicles. In this case, one base of the flap is placed in the zygomatic and buccal regions of the corresponding side, and the other base is located in the area of the base of the wing of the nose. Then, alternately, the flaps are moved to the area of the defect of the corresponding side. The flaps are sutured with a double-row suture to the subcutaneous fat of the nose and the skin of the outer surface of the nose. After 2.5 months, the feeding bases of the flaps are cut off, departing from the intended bases of the wings of the nose by 0.5 cm towards the buccal regions. Next, the distal bases of the flaps are immersed with U-shaped sutures to the base of the wing of the nose of the corresponding side. From the remaining proximal fragments of the flaps in the region of the alae of the nose, the outer contour of the alae is modelled.

EFFECT: simultaneous elimination of defects of the alae of the nose on both sides after surgical treatment of skin malignant neoplasms and improvement of the functional and aesthetic result.

1 cl, 5 dwg, 1 ex

Description

SUBSTANCE: invention relates to medicine, namely to oncology, and can be used to eliminate defects of the wings of the nose after surgical treatment of malignant neoplasms (MN) of the skin of the corresponding area.

A known method of eliminating a through defect of the external nose skin-fat nasolabial flap with the inclusion of a free cartilage graft from the auricle (RU 2371124 C2). A long skin-fat flap is moved from the cheek. The distal part of the skin-fat flap is tucked inside the nose and sutured to the mucosa, forming an internal lining. The skin of the proximal part of the flap is sutured on one side to the skin of the outer surface of the nose. A free cartilaginous autograft from the auricle bowl is placed between the outer and inner linings. Further, the other side of the proximal part of the flap is sutured to the wing of the nose. The method allows to restore the function of the nose, to provide an aesthetic result.

The disadvantages of this method are: the need to correct the cut-off distal part of the leg of the flap; the impossibility of forming the contour of the base of the wings of the nose; the volume of displaced tissues is not always sufficient for total defects of the wings of the nose; additional wound surface (auricle).

The closest (prototype) to the claimed method is the method of rhinoplasty with a long skin-fat flap from the cheek (EN 2371124 C2). The method consists in the fact that after excision of the tumor of the ala of the nose on the side of the face corresponding to the tumor, a long skin-fat triangular buccal flap is formed, while the base of the triangle with a width of about 1.5-2 cm is located in the region of the nasal slope, the apex is 1 cm above the corner of the mouth, the median of the triangle runs along the nasobuccal fold of the corresponding side. Next, the flap is rotated inwards, the distal part of the flap is tucked inside the vestibule of the nose, the skin of the flap is sutured to the mucous membrane of the vestibule of the nose, forming the inner lining of the vestibule of the nose; the skin of the proximal part of the flap, on the one hand, is sutured to the skin of the outer surface of the wing of the nose. In order to create a rigid frame of the nostrils, a free cartilage graft from the auricle is implanted between the outer and inner linings.

The disadvantage of the known method is that the basis of the displaced tissues is not always sufficient for total defects of the wings of the nose, and it is also technically difficult to form the contours of the bases of the wings of the nose with the displaced tissues.

The technical result of the proposed invention is the improvement of functional and aesthetic results, the elimination of through defects of the wings of the nose on both sides.

This problem is solved by the fact that, as well as in the known method, after removal of the skin tumor of the corresponding areas, a skin-fat buccal flap is formed.

A feature of the proposed method is that trapezoidal flaps are formed on the right and left, and one base of the flap is placed in the zygomatic and buccal regions of the respective sides, and the other base is in the area of the base of the wings of the nose, on the proximal vascular legs, alternately moved to the defect area of the corresponding sides , the flaps are sutured with a double-row suture to the subcutaneous fat of the nose and the skin of the outer surface of the nose; after 2.5 months, the feeding base of the flaps is cut off, departing from the supposed bases of the wings of the nose by 0.5 cm towards the buccal areas, then the distal base of the flaps is immersed with U-shaped sutures to the base of the wings of the nose of the corresponding sides, and from the remaining proximal fragment of the flaps in the area the wings of the nose model the outer contours of the wings of the nose.

The method is explained by a detailed description, a clinical example and illustrations, which show:

Fig. 1 - Appearance of patient C. before surgery: a) view on the right; b) view from the left.

Fig. 2 - Schematic representation of the first stage of elimination of the nasal alar defect after the resection stage: plasty with a displaced sliding buccal skin-fat flap: a) side view, 1 - buccal skin-fat flap; b) bottom view, 1 - skin-fat buccal flap.

Fig. 3 - Schematic representation of the second stage of eliminating the defect of the ala of the nose: cutting off the feeding base of the flap with its subsequent immersion with U-shaped sutures to the base of the cartilaginous base of the ala of the nose: a) side view; 1 - fragments of the skin-fat buccal flap: b) bottom view; 1 - fragments of skin-fat buccal flap.

Fig. 4 - Schematic representation of the second stage of elimination of the defect of the nasal wing: modeling from the remaining fragment of the flap in the area of the nose, the outer contours of the wing and the vestibule of the nose: a) side view; 1 - fragments of skin-fat buccal flap; b) bottom view; 1 - fragments of skin-fat buccal flap.

Fig. 5 – Appearance of patient S., 2 months after the second stage of the operation: a) view on the right; b) view from the left.

The method is performed as follows.

After removal of the skin tumor of the corresponding areas, displaced sliding skin-fat buccal flaps are formed on both sides. Plastic surgery is carried out in two stages. On the first one, plastic surgery is performed by moving sliding trapezoidal buccal skin-fat flaps (Fig. 2 a, b), with the base of the flaps located in the zygomatic and buccal areas of the corresponding sides, and the top in the area of the wings of the nose. At the second stage, after the primary plasty, after 2-2.5 months, the feeding base of the flaps is cut off at a distance of 0.5 cm from the supposed bases of the wings of the nose towards the buccal areas (Fig. 3 a, b), and the base of the flaps is immersed with internal sutures to the base the cartilaginous base of the nose wing, and from the remaining fragment of the flaps in the nose area, the outer contours of the wings of the nose and the vestibule of the nose are modeled (Fig. 4 a, b).

Clinical example.

Patient S., aged 67, was treated at the Department of Microsurgery of the Moscow Research Institute of Oncology. P.A. Herzen - branch of the Federal State Budgetary Institution "National Medical Research Center for Radiology" of the Ministry of Health of Russia with clinical diagnosis: basal cell carcinoma of the skin of the wings of the nose, stage I. setT1(m)N0M0. Cryodestruction of education on the right 2008. Laser therapy of education on the left 2010. Relapse of rcT3(m)N0M0 disease. Cytological recurrence of basal cell skin cancer (Fig. 1 a, b).

Under endotracheal anesthesia produced a phased removal of the tumor of the skin of the wings of the nose on the right and left. The tumor was removed en bloc along with the skin, subcutaneous adipose tissue up to the underlying cartilage on the right and left. According to the preliminary marking, sliding skin-fat buccal flaps were cut out on the right and left on the proximal vascular pedicles, alternately moved to the area of defects of the advising parties. Turunda was installed in the left and right half of the vestibule of the nose. Then, alternately, the flaps were sutured with a double-row suture to the subcutaneous fat of the nose and the skin of the outer surface of the nose. Donor wounds on the cheeks on the left and right were sutured with an intradermal suture leaving latex graduates.

Wounds healed by first intention. No necrotic changes in the flap were observed in the postoperative period.

The second stage, 2.5 months after the first operation, was the second stage.

Under endotracheal anesthesia, a phased cutting off of the feeding bases of the previously displaced flaps was performed, departing from the alleged wings of the nose by 0.5 cm into the buccal regions. The distal ends of the cut-off bases of the flaps were immersed with internal sutures to the base of the cartilaginous base of the nose wings. Next, the proximal parts of the flaps remaining in the nose area were used to model the outer contours of the wings of the nose and the vestibule of the nose, the flaps were sutured with a single-row suture to the subcutaneous fat of the distal ends of the bases of the flaps.

At the control examination after 2 months, the nasal lumen on the right and left is wide, nasal breathing is free (Fig. 5 a, b).

The proposed method allows you to simultaneously eliminate the defects of the wings of the nose, after surgical treatment of skin cancer, on both sides and improve the functional and aesthetic results.

Claims (1)

A method for eliminating defects of the wings of the nose after surgical treatment of malignant skin tumors, including the formation of a skin-fat buccal flap, characterized in that trapezoidal flaps are formed on the right and left, with one base of the flap located in the zygomatic and buccal regions of the corresponding sides, and the other base - in the area of the base of the wings of the nose, on the proximal vascular legs, is alternately moved to the area of the defect of the corresponding sides, the flaps are sutured with a double-row suture to the subcutaneous fat of the nose and the skin of the outer surface of the nose; after 2.5 months, the feeding base of the flaps is cut off, departing from the supposed bases of the wings of the nose by 0.5 cm towards the buccal areas, then the distal base of the flaps is immersed with U-shaped sutures to the base of the wings of the nose of the corresponding side, and from the remaining proximal fragment of the flap in the area the wings of the nose model the outer contours of the wings of the nose.

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