SU1599029A1 - Method of encreasing skin transplant surface - Google Patents

Abstract

This invention relates to plastic and reconstructive surgery. The purpose of the invention is to reduce the time for obtaining skin grafts and reduce complications. Within 2-3 days, the donor field is irradiated with helium-neon radiation at a power density of 25.5-31.6 mW / cm ² . After skin preparation, the operation of implanting the expander under the skin is performed and filled with liquid, the incision is sutured, the irradiation of the donor floor is repeated throughout the entire period of skin surface increase, and before the introduction of each subsequent portion of the liquid into the implanted expander, the subject is vibrated soft tissue to the skin flap for 10-15 minutes, with the introduction of each portion of the liquid carried out discretely within 45-60 minutes. The method makes it possible to reduce the time required for obtaining skin flaps by 1.5 times, to increase the rate of recovery of the initial level of microcirculation by 4 times, and the occurrence of complications is practically eliminated.

Description

This invention relates to medicine and can be used in plastic and reconstructive surgery.

The aim of the invention is to reduce the time taken to obtain skin flaps and reduce complications due to irradiation with helium-neon laser radiation and vibratory massage.

The method is carried out as follows.

After determining the indications for treating a patient using a skin graft, the area of the defect to be repaired is determined by a flap, and a donor field is selected — a healthy skin area to be stretched — near the wound defect. Based on the measurements made, the size and shape of the implantable device is determined.

Then the selected area of healthy skin

(donor field) prepared for 2

3 days of laser irradiation. Sessions are conducted daily using a 10 mW helium – neon laser, with a radiation power density of 30.0–31.6 mW / / cm, the duration of each session is 3 min.

After the skin preparation has been carried out, the device is implanted under the skin; a small incision along the edge of the future flap gives access to the space between the hypoderm and the subcutaneous fascia; in this space, in a blunt way, a pocket is formed, the dimensions of which correspond to the area of the implantable device;

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Introduction of the first portion of fluid immediately after placing the device in the pocket is necessary for reliable hemostasis, eliminating voids in which blood can accumulate, and creating a minimal tension stimulus in tissues that adapts to the implanted foreign body and responds with increased mitotic index in the basal layer of the epidermis.

Next, the incision is protected and a laser irradiation session is carried out in the same mode as before implantation (radiation power density 30.0-31.6 mW / cm, exposure time 3 min).

A local temperature and microcirculation level in a stretched flap of skin are determined daily in a patient with known methods and laser irradiation sessions are conducted. Sessions are conducted in the following mode; radiation power density of 25.5-30.0 mW / cm, exposure 30-40 s.

After the local temperature of the flap is normalized (usually in 4-5 days), the next injection of fluid into the device is carried out. Fluid injection is carried out according to the following method: half of the fluid introduced earlier is extracted from the latter by means of a trans-puncture of the valve of the implanted device, and a vibratory massage of the underlying soft tissues and stretchable flap is performed on the lowered device for 10-15 minutes Stretched or collapsed vessels of the bone marrow and flap; carry out the discrete introduction of fluid into the implanted device, repeat the following filling cycles - partial emptying of the device within 45-60 minutes, thus accomplishing a smooth hydromassage of the flap and surrounding tissues.

Such a technique for administering portions of a fluid allows the dose of the injected fluid to be increased up to 20-30% of the final volume of the device without compromising the viability of the skin tissue.

Further, daily laser irradiation and the next injection of a portion of the fluid is repeated until the last portion of the fluid is introduced.

After the last injection of the fluid into the implanted device, the flap relaxes for 15–18 days, fixing the effect of stretching and growth of skin tissue. During this time, the flap with surrounding tissues is irradiated with a helium-neon laser, the wire sessions every other day under the same modes as between fluid injections (radiation power density 30.0-31.6 mW / cm, exposure 30-40 s ).

Then the implanted device is removed and a flap is prepared, ready for transplantation.

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The proposed method can be implemented using a device comprising an elastic chamber with a thickened or reinforced base containing a stretchable under the action of internal pressure, and a peelable autonomous receiving capsule. The elastic chamber and the receiving capsule of the device are connected by a tube.

To enable discrete filling of the device chamber by carrying out filling cycles — partial emptying the receiving capsule of the known device is provided with an integrated control valve comprising a housing and a plate associated with it by an elastic element.

The operations of filling the chamber of the device and partially emptying it are performed using a syringe with an injection needle. Example 1. The patient was admitted to the burn ward because of a soft tissue defect in the fronto-parietal region of the scalp, 14X10 cm in size.

The patient is shown to repair the defect of soft tissues of the scalp by the stretched dermotension scraps of the scalp. Healthy dermal areas of the scalp on the right and left of the wound defect (left and right temporo-temporal areas) were selected for dermotension (stretching).

In the preoperative period, the patient received 3 sessions of laser irradiation of donor fields. Sessions were carried out daily with four helium-neon radiators with a total power of 100 mW, radiation power density of 31.6 mW / cm for 3 minutes.

On the fourth day, two 750 ml devices each were implanted into the subfascial pockets to the right and left of the wound defect parallel to its edge without contact with the wound. The receiving chambers were located in the occipital-parietal region.

After controlling hemostasis, before the final infestation of the postoperative incision, 70 ml of furacilin was injected into the cavity of each chamber of the device.

Skin tension over the chambers with microcirculation preservation has been achieved.

In the postoperative period, the patient underwent 5 daily sessions of laser irradiation with four helium-neon radiators with a total power of 100 mW, a radiation power density on the first postoperative day of 31.6 mW / cm for 4 min, and on the following days a power density of 25.5 mW / cm for 40 s.

On the fifth day after the laser irradiation session, in a similar mode under the conditions of clean dressing,

The evacuation of 35 ml of furatsilin from each chamber of the device and the vibromassage of the underlying soft tissues and dermo tensile graft was performed within 5 minutes.

Then, step-by-step filling of the chambers was carried out for 45 min with the achievement of a volume of 2 BO ml in each of the VCTROISTE chambers.

Evacuation and step filling is carried out by means of a hollow injection needle with a syringe through the receiving capsule of the implanted device.

Subsequently, the patient received daily laser irradiation sessions with four helium-neon radiators with a total power of 100 mW and a power density of 25.5 mW / cm for 40 minutes per session.

Every fifth day after the irradiation session, first half of the liquid contained in the chambers was evacuated, vibratory massage was performed for 15 minutes and stepwise introduction of another portion of furatsilin within 45 minutes with reaching the volume of the chambers of each device on day 10 - 430 ml, 15 day - 610 ml, on the 20th day - 790 ml.

After reaching the calculated volume of the chambers (790 ml), the stretched flaps were relaxed under constant load with the pressure reached for 8 days and irradiated with four helium-neon laser emitters with a total power of 100 mW, the radiation power density of 25.5 mW / cm at session duration 50 s. Sessions were conducted every other day.

On the 38th day, an operation was performed to remove the implanted devices and plastic closure of the wound defect. The postoperative course is smooth, the engraftment of the stretched dermotension grafts is complete, the sutures were removed on the P-day after plasty. A full-fledged hair covering was preserved over the entire area of the extended flaps.

A complete viable flap was obtained within 5.5 weeks.

Example 2. A patient was admitted about extensive post-burn keloidosis of the right lower extremity with ulceration of the popliteal scars.

The patient is shown excision of the cicatricial mass of the right popliteal micron with the replacement of the defect with a full-layer stretched flap.

The area of healthy skin between the scars of the lower third of the outer surface of the right thigh was chosen as the donor floor.

An implantable device with a final filling volume of 1000 ml was selected using the simulation method to replace the wound defect that forms after the excision of the scar mass.

The entire period of progressive increase in the skin surface of the donor field

gels were irradiated with a 100 mW neon laser, radiation power density 30.0 mW / cm1

Before implantation, the device had 5 2 sessions, B the day of implantation - 1 session lasting 3 minutes each, daily, including the day of administration of a portion of furacilin, sessions of 30 seconds and during the resuscitation period, sessions every other day of 30 seconds.

The device chamber was filled in equal portions of furacilin, 200 ml each (20% of the total chamber volume) at the time of implantation, on the 5th, 10th, 14th and i8th days.

15 The introduction of each subsequent portion of furatsilin was performed stepwise for 50 minutes, with a preliminary 10-minute vibratory massage being performed with the device chamber half empty.

Flap relaxation was performed for

20 15 days

A full-layered stretched skin flap of 15X12 cm in size was obtained in 4.5 weeks.

A wound defect measuring 14x10 cm, 25 formed after excision of the scar mass, was covered along the contour by the graft obtained.

Engraftment of the flap 100%. Stitches are you on the 10th day.

Immediate and long-term results: 0 full skin in the popliteal IU, the function of the knee joint without any restrictions.

Example 3. The patient arrived at

coarse, -shaving rub array

skin of the back of the chest

5 on the left in size 15X20 cm, with initial

signs of left-sided scoliosis.

To obtain an expanded flap, an area of healthy skin below the cicatricial mass was selected.

The volume of the chamber of the implantable device, selected by simulation, is 750 ml.

The entire period of progressive increase in the skin surface of the donor field was irradiated with a helium-neon laser with a power of 100 mW, the power density of the radiation

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27 mW / cm.

Before implantation, the devices performed three sessions and, on the implantation day, 1 session lasting 3 minutes each. Every day, including the day of administration of the last portion of furatsilin, and every other day during the relaxation period, sessions of 1 minute duration were performed.

The device chamber was filled in five portions in portions: 50 ml at the time of implantation, 150 ml each - on the 5th and 9th days, 300 ml each - on the 15th and 21st days.

The introduction of each subsequent portion of uracilin was carried out stepwise during 10

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60 minutes with a preliminary 15-minute vibratory massage of the underlying and surrounding tissues of tissues with the device chamber half-emptied.

The relaxation period was 16 days.

The wound defect, 17X22 cm in size, formed after excision of the colloidal massif, is closed but the contour with a full-layer dermotension autotransplant 17X23 cm in size without tension.

The course of the post-non-period is smooth, the shts are clear on the 10th day.

Engraftment of transplantation 100%.

Long-term results: full-fledged skin in the transplantation zone, mobile, there are no signs of pathology on the part of the spine.

A full-layer stretched skin flap was obtained in 5.3 weeks.

Were investigated 10 patients who underwent the first stage of dermontenia according to the proposed method, and 10 patients, the first stage of dermontenia which was performed in a known manner.

Example 4. A patient was admitted about post-burn alopecia of the fronto-parietal region with the size of 17X12 cm, a pronounced cosmetic defect, permanent elimination of the cicatricial mass.

The patient was shown elimination of post-burn alopecia, however, it was not possible to excise the alopecia site and replace the wound defect with local healthy tissues due to the large size of the defect.

The patient is shown a dermotension procedure using two medium-sized bottles with a chamber volume of up to 250.0 ml. Plots near alopecia in the parietal-occipital and parietal-temporal areas were selected as donor sites, and to accelerate the timing of dermotension, it is advisable to irradiate the stretchable areas of healthy skin with a 100 mW helium-neon laser at 31.6 mW / cm.

The entire period prior to the operation of implanting tissue expanders and the period of progressive increase in the skin surface the donor field was irradiated with four helium-neon lasers with a power of 100 mW, a radiation power density of 31.6 mW / cm, duration 3 minutes.

The chambers of the devices were filled in equal portions sequentially with alternating injections into different cylinders of 40.0 ml at the time of implantation on the 6th, 9th, 12th, 15th, and 18th days into the first cylinder; in the second cylinder - at the time of implantation on the 7th, 10th, 13th, 16th, 19th day.

The viability control of flaps 55 undergoing stretching served as a study of the volumetric rate of capillary blood flow, which corresponded to a maximum of 22 ml / min per 100 g of tissue.

These data suggest that the laser power density of 31.6 mW / cm causes an increase in the capillary blood flow rate to maximum figures on the first day after the start of irradiation, an acceleration of the timing and an increase in the volume of injected fluid.

The introduction of each subsequent portion of furatsilina was performed stepwise for 45-60 minutes, with a preliminary 10-minute vibratory massage performed with the device chamber half emptied.

Relaxation of flaps was performed for 10 days. A full-layer stretched skin flap of cm size was obtained in 5.5 weeks.

In the postoperative period, normal blood circulation in the displaced rast - 20 chick peel recovered on the third day.

Total dose. Irradiation for the entire period of dermotension was below the maximum allowable.

The data obtained indicate that the irradiation of areas subjected to stretching by four 100 mW laser emitters at a power density of 31.6 mW / cm accelerates the time needed to obtain autoplastic material, shortens the patient stay in the hospital, leads to an increase in microcirculation early periods after the onset of dermotension and its restoration in the early postoperative period in displaced derothensis flaps. At the same time, patients were chosen with approximately the same defects, covered by a similarly sized dermo tensile flaps.

The effectiveness of the methods was evaluated according to the following indicators:

the volumes of the portions of the fluid introduced into the implant density of the 40 ml device;

intervals between administrations, days;

restoration of the initial level of microcirculation, h;

mitotic index in stretchable tissue,%;

contractility of dermo-tensile patches in the process of stage II,%;

number of complications, pcs;

total duration of the method.

The analysis showed that the proposed method, in comparison with the known method, reduces the time required for obtaining a skin flap of the required size by 1.5 times, increasing the mitotic index by 0.3%, increasing the speed of restoring the initial level of microcirculation by 4 times.

Along with the improvement of the above indicators, the use of the proposed method virtually eliminates the occurrence of complications during skin stretching.

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An additional effect from the use of the proposed method is a significant reduction (by 15%) in the contractility of the resulting skin flaps upon their subsequent use in skin plastic surgery.

Claims (1)

Invention Formula A method for increasing the surface of a skin graft, including dosed progressive stretching of skin tissue by periodically introducing portions of fluid into an implantable espander, characterized in that, in order to speed up the graft production process and reduce complications, the donor field is irradiated with a helium-neon laser radiation density of 25.5-31.6 mW / cm before and after implantation of the expander during the whole period of skin graft increase By introducing each subsequent portion of the liquid into the expander, when it is partially emptying, the vibratory massage of the underlying soft tissues to the skin graft is performed for 10-15 minutes, and each portion of the liquid is introduced into the expander by spared within 45-60 min.