UA9385U - Technique for inserting breast prosthesis after subcutaneous mastectomy - Google Patents

Abstract

The technique for inserting the breast prosthesis after subcutaneous mastectomy comprises the subcutaneous mastectomy accompanied with the concurrent insertion of the endoprosthesis, the radial incision of the skin in the upper external quadrant, the separation of the fibers of the large pectoral muscle with the lateral part placed perpendicularly on the external side of the prosthesis directly below the sutures in the skin with partial fixation to the lower flap of the subcutaneous fat.

Description

Description of the invention

The useful model refers to medicine, namely to oncology and can be used in complex 2 treatment of patients with breast cancer (breast cancer).

Over the past decades, the number of organ-sparing operations that have successfully established themselves in the treatment of early (I-I) stages of breast cancer has increased. However, there are cases when organ-sparing operations are contraindicated as a surgical intervention due to the high probability of disease recurrence. These include: multicentric growth of the tumor, small size of the gland, subareolar localization of the tumor. In such 70 situations, it is recommended to use mastectomy |1Y). In cases where it is difficult or impossible to perform an organ-sparing operation, a subcutaneous mastectomy with one-time breast plastic surgery is used to restore the shape of the mammary gland.

Endoprosthetics of the mammary gland does not interfere with chemotherapy and radiation therapy in the postoperative period, that is, standard treatment regimens are not violated |21. 12 A known method of one-time endoprosthesis of the mammary gland after mastectomy IZ| chosen by us as a prototype. The position of the patient on the operating table is typical for mastectomy and other operations on the mammary gland - on the back. Skin dissection is performed in the form of a transversely oriented ellipse, which covers the tumor. Subcutaneous tissue of the mammary gland is excised in all directions, leaving the nipple-areolar complex in one unit with the tissue and lymph nodes of the subscapular, axillary, and subclavian groups. The pectoralis minor muscle is cut proximally near its attachment to the beak-like sprout. After removing the drug, cross the fibers of the pectoralis major muscle to the ribs. A prosthesis made of polyacrylamide gel (PAAG Interfal) is inserted under the muscle. The lower contour of the prosthesis is placed on the formed submammary fold. The upper and outer edges are covered with knotted seams between the pectoral muscles. A muscle is located above the prosthesis, its free, crossed edge is sewn with knotted sutures to the subcutaneous tissue of the lower 22 flap of skin. The skin over the muscle is sutured with knotted sutures. The drainage is brought out through the counter-aperture and is placed in the axillary cavity.

A known method of single-moment endoprosthesis |Z| has the disadvantage that when the tumor is localized in the upper-outer quadrant of the mammary gland, skin dissection should also be performed in this area. Therefore, after subcutaneous mastectomy and breast endoprosthesis, the prosthesis will be partially located directly under the sutures on the skin, which is not desirable. with

The purpose of the claimed useful model is to position the prosthesis in the intermuscular space in such a way that a portion of the pectoralis major muscle is located directly between the prosthesis and the sutures on the skin. at

The technical result is the creation of conditions for a reliable placement of the prosthesis in the intermuscular space, protection of the skin sutures by a layer of fibers of the pectoralis major muscle, and creation of optimal conditions for the nutrition of the skin suture.

The set task was achieved by the fact that in the known method |Z| performed a subcutaneous mastectomy with one-moment endoprosthesis of the mammary gland, a prosthesis was placed under the pectoralis major muscle, the costal part of which was cut off from the chest wall. The pectoralis minor muscle is transected in the proximal part near the 8th attachment to the coracoid sprout of the scapula and is sutured with the pectoralis major muscle above the upper and 740 outer edges of the prosthesis, according to the useful model, the fibers of the pectoralis major muscle are divided in the middle c and the lateral part is placed perpendicularly from the outer edge of the prosthesis directly under the seams on

With" the skin.

According to the useful model, the prosthesis is located on the pectoralis minor muscle under the medial part of the pectoralis major muscle and on the lateral side it is limited by the lateral part of the pectoralis major muscle.

The free end of the lateral part of the pectoralis major muscle is fixed to the subcutaneous tissue. Sutures on the skin of the leg are located above the prosthesis. So, the prosthesis is bounded below by the submammary fold, medially by the pectoral part of the pectoralis major muscle, and above and laterally by the created seam between the pectoral muscles. The pectoral muscle protects the skin suture line. со The essence of the proposed method is explained by the drawing, where: сл 20 1 - large pectoral muscle; 2 - nodal seam between the pectoralis major and minor pectoral muscles;

C - endoprosthesis; 4 - skin seam;

The method is performed as follows.

So" The position of the patient on the operating table is typical for mastectomy and other operations on the mammary gland - on the back. A skin incision is made radially in the upper-outer quadrant in the form of an ellipse that covers the tumor. Tissues of the mammary gland, with the tumor, are excised subcutaneously in all directions, in one block with the tissue and lymph nodes of the subscapular, axillary, and subclavian groups. The pectoralis minor muscle is cut proximally near its attachment to the coracoid process. After removing the drug, perform 60 crossings of the fibers of the pectoralis major muscle from the ribs. A prosthesis (3) is inserted under the muscle. The lower contour of the prosthesis is placed on the formed submammary fold. The outer edge is covered by knotted seams between the pectoral muscles (2). Above, above the prosthesis, is the medial part of the pectoralis major muscle. The lateral part of the pectoralis major muscle (1) is located outside the prosthesis and its free end is sewn to the lower flap of the subcutaneous tissue. The skin over the muscle is sutured with knotted sutures (4). The drainage is removed through the contraperture because it is placed in the axillary cavity.

An example of a specific implementation. Patient O.A. Berestyan, born in 1950. Diagnosis: cancer of the left mammary gland, art. PA TI»MiMo. 23.01.02. a subcutaneous mastectomy of the left mammary gland with axillary lymphadenectomy and one-time endoprosthesis of the mammary gland was performed. PGZ - infiltrating ductal cancer of the mammary gland with -2, in 2 lymph nodes - metastases. In the third week of the postoperative period, sutures were removed from the skin. In December 2004, the patient was examined for the last time, the results of prosthetics are satisfactory.

The proposed method was tested in the Kyiv City Oncology Hospital in the surgical department, and proved to be an effective method of one-time endoprosthesis of the mammary gland.

LIST OF REFERENCES: 70 1. Sagpvop (s.MU., Vovimisk 9.0g., ZUBio T.M., Mooge V., Vgiei 9.T., Mytau O.K., MUosa MU.S. ZKip-zragipd taviesiotu. Opsoiodis apa hesopvigysiime sopzidegayopv. App.5ygo, 225:570-5 1997. 2. Cheshuk V.E. Individualization of complex treatment of patients with breast cancer of the I-I stages.

Abstract. Kyiv-2003.

Z. Patent Mo 68132A. The method of one-time endoprosthesis of the mammary gland after mastectomy. Scabies

V.S., V.V. Zaichuk, 0.1. Sydorchuk, M.M. Nosko. Published on 15.07.2004. Bul. Mo 7.

Claims (1)

The formula of the invention is the method of one-moment endoprosthesis of the breast after subcutaneous mastectomy, which includes the performance of subcutaneous mastectomy with one-moment placement of the oendoprosthesis in the mammary gland, which is distinguished by the fact that the skin incision is performed radially in the upper-outer quadrant of the mammary gland, and the fibers of the pectoralis major muscle are divided in the middle and the lateral part is placed perpendicularly from the outer edge of the prosthesis directly under the sutures on the skin and is partially fixed to the lower flap of the subcutaneous ov CLlitkovyna. - IS) (ee) (ze) (o) - with . and? se) (95) (ee) art 70 So 60 b5