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Madazimov Madamin Muminovich, M.D., associate Professor of faculty, hospital surgery, anesthesiology and reanimation of the Andijan State medical Institute Kayumhodjaev Abdurashit Abdusalamovich, M.D., head of the Department of Plastic and Reconstructive Microsurgery of the Republican Specialized Center of surgery named after Academician V. Vahidov, E-mail: kaumhodjaev.flap@mail.ru Madazimov Komil Madaminovich, assistant of faculty, hospital surgery, anesthesiology and reanimation of the Andijan State medical Institute E-mail: komil-madazimov@inbox.ru Teshaboev Muhammadyahyo Gulomkadyrovich, Ph D., assistant of faculty, hospital surgery, anesthesiology and reanimation of the Andijan State medical Institute E-mail: teshaboev2013@mail.ru
DEVELOPED METHODS OF SURGICAL TREATMENT OF POST-BRAIN DEFECTS OF SOFT AND BONE TISSUES OF THE CRANIAL VAULT
Abstract. This article is devoted to the introduction into clinical practice of the conventional method of surgical treatment of patients with cicatricial defects and deformities of the soft and bone tissues of the cranial vault. The results of surgical practice were studied in 22 patients. In the long-term period in the main group (n-10) patients, where improved methods of surgical treatment were used, good functional and aesthetic results were observed in 9(90%) patients, satisfactory in 1(10%) patients.
Keywords: scar, defect, soft tissue, bone tissue, cranial vault, surgical treatment, combined plastics, flap.
The urgency of the problem. Defects of the soft and Of the 22 patients,18(83.9%) had a soft tissue defect with
bone tissues of the cranial vault arise mainly after injures, exposure of the bones of the cranial vault, 4 (16.1%) had a de-
burns and excision of tumors. Head burns account for fect of soft tissues and bones with exposure of the brain tissue.
about 40% among other sites, and their consequences, In 12 (54.8%) patients, soft tissue defects with exposure
due to the opennes of zones and the tendency of scars to of the bones of the cranial vault were eliminated by traditional
pathological growths, put the problem of rehabilitation of combined plastics.
these patients in the first place (Gurlek A. et al., 2004). Combined plastics technique:
The main ways to solve the problem is the development Before the operation, the boundaries of excision of the soft
and introduction of new methods of surgical correction of tissues defect of the cranial vault, as well as the boundaries of
cicatrical deformations, defects (balloon stretching of tis- the skin-aponeurotic flap, were marked with a marker. Under
sues, plastic with flaps on the vascular pedicle, microsurgi- general anesthesia, an incision of a skullap defect was dissected
cal auto transplantation of tissue complexes) (Azolova V. V. within the limits of healthy tissues. In cases of exposure of the
and co-author (2002)). bones ofthe cranial vault in 12 (54.8%) patients, a skin flap was
Materials and research methods. The research is based cut out from the unaffected tissues next to the defect. After the
on the results of surgical treatment of 22 patients with post- rotation of the flap to the defect, the edges ofthe wound and the
burn defects and deformities of the soft and bone tissues of flap were sutured with interrupted a-traumatic sutures.
the cranial vault area, who were in the ward of the injures of The donor wound was closed with a split autodermal
the multidisciplinary medical center of Andijan region from graft, 5 mm thick, taken from the anterolateral thigh. At the
2010 to 2015 yy. edges of the graft and donor wounds, nodal a-traumatic tensile
stitches were also applied with a 'pilot' pressure bandage. The under-patchwork space was drained by vacuum drainage.
In the post-operative period, local hypothermia and antibiotic therapy were prescribed.
Figure 1. Defect of the soft and bone tissues of the cranial vault with the exposure of dura mater. The boundaries of the skin aponeurotic flap are outlined
Figure 2. Pathologically altered tissues dissected, skin aponeurotic flap cut
Figure 3. Defect is closed by a skin aponeurotic flap by rotation. The donor wound is covered with a free split autodermal graft
Figure 4. Post-burn scar alopecia and soft tissue defect with exposure of bone tissue
Figure 5. The same patient has the closest result of plastic surgery of the defect with a skin aponeurotic flap on the leg
An improved method of combined plastics of soft and bone defects of the cranial vault was used in 10(45.4%) patients. In cases when the patients had bone defects with exposure of the dura mater and liquorrhea, for vital reasons an urgent operation, using an improved method of combined plastics.
Operation techniques: Before the operation, using a marker, the boundaries of the skin aponeurotic flap were outlined, respectively, the area and contour of the defect next to it were used to cut out the skin-aponeurotic flap from the unaffected tissues. The end of the flap was taken on the handles. The edges of the bone defect were carefully treated in the traditional way.
According to the size and contour of the defect, a graft was formed from a carbon plate. The latter was fixed to the edges of the bone defect of the cranial vault using prolene threads. After washing the surgical wound with an antiseptic solution (Tsiteal), the latter was closed with a previously formed skin aponeurotic flap. Under the patchwork space drained vacuum
drainage. In 2 (50%) patients, intra-operatively stretched tissues were used to close the donor site.
Figure 6. Defect of the soft tissues of the temporal region with the exposure of the bone tissue. The boundaries of the skin aponeurotic flap and excised pathological tissues are outlined
Figure 7. The defect in the temporal region is closed by a skin-aponeurotic flap by rotation, the donor wound is closed by a free full-layer skin bone
Figure 9. The same patient. The closest result of the plastic repair of the defect is a rotated skin aponeurotic flap. The donor wound is covered with a free full-layer skin flap
Results: In the main group of patients (n-10), there was no necrosis of the flap and no cases of suppuration. Subcutaneous hematoma occurred only in 1 (10%) patient. Observations for periods of up to 3 years showed that the thus-closed, long-exposed bone was not sequestered, and no osteomyelitis recurred.
In the control group, necrosis of the distal end of the flap was observed in 1(8.3%) patients after the final plastic surgery. Hair loss along the suture line was found in 1(11.7%)patient. Under-scrap hematoma occurred in 2(16.6%)patients.
In the long-term period in the main group (n-10) patients, where improved methods of surgical methods were used, good functional and aesthetic results were observed in 9(90%) patients, satisfactory in 1(10%) patients.
In the control group, using traditional methods of surgical treatment due to complications, good results were observed in 10(88.2%) patients, satisfactory in 2(11.8%) patients.
Figure 8. post-burn scar alopecia with the exposure of the skull bone
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2. Madazimov M. M., Teshaboev M. G., Temirov P. Ch., Madazimov K. M. Intra-operative balloon skin stretching while removing cicatrical deformities of nasolabial region // Combustiologist. 2013.Russia,- M.- P. 54-58.
3. Papaskiri D. G. Surgical treatment of patients with cicatrical defects of the scalp.: Theses. Cand. of med. sciences.- M., 2010.- 40 p.
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