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Two patients after skin-grafting and muscle in 1 case after au-torib plastics in the early postoperative period, there was a partial failure of seams from the air intake of the zone created by skin-muscular front wall without differences external seams. In both cases, conservative methods achieved the elimination of signs of insolvency seams with the termination of air intake and phonation when coughing with a hermetic closure of the defect. In all other cases obtained good immediate and long-term results. The control broncho spectroscopy determined defect plastics sheltered area of the skin insertion, without disturbing the terrain and without narrowing the lumen of the trachea.
Thus, the selection process plastics or tracheal reconstruction of the defect is determined in each case individually. Local skin-muscle flaps, as well as complicated skin and musculoskeletal grafts from adjacent the neck and different parts of the thorax may be used. The indication for this operation is the presence of a defect and persistent tracheal lumen formed at this level, with no signs of restenosis of the respiratory tract, the absence of inflammation
and infection of the tissues around the stoma. When the size of the tracheal defect to 2 x 4 cm., sufficient depth corresponding to the lumen of the lumen of the trachea below and above the stoma, the single axis of the trachea and larynx without distal displacement and deformation of the lumen is a skin-muscle plastic defect replacement with local fabrics.
Conclusions
1. The large number of donor zones hinged flap near the neck defects allows to use them widely for plastics extensive and persistent tissue defects. Using an improved method of forming prefabricated flap, it allows to produce plastic large tracheal defects with the restoration of the cartilaginous skeleton.
2. Formation of rotational flaps, in particular autocartilage and delta-pectoral flap for reconstruction of extensive persistent tracheal defects and soft tissues of the neck is technically simple, requires no additional microsurgical benefits to create a framing the front wall without violating the patency of the respiratory tract, without constriction and deformation lumen.
References:
1. Gudowski L. M., Milanov N. O., Parshin V. D., Trofimov E. I. Long-term results of extensive elimination of defects of the trachea using micro surgical techniques//The problem of tuberculosis and lung diseases. - 2006. - № 3. - P. 18-23.
2. Milanov N. O., Parshin V. D., Trofimov E. I. The results of the use of sophisticated revascularized grafts in reconstructive surgery of the trachea//Annals of the Surgery. - M., 2005. - № 6. - P. 27-30.
3. Milanov N. O., Trofimov E. I., Parshin V. D. Closure of large tracheal defects using revascularizing prefabricated radial skin and cartilage autograft//Annals of the plastic, reconstructive and aesthetic surgery. - 2006. - № 4. - P. 109.
4. Milanov N. O., Trofimov E. I., Parshin V. D., Shimbireva O. Y. and et al. Easy revascularized autografts in surgery of the trachea//Prob-lems of Reconstructive and Plastic Surgery. - 2007. - № 3-4. - P. 79-82.
5. Parshin V. D., Milanov N. O., Gudowski L. M., Trofimov E. I., Zelyanin A. C., Rusakov M. A., Vishnevskaya G. A., Volkov A. A. Ten years of using microsurgical techniques in reconstructive surgery of the trachea//Breast and Cardiovascular Surgery. - 2008. - № 2: 36-42.
6. Starokha A. V., Simonov S. V., Muhamedov M. R., Günter V. E. and et al. Method plastics of gaping tracheal defects. Patent for invention. RUS 2453281. 03.12.2010.
7. Topolnitsky E. B., Dambaev G. C., Semichev E. V., Schafer N. A., Günter V. E. Method of replacement fenestrated defects of the trachea and larynx. Patent for invention. RUS 2440789. 25.11.2010.
8. Royer Allison K., Royer Mark C., Ting Jonathan Y., Weisberger Edward C. et al. The use of a prefabricated radial forearm free flap for closure of a large tracheocutaneous fistula: a case report and review of the literature//J. of Medical Case Reports. - December 2015. - 9: 251-253.
9. Hashizume K., Kanamori Y., Sugiyama M., Tomonaga T. et al. Vascular-pedicled costal cartilage graft for the treatment of subglottic and upper tracheal stenosis//J. Pediatric Surgery. - Dec. 2004. - Vol. 39, Issue 12: 1769-1771.
10. Jianxing He, Xin Xu, Manyin Chen, Shuben Li, Weiqiang Yin, Susheng Wang. Novel Method to Repair Tracheal Defect by Pectoralis Major Myocutaneous flap//Ann. Thorac. Surg. - July 2009. - 88: 288-291.
11. Kamiyoshihara Mitsuhiro, Nagashima Toshiteru, Takeyoshi Izumi. A novel technique for closing a tracheocutaneous fistula using a hinged skin flap//Surgery Today. - August 2011. - Volume 41, Issue 8: 1166-1168.
12. Watanabe Yui, Umehara Tadashi, Harada Aya, Soichi the Suzuki. Successful closure of of a tracheocutaneous a fistula the aftertrache-ostomy using the the skin flaps to two two: a case report a. Surgical Case Reports. - December 2015. - 1: 43-47.
Yuldasheva Nasiba Alisherovna, Tashkent State Stomatology Institute, Department of Orthopedical stomatology E-mail: [email protected]
Prognosis of the individual risk of periodontal disease development in the pregnant women
Abstract: The pregnant women have one of the highest risks of the occurrence of stomatological diseases. We observed 847 pregnant women at the age of18 to 36 years. The research showed, that development of the prognostic coefficients by the most important and characteristic for pregnant women risk factors, particularly where there is danger of the occurrence of the periodontal pathology, present the opportunity for physician-stomatologists and obstetrician-gynecologists.
Keywords: pregnancy, parodontitis, risk factors, reproductive health.
Prognosis of the individual risk of periodontal disease development in the pregnant women
The state of the stomatological health in the population has significantly improved over the last 10 years, however, the group of people with high intensity of periodontium impairment have still remained. The authors in their researches determined the risk factors for development of periodontal diseases [1; 4].
The pregnant women have one of the highest risks of the occurrence of stomatological diseases [3; 6]. The change of the hormonal fond, redestruction of all types of metabolism, reduction of the body defensive forces, change of the function of salivary gland and others these are factors, accompanying any pregnancy and simultaneously seem to be risk factors of development of stomatological diseases. The main diseases of the oral cavity, with which women meet, appeared to be caries and parodontitis [1; 5; 6].
Evidently that additionally to mass hygienic and therapeutic-prophylactic measures for this contingent the individual approach to the therapeutic prophylactic care is required. The modern methods ofprognosis allow selection ofpregnant women, more sensitive to the periodontal diseases for the timely providing for them the therapeutic-prophylactic care [1; 2].
On the basis of factor analysis there are revealed real functional causes, pathogenically determining risk of parodontitis development in this specific contingent [1; 6].
This time there is need in complex assessment of the effect of genetic, social, somatic state of reproductive health and factors arising during pregnancy on the level of prevalence of parodontitis, determination of "burden" of the factors and intensity of their influence in the integrated risk of morbidity. The initial predisposition appeared to be presence of interconnection between development of disease and factors, functionally effecting on its development.
Material and methods. The specially developed individual card was used for interview and examination of847 pregnant women at the age of 18 to 36 years, visiting therapeutic institution, as well as there was performed copying of data from primary medical documentation of the same consultation (F.025; F. III/Y; F.113/4).
While investigating risk factors for development of parodon-tium in pregnant women there were revealed different reasons determining pathogenic mechanisms of the development of periodontal diseases united into group: 1) local; 2) social 3) factors reflecting the state of reproductive health; 4) the state of somatic health and 50 obstetric and neonatal pathology.
During development of the diagnostic algorithms there were used expert assessment for determination of every informative evidences and symptoms including into this study both in group of pregnant women with present of periodontium diseases and presenting the randomized selection from the contingent of pregnant women without pathology of parodontium. The experts were selected from the skilled physicians and researcher-specialists whose opinions were taken into consideration. In order to make the diagnostic conclusion there were used 47 risk factors.
The proposed method was developed on the prognostic model based on the Bayes' formula for independent evidences, method of assay ofVolts and assessment of informativity by informative measure of Kulboch with use of recommendations offered by Kubler G. P.
While estimating statistical parameters there were calculated the following scores: mean error M ± m, parametric Student's criterion (t), index of Kolmogorov-Smirnov (X.2), Pirson's goodness measure (x2). The differences were considered as reliable at the value P < 0.05.
Results and discussion. The mathematic analysis of the risk factors of disease development allows not only identification of the most significant from them with high degree of reliability, but provided
prognosis, on the basis ofthe algorithm proposed, ofpossible development of parodontitis in the pregnant women from the risk group.
There are presented prognostic coefficients (PC) and informativity (I) of the parameters. The positive sign "plus" indicated in favour of development of GP, and sign "minus" denies its exacerbation.
All the studied factors have high prognostic informativity. And the summarized prognostic informativity (I) of the obstetric and perinatal pathology accounted for 121.01; the summarized coefficient of informativity of the local (hygienic) factors was 97.66.
The rather high prognostic significance of the factors of reproductive health (I = 76.66) and somatic factors (I = 65.25) and the least prognostic significance were established in the social factors (I = 46.93).
Among the hygienic factors the very high prognostic informativity was found in the factor not referrals to stomatologist (I + 26.73); besides the high prognostic significance (I + 2.0) in descending order was established in relation to not use of therapeutic-diagnostic care for oral cavity (I = 19.21); absence of the appointment card from gynecologist to stomatologist (I = 11.30) and not usage of vitamin-mineral complexes prescribed by stomatologist (I = 11.15).
In relation to factors occurring during pregnancy the high prognostic informativity has the anemia ofpregnant women (I = 15.08); marked early gestosis (I = 12.39); colpitis (I = 13.75); hemorrhage in the first trimester (I = 11.12); acute infection ofthe urinary tract (I + 11.03) and acute infection of pregnant women (I = 10.60). It is necessary to note high prognostic significance of the placental insufficiency (I = 9.21); cytomegalovirus infection (I = 6.37); edemas of pregnant women (I = 5.63); intrauterine fetal infection (I = 5.23); diabetes mellitus of pregnant women (I = 3.38); oligohydramnios (I = 3.37); hemorrhage in the II trimester (I = 2.79); herpes virus infection (I = 2.55); fetal hypotrophy (I+2.36) and threat of pregnancy interruption (I = 2.34); other factors have less prognostic significance (I < 2.0).
From the factors of reproductive health the most prognostic significance has aggravated obstetric anamnesis (I = 20.43); high prognostic significance was found in such factors as interval between pregnancies not less than 1 years (I = 11.96); uterine and adnexa uteri inflammation (1 = 10.52); premature delivery in the anamnesis (I = 9.16); high informativity has the factor of the third pregnancy (I=7.78) and then in descending order the following factors distributed: interval between pregnancies >1 year (I = 6.06); more that 3 abortions in the anamnesis (I=4.58); such factors as the first pregnancy and 0-1 abortion in the anamnesis have low informativity (I < 2.0).
Among the somatic factors the very high prognostic informativity the diseases ofthe gastrointestinal tract have (I = 15.53); practically the identical prognostic informativity was established in diseases of the thyroid gland, urinary tract and chronic specific infections and arterial hypertension informativity accounted for, respectively 11.13; 11.92; 11.47 and 9.61; the least prognostic significance is found in hypotensive syndrome (I = 2.90) and varicous disease (I = 1.45).
The difficulties of the social interrelationship, living-conditions, level of incomes, education, family history and other factors, which are considered as insignificant separately, together they have negative effect on the occurrence and severity of the parodontium pathology.
Thus, the study of the parameters in relation to risk of occurrence of parodontitis the high prognostic significance the social factors have: level of education (I = 9.80); marital status — single (I = 6.7); low level ofincomes (I = 6.84).In this situation such obvious unfavourable risk factors as smoking, drinking of the alcohol had informativity lower, respectively 1 + 4.28 and I = 5,76. The high informativity was characteristic for index of non-planned pregnancy (I=4.01); for middle
special education (I=4.28); besides the factors indicated the pathogenic significance in the development ofparodontitis was revealed in the age of pregnant woman not less than 18 years (I = 1.94) and more than of 36 years old (I = 1.17).
The data presented confirm that the leading factors in the development of generalized parodontitis in the pregnant women are simultaneously with general (hygiene of oral cavity, social state, somatic pathology and reproductive health) the factors occurring during pregnancy, among which the more significant pathogenic role belongs to anemia ofpregnant women, gestosis, hemorrhage in the first trimester, colpitis, acute infection of pregnant women, placental insufficiency.
Prognosis for development of generalized parodontitis ofpregnant women with use of developed algorithm is determined with use of mathematic summary of the prognostic coefficients (PC) to achievement of the prognostic threshold.
According to the theory of relativity the prognosis is not considered as regulations, and should be taken as hypothesis of the most probable development of the pathology (particularly, exacerbation of the progressing of the inflammatory-destructive periodontal lesion) in the further.
With taking into account of desired errors for establishment of diagnosis, prognosis of the pathological process the threshold values of prognostic coefficients are determined. The exceed of one of prognostic hypotheses which corresponds to the required exceed of the frequency of the correct prognoses over the frequency of errors is considered as threshold meaning. At 5 % level of error probability the threshold values of the prognostic coefficients (PC) account for: PC + thresh. = + 13.0; PC - thresh. = -13.0.
The threshold values of PC divide all diapason of the prognosis into 3 intervals:
• Sum of PC < -13.0 — favourable;
• Sum of PC from -13.0 to 0 — indefinite favourable;
• Sum of PC from 0 to 13.0 — indefinite unfavourable;
• Sum of PC > 13.0 — unfavourable.
For individual prognosis and determination of the required volume of therapeutic-diagnostic measures in the pregnant
2.
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women with risk of periodontal disease development there have been developed criteria of the efficacy of the therapeutic-diagnostic measures in the pregnant women with various risk for development of generalized parodontitis.
The data on integral evaluation of the factors determining occurrence of parodontitis of the pregnant women may be used for performance of concrete therapeutic-prophylactic measures.
Knowing the character and degree of the effect of some factors it is principally possible to define probability of the occurrence of the parodontitis of the pregnant women.
The solution of the questions of such kind by the technique proposed includes the following stages:
1. Identification of the factors influencing on the occurrence of the parodontitis.
Evaluation of the degree of the effect of risk factors on the risk index.
Determination of the probability of the occurrence of the periodontal pathology taking into account the prognostic coefficients of the various factors.
Conclusions
Thus, development of the prognostic coefficients by the most important and characteristic for pregnant women risk factors, particularly where there is danger of the occurrence of the periodontal pathology, present the opportunity for physician-stomatologists and obstetrician-gynecologists:
1. To determine probability of the occurrence of the periodontal pathology, to select the groups, factors, contributing most of all to development of parodontitis, to reveal the most prognostically significant factors. To explain necessity of the measures taking for treatment and prevention.
To more rationally effect on the main unfavourable factors, determining occurrence of the periodontal pathology. To develop individual program of the therapeutic-preventive measures, providing reduction and stopping occurrence of the periodontal pathology of the pregnant women.
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References:
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Mirsalikhova Feruza, PhD, Assistant to chair, Tashkent State Dental Institute, Department of children's therapeutic stomatology E-mail: [email protected]
Modern aspects of prevention of dental caries in children
Abstract: The status of healthy primary teeth for child health and dental health later in life has long been undervalued. This insolence has since changed considerably. Protective programs that have lead to an improvement in the dental health of
