CC BY
11
Madazimov Madamin Muminovich, M.D., associate professor, of hospital surgery, anesthesiology and reanimation faculty of the Andijan
State medical Institute E-mail: plastic62@bk.ru 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
SURGICAL APPROACH TO TREATMENT OF PATIENTS WITH CONSEQUENCES OF THE CRANIAL VAULT BURNS
Abstract: The author of the article highlights the methods of surgical approach in patients with consequences of burns in the area of the cranial vault. This article presents the results of surgical treatment of 76 patients with different approaches. Patients were divided into two groups, control and main. Good and satisfactory results of surgical treatment in the main group of patients were observed in 90.2%, which was higher than the parameters of the control group (85.6%). Keywords: surgical approach, consequences, cranial vault, burns.
Background information. Approximately fat layer is restored, but alopecia remains, as well as the 6,000,000 people per year around the world are ap- problem associated with it [1, 4] pointed for medical care due to burns [2, 4]. Materials and methods of research. The work is
In our Republic, about 18,000 (out of 32 million) of based on the results of surgical treatment of 76 patients the population receive burns every year. with post-burn cicatricial defects and deformities of
Deep burns of the scalp are found in 15% of patients the cranial cervical area in the department of the con-who received thermal trauma. The resulting burn soft tis- sequences of injuries of the multifield medical center of sue defects are one of the most tragic consequences of Andijan region. Their age of the patients ranged from 4 to underwent burn injury [3, 5]. 61 years. Of these, 24 (31.8%) are male and 52 (68.2%)
Some patients who seek help have soft tissue defects are female. 54 patients of the main group and 22 patients with the exposure of the bones of the cranial vault or of the control group. The main damaging factors were hot the defect of soft and bony tissues with the exposure of fluid - 23 (30.2%) and contact burns - 19 cases (25%). brain tissue, which requires the application of immedi- Patients admitted the department at various times after ate patchwork with the help of microsurgery, combined the injury - from 5 months to 27 years after the healing plastics or "the Filatovs stalk". In this case, only the skin- of burn wounds.
Section 7. Medicine
Results and discussion. In order to effectively model the plasty of scarring alopecia and soft tissue defects of the cranial vault, they were subdivided into groups according to size: small (up to 120 cm2, which was less than 25% of the scalp area), which occurred in 30 (40%) patients; average (121-250 cm2-25-40% of the scalp area), observed in 35 (46.6%) patients and large (more than 250 cm2, ie more than 40%), used in 11 (13.4%) patients.
In the control group of patients, acute dermatosia was used in 7 patients, traditional expander plastics occurred in 15 patients.
In the main group of patients intraoperative rapid balloon stretching was used in 35 patients. Improved expander plastics in 19 patients.
In scarring alopecia with a width of up to 2.5 cm, 7 (9.2%) patients used the method of acute dermatension.
Long-term observations have shown that the method of acute dermatosy has the following disadvantages:
1. Teething of seams due to tension;
2. Possibilities of superimposing delayed seams in the case of defects in tissues for plastics;
3. Expansion of postoperative cicatrix in the long-term period in 71% of patients.
Due to this, we have studied the possibility of using intraoperative (rapid) balloon stretching of tissues in this group of patients.
15 patients had surgery with the method of traditional expander plasty. With defects of small and medium size, patients implanted one expander with a base size of 6 x 12 cm.
If the defect was more than 30% of the hair, two balloons were used.
In all patients, tissue stretching was performed on an outpatient basis.
Enhanced expander plastic n = 19 (25%).
The advantages of this method
1. Expander implantation through a wide incision allows visually monitoring the state of the expander dome and prevents the formation of folds resulting in reduced probability of pressure sores.
2. Fixing the valve dome of the expander when it is implanted with a needle prevents the dome from slipping back towards the main reservoir.
Enhanced Expander Implantation Technique at the border with a healthy skin with a scar, a 5-6 cm long incision was made. With the help of the corncang, a
channel and a bed for the valve tube are separately formed. Through a wide incision, the hemostasis of the area of the bed is visually performed. The expander is implanted. To prevent the valve tube from sliding backward, the latter is fixed subcutaneously with needles from the syringe. With the help of a spatula, the folds of the expander are leveled, at the base and the dome. The void space is drained by vacuum drainage. The wound is layer-by-layer closed with two-row sutures. Depending on the prevalence of the lesion, its localization and available stocks of stretched tissues, the methods of their usage were different.
Intraoperativerapidstretchingoftissues n=35(46.1%). The width of cicatricial alopecia varied from 1.0 to 2.5 cm.
Technique of operation: A cut is made at the border of the cicatricial massif with healthy skin. Through this incision, a subcutaneous pocket is formed, corresponding to the size of the balloon.
The balloon is implanted in the formed bed.
The wound is temporarily sutured with nodal sutures. The balloon is intraoperatively filled with a maximum solution of furacillin, creating a compression on the tissue from the inside. After five minutes, the liquid is drawn back and relaxation of the stretched tissues occurs. After a three-minute interval, the balloon is again filled with liquid for 5 minutes.
This procedure is repeated three times. After this, taking into account the available amount of tissues, scars are excised and the wound formed is closed by intraop-eratively stretched tissues
Results: In the near postoperative period, all 7 patients had no complications. In the long-term period (after 1.5-2 years), 6 (85.7%) of the 7 patients reported an expansion of the postoperative scar to 2-3 cm, which significantly reduced the functional and aesthetic results of operations.
In 1 (6.6%) patients after the final stage of plastic surgery, the necrosis of the distal end of the flap was observed in a traditional way. Subcutaneous hematoma occurred in 1 (6.6%) of the patient. In the long-term period, good results were recorded in 12 patients (80.2%) and satisfactory in 3 patients.
35 patients were operated in the main group of patients by the method ofintraoperative rapid balloon dilatation. All 35 patients had no complications in the immediate postoperative period. In a remote period (1-1.5 years), 30 (85.7%) of 35 patients were examined. In 26 (88.7%)
patients, the results of operations were considered good, that is, their postoperative scars did not expand. Their width reached up to 2-3 mm, which greatly improved the functional and aesthetic results of the operation.
In one patient in the long-term period, because of divergence of the sutures, there was an increase in the postoperative scar.
As a result of improved expander plasty, there were no complications in the immediate postoperative period. In the long-term period, 1 (5.2%) patients had hair loss along the seam line. At the same time, good results were recorded in 18 (94.8%) patients and satisfactory results in 1 (5.2%) patients.
References:
1. Azolov V. V., Dmitriev G. I. Nizhny Novgorod School of Combustiology // Combustiology at the turn of the century: Intern. Kongress.- Moscow,- 2007.- P. 17-18.
2. Bogosian R. A., Vorobiev A. V. et al. The method of expander dermotension in the treatment of patients with thermal lesions of the soft tissues of the head and bones of the cranial vault // Mater. Intern. Conf. "Actual problems of thermal injury", dedicated. 60th anniversary of the burn center of the Institute of First Aid to them. I. I. Djanelidze. June 20-22,- 2011.- St.-Petersburg,- 2011.- P. 225-226.
3. Krainik I. V., Anikin Yu. V. and others. Prospects and possibilities of the radiosurgical method in surgery and treatment of fired patients // Mater. Intern. Conf. "Actual problems of thermal injury", dedicated. 70th anniversary of the Institute of First Aid to them. II Dzhanelidze and the 55th anniversary of the burn center. June 27-29.2008.- St.-Petersburg,- 2008.- P. 433-434.
4. Driscoll D. N., Levy A. N., Gama A. R. Dermabrasion and Thin Epidermal Grafting for Treatment of Large and Small Areas of Postburn Leukoderma: A Case Series and Review of the Literature // J. Burn Care Res.-2015.-Vol. 30.- No. 6.- P. 287-293.
5. Grishkevich V. M., Grishkevich M., Menzul V. Postburn neck anterior contracture treatment in children with scar-fascial local trapezoid flaps: a new approach // J. Burn Care Res.- 2015.- Vol. 36.- No. 3.- P. 112-9.
