Использование артеризированных трансплантатов при пластике дефектов тканей на голове и шеи

Abstract

Восстановление деформированных тканей и органов человеческого организма всегда было актуальным в кругу медико-социальных проблем человечества. Особенно сложными для функционального и косметического восстановления являются повреждения головы и шеи. Морфологическая характеристика донорской зоны заднебоковой поверхности груди и в частности трансплантатов на базе широчайшей мышцы спины по данным выполненных исследований позволяет рекомендовать авторизированный трансплантат данного региона для восстановления обширных дефектов тканей на голове и шее. В исследовании представлены научно обоснованные морфологические характеристики донорской зоны и успешные клинические наблюдения при выполнении реконструктивных операций на голове и шее; Відновлення деформованих тканин і органів людського організму завжди було актуальним в колі медико-соціальних проблем людства. Особливо складними для функціонального і косметичного відновлення є пошкодження голови та шиї. Морфологічна характеристика донорської зони задньобокової поверхні грудей і зокрема трансплантатів на базі найширшого м’яза спини за даними виконаних досліджень дозволяє рекомендувати авторизований трансплантат даного регіону для відновлення великих дефектів тканин на голові та шиї. В дослідженні представлено наукове обгрунтування морфологічної характеристики донорської зони і успішні клінічні спостереження при виконанні реконструктивних операцій на голові і шиї; Restoring deformed tissues and organs of the human body has always been relevant in the range of medical and social problems of mankind. Especially difficult to restore functional and cosmetic damage are head and neck. The high level of injuries, especially the destructive power of modern weapons and the increasing number of oncological diseases characterized by the presence of heavy categories of patients combined with extensive injuries, treatment and rehabilitation which is relevant and, at the same time, a challenge of modern medical science and practice. Replacement of large tissue defects complicated autografts on microvascular astomosis has become fairly widespread in plastic surgery in recent years. Objective: To study the clinical and morphological plasticity grafts authorized on the basis of the latissimus dorsi muscle. Materials and methods: Morphological studies performed on twenty anatomical preparations. We used the classical methods of anatomical dissection, rengen angiography, spatial reconstruction of the donor zone vessels bloodstream using anatomical corrosive agents. The clinic performed eighteen restoration and reconstructive surgery using arterizirovannyh transplants on the basis of the latissimus dorsi muscle in patients with extensive injuries of the head and neck. Successful clinical experience with graft transplantation laminated using microvascular anastomoses and existence perforating vessels between the skin and muscle suggests that the surface layers of tissue blood flow depends on back muscles located underneath. Vascular area system is fairly constant, individual differences are ob served only at the branching arteries in the muscle, such as in 8 patients, of which we have seen, it was a loose type and the main trunk has a length of 6 cm. The length of the vascular graft legs – thoraco-umbilical arteries and veins are relatively constant and is 8-12 сm. With preservation of the muscle and the vessels continuous skin-fascial feet and without it – two types of flaps of this type can be formed. In studies on cadavers it has been found that by pouring ink thoraco-dorsal artery staining occurs only over the latissimus dorsi muscle, that is, from the scapular spine and lower, so when you turn in the leg flap of skin and fascial strip of suprascapular portion of its power increases. For the movement of the flap on the short distance (on the upper limb, shoulder, anterior chest) is not necessary to carefully allocate pedicle, since the rotation angle does not exceed 90 degrees and the upper part of the muscle is easily shifted to covering it with a cloth. It is known that the thinner the pedicle, the flap is easier. In theory, there are three ways to move the flap on the head and neck: a direct transfer from the skin deltopektoralnoy groove, moving across the back above the skin suprascapular area and holding through a subcutaneous tunnel above or below the head of the pectoralis major muscle. The average distance from the front edge of the armpit to collarbone 8-12sm with lowered hand, it can be reduced by bringing the shoulder to the upper thorax. Even more the distance has to overcome when moving the flap through the upper back and suprascapular area. Patients with extensive injuries, defects and deformities of the head and neck are of particular clinical group of patients, the treatment and rehabilitation which is a challenge for surgeons. As a rule, extensive defects of the head, face and neck are accompanied by tissue damage of the complex and to restore their need to find a plastic material and the thickness of a large area, including skin, fat, muscle and bone.Traditional methods of plastics using local fabrics, Filatov stem-free auto-and allografts (avascular) in most cases, did not give the desired effect.