Совершенствование методики подъема и мобилизации слизистых и слизисто-надкостничных лоскутов в полости рта на этапах аугментации альвеолярного отростка

Abstract

Наиболее оптимальное заживление раны происходит при подъеме и мобилизации лоскутов по авторской методике: это проявляется ускорением формирования соединительнотканного рубца, в результате чего на седьмые сутки в ране образуется рыхлая соединительная ткань и наступает полная эпителизация раневой поверхности. Сравнительная оценка местных послеоперационных клинических изменений состояния слизистой оболочки рта показала, что наибольший функциональный и косметический эффект достигается при применении авторской методики отслоения и натяжения слизисто-надкостничных лоскутов, что подтверждается появлением у 76,8% больных более тонких, бледных, бледно-розовых, безболезненных при пальпации рубцах. Это также доказано динамическими результатам термометрии (средняя температура снижена на 0,5-0,9°С), реографии (нормализация кривой реограммы быстрее на 2-3 дня); Найбільш оптимальне загоєння рани відбувається при підйомі і мобілізації клаптів за авторською методикою: це проявляється прискоренням формування сполучнотканинного рубця, в результаті чого на сьому добу в рані утворюється пухка сполучна тканина і настає повна епітелізація поверхні рани. Порівняльна оцінка місцевих післяопераційних клінічних змін стану слизової оболонки рота показала, що найбільший функціональний і косметичний ефект досягається при застосуванні авторської методики відшарування і натягу слизисто-надкостнічних клаптів, що підтверджується появою у 76,8% хворих більш тонких, блідих, блідо-рожевих, безболісних при пальпації рубцях. Це також доведено динамічними результатами термометрії (середня температура знижена на 0,5-0,9 ° С), реографії (нормалізація кривої реограми швидше на 2-3 дні); Taken into account the development of modern oral surgery, the problem of optimizing the closure of the wounds of the mucous membrane after carrying out patchwork operations in the oral cavity remains relevant. In our opinion, it is important to study the biomechanical properties of the mucosa-periosteal flaps of their peeling boundaries and the optimum tension of values. Another important feature of optimal wound healing is the characteristic of the hemodynamics of the microvascular bed of the oral mucosa in the area of suturing and the formation of a future scar. Aim of the study is theimprovement of the technique of lifting and mobilizing muco-periosteal flaps during plastic and patchwork operations, taking into account their biomechanical characteristics. Materials and methods of research.Two main branches of research were identified: clinical andmorphological that wasbased on the goals and objectives of the work. Clinical studies have been performed to inspect possible aspects of the implementation of the theoretical data that are obtained in the practice of patchwork surgery in the oral cavity. To determine the features of the postoperative course and the dynamics of wound healing of the oral mucosa, we selected 40 patients, practically healthy, without somatic diseases, who had indications for performing surgical interventions on non-infected tissues of the oral mucosa. Rheography was used to control the dynamics of blood flow restoration in the tissues of the operated zone. The records were performed using the RPG-2-02 reoplatysmograph using a bipolar technique. The tissue thermometry in the area of the operating injury was performed using the TEMP-1 apparatus. To compare the obtained data, the temperature was measured at symmetrical points on the healthy side. Results and discussion.During conduction a comparative analysis of the nearest (on the 30-th day) and delayed (after 6 months) clinical results of treatment, our four-scoring system was used. The main criteria for this were: the presence of a symptom that characterizes the course of the inflammatory or recovery processes, as well as the degree of their manifestation. A comparison of the obtained data showed that a high average score (4.37) on the 30-th day of observations was obtained in the main clinical group. Below the score (3,6) was registered in the control group. In the analysis of the long-term results of treatment (6 months after the operation), it was found that the most favorable recovery processes were completed in patients of first clinical group (the reference point is 4.79). The analysis of rheographic indices of the course of recovery processes was carried out on the 3-rd, 7-th, 14-th and 21-st days after the surgical interventions. During comparing the results, it was found that in the treatment of wounds in patients in two clinical groups, there are significant differences in the indices of rheographic studies. Conclusions. The most optimal wound healing occurs at lifting and mobilizing of flaps according to the author's method: this is manifested by the acceleration of the formation of connective tissue scar, as a result of which on the seventh day a loose connective tissue is formed in the wound and complete wound epithelization is occured. A comparative assessment of local postoperative clinical changes of the state of the oral mucosa showed that the greatest functional and cosmetic effect is achieved during using the author's technique of delamination and stretching of mucosal periosteal flaps, which is confirmed by the appearance in 76.8% of patients of thinner, pale, pale pink, painless at palpation scars. This is also proved by the dynamic results of thermometry (mean temperature is reduced by 0.5-0.9 ° C), rheography (normalization of the rheogram curve is faster by 2-3 days).