Method of improving functional-aesthetic results of plastic surgery of post-traumatic eyelid deformations

FIELD: medicine.

SUBSTANCE: to improve functional-aesthetic results of the plastic surgery of post-traumatic eyelid deformations, starting from 7-8 day from the moment of carrying out blepharoplasty of the post-traumatic cicatrical eyelid deformation, immediately after the removal of operational sutures, on the operated zone of the eyelid performed is a procedure of magnetic-photophoresis of a medical solution, made from 3000 ME of longidaze, 3 ml 25% solution of dimethylsulphoxide and 1 ml 0.25% solution of derinate, with 2 ml of the prepared solution being applied on an autodermal transplant and healthy skin surrounding it, with up to 1 cm indent from the wound edge, after 3-5 minutes a gauze pad, soaked with 2 ml of the remaining prepared solution, is applied on the processed surface of skin with the further 10 minute impact by a contact method by a travelling pulsed magnetic field of the apparatus "AMO-ATOS" with the frequency of pulse consecution of 5-10 Hz. Then, after the pad is removed, without the time interval, borders of the autodermal transplant and healthy skin closing are processed by infrared laser irradiation of a range of 0.89 mcm of the apparatus UZOR-2K with the frequency of the pulse repetition rate of 1500 Hz, in accordance with a contact labile method, 1 minute on each field, with carrying out 1 procedure daily for 10 days.

EFFECT: improvement of the quality of skin transplant engraftment, absence of secondary eyelid deformations, and reduction of the post-operational treatment duration.

1 tbl, 2 ex

 

The invention relates to medicine, namely to ophthalmology, and is intended to improve the results of plastic surgery post-traumatic deforming scarring of the eyelids.

Plastic surgery of the eyelids (blepharoplasty) post-traumatic deforming scarring of the eyelids is one of the hardest sections in ophthalmic surgery. Standard surgical methods of replacing tissue defects of the eyelids after removal of scars local or free skin and skin and fascial flaps due to inadequate connective tissue response to operative trauma often lead to the formation of hypertrophic scars, reduce dermal graft, with the development of secondary cicatricial deformities of the eyelids, requiring repeated surgical interventions (Korablev, S. B. Experimental study of the development of autoimmune reactions and their influence on engraftment of transplants for multiple autoplasty of the skin: author. dis. ... candidate. Biol. of Sciences / Institute of the clinical hospital. immunology of Academy of medical Sciences of the USSR. - Novosibirsk, 1988,, 22 p)

General background of unsatisfactory results of blepharoplasty cicatricial eyelid defects are reduced local immunity, intensification of lipid peroxidation, neurotrophic disorders, maintenance of chronic inflammation and causing a disconnect between the percent�themselves of collagen formation and collagenolysis (A. A. Delvig A study of the metabolism of collagen in hypertrophic scars and keloids. // Bulletin of the Russian Academy of medical Sciences. - 1995. - No. 12. - Pp. 41-45.).

Among medicines, limiting excessive formation of connective tissue structures and their fibrilization include glucocorticoids (Astakhov Yu. s., Egorov E. A., T. V. Stavitsky Oftalmologia. A guide for physicians / GEOTAR-MED, 2004. - P. 468). However, their disadvantages include the ability to:

- decrease local immunity;

- increase intraocular pressure;

- to break skin pigmentation;

- to induce the formation of telangiectasias.

Classic means preventing excessive formation of connective tissue in skin plastics are recognised enzyme preparations, for example lidaza.

The composition of hyaluronidase is an enzyme hyaluronidase, which is in the process of collagen formation in skin grafting leads to lysis of excess intercellular cementing substance of connective tissue, is necessary for reproduction of cells and collagen formation, which is accompanied by the formation of normotrophic scars (ulashchik B. C. Physico-pharmacological methods of treatment and prevention. Minsk: Belarus, 1979. - Pp. 61-63)

To prevent excessive formation and vibrationaly connective tissue in plastic surgery scarring of the eyelids perform conta�wide electrophoresis lidazy (Sosin, I. N., Buevich A. G. Physical therapy of eye diseases: a practical guide. - Simferopol: Tavria, 1998. - P. 17-22).

The disadvantages of this method are:

- the short duration of therapeutic effects due to the rapid hydrolysis of hyaluronidase, which is part of hyaluronidase, the tissue inhibitors of proteases;

- only 4-15% of the drug goes by electrophoresis in the tissue of the eyelids because of the epidermal barrier;

- possibility of destruction of healthy tissue, which impairs the engraftment of autodermotransplantat;

allergic reactions and contact dermatitis.

The closest analogue prototype is the photophoresis of Lomidze. Logidata - enzyme preparation for the treatment of diseases involving the growth of connective tissue, representing a conjugate of hyaluronidase and macromolecular polyoxidonium, immunomodulator, antioxidant and anti-inflammatory activity, are promising for therapeutic use in the connective tissue damage.

The implementation of the method is carried out from the apparatus that generates low-energy pulsed laser radiation in the infrared range with a wavelength of 0.89 microns, a pulse frequency of 1500 Hz, pulse power 4-6 W/imp. For the procedure longido ME 3000 diluted in 2 ml of distilled water and nano�it on the projection area of damaged skin, then no time interval is exposure to infrared laser radiation. Photophoresis is carried out by contact-labile method by 1-3 minute on the field, the total exposure time of up to 15 minutes, on a course - 15-20 procedures carried out daily or every other day (gagina T. A. Photophoresis of longitute in the rehabilitative treatment of localized scleroderma: author. dis. ... candidate. honey. Sciences. - M., 2011. - 22 p.).

The disadvantages of the method:

1. To create the necessary therapeutic concentrations of longitute in the skin and prolonging its physiological hinder the effectiveness of the barrier properties of the epidermis of the skin, has a low conductivity (Bogolyubov V. M. Balneology and physiotherapy. Volume 1. - M.: Medicine, 1985).

2. Due to the low bioavailability of longitute there is a high risk of poor functional (eyelid retraction, incomplete closure of the eyelids, ectropion or entropion, shortening of the palpebral fissure) and aesthetic (rough scarring, congested tissue skin graft with cyanotic edema) results blepharoplasty.

3. High incidence of secondary cicatricial deformities requiring repeated surgical intervention.

4. Due to the shortage of nucleic acid in traumatized tissue plastic and not replenished energy reserves of the cells of the connective tissue, gain his / her trust physiological processes of collagen formation.

Task - improving the anatomical and aesthetic and functional results of plastic surgery of posttraumatic deformities and defects of the eyelids.

The technical result - improving the quality of healing of the skin graft, the absence of secondary deformities of the eyelids, reducing the duration of postoperative treatment, improving the quality of life of patients.

The technical result is achieved as follows: since 7-8 days from the date of execution of blepharoplasty post-traumatic cicatricial deformity of the century, immediately after the removal of the operating joints, which corresponds to the stage of formation of the connective tissue and the regeneration of the epidermis on the area operated upon century perform the procedure consistent combined magneto-laser - magneto-photophoresis of a solution of three drugs: logidata 3000 ME, 25% solution of dimethyl sulfoxide (DMSO), 0.25% solution Derinat.

For holding the magneto-photophoresis longido ME 3000 diluted in 3 ml of 25% DMSO solution and add 1 ml of 0.25% solution Derinat. 2 ml of the prepared solution was applied by pipette to autodermal the graft to the surrounding healthy skin, receding from the edges of the wound of 1 cm, and evenly using a glass rod to distribute the solution over the surface. 3-5 minutes is applied to the entire surface of the treated skin Marle�first strip, impregnated with 2 ml of remaining manufactured solution, and the contact method for 10 minutes affect the running pulsed magnetic field apparatus "AMO-ATOS" with the pulse repetition rate of 5-10 Hz. Then, gauze pad is removed and time interval without affecting the border closure autodermal transplant and healthy skin infrared laser radiation in the range of 0.89 microns machine PATTERN-2K with a pulse repetition rate of 1500 Hz, the contact labile method by 1 minute on each field defocused beam. Magneto-photophoresis occurs daily 1 procedure within 10 days.

Components logidata - hyaluronidase and polyoxidonium - prevent excess collagen formation. DMSO has a high conveying properties and helps overcome longitute and Derinat epidermal skin barrier. Derinat is a source of nucleic acids that are involved in biosynthetic processes normally regenerating connective tissue cells.

Magnetic therapy, along with anti-inflammatory, immuno-and neuro-trophic activity, increases the flow of drugs into epidermal-dermal tissue of the eyelids. Low-frequency laser radiation enhances the process of protein synthesis from nucleic acid derived neurotrophic AK�Yunosti. The similarity of the main therapeutic effects of magnetic fields and low-frequency laser radiation contributes to their strengthening.

Advantages of the method:

1. Increased bioavailability of longitute due to the summation of the transport properties of the magnetic field, laser radiation and DMSO.

2. The use of DMSO and Derinat improves the conductivity of the epidermis, contributing to the creation of the necessary therapeutic concentrations of longitute in the skin and prolonging its physiological effectiveness.

3. Through the use of Derinat - source nucleic acid - filled plastic and energy reserves of the cells of the connective tissue.

4. Reducing the time of engraftment of the skin graft as a result of summation of the anti-inflammatory, immunomodulatory, antioxidant properties, and biosynthetic activity of physical factors and drugs used.

5. Improved functional and aesthetic results of blepharoplasty: the lack of a difference in width of the palpebral fissure and the provisions of the eyelids, ectropion or entropion of the eyelids, formation of normotrophic scars, matching patterns and colors of transplant as healthy skin, complete the eyelids.

6. Reducing the frequency of repeated plastic surgery, as it prevents the development of secondary cicatricial deformity of the eyelids because of their eversion or inversion, shortening of the palpebral fissure.

7. Reducing the total time of postoperative care.

Treated 24 patients (24 eyes) with rough scar deformity of the eyelids after blepharoplasty. With 7-8 days of the postoperative period all patients underwent physiotherapy treatment to improve the results of surgery, reduce the degree of scarring of the skin, of which 10 patients (10 eyes) - photophoresis of longitute; 14 patients (14 eyes) - magneto-photophoresis solution longdoz, DMSO and Derinat. Table 1 shows the data obtained during the observation period after surgery 1 year.

Analysis of the results showed that in the postoperative period in all 14 patients receiving physiotherapy treatment according to the proposed method - magneto-photophoresis solution longdoz, DMSO and Derinat, observed the formation normotrophic scars, the restoration of normal color and pattern of the skin.

Example 1. Patient B., 55 years old - made plastic free skin flap lower eyelid of the right eye over rough scar of inversion. When suture removal on day 7 after surgery diagnosed retraction of the skin graft, the tendency to the formation of rough premierowy above the surface of the skin scars. The patient was assigned magneto-photophoresis of longitute 3000 ME dissolved in 3 ml of 25% solution of DMSO and 1 ml of 0.25% solution Derinat, 1 p�ocedure within 10 days by the proposed method. As a result of treatment postoperative scar and skin graft became more soft, elastic, structure and color of skin graft closer to the normal adjacent healthy tissue. Saved the correct position of the lower eyelid in the operated eye, the border closure between the graft with the wound bed even without the color change. After 1 year of follow-up was marked complete the eyelids, the difference in width of the palpebral fissure and the position of the eyelid was absent.

Example 2. Patient G., age 38 - was held Ζ-plastic post-traumatic scars with an additional transplantation of free skin flap upper eyelid local fabrics by reason of the retraction of the upper eyelid with the formation of lagophthalmos to 3 mm. Before entering surgery twice was operated in a residence, but the operation ended with the formation of a rough strain of transplant and age. On the 7th day of the postoperative period after removal of sutures assigned by the proposed method magneto-photophoresis of longitute 3000 ME dissolved in 3 ml of 25% solution of DMSO and 1 ml of 0.25% solution Derinat. After 10 sessions, magneto-photophoresis was complete engraftment with restoring proper position and form of the century, with good functional activity, with the formation of a Mature scar in color, PR�approximate to the healthy skin. After 6 months: the eyelids and restored functional activity; the difference in width of the palpebral fissure compared with the healthy eye is missing; structure and color took hold of transplant correspond to healthy skin; secondary cicatricial deformity of the upper eyelid was observed.

Table 1
Comparative characteristics of the results obtained 1 year after pharmacopolitics treatment
The results of plastic surgeriesThe surveyed group (absolute number of patients)
Photophoresis of longitute,
n=10
Magneto-photophoresis of longitute, DMSO and Derinat, n=14
The presence of scars:
normotrophic714
hypertrophic3-
The eyelids:
full8 14
incomplete2-
The difference in width of the palpebral fissure compared with the healthy eye:
missing612
available42
Secondary cicatricial deformity of the eyelids (ectropion, entropion century, shortening of the palpebral fissure):
missing713
available31

A method for improving functional-aesthetic plastic surgery of posttraumatic deformities of the eyelids, consisting of pharmacopolitics introduction to tissue-century longdoz, characterized in that, starting from 7-8 days from the date of execution of blepharoplasty post-traumatic cicatricial deformity of the century, immediately after the removal of the operating joints, the area operated upon century perform the procedure magneto-photophoresis of a medicinal solution, izgotovleno� from 3000 ME of longitute, 3 ml of 25% solution of dimethyl sulfoxide and 1 ml of 0.25% solution Derinat, 2 ml of the prepared solution was applied to autodermal the graft to the surrounding healthy skin, receding from the edges of the wound 1 cm, 3 to 5 minutes is applied to the treated surface of the skin with a gauze pad soaked in 2 ml of remaining manufactured solution, and the contact method for 10 minutes affect the running pulsed magnetic field apparatus "AMO-ATOS" with the pulse repetition rate of 5-10 Hz, and then removing the strip, without a time interval, handle the border closure autodermal transplant and healthy skin infrared laser radiation in the range of 0.89 microns machine PATTERN-2K with a pulse repetition rate of 1500 Hz, the contact labile method by 1 minute on each field by performing daily 1 procedure within 10 days.



 

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