Method of corset plasty of neophallus muscle
SUBSTANCE: muscle of the neophallus is mobilised. A corset is formed intra-operatively according to the diameter and length of a mobilised muscle from a mesh with non-absorbable polypropylene 0.5-0.6 mm thick monofilaments, with the porosity of 85-90%, with run-proof edges in case of resection. The muscle is circularly wrapped up with the formed corset.
EFFECT: provision of the sufficient rigidity of the neophallus and elimination of its deformation due to the application of the corset, formed from the mesh with non-absorbable polypropylene monofilaments.
The invention relates to the field of medicine, namely urology, and andrology, and can be used in male genital surgery (in case of loss of the penis) and when masculinities correction for sex corset muscle plasty neophallus.
The primary task in neillandbrittany is the creation of a functional body that ensures the Commission of a sexual act, sexual rehabilitation and social adaptation of the patient.
Reconstructive plastic penis is one of the most difficult problems in male genital surgery.
Currently there are various ways to phalloplasty: phalloplasty Filatov way of skin and fat inguinal flap, etc. However, multistage methods, the lack of axial blood supply, impairing tissue trophism and complicating subsequent stages of urethroplasty and prosthetics, and lack of physical activity and adequate skin sensitivity neophallus is a significant shortcomings, which result in low efficiency of therapeutic interventions. [Kirpatovski I. D., Golubeva I. V. // Pathology and correction of sex / Publishing house of the Russian University of friendship of peoples. M - 1992. - P. 229].
The most effective solution to problems of plastic corresponds phalloplasty free thoracodorsal�th musculocutaneous flap, based on the latissimus dorsi muscle with preservation remove arteries, veins and remove motor nerve. Revascularization is due to the inferior epigastric vessels, and muscle reinnervation fundamentals flap motor branch of the obturator nerve.
[Adamyan, R. T. // Plastic and reconstructive microsurgery in the treatment of transsexualism /Diss. doctor. honey. science - M, 1996].
Reinnervation of muscle neophallus usually occurs within 4-12 months. When training patients achieve the muscle contraction of the flap and sufficient rigidity of neophallus, providing the sexual intercourse.
If the voltage neophallus does not meet patients, we performed the implantation of prostheses in neophallus. In some patients with reduced muscle neophallus is its deformation with shortening and nodular thickening, leading to the impossibility of implementation of introjection. To correct such deformation previously recommended bandaging phallus with condom use [W. Eicher // Trans-sexualismus Stuttgart-New York - 1984 - C. 190]. The majority of patients for aesthetic and functional reasons it was felt that this method was unacceptable.
After the restoration of motor activity muscle the basics of neophallus and the lack of sufficient rigidity in its reduction, and t�activate in the presence of deformation of neophallus patients perform corsetry fasciolasis muscle neophallus.
As a prototype we have chosen the way of corsetry fasciolasis muscle neophallus proposed N. About Milanowek, R. T. Adamyan et al. [Milanov N. About., Adamyan R. T., Kozlov G. I. // Correction of gender in transsexualism / M., 1999. - P. 151].
The intervention consists of a circular wrap mobilized muscle neophallus a fragment of the broad fascia of the thigh. In this way, a fascial sheath, which not only prevents the thickening and shortening, but also increases its rigidity.
When frame fasciolaria muscle neophallus in this way it is necessary to perform additional surgery on the hip with the release of a fragment of the broad fascia of the thigh, followed by grafting of the defect with fascia Lata and suturing wounds. The use of wide fascia of the thigh as a corset the muscles of neophallus does not provide sufficient rigidity, making it difficult to intreccio and implementation of sexual intercourse, affects sexual and social adjustment.
The object of the invention is to optimize sexual and social adaptation of patients after the formation of neophallus.
The technical result of the invention is to provide a sufficient rigidity of neophallus and elimination of its deformation when performing frame fasciolasis muscle neophallus with the exception of the additional operational BME�force on the hip that will reduce the trauma and reduce the time of transaction.
The technical result of the invention is achieved in that mobilize muscle neophallus and circular wrap her corset. Corset shape intraoperatively from polypropylene mesh respectively the diameter and the length of the mobilized muscle.
The method is as follows: After performing the steps of forming neophallus and restoration of motor activity in the absence of sufficient rigidity when it is reduced, and deformation of neophallus perform plastic corset his muscular framework.
The operation is performed with the patient supine. The midline of the ventral surface of neophallus an incision of the skin with subcutaneous tissue. Circular bluntly and sharply distinguish muscle neophallus, keeping the connection between the muscle and skin at the proximal and distal segments. Respectively the diameter and the length of the mobilized muscle cut out corset from polypropylene mesh, which circular mantle muscle and sutured over her non-absorbable sutures. The wound is sutured in layers.
We used an endoprosthesis for filter ESFIL, made of biologically inert non-absorbable polypropylene monofilament. Osnovana structure of the endoprosthesis - mesh provides prispuskaesh cu�EB when cut, and a special weave - dimensional stability and limited stretchability in all directions. An endoprosthesis for filter ESFIL have a small thickness (0.5-0.6 mm) and high porosity (85-90%), enabling fast and uncomplicated germination corset polypropylene mesh connective tissue [Catalog of the Company "Medicine and new technology" Esfil info(5)mednt.ru].
The associated analysis of the claimed solution with the prototype shows that the inventive method differs from the known fact that when corset muscle plasty neophallus no need surgical procedure to cut out a fragment of the broad fascia of the thigh. It is replaced by a polypropylene mesh, which reduces the time and reduces the trauma of surgery. The proposed method allows to eliminate the deformation of phallus and reach necessary for carrying out sexual intercourse rigidity that accelerates sexual and social rehabilitation of patients. These differences allow to draw a conclusion about conformity of the proposed method the criterion of "novelty."
The features distinguishing the claimed method from the prototype, not identified in other ways in the study of this and related areas of medicine and, therefore, provide the claimed method "significant difference". The inventive method and the positive results of its approbation correspond remodeling�active-plastic problems of male genital surgery for surgical correction of sex.
Give examples from clinical practice:
Example 1. Patient A. age 29. In April 2006, underwent one-stage phalloplasty remove the flap. Contraction of muscle the basics of neophallus occurred after 5 months. after your surgery. Six months after the recovery of contractility of the attempt to establish a sexual relationship is not possible, as muscle contraction of neophallus unreasonably (spherical) its thickening. In November 2007, the operation performed corset muscle plasty neophallus of the claimed method. The postoperative period was uneventful. After 4 weeks, reduction of muscle neophallus was not accompanied by a shortening and deformity of the organ, thus achieved considerable rigidity, simulating an erection. After 8 weeks, the patient successfully carried out the sexual act. Later abandoned the intention to produce populattion. Plans to start a family.
Example 2. Patient S., 32 years. Performed phalloplasty remove the flap in may 2008. Contraction of muscle the basics of neophallus occurred after 6.5 months. However the patient noted that when the voltage of the muscles neophallus significantly shortens and thickens. This deformation prevents the Commission of a sexual act. The patient is asked to produce falloprotezirovanie. In February 2009 op made�radio corset muscle plasty neophallus of the claimed method. The postoperative period was uneventful. When examining a patient after 6 weeks, the deformation of neophallus when muscle tension is absent.
The patient is satisfied with the result of surgery. At the follow-up visit six months later, the patient reported that has a female sexual partner. Indianapolisindiana not required.
Method developed at the Department of urology of the North-Western state medical University named after I. I. Mechnikov and was clinically tested in 5 patients with sex-change from female to male with a positive result. The postoperative period was uneventful. In the analysis of remote results until 3-5 years reported satisfactory outcomes, providing patients a full sexual rehabilitation and social adaptation in a new field.
Thus, the claimed method corset muscle plasty neophallus provides sufficient rigidity neophallus and eliminates deformation, at the same time eliminates additional surgery on the hip, unlike the prototype method, which reduces the trauma and shortens the surgery time, which helps improve sexual and social adaptation of the patient.
A way corset muscle plasty neophallus consisting of mobilization of the muscles of neophallus and circular�about wrapping her corset, characterized in that the corset shape intraoperatively respectively the diameter and the length of the mobilized muscle from the grid c non-absorbable polypropylene monofilaments thickness 0.5-0.6 mm, a porosity of 85-90%, with no melt edges during the resection.
SUBSTANCE: invention relates to medical equipment, namely to sealing device for reparation of heart defect and vessel diseases in the process of performing surgical operations for treating such diseases as patent foramen ovale (PFO) or heart stunt, vascular system diseases, etc. Sealing device contain stretchable frame ad sealing element. Frame contains multitude of wires, each of which passes from proximal end to distal end of frame. First and second segments from multitude of wires form wound proximal loop and distal loop respectively. Multitude of wires form proximal disc and distal disc when sealing devise is extended. Proximal disc and distal disc are located between proximal and distal loops. Each wire from multitude of wires forms respective petal of proximal disc and respective petal of distal disc. Respective petals form zones of overlapping and unsupported sections. Sealing element, at least, partially encapsulates extending wire frame.
EFFECT: invention has improved compatibility with heart anatomy, it is easier to extend, reposition and return into initial condition in the place of opening.
25 cl, 16 dwg
SUBSTANCE: invention refers to medicine, namely surgery, and can be used for treating aseptic pancreonecrosis. Intra-organic pulseless pancreatic segments are localised and removed. To cover the pancreas, a greater omentum is incised into two portions - 1/3 from the left and 2/3 from the right up to a base of the greater omentum. Segments with pulse oscillation amplitude not less than 3.0 mm in the left 1/3 of the greater omentum and not less than 2.0 mm in the right 2/3 of the greater omentum are localised. The left portion in the distal segment is anchored with U-sutures to peripancreatic subcutaneous fat, whereas the right portion in the distal segment is anchored to a right hepatic lobe.
EFFECT: method enables arresting the disease progression and preventing infected pancreatic necrosis, improving pancreatic tissue blood supply by detecting the intra-organic pulse, removing all necrotic portions of the pancreas and using the greater omentum to cover the pancreas.
3 dwg, 2 ex
SUBSTANCE: distal pancreas resection is performed. That involves transecting a parenchyma to the right from a superior mesenteric vein. That is followed by a resection of an anterior surface of the pseudocysts of the head of pancreas. A Roux pancreatocystojejunoanastomosis with isolated enteric loop is created.
EFFECT: reduced intraoperative injuries and risk of postoperative complications, lower extent of the operation, preserved portion of the pancreatic parenchyma and physiological passage of food and bile in the gastrointestinal tract by the distal pancreas resection and created pancreatocystojejunoanastomosis with the cyst walls and the anterior surface of the head of pancreas.
SUBSTANCE: invention refers to systems for applying a filling material onto a working surface and can be used for applying a multicomponent compound, such as a surgical filling material for a tissue mass. A mixture feed device comprises a Luer mandrel sub-assembly, a cannula and a nozzle atomiser sub-assembly. The Luer mandrel sub-assembly is formed to contact at least two containers and forms the first and second fluid pipes of the mandrel for facilitating the flow of the first and second components. The cannula comprises the first and second cavities carrying the fluid. Each cavity is fluid connected to one of the first or second fluid pipes of the mandrel. The nozzle atomiser sub-assembly is arranged at the end of the cannula and involves at least a part of a nozzle insert placed into a nozzle cap. The nozzle cap has an end wall with an outlet therein. The nozzle insert and nozzle cap form at least three feed channels and are configured to limit at least three fluid passages in three respective feed channels. Each of the three feed channels is fluid connected to the fluid passage.
EFFECT: more effective mixing of the components, prevented cross-contamination of the components and facilitated fluid feed.
12 cl, 25 dwg
SUBSTANCE: invention refers to traumatology and orthopaedics and is applicable for joint drainage in revision endoprosthesis replacement. A drain tube is inserted into a wound with implanting a bone cement spacer containing an antibiotic. Within the first 24-48 postoperative hours, the fluid content is actively gradually evacuated from the postoperative wound every hour for 10-15 minutes.
EFFECT: method enables increasing the antibacterial effect.
SUBSTANCE: invention refers to medicine, namely to otorhinolaryngology, and can be used in myringoplasty, for repairing partially lost anatomic structures, such as tympanic membrane. The surgery is performed with local or general anaesthesia. A tympanic membrane defect is closed with a thinned prepared alloplant in the form of an allogeneic cartilage plate. Before implanting, the alloplant is fragmented up to 0.2-0.3 mm thick and 0.8-0.9 cm in diameter that is followed by placing the plate into a bottle with a fixing fluid. The final stage of the operation involves placing the alloplant on the edges of the tympanic membrane defect. The cartilage plate is supposed to be more by 1.0-1.5 mm in size with the plate edges to be ovelapped with the acoustic meatus skin. The acoustic meatus is packed.
EFFECT: method provides the reliable fixation of the alloplant, preventing its postoperative dislocation and retraction, audiological characteristics of the alloplant as close to the characteristics of the normal tympanic membrane as possible, the absence of implant rejection and pronounced immune response, proteolytic enzyme stability, necessary rigidity of the cartilage plate, reduced length of the intervention, the absence of a cosmetic auricle defect.
SUBSTANCE: surgical management of colon cancer is required in low colonic obstruction. A midline laparotomy and abdominal organs inspection is followed by colon mobilisation. A colonic segment with a tumour is resected. The segmented intestine is decompressed with an electric suction machine. The rectal stump is stitched with a stapling apparatus. A superposed segment of the segmented intestine is mobilised to be brought down. A tunnel is formed behind the rectal stump from the side of the anus as close as possible to the oral end of the stump. A hole is formed along the posterior wall with an electric knife and used to bring down the mobilised segmented intestine by means of a guide. The intestine is fixed to the hole borders with four stitches. The excessive intestine is brought out through the anus and fixed to the perineal skin. A dioxidine solution is administered into the abdominal cavity. The rectal stump is daily washed with antiseptic solutions until the excessive brought out intestine is dissected away on the 10-14th day.
EFFECT: method enables applying the primary stitch-free colorectal anastomosis, requires no rehabilitation stage of treating colon cancer by the natural formation of the anastomosis and prevention of its leakage; it also reduces the length of disability and improves the patient's quality of life.
1 ex, 2 dwg
SUBSTANCE: axial line of two enclosing incisions is marked by connecting the centres of outer mouths of fistula sequentially from up to down by a wavy line. That is followed by making two wavy enclosing incisions parallel with the axis: right and left at 20 mm from the axial line. The left incision starts 15 mm above the proximal outer mouth of fistula, and ends 15 mm below the distal outer mouth of fistula, whereas the right incision starts at the level of the proximal outer mouth of fistula and ends at the level of the distal outer mouth of fistula. Thereafter, RPF is excised in the radial direction. Two L-sutures relaxation incisions are made. The upper relaxation incision originates from the point at the beginning of the right enclosing incision and extended to the point at the beginning of the left enclosing incision and 20 mm further, turned at a right angle 25 mm upwards, and an upper triangular adipocutaneous flap is formed. The lower relaxation incision originates from the point at the end of the left enclosing incision and extended to the point at the end of the right enclosing incision and 20 mm further, turned at a right angle 25 mm downwards, and a lower triangular adipocutaneous flap is formed. That is followed by closing a wound defect by adipocutaneous repair by shifting the formed upper and lower triangular adipocutaneous flaps onto the wound defect and fixing them with interrupted sutures. The lower edge of the upper adipocutaneous flap is fixed to the right enclosing incision, and its upper edge - to the left enclosing incision. The lower edge of the lower adipocutaneous flap is fixed to the left enclosing incision, and its upper edge - to the right enclosing incision; thereafter, the wavy s are closed.
EFFECT: more effective surgical management of recurrent pilonidal fistulas, reduced number of complications and recurrences and improved aesthetic effect of the operation.
SUBSTANCE: own finger artery, dorsal vein and own finger nerve of the fifth finger are cut and bandaged. A common finger artery of the transplant is sutured with own finger artery of the third finger stump. The dorsal vein of the transplant is sutured with the dorsal vein of the stump. Own finger nerve of the transplant is sutured with own finger nerve of the stump.
EFFECT: method improves results of treatment due to the correspondence of dimensions of the transplanted finger vessels to the dimensions of the vessels of the recipient area.
SUBSTANCE: tumour is removed by a laryngectomy within the boundaries of health tissue together with an underlying part of a thyroid cartilage. The upper and lower parts of the thyroid cartilage not involved into the tumour process are presented on the involved side in the form of horizontal plates 6.0-8.0 mm wide. A skin flap is cut out on the neck 0.4 cm more than the width of the created larynx defect, while its length is supposed to be equal to the one of the defect. The skin flap is thrown over the preserved fragments of the thyroid cartilage. That provides restoring the removed part of the larynx. The flap is anchored with single sutures to the intact mucosa of the preserved parts of the larynx along the perimeter of the defect. A lumen of the newly formed larynx is packed. A laryngostoma and a tracheostoma is formed. A tracheostomic tube No. 5-6 is inserted into the tracheostoma. A dressing is applied.
EFFECT: method provides performing the functionally conservative surgery, preserving the natural respiratory and vocal functions, reducing postoperative inflammatory complications, preventing a laryngeal lumen stenosis and rehabilitating its functions, reducing a rate of intraoperative injuries and a length of staying in hospital, improving the patient's quality of life, making it possible to start a radiation therapy by preserving the intact upper and lower parts of the thyroid cartilage and repairing a laryngeal side wall with the thrown-over skin flap cut out on the neck.
4 dwg, 1 ex
SUBSTANCE: method involves applying one or two parallel through draining tubes having lateral perforations. Flow lavage of the retroperitoneal space with antiseptic solutions is carried out via the perforations at room temperature and cooled solutions are administered concurrently with vacuum suction. Omental bursa is concurrently drained using the two parallel through draining tubes. Flow lavage of the omental bursa is carried out using these tubes.
EFFECT: enhanced effectiveness of treatment in healing pyo-inflammation foci.
5 cl, 1 dwg
SUBSTANCE: method involves carrying out left-side laparophrenotomy. Esophagus and stomach stump extirpation is carried out. Large intestine is conducted in the posterior mediastinum. Distal end-to-end anastomosis of transplant and the duodenum is created using atraumatic sutures.
EFFECT: enhanced effectiveness of plastic repair in the cases of resected stomach cancer.
SUBSTANCE: method involves carrying out hernia removal in intralaminar way. Posterior longitudinal ligament defect is covered with Tacho-Comb plate after having done disk cavity curettage. Subcutaneous fat fragment on feeding pedicle is brought to dorsal surface of radix and dural sac.
EFFECT: enhanced effectiveness of treatment; reduced risk of traumatic complications.
FIELD: medical engineering.
SUBSTANCE: device has thread knitted into fabric. Fabric for tamponing wound and removing it by pulling the thread is connected to internal film surface with collagen gel. The film overlaps fabric area and has opening equal to two-lumen draining tube canal connected to external film surface and having one canal longer than the other one. Distal end of the shorter canal is connected to opening in the film and distal end of the longer one is brought outside of its boundary. Proximal ends are connectable to vacuum receiver. Fabric thread is brought to the shorter canal from the internal wall and fixed on the external shorter canal wall.
EFFECT: reliability in stopping hemorrhages and retaining patient mobility.
SUBSTANCE: method involves applying sling urethropexy. Pneumoextraperitoneum is created by means of trocar introduced under the pubis. Then, longitudinal perineotomy and paraurethral tissue dissection is carried out to the right and to the left towards the descending branches of pubic bones to pelvic fascia. The urethra is moved to its left. TVT needle is introduced under descending branch of pubic bone to the right of the urethra. The pelvic fascia is perforated in away that needle tip enters retropubic space laterally with respect to the prostate and in front of the urinary bladder. The needle is brought along the posterior pubic bone surface and exits via abdominal wall outside pulling one end of polypropylene ribbon. The like manipulations are accomplished at the left side to form a loop around the urethra tightly adjacent to bulbocavernous muscles. Final ribbon fixation is carried out after having eliminated the pneumoextraperitoneum and having removed the trocar.
EFFECT: simplified operation; avoided intra- and postoperative complications and recidivation.
SUBSTANCE: method involves evaginating duodenum stump with polypotomy loop into organ wall followed by electric surgical excision.
EFFECT: stable hemostasis; provided aseptic conditions in sealing the stump.
3 dwg 1 tbl
SUBSTANCE: method involves carrying out rein performing pancreaticoduodenal resection. Cholecystoenteroanastomosis is built. Anastomosis application takes place between the right hepatic duct and gallbladder neck near its flexure.
EFFECT: prevented biliary hypertension.
FIELD: medicine, surgery.
SUBSTANCE: one should perform incisions of parietal peritoneum by leaving 2 cm against inferior and superior edges of patient's pancreas being of 1.5 cm length to apply them in checkered order for the purpose to prevent vascular lesion.
EFFECT: higher efficiency of decompression.
FIELD: medicine, surgery.
SUBSTANCE: the method is applied for the purpose to correct combined deformations of external nose due to oral-vestibular operative access. The method deals with dissecting mucosal membrane and periosteum in oral vestibule followed by separating soft tissues of the upper lip. Then one should perform internal incision along the edge of alar cartilages to connect two incisions together. Then comes final tissue separation at subsequent correction of the shape, size of external nose structures and its septum. The method enables to achieve wide access to all the structures of external nose and provide optimal cosmetic result.
EFFECT: higher efficiency of correction.
FIELD: medicine, urology.
SUBSTANCE: the present innovation deals with affecting the sclera and applying deformation-correcting sutures at the background of medicinal erection. Along lateral surfaces of cavernous bodies symmetrically from both sides one should make incisions of scleral surface layer. Then comes manual derotation, moreover, at the side of derotation incision's lower edge should be shifted downwards and backwards, its upper edge - upwards and to the front, and at contralateral side the lower edge is shifted downwards and to the front, and the upper edge - upwards and backwards. After manual penile derotation one should apply sutures onto the edges of dissected scleral layer in incision area by shifting needle's puncture out towards the side being opposite to shift direction of the lower edge against incision's perpendicular axis. The quantity of incisions should be calculated by the following formula: Q = N/n, where Q - the desired quantity of incisions, N - the angle of total initial rotation, n - the angle of derotation achieved after applying sutures onto the first pair of incisions. The method enables to decrease the risk for development of either new or residual penile deformation in postoperational period.
EFFECT: higher efficiency of correction.
3 dwg, 1 ex