The method of fixation of the graft

 

(57) Abstract:

The invention relates to medicine, namely to laser ENT surgery. At the eardrum on the edge of the perforation holes after it decapitalization before putting graft of Dura mater of the human fetus, causing a thin layer of a 10% emulsion “Syntomycin” for better bonding of the graft to the edges of the perforations of the eardrum. Optionally, the graft was fixed to the eardrum by laser “biological” welding (lbs). Fixation carry out the distal part of the end face of the optical fiber, the semiconductor laser “ATCUS-15” contact method in pulsed mode, with pulse duration of 600-700 MS and the output power of laser radiation 8.5 watts. The welding of allbritton to the edges of the perforations of the tympanic membrane is carried out in 6-8 points. The method allows to achieve thorough fixation of allbritton to the edges of the perforations without fixing tampons impregnated with antibiotics to eliminate excessive coagulation of the eardrum in the place of application of the end face of the fiber, due to partial absorption of laser energy by emulsion “Syntomycin”, virtually the passage, significantly improve the conduction of sound through the drum cavity toward the inner ear.

The invention relates to medicine, namely to laser ENT surgery.

There are ways to restore the anatomic integrity of the eardrum by means of various types of operations with the use of grafts. In ENT surgery, there are reports of the use of autopaste temporal muscle with its fixation to the eardrum roof skylight glassed with acrylate glue (1).

Over a sprocket hole in the eardrum after decapitalization its surface layer around the diameter of the perforation holes fit the flap autopaste temporal muscle and was fixed to the eardrum roof skylight glassed with acrylate glue. Optionally, the graft was fixed to the eardrum with a cotton ball moistened with solutions of antibiotics introduced into the ear canal for 10-12 days.

The disadvantages of analog is:

1. Duration tamponade external ear canal.

2. The lack of control over the condition of the graft.

3. The inability to perform in the early postoperative period due to tamponade the outer ear is transplantat leads to displacement of implanted flap (2, 3).

5. Perform patient additional operations in the capture of the fascia of the temporal muscle.

6. Have an irritating and toxic effect on the tissue of the tympanic cavity and the receptors of the inner ear (4, 5).

As the prototype was taken way to close the perforated holes in the eardrum by Autopista temporal muscle and its fixation with the use of biological glue (6).

Fixation autowaschanlage flap to the remnants of the tympanic membrane is performed with the use of fibrin glue with additional fixation of the graft with a cotton ball, put in ear canal up to 10-12 days.

The disadvantages of the prototype are:

1. Duration tamponade external ear canal.

2. Lack of monitoring of the transplant and the effectiveness of its fixation.

3. It is difficult to conduct in the early postoperative period additional stimulation of regeneration processes (7).

4. The high price of biological glue prevents its widespread use.

The purpose of this invention is to commit allbritton (Dura fetal human) to the edges of the perforation Otsa 10% emulsion of Syntomycin using a semiconductor laser “ATCUS-15” contact method.

This objective is solved in that at the eardrum on the edge of the perforation holes after it decapitalization before putting graft of Dura mater of the human fetus in excess of 0.2 cm diameter sprocket holes, put a thin layer of 10% emulsion “Syntomycin” for better bonding of the graft to the edges of the perforations of the eardrum, then optionally, the graft was fixed to the eardrum method LBC, the distal part of the end face of the optical fiber, the semiconductor laser “ATCUS-15” contact method in pulsed mode, with pulse duration of 600-700 MS and the output power of laser radiation 8.5 W, was welding allbritton to the edges of the perforations of the eardrum in 6-8 points. Solder and contact laser “biological” welding (educate) allowed to achieve thorough fixation of allbritton to the edges of the perforations without fixing paralonovyj or cotton swabs impregnated with antibiotics to eliminate excessive coagulation of the eardrum in the place of application of the end face of the fiber, due to partial absorption of laser energy by emulsion “Syntomycin”, por the dashed passage, significantly improve the conduction of sound through the drum cavity toward the inner ear.

Specific example:

Under supervision there were 7 patients in the age from 20 to 52 years with a chronic one - and two-sided mesotympanum and lack of relapse from 4 to 6 months. All operations were performed under local infiltration anesthesia.

Our proposed method of closure of perforated holes in the eardrum Dura mater of the human fetus using laser “biological” welding (LAN) was preceded by a comparative assessment of different existing up to the present time of closure of the perforating defects in the ear-drum, different methods of preparation and preservation of donor tissue that subsequently when conducting experimental studies have confirmed the feasibility of using Dura mater of the human fetus and the FOREST to restore the anatomic integrity of the eardrum.

Transplantation of Dura mater of the human fetus after 2 weeks of the experiment leads to razvlecheniy and degeneration of the collagen fibers of the graft. The% is the R of the collagen fibers. In the area of contact of the graft with the parent bed are determined by a single lymphoid cells. The laser effects observed acceleration of collagenopathy in the zone entered transplant due to activation of auxiliary reserves (fat and fat cells), the old structure of the graft of Dura mater is not restored, being thus only stimulating matrix to form their own loose irregular connective tissue.

Example. Patient K., 31 year was in outpatient treatment with a diagnosis of chronic right mesotympanic, without exacerbation. After the examination of the patient performed the surgery Tympanoplasty Dura mater fetal human right laser “biological” welding (lbs) contact method using solder,

At the eardrum after it decapitalization on the edge of the perforation holes, which achieved a size of 0.2×0.2 cm before placing the graft of Dura mater of the human fetus was applied a thin layer of 10% emulsion “Syntomycin” for better bonding of the graft to the edges of the perforations drum peerapong the strength lbs contact method. At the distal portion of the end face of the optical fiber, the semiconductor laser “ATCUS-15”,mounted directly on the graft perpendicular to its surface, was applied laser radiation power of 8.5 W in pulsed mode with a pulse duration of 600 to 700 MS, which provided the welding of graft in place, touch the end face of the light guide. Point welding transplant was 8. Solder and contact method lbs allowed to obtain thorough fixation of the graft around its diameter to the eardrum, preclude the use of additional fixation of the graft from the ear. Given the short duration of laser irradiation (pulse width 600-700 MS) in the Dura mater of the fetal human and subject to the ear drum with in between the solder (10% emulsion “Syntomycin”), was their bonding were excluded factor expressed coagulation of the eardrum due to partial absorption of laser energy by the solder. Patient after surgery noted improvement in hearing, which was subsequently confirmed by audiometric examination, which revealed a decrease of the threshold of perception at low and medium frequencies Noah cavity through the wound secretion was conducted short course of dehydration therapy. For the reconstruction of the graft was performed dynamically conducted biochemical and immunological research, with the obligatory individualtree status of the graft. In the late postoperative period after 3.5 months the patient has a relapse, perforation of the eardrum was not observed.

Sources of information

1. Zagorodnikov, K. //journal of otorhinolaryngology. - 1979. No. 4. - S. 21-23.

2. Mechanisin N. In. Issues of clinical presentation, diagnosis and treatment of chronic otitis. - Omsk, 1979.

3. Kanzaki J. //J. Arch. Oto-Rhiono-Laring (Basel). - 1979. 25:3. - P. 181-184.

4. Baranov, B. N. //journal of otorhinolaryngology. - 1981. No. 5. - S. 30-32.

5. Kaufinan R. S. //Laryngoscope. - 1974. - Vol. 84. No. 5. - R. 793-804.

6. Maeta M., Saito R., F. Nakagawa et al. A clinical comparison of orthodox myringoplasty and a simple mrthod with fibrin glue //Nippon Abiinkoka Gakkai Kaiho. - 1998. - Vol. 101. No. 9. - P. 1062-1072.

7. Moles Y. A. Myringoplasty with extensive perforations of the eardrum //Bulletin of otorhinolaryngology. - 2001. No. 5. - S. 57-59.

The method of fixation of the graft of Dura mater of the human fetus, including fixation Dura mater of the human fetus to the edges of the perforations of the tympanic membrane, characterized in that region perforations is of susceptibility”, and then additionally recorded the graft distal part of the end face of the optical fiber, the semiconductor laser contact with the output power of 8.5 W in pulsed mode with a pulse duration of 600-700 MS 6-8 points.



 

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FIELD: medicine, otolaryngology.

SUBSTANCE: the present innovation deals with introducing neomycin sulfate antibiotic in granules prepared by the following technique. Tablet of neomycin sulfate 1.0g should be put into a vial with 100 ml distilled water till tablet's decomposition. Then vial's content should be shaken and kept till suspension sedimentation. In a day one should take 1 ml of supernatant liquid to be put into another vial and diluted with distilled water at 1:100 ratio. This procedure should be repeated 4 times more, moreover, during the last procedure one should apply alcohol for dilution. Then one should transfer the drop of alcoholic solution into a vial with granules out of milk sugar to then shaken and kept open for 1 d till granules" drying up. The suggested preparation should be applied per 1 granule under the tongue, moreover, multiplicity and duration of the above-suggested intake should be matched individually by patient's sensitivity and obtaining the clinic effect. The method enables to improve the value of tonic threshold audiometry by about 30-50 dB, decrease perception threshold of vocal range frequencies and widen the range towards high frequencies.

EFFECT: higher efficiency of therapy.

1 dwg

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