Method for transplant's fixation
FIELD: medicine, otorhinolaryngological surgery.
SUBSTANCE: one should apply thin layer of "Solcoseryl" gel onto osseous facial walls of frontal and maxillary sinuses at the border with trepanation opening after removing pathological content out of them and before applying a transplant out of flat bone of human fetal cranial arch that exceeds the diameter of trepanation opening by 3-4 mm. Then, one should additionally fix the transplant by affecting with distal edge part of a light guide of semi-conductor laser "ATKUS-15" with contact-type technique at output power of laser radiation being 8 W at constant mode. The method enables to increase fixation density of allobrefobone to osseous walls of sinus along its whole diameter.
EFFECT: higher efficiency of fixation.
The invention relates to medicine, namely to laser ENT surgery.
There are ways to restore the anatomic integrity of the frontal and maxillary sinuses after opening and removal of pathological content in them by means of a variety of types of transactions using cartilage xenografts. In ENT surgery, there are reports of the use of animal cartilage in humans (1).
As the plastic material used costal cartilage pigs. The material was pre-preserved in 0.5% formalin solution in terms of 1 to 12 months. The model of the bone cavity was frontal sinuses of dogs, the cavity after the operation type of radical frontotomia was filled with fragments of canned cartilage volume of about 0.5 cm2. Drugs frontal sinus investigated standard histological techniques at different times after implantation.
The disadvantages of analog is:
1. Due to the fact that the implanted tissue of the animal is genetically alien to humans, there are frequent cases of resorption after transplantation.
2. Resorption of the graft often happens with his festering and development of complications.
3. Due to processes of reconstruction of cardiac tissue in the cavity of the sinus develops scar tissue, to ora divides the cavity of the sinus into multiple, isolated cavities, with possible development of suppurative process in the past.
4. The lack of a front wall of the sinus can lead to the formation of a cosmetic defect in the retraction of the soft tissues of the forehead and cheeks in the sinus cavity with infringement of the first and second branches of the trigeminal nerve.
5. Formalin inhibits the restructuring of the graft and its replacement in the recipient implanted in the mother's bed for up to 12-18 months, does not provide true healing and has a carcinogenic effect (2 - 4).
As the prototype was taken way to close defects of the facial wall of the frontal and maxillary sinuses flat bone of the skull vault of the human fetus (5).
In place of the defect of the front wall of the frontal and maxillary sinuses after trephination and removal of pathological content laid transplant from a flat bones of the cranial vault of the human fetus in excess of 3-4 mm diameter trepanation holes (1.5 cm). The graft was fixed to the bone edges trepanation holes “splitting”imposed on the edges of the graft. Postoperative wound was usuals layers.
The disadvantages of the prototype is:
1. Splitting imposed on the flat bone of the skull vault of the human fetus, are not allowed tightly to fix the graft to the edges trepanation holes.
2. Weak fixation of the graft to the bone edges trepanation holes was significantly extended the terms of restructuring of cost the first transplant and did not rule out the possibility of penetrating wound of the contents of the sinus in the tissue of the buccal region.
The purpose of this invention is to commit allowreboot (flat bones of the skull vault fetal human) to the bone walls of the frontal and maxillary sinus through the solder, which is jelly “Solkoserila” laser “biological” welding using a semiconductor laser “ATCUS-15” contact method.
This objective is solved in that on the facial bone wall of the frontal and maxillary sinuses on the border with trepanation hole after the removal of pathological content before placement of the graft from the flat bones of the cranial vault of the human fetus in excess of 3-4 mm diameter trepanation holes, put a thin layer of jelly “Solkoserila” for better bonding of the graft with the bone walls of the sinuses, and then further recorded the transplant method LBC, the distal part of the end face of the optical fiber, the semiconductor laser “ATCUS-15” on contact with the output power of the laser radiation 8 watts in continuous mode was carried out welding of allowreboot to the facial bone wall frontal and maxillary sinuses through the solder. Solder and contact laser “biological” welding allowed to obtain thorough fixation of allowreboot to the bony walls of the sinuses around its diameter without imposing on its surface, a lot more is edst commit completely prevent penetration of wound discharge from the sinus outside through trepanation hole.
The study included 17 patients at the age from 20 to 62 years with various forms of recurrent purulent-polyposis; sinuitis. All operations were performed under General anesthesia.
Our proposed method of closure of defects of the facial wall of the frontal and maxillary sinuses by allopathically through the solder with a laser “biological” welding (LBC) was preceded by a comparative evaluation of existing and up to date methods of treatment of recurrent sinuitis, closure of defects of the walls of the sinuses, methods of harvesting and conservation of the applicable donor tissues that subsequently when conducting experimental studies have confirmed the feasibility of using lbs to restore their anatomical integrity.
The transplantation of the flat bones of the skull vault fetal human marked some staging. So the 10 day experiment on the laser fixation is formed coarse-fibered connective tissue with areas of coarse-fibered bone. By the 20th day enchondral growth is accompanied by signs of destruction. Differentiating osteoclasts form large cavities and spaces is with the formation of bone marrow cavities. At the same time on the periphery of callus from the periosteum begin to grow new bone tissue. To the 30-th day of the experiment the border of the defect are determined with difficulty. The laser exposure periosteal bone merges with enchondral and form a continuous bone plate. To the 40-th day the internal structure of the bone is a finally formed bone, consisting of parallel oriented bone plates.
Example. Patient C., 51 were hospitalized with a diagnosis of post-Traumatic left frontal sinusitis, purulent form, complicated hiss of the front wall of the frontal sinus. After the examination the patient underwent surgery radical frontonia left with excision of the fistula and the plastic of the front wall of the sinus flat bone of the skull vault of the human fetus using laser “biological” welding (lbs).
After incision of the skin and periosteum on the eyebrows with the transition to the slope of the external nose to the left was exposed front wall of the frontal sinus, which has been a bone defect with a size of 0.3×0.5 cm opening in the sinus cavity and coincident with the location of the fistulous course on the skin of the forehead. Bone allow extended defect in the front wall of the frontal sinus to 1.5 cm in diameter, pathological contents of the cavity of the sinus pieces “forces the rolling brick”, which the patient was injured 3 months ago, completely removed. Spoon-rasputia extended fronto-nasal fistula. On bare bone wall of the frontal sinus on the edge trepanation holes before putting on him a transplant from the flat bones of the cranial vault of the human fetus was applied solder, which was used jelly “Solkoserila”, transplant exceeded the size trepanation holes at 3-4 mm and was fixed to the bone walls of the frontal sinus with the help of lbs. At the distal portion of the end face of the optical fiber, the semiconductor laser “ATCUS-15”, mounted directly on the border of the contact surface of the graft with bone wall of the sinus, between which was the solder was applied laser radiation power of 8.5 W in continuous mode, which provided the welding of a bone graft to a bone. Solder and contact laser “biological” welding allowed to obtain thorough fixation of allowreboot to the bony walls of the sinuses around its diameter without imposing on its surface an additional means of fixation, were completely excluded the possibility of penetrating wound of the frontal sinus outside through trepanation hole. Given the short duration of laser irradiation on bone labradorescence and underlying bone tissue h is cut solder, excluded factor charring of the graft and the underlying bone wall of the frontal sinus in its contact with the distal part of the end face of the optical fiber due to partial absorption of laser energy by the solder. Surgical wounds were usuals layers. Control over the restructuring of the transplant was carried out dynamically carried out x-ray, biochemical and immunological studies. So on chest x-ray of the paranasal sinuses 3 months after implantation flat allowreboot defect in the left frontal sinus was observed ingrowth transplant in the structure of the formed bone spur, gradually merging with the bone edges recipient, turning in solid newly formed bone. In the postoperative period the patient received anti-inflammatory therapy, recurrent frontal sinusitis was not observed.
Sources of information:
1. Melnikov mathematical SCIENCES. The results of obliterating operations canned xenodream //materials of the regional scientific-practical conference of otolaryngologists and extended Plenum of MOLO (Irkutsk, June 20-21, 1990). - M - 1990. - s-95.
2. Didenko V., Gusakov ROAD Primary and secondary reconstructive plastic surgery on the frontal sinuses using the sponge autoceste and bone marrow //Folia Otorhinolaryngologica. - Vol.3. - №3-4. - R-37.
3. BallengerJ.J. Some effects of formaldehyde on the upper respiratory tract //Laryngoscope. - 1984, 94. No. 11. - R-1413.
4. Holstrom M., Wilhemsson Century, Hellgust H. et al. Histological changes in the nasal mucosa in persons occupationally exposed to formaldehyde alone and in combination with wood dust //Acta Otolaryngology. - 1989. - V.107. -№1-2. - R-129.
5. Blocky A.A. Labradorescence in reconstructive rhinosurgery of the nose and paranasal sinuses: author. Dis....Kida. the honey. Sciences. - St.-Petersburg, 1997. -18 C.
The method of fixation of the graft from the flat bones of the cranial vault of the human fetus, including fixation of the graft to the bone walls of the frontal and maxillary sinuses, characterized in that the bone of the front wall of the frontal and maxillary sinuses on the border with trepanation hole put jelly solkoserila, and then further secure the graft radiation of a semiconductor laser “ATCUS-15” by contact of the distal part of the end face of the light guide output radiation power of 8 watts in continuous mode.