Surgical method for treating the cases of rhinophyma

FIELD: medicine.

SUBSTANCE: method involves carrying out anterior vestibular nose skin incision. The nose skin is separated with underlying tissues from pterygoid nasal cartilage, cartilaginous and bony parts of nose. Subcutaneous excision of changed neoplasm tissue by means of high intensity laser radiation. Next to it, wound surface is covered with retained skin flap and sutures are placed. Changed neoplasm tissues are excised in particular cases to healthy tissue with laser radiation of diode laser at wavelength of 0.97 mcm and power of 5-8 W in continuous mode.

EFFECT: enhanced effectiveness of treatment.

2 cl

 

The invention relates to otorhinolaryngology, to surgical methods of treatment of chronic skin diseases of the nose, in particular rhinophyma.

A known method of removing rhinophyma on Kantorova A.G., consisting in the execution of shallow incisions in the skin, the maximum non-flaking skin from the tumor to the borders with healthy tissues, with the broader conservation Foundation of the flap, the peeling Nude from skin tumors from the underlying tissues, with maximum preservation of the integrity of the base of the nose, removal of the tumor or in parts or as a single conglomerate, hemostasis of the wound surface, coating it saved the flap and the connecting seams (see Satarov A.G. and others "Eponymously reference otorhinological operations", Irkutsk, 1984, str).

This method is quite complicated and does not exclude the possibility of recurrence of the disease.

There is a method of surgical treatment of rhinophyma selected as the closest analogue, consisting in the execution of V-shaped and T-shaped incision and subcutaneous excision of the newly formed connective tissue through these incisions (see Small medical encyclopedia, v.9, Moscow, 1968, SCR-132).

However, this method is not universal; it is used for rhinophyma, with small volume process, with minor roughness. It is ineffective p and large the process of rhinophyma when the great tuberosity of the affected tissues. In addition, subcutaneous excision of the newly formed tissue via the V - and T-shaped sections do not exclude the possibility of relapse, because there is no visual control of the thoroughness of the removal of this tissue. Thus the performance of the sections, the location of incisions and excision of the newly formed connective tissue with a scalpel significantly reduce the cosmetic effect of the operation.

Thus, the technical result for the solution of which this invention is directed, is to increase the efficiency of operation at different volumetric processes and improved cosmetic effect.

This technical result is achieved by the fact that in the known method of surgical treatment of rhinophyma, involves incision of the nasal skin, subcutaneous excision modified newly formed tissue covering the wound surface saved the flap and applying the seams, according to the invention produce anterior vestibular incision, before excision of skin of nose usepreview with the underlying tissues from krylnyh cartilage of the nose, the cartilage and bone of the departments of nose, excision of the modified newly formed tissue exercise to healthy tissue, the laser radiation from a diode laser with wavelength of 0.97 μm with a capacity of 5-8 watts in continuous mode.

The authors experimentally found that the implementation of the ima is but the anterior vestibular incision and before excision of the separation of the skin of the nose from krylnyh cartilage of the nose, cartilage and bone of the departments of the nose and the modified excision of the newly formed tissue to healthy tissue by laser radiation contributes the most to the effective implementation of this surgery.

This is according to the authors achieved through a more thorough removal altered the newly formed connective tissue, maximum hemostasis surgical field, the antitumor action of laser radiation, which completely eliminates the possibility of recurrence of the disease.

In addition, the anterior vestibular incision and the use of laser radiation for excision of the diseased tissue provides more accurate mapping of the edges of the skin flap and better healing of the wound, which results in high cosmetic effect.

While the authors experimentally found that the best results are achieved when using high-intensity laser radiation from a diode laser with wavelength of 0.97 μm with a capacity of 5-8 watts in continuous mode.

The method is as follows.

The patient under local anesthesia in the supine position perform anterior vestibular incision, such as W-shaped incision on columella with the transition to the partition and krylnyh the cartilage of the nose. There may be other embodiments of the anterior ve is tabularasa section, for example,and-shaped. The skin of the nose usepreview with the underlying tissues from krylnyh cartilage of the nose, the cartilage and bone of the departments of the nose sharp (scissors, scalpel). Diode laser with a wavelength of 0.97 μm (high-intensity) of the light guide with a diameter of 0.6 mm, the power radiation 5-8 watts in continuous mode to produce the excision of the subcutaneous fibrous-modified newly impregnated large vessels tissue. Excision of the modified fabric is carried out until healthy tissue gradually, as if in layers, starting from the inner layers with the minimum power of the laser radiation. As the laser light source can be used scalpel laser programmable portable with a wavelength of 0.97 μm model LS-0,97-"IRE-Polus. For example, the first fibrous layer is modified newly formed tissue excised by the radiation of the diode laser power of 5 watts for 3 minutes, the quartz-quartz fiber with arsenevym coating diameter of 0.6 mm, Then the light returns to the starting place of the previous exposure to laser radiation and do the next step the impact of them on the surface. When you run the next transition using laser cure diode laser power of 7 watts. This excision is carried out for 2 minutes. And the next paragraph is the wordcourse do for example, laser radiation with a capacity of 7.6 W for 6 minutes. The number of passes during which carry out excision of fibrous-modified tissue depends on the amount of destruction and runs until healthy tissue. After excision of bleeding tissue is significantly reduced. The wound is washed with aseptic solutions. The atraumatic sutures the monofilament placed on the skin of the nose and nasal mucosa. Install the glove drains into the nasal vestibule. Perform anterior nasal tamponade. Impose alcohol-Furacilinum dressing on the skin and fixed with adhesive tape.

The sutures are removed on the 6-7th day after the operation.

Control patients 6-12 months revealed no recurrence of the disease. Compared with known methods showed good cosmetic effect.

The method is confirmed by the examples.

Example No. 1. Patient C. for 45 years. Diagnosis: rhinophyma, with symmetrically affected areas of the wings, the side slopes and the tip of the nose.

Under local anesthesia in the supine position the patient underwent anterior vestibular W-shaped incision on columela with the transition to the partition and krylnyh the cartilage of the nose. Leather tsepilova with the underlying tissues from krylnyh cartilage of the nose, the cartilage and bone of the departments of the nose sharp way with a scalpel. High-intensity laser diode is on laser with a wavelength of 0.97 μm fiber of 0.6 mm radiation power 5 W, 7 W 7.6 W in continuous mode produced subcutaneous excision of the subcutaneous fibrous newly modified, impregnated, large vessels tissue. Excision made several transitions to healthy tissue. The first transition excision of fibrous-modified tissue by laser radiation carried out by the radiation power of 5 watts for 3 minutes. After the first exposure of the operative field treated with disinfectant and dried, after which they are taken hemostasis, in particular hydrogen peroxide. Carried out inspection of the surgical field, which resulted from subsequent exposure to laser radiation is excluded areas of the treated surface, representing healthy tissue. The following transition excision carried out by laser radiation power of 7 W for 2 minutes, and avoiding areas of healthy tissue. Treatment of the surgical field is similar to the processing performed after the first transition. After the second transition of the exposure laser radiation is carried out following the inspection of the surgical field, which identified the remaining areas covered with fibrous-modified newly formed tissue, the final excision of the fibrous-modified newly formed tissue, after which the operative field is fully decorated healthy tissue, performed laser) is a treatment capacity of 7.6 W for 6 minutes. In the final excision of the influence of the laser radiation was exposed to only the parts of the surface containing fibrous changed the newly formed tissue. After excision, the wound washed aseptic solution produced by the drying of the surgical field and made the final hemostasis, in particular hydrogen peroxide. The atraumatic sutures the monofilament placed on the skin of the nose and nasal mucosa. Set the glove drains into the nasal vestibule. Front tamponade nose. Imposed porcelanowa bandage on the skin and fixed with adhesive tape.

The drainage was removed on the 3rd day after the operation.

Sutures were removed on the 6-7 day.

Control examination of the patient after 7 months revealed no recurrence of the disease. Cosmetic effect is good.

Example No. 2. Patient J. 54, Diagnosed with severe rhinophyma process in the area of the wings, the nose and the cartilage Department backrest.

The patient under local anesthesia in the supine position; performed anterior vestibular-section on calomel with the transition to the partition and krylnyh the cartilage of the nose.

Further operation is carried out according to example No. 1, except that the number of transitions by excision of the fibrous-modified newly formed tissue is one. Thus, the laser power is iodine laser with a wavelength of 0.97 μm is 8 watts, and the exposure time of 7 minutes. The influence of the laser radiation is carried out in a continuous mode fiber of 0.6 mm

Control examination after 12 months revealed no recurrence of the disease. Cosmetic effect is good.

1. A method of surgical treatment of rhinophyma, consisting of excision of the modified newly formed tissue using high-intensity laser radiation, characterized in that before you perform excision of the anterior vestibular incision of the skin of the nose, the skin of the nose usepreview with the underlying tissues from krylnyh cartilage of the nose, the cartilage and bone of the departments of the nose, perform subcutaneous excision modified the newly formed tissue, after which the wound surface cover saved the flap and suture.

2. The method according to claim 1, characterized in that the modified excision of the newly formed tissue is carried out until healthy tissue laser study of diode laser with a wavelength of 0.97 μm, the capacity of 5-8 watts in continuous mode.



 

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