“The use of endoexpander dermatoplasty in the skin
scar deformations”
Zhakupova
S.S., Kemaladdinova K.N., Artykbay S.N., Kharissova N.M.
Karaganda
state medical university
The actuality of the problem.
The
treatment of patients with scar deformations and wide defects of soft tissues
arising after damages and traumas is a complicated problem.
In
spite of successes achieved in the field of reconstructive – restorative and
aesthetic surgery there are unsettled problems which are connected with deficit
of local plastic material and demand
the use of different methods of
tissues transplantation which are complicated, prolonged and traumatic and not
always allow to achieve wishful cosmetic result. According to some authors’
opinions the plastic with free split dermal transplant doesn’t give satisfied
results because of second retraction and dispigmentation of transplanted skin in 45% cases[1].
Using
of Italian grafting or Filatov grafting method as a rule several stages of
operation and long fixation of extremities in constrained state are necessary
that is especially difficult in children and old people [3]. It became a reason
for quest new ways in improving tactics of surgical treatment of patients with
post- burn and post- traumatic scars. And one of the such ways is method of
endoexpander dermatension.
The
complication of microsurgical
operations, the necessity of special equipment make these operations accessible
only in high specialized institutions. The percent of complications is still
great and is connected with thrombosis of microvascular anastomosis.
In
the system of complex treatment of patients with burns the important role
belongs to dermatoplastic operations.
The
independent rejection of died tissues in burns leads to full cleaning of wound
in 4-6 weeks. The long existence of burn eschar prevents fulfilment of autodermoplasty, promotes the
development in burn wound of pyogenic micro flora and in discharge of toxic
substances. Therefore the methods hastening rejection of necrotizing tissues
are used. One of them based on use of necrotic substances.
The purpose of investigation.
1.
The study of endoexpander
dermatension method results.
2.
The retrospective analysis of balloon
dermatension method use in treatment of
patients with scar deformations.
The materials
and methods.
The
base of the work are the results of
investigation and treatment of 50 patients in regional center of
traumatology of burn therapy department
with following diagnosis: post- traumatic scars- 10, post- burn defects- 40.
The classic scheme of dermatension fulfilment with one moment introduction of
solution 1 time per 3 days is used for all patients. The implantation the
connected pipe and port of expander were left outside fastening by 2 or 3
sutures that allowed to fulfil the control after the state of formed pocket of
cavity. In the aims of prevention of inflammatory complications the course
of antibiotic therapy were conducted.
In fractional introduction of dermatension the capsule near endoexpander didn’t
subject sclerotic changes retaining the type of thin, elastic connected tissue
of layer.
The results and discussion.
According
to retrospective analysis the following types of complications were observed:
one patient had rupture of endoexpander and three patient had necrosis under
expander.
Clinical
case ¹1. Post-burn skin scar deformation of right forearm.
Before
dermatoplasty
After dermatoplasty
Clinical
case ¹2. Defect and scar changes of soft tissues ùà
shank.
Before dermatoplasty
A month later after
dermatoplasty
Conclusion.
The
wide inculcation of balloon dermatension method use is a high effective in
liquidation of scar deformations arising after bun wounds and surgical
treatment. The method allows to eliminate tissues defects and quantity of
complications.
Literature .
1.
Bogosyan R.A. “Expander dermatension
–the new method of surgical replace of dermal tegument defects”.
2.
Yudenich V.V.,
Grishkevich V.M. “Guidance of whitewash encaustic”. Ì; 1986.
3.
Tolhurst D. “The development of the
fasciocutaneous flap and its clinical applications. Plast Reconstr Surg “1983;
71: 597—605.