RU2257154C2 - Method for dissecting gynecomastia - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: mastectomy should be performed due to subareolar access, the wound should be drained and sutures should be applied. For the purpose to shorten therapy terms and improve cosmetic result one should mobilize full-layer superior and inferior fragments, suture subcutaneous fiber of both fragments with separate interrupted sutures in horizontal direction, replace the developed excess of superior fragment with mammilo-areolar complex onto the skin, mark its borders and deepithelize inferior fragment along its new contour. Then one should apply cutaneous sutures. The method enables to shorten terms for wound healing.

EFFECT: improved cosmetic result.

5 dwg, 1 ex

Description

The invention relates to medicine, namely to surgery, and can be used to remove gynecomastia in men.

A known method of excising gynecomastia, which consists in subareolar removal of the mammary gland through a linear incision along the lower edge of the areola, drainage of the cavity, simple suturing of the wound by applying skin nodal sutures (1).

The disadvantage of this method is the formation of a cavity at the site of excised tissue, especially in obese patients, which leads to prolonged lymphorrhea, suppuration of the wound or the formation of a cosmetic defect in the form of entrapment.

The aim of the invention is to reduce the healing time of the wound and increase the cosmetic result.

This goal is achieved by the fact that, after drainage, the wounds mobilize the full-layer upper and lower flaps, suture the subcutaneous tissue of the upper and lower flap with separate interrupted sutures in the horizontal direction, transfer the excess of the upper flap with the nipple-areolar complex to the skin of the lower flap, mark its borders, and deepithelize lower flap along a new contour, impose skin sutures.

The invention is illustrated by drawings. Figure 1 shows a General view of the wound at the stage of mobilization of the mammary gland from the upper flap, Figure 2 - General view of the wound after removal of gynecomastia, Figure 3 - View of the wound after mobilization of a full-layer upper and lower flaps, the application of nodal sutures on the subcutaneous tissue and drainage of the wound, figure 4 is the final view of the wound after the application of skin sutures, figure 5 is a section II of figure 4.

The method is implemented as follows.

After removal of the mammary gland 1 and drainage of the wound, a full-layer upper 2 and lower 3 flap is mobilized. Separate interrupted sutures are applied to the subcutaneous tissue 4 of the upper and lower flap in the horizontal direction. The resulting excess of the upper flap with the nipple-areola complex 6 is moved to the skin of the lower flap, its borders are marked 7. The lower flap is depepithelized along the newly formed contour 8. The flaps are sewn together 9, and the nipple-areolar complex is located on the site of the de-epithelized lower flap.

Example. Patient V.R. (IB No. 741). The diagnosis of gynecomastia on the left 1-6 C. gr.

A paraareolar incision along the lower edge of up to 10 cm results in the removal of the mammary gland measuring 7 · 5 · 4 cm. Hemostasis. The upper and lower flaps are mobilized. The wound was drained with a vinyl perforated tube. Separate interrupted sutures were placed on the subcutaneous tissue. The excess of the upper flap with the nipple-areolar complex is moved to the skin of the lower flap with simultaneous marking. The lower flap is de-epithelized along the new border. Skin sutures are applied. The postoperative period without complications. Lymphorrhea is insignificant. Sutures were removed on the 8th day. Primary wound healing.

Control examination after 6 months. There are no complaints. The postoperative scar is soft, painless, and hardly noticeable. No deformation noted.

According to the proposed method, 20 operations were performed in the Samara Regional Oncology Center. In all patients, the postoperative period was uneventful, the wounds healed by primary intention. Deformation of the soft tissue of the chest is not observed.

The proposed method has the following advantages over the known.

1. There is a liquidation of the cavity in the soft tissues of the chest wall due to the stitching of the subcutaneous tissue of the upper and lower flap.

2. The likelihood of necrosis of the nipple-areolar complex is reduced, since moving it to the de-epithelialized area of the lower flap improves its “nutrition”.

3. The absence of a cavity dramatically reduces the number and timing of lymphorrhea.

4. The elimination of the defect due to the stitching of its own tissues prevents the occurrence of deformation and retention in this area.

Sources of information

M.I. Kuzin “Surgical diseases”. "The medicine". Moscow. 1986, p. 40.

Claims (1)

The method of excising gynecomastia by subareolar removal of the mammary gland, draining the wound and suturing, characterized in that, in order to reduce the healing time and improve the cosmetic result, mobilize the full-layer upper and lower flaps, sew subcutaneous tissue of the upper and lower flaps with separate nodal sutures in the horizontal direction , the excess of the upper flap with the nipple-areolar complex formed is transferred to the skin of the lower flap, its borders are noted, the lower flap is depepithelized along a new office, impose skin sutures.

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