RU2340277C1 - Method of estimation of integument plasticity - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: in an online mode define factor of an integument plasticity which count as a parity of an indicator of rate of diffusion of a superficial acoustic wave in the same direction at maximum flexion and extension in interfacing joints of a segment of an extremity, in longitudinal, cross-section and oblique diagonal 45 and 135 degrees directions. At an indicator of factor of plasticity of an integument lower than 0.9, reserve of plasticity of a cover tissue is estimated as low, at an indicator of factor of plasticity of an integument 0.9-1.2, reserve of plasticity of a cover tissue is estimated as satisfactory, at an indicator of factor of plasticity of an integument above 1.2, reserve of plasticity of a cover tissue is estimated as high.

EFFECT: allows to estimate mechano-acoustic heterogeneity of an integument and to prognosticate degree of skin extensibility.

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Description

The invention relates to the field of life sciences, in particular to an objective quantitative assessment using sound waves of the biomechanical state of integumentary tissues of humans and animals.

A known method of measuring the propagation velocity of surface acoustic waves in predicting and diagnosing the course of the wound healing process, in which, according to the obtained specific values of the speed of sound in the skin at the edges of the purulent foci, the healing process was evaluated (Makeev M.M., Sopuev A.A., Salibaev .A. Measurement of the propagation velocity of surface acoustic waves in predicting and diagnosing the course of the wound healing process. NI Pirogov Surgery, 2000, No. 1, pp. 54-55).

However, in the known method, acoustic testing was carried out without taking into account the mechanoacoustic inhomogeneity of the skin during the passage of sound in different directions relative to the longitudinal axis, and did not take into account the change in the position of the test area of the body or limbs in space that occurs during movements and locomotor activity; to conclude on the nature of the course requires a long time of the treatment process.

A known method for assessing the effect of peeling with chemical acids on the microstructural changes of aging facial skin using the method of two-dimensional ultrasonic dermoscanning of the skin, which allowed us to determine the ultrasonic echo density of the skin area being exposed and the thickness of its layers before and after exposure to chemicals (Chemical peeling. Ultrasonic scanning in the evaluation of the method / Korchagin E.A., Ivanova E.V., Potekaev N.N., Tkachenko S.B. // Experimental and clinical dermatocosmetology. - 2005. - No. 1. - P.51-54).

However, in the known method, ultrasound scanning does not provide for the influence of heterogeneity of the structural and acoustic properties of the studied integumentary tissues of the face, which leads to a decrease in the information content of the method used in assessing the effect of chemical peeling and the nature of the course of the rehabilitation period, as well as ultrasound scanning is contraindicated in case of violation of the integrity of the skin.

A known method for assessing the biomechanical state of the skin, in which the studied area was scanned, measured the speed of sound in 4 mutually perpendicular directions of each pole of the scanned area in the initial state, during periods of distraction and fixation. With an increase in the average speed of sound three times from the initial value, the skin was evaluated as prepared for plastic (Patent 2153841, publ. 10.08.2000, Bull. No. 22).

However, in the known method, the biomechanical condition of the skin was evaluated in a prolonged period of time: in the initial state, in periods of dosed stretching, fixation: with the segment being in a constant static position, which does not take into account the change in the rheological properties of the integumentary tissues in the physiological range of motion.

The objective of the present invention is to determine on-line the coefficient of plasticity of the skin, which makes it possible to assess the reserve of plasticity of the skin, thereby allowing us to predict the degree of its extensibility during reconstructive treatment of patients with various pathologies, during plastic surgery in maxillofacial surgery, and also in experimental animals.

The problem is solved in that in a method for assessing the plasticity of the skin, including acoustic testing of a designated area of the skin and obtaining averaged values of the surface acoustic wave, the on-line mode determines the rheological plasticity coefficient with maximum flexion and extension in adjacent joints of a limb segment, in two mutually perpendicular directions and with an increase or decrease in the coefficient of plasticity of the skin is assessed as a high or low reserve of plasticity of the coating implicit tissue.

The present invention is illustrated by a detailed description, examples of the method and illustrative material, on which:

Figure 1 - table of the propagation velocity of a surface acoustic wave (SRPAV, m / s) in the skin of the right cheek of a healthy patient before a functional test and after 3 minutes in the process of extension of the head in the cervical region.

Figure 2 - table of the coefficients of plasticity of the skin in different directions when testing the skin of the face of the same patient using a functional extension test in the cervical region.

Figure 3 - table SRPAV (m / s) in the skin of the congenital stump of the left forearm of the patient K., 10 years before and during the functional test for extension. Condition after surgical lengthening of the stump of the forearm by 5 cm. 3 years after removal of the apparatus.

Figure 4 - diagram SRPAV (m / s) in the skin of an elongated stump of the forearm of the same patient in the process of conducting a functional test - before the test.

Figure 5 is a diagram of SRPAV (m / s) in the skin of an elongated stump of the forearm of the same patient during a functional test after 3 minutes in the process of conducting it.

6 is a table SRPAV (m / s) in the skin of the intact forearm of the same patient.

7 is a diagram of the values of the coefficients of plasticity of the skin of the intact forearm according to the results of a functional test.

Fig. 8 is a photo of patient K., 10 years after lengthening a congenital shortened stump of the left forearm in an extension position in the elbow joint, general view and close-up;

Fig.9 is a photo of the same patient with flexion of the affected upper limb in the elbow joint, general view and close-up.

The method is as follows.

In the initial position of the patient lying on his back with extended elbow and knee joints on the front surface in the middle third of the segments of the limbs, the propagation velocity of the surface acoustic wave (SRPAV, m / s) in the skin of the marked area of at least 10 mm ² in two mutually perpendicular is measured directions.

After a functional test is carried out with maximum limb flexion in the elbow, knee joint or a certain part of the spine (cervical, thoracic, lumbar) lasting 3 minutes, the SRPAS is measured again in two mutually perpendicular directions. During acoustic testing of the skin of the face and other areas of the body, sound velocity measurements are carried out in the patient’s sitting position with the physiological position of the head relative to the cervical spine.

The coefficient of plasticity of the skin is calculated using the ratio of the speed of sound in the same direction before a functional test is carried out and after 3 minutes in the process of conducting it.

When the coefficient of plasticity of the skin is 0.9-1.2, a satisfactory level of rheological plasticity is estimated.

The presence of an indicator of the coefficient of plasticity above 1.2 is estimated high level of plasticity of the skin.

If the coefficient of plasticity of the skin is below 0.9, low rheological plasticity is evaluated.

Examples of the method.

Example 1. The facial skin of a healthy patient E., 35 years old, was examined. SRPAV (m / s) in the skin of the right half of the face in the cheek area in the initial state and during the functional test are presented in figures 1, 2. The rheological plasticity coefficient of the skin of the face, equal to 1.5, evaluates the high plasticity of the skin; a ductility coefficient of 0.87 indicates a low ductility of the integumentary tissue; ductility coefficients of 1.13 and 1.14 evaluate satisfactory ductility of the skin.

Example 2. The skin of the stump of the left forearm of patient K., 10 years old, was examined. Card of the clinical patient No. 35641. Diagnosis: congenital stump of the left forearm. Condition after surgical lengthening of the stump by 5 cm. Three years after removal of the external fixation apparatus. The table (figure 3) presents the results of measurements SRPAV (m / s) in the skin of an elongated stump of the left forearm before a functional test and after 3 minutes in the process of flexion of the elbow joint. The coefficient of ductility in the longitudinal direction, equal to 0.68, reflects the low ductility of the skin of the stump; the coefficient of plasticity in the transverse direction, equal to 1.64, estimates the high plasticity of the skin of the stump; a plasticity coefficient of 1.0 and 1.26 indicates a satisfactory plasticity of the skin in the directions of 45 and 135 degrees. respectively.

Example 3. Patient K. was examined, 10 l. Hospital Patient Card No. 35641. Diagnosis: congenital stump of the left forearm. 3 years after surgical lengthening of the stump by 5 cm. Figures 4 and 5 show the results of measuring SRAP in the skin of an intact forearm before and during a functional flexion test in the elbow joint. The coefficient of plasticity of the skin (Fig.7) in the longitudinal direction, equal to 1.31, reflects the high plasticity of the skin of the intact forearm; a coefficient of 1.52 and 1.44, estimates the high ductility of the tissue in the transverse and in the codiagonal direction of 45 degrees. accordingly, a coefficient of 1.11 estimates satisfactory plasticity of the skin in the oblique direction 135 degrees.

The proposed method is an objective criterion for assessing the mechanoacoustic heterogeneity of the skin, taking into account changes in the links of the kinematic chain and parts of the body in space during the movement.

The method evaluates the rheological reserve of the skin in healthy people and patients with various pathologies, as well as in experimental animals based on non-invasive intravital acoustic testing in on-line mode.

In addition, the method allows to predict the degree of skin elongation during reconstructive treatment of patients with plastic surgery, maxillofacial surgery, combustiology.

Also, the proposed method allows acoustic monitoring of the skin at various periods of the rehabilitation process during medical treatment in cosmetology and after plastic surgeries.

The proposed method is used in the scientific, clinical and experimental departments of the Federal State Institution Scientific Research Center “WTO” named after Acad. G.A. Ilizarova Roszdrav. "

Claims (1)

A method for assessing the plasticity of the skin, including acoustic testing of a designated area of the skin and obtaining averaged values of the surface acoustic wave, characterized in that the on-line mode determines the coefficient of plasticity of the skin, which is calculated as the ratio of the rate of propagation of the surface acoustic wave in the same direction with maximum bending and extension in adjacent joints of a limb segment, in the longitudinal, transverse and codiagonal directions of 45 and 135 ° at a coefficient of plasticity coefficient of the skin below 0.9, the reserve of plasticity of the integumentary tissue is assessed as low, with an indicator of the coefficient of plasticity of the skin 0.9-1.2, the reserve of plasticity of the integumentary tissue is satisfactory, with an indicator of the coefficient of plasticity of the skin above 1, 2 reserve plasticity of the integumentary tissue is assessed as high.

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