RU2840576C2 - Method for stopping capillary haemorrhage after sampling autograft from palate with plastic surgery of soft tissues of oral cavity - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, dentistry. At the first stage, by means of a carpool syringe along the entire perimeter of the autograft sampling site, an anaesthetic with a vasoconstrictor, for example adrenaline, noradrenaline, epinephrine, is administered, in dosage of 1:100,000 under the mucous membrane, at a depth to the periosteum, at distance of 1–2 mm from the donor site to the ischemic symptom. At the second stage, 30 seconds later, the wound surface of the sampled autograft is coated with Hemocompact haemostatic adhesive 0.05 ml in drops 0.5–1 mm thick.

EFFECT: method enables to stop capillary bleeding after sampling autograft from palate when plastic surgery of soft tissues of oral cavity, provides minimum injuries of adjacent healthy tissues, fast and comfortable rehabilitation of the patient during the healing of the donor zone.

4 cl, 2 ex

Description

The invention relates to medicine, to dentistry, and can be used in surgery of soft tissues of the oral cavity with the collection of an autotransplant from the palate for comfortable and safe rehabilitation of the patient.

Oral soft tissue plastic surgery is an important surgical procedure aimed at restoring the aesthetic and functional characteristics of periodontal tissues. Harvesting a soft tissue graft from the palate is one of the common approaches to gingival reconstruction when eliminating recession or increasing keratinized attached gingiva. An important component of successful plastic surgery is the quality of the wound coverage after this procedure. With this technique, the healing process of the donor site occurs in 2-4 weeks by secondary intention. The highest level of pain in the donor site is felt on the first day after surgery and decreases to the preoperative level approximately 2 weeks after the intervention.

However, most complications after this procedure are associated with underestimation of anatomical structures, such as the greater palatine artery. Regardless of the method of harvesting the graft from the palate, prolonged intra- and postoperative bleeding caused by damage to the palatine vessels is one of the most common complications of this procedure. There is also a risk of infection of the wound surface of the donor area.

Thus, there is a need to find the most effective way to stop bleeding from the donor area of the palate. There is also a need to minimize discomfort in the area of graft collection and safe rehabilitation of the patient in the postoperative period.

A method is known for stopping bleeding from the vessels of the mucous membranes (RU 2104068 C1 dated 10.02.1998) using the radiation of a YAG-NO laser from the working end of the light guide to the surface of the mucous membrane.

The disadvantages of this technique are the risk of late bleeding if the area is injured during a meal, as well as discomfort for the patient with each act of swallowing, when the tongue will constantly come into contact with the wound surface.

The closest (prototype) analogue to the claimed invention is a method for alveolar ridge plastic surgery in children with congenital cleft lip and palate (RU 2613673 C1 dated 03/21/2017), in which an autograft is collected with subsequent hemostasis of the donor area using a hemostatic sponge and suturing the postoperative wound with vicryl.

The disadvantage of this method is that after applying the sponge and suturing, reliable stopping of capillary bleeding is not guaranteed due to the fact that due to heavy bleeding it is difficult to accurately position the hemostatic sponge. In addition, as a result of heavy capillary bleeding, it is difficult to determine the edges of the formed wound, due to which reliable stopping of bleeding is not always guaranteed during suturing, and adjacent healthy tissues are often injured. Patients also note discomfort after the described procedure due to the sensation of the hemostatic sponge and sutures on the tissues of the oral cavity.

The technical result of this invention is the development of a method for stopping capillary bleeding after taking an autograft from the palate with reliable hemostasis with minimal trauma to adjacent healthy tissues and minimal consumption of administered anesthetic with a vasoconstrictor and hemostatic glue "Gemocompact" along with fast and comfortable rehabilitation of the patient during the healing period of the donor area.

The technical result is achieved by the fact that the capillary bleeding is stopped in two stages using a vasoconstrictor drug, while in the method for stopping capillary bleeding during soft tissue plastic surgery, at the first stage, using a carpule syringe, an anesthetic with a vasoconstrictor agent is injected along the entire perimeter of the autograft collection area in a dosage of 1:100,000 under the mucous membrane to a depth of the periosteum, retreating from the donor area by 1-2 mm to the symptom of ischemia, to achieve temporary hemostasis; at the second stage, after 30 seconds, Hemocompact hemostatic glue is applied to the wound surface of the autograft collection area in drops of 0.05 ml with a thickness of 0.5-1 mm.

Implementation of the invention

The method for stopping capillary bleeding after taking an autograft from the palate is as follows: at the first stage, an anesthetic with a vasoconstrictor, such as adrenaline, noradrenaline, epinephrine, in a volume of up to 0.5 ml, at a dosage of 1:100000, is injected under the mucous membrane, to a depth of the periosteum, retreating from the donor site by 1-2 mm along the entire perimeter of the site of taking the autograft from the palate, using a carpule syringe to achieve temporary hemostasis.

This creates a depot of anesthetic, which, on the one hand, temporarily compresses the surrounding blood vessels, and on the other, has a vasoconstrictive effect due to the vasoconstrictors in its composition. As a result, a good field of vision of the resulting wound is ensured, its clear edges are determined.

At the second stage, after 30 seconds, apply 0.05 ml drops of Hemocompact hemostatic glue with a thickness of 0.5-1 mm to the wound surface of the autograft collection area from the palate. The glue acquires a jelly-like consistency within the first few seconds. After 30-60 seconds, an adhesive film is formed, which guarantees reliable hemostasis of the resulting wound. The adhesive film contributes to a more comfortable and rapid rehabilitation of the patient during the healing period of the donor area due to the smooth surface formed and does not interfere with patients in everyday life.

Thus, the developed method of stopping capillary bleeding after taking an autograft from the palate with reliable hemostasis ensures minimal trauma to adjacent healthy tissues, since the tissues are not punctured during suturing, as in the prototype, after injections of anesthetic with a vasoconstrictor, the tissues return to their original state, and the wound remains covered with a reliable layer of adhesive film. Due to the joint sequential use of anesthetic with a vasoconstrictor administered in the declared concentrations in a volume of up to 0.5 ml and hemostatic glue "Gemocompact" in drops of 0.05 ml, reliable hemostasis is ensured, due to the fact that the glue is applied to all clearly visible, due to preliminary injections, edges of the wound. Also, due to the joint sequential use of an anesthetic with a vasoconstrictor in a volume of up to 0.5 ml and the hemostatic glue "Gemocompact" in drops of 0.05 ml, administered in the stated concentrations, a minimum consumption of therapeutic substances administered to the patient's body is ensured, since good visual access is provided to the edges of the wound, and an excessive amount of glue is not applied to it.

"Gemocompact" is registered in the Russian Federation and included in the state register of medical devices and medical equipment (registration certificate No. FS 01032005.2045). The certificate of conformity was issued according to the certification system of the State Standard of Russia under No. ROSS 1SH IM09. VO 1332.

The glue is intended mainly for stopping and preventing acute gastroduodenal bleeding and preventing its recurrence, other endosurgical and surgical interventions in gynecology, traumatology as a hemostatic sealing material to prevent bleeding at the sites of surgical interventions and for the purpose of preventing recurrence.

The glue is made from the following substances:

- aqueous solution of feracryl 1%, produced by Khimfarmzavod, Usolye-Sibirskoye, FSP - 2-11, registration certificate No. 000/55 dated 01.01.2001;

- sodium alginate, produced by the Arkhangelsk algae plant, registration certificate No. 000/01 dated 01.01.2001;

- acetic acid, chemically pure (dry cleaning) for pharmacology, content not less than 99.85% according to GOST 61-75, GOST 2654-86. Manufacturer "Azot";

- distilled water for pharmacology, according to GOST 6709-72, produced on DE4 brand water distillers from the company "Analit-Service".

The developed method was tested in practice and is explained by the following examples.

Example 1. Patient S., 65 years old, was referred by an orthopedic dentist to increase the volume of keratinized gum in the area of a previously installed implant in the projection of teeth 2.5, 2.6, 2.7. After anesthesia and creation of a recipient bed, a free gingival graft (FGG) was taken from the palate. The graft was immersed in saline. Stepping back 2 mm from the wound edge, an anesthetic solution with the vasoconstrictor adrenaline was infiltrated at a dosage of 1:100000. Gemocompact glue was applied to the wound surface in portions, in small drops of 0.05 ml. An adhesive film 0.5 mm thick was formed on the wound surface. Recommendations were given. On the 4th day, the patient came for a control examination. An active process of epithelialization of the wound surface was noted. Discomfort in the donor area was noted only on the first day. On the 14th day, the wound was epithelialized. The patient noted painless food intake during the rehabilitation period.

Example 2. Patient A., 30 years old, was referred by an orthodontist to correct recession of teeth 4.3-3.3. After anesthesia and creation of a recipient bed, the SDT was taken from the palate. The graft was immersed in saline. At a distance of 1 mm from the wound edge, an anesthetic solution with the vasoconstrictor epinephrine was infiltrated at a dosage of 1:100000. Gemocompact glue was applied to the wound surface in portions, in small drops of 0.05 ml. An adhesive film 1 mm thick was formed on the wound surface. Then the doctor continues the main manipulation. During the control examination on the 4th day, an active process of epithelialization of the donor site was noted. On the 14th day, the wound was epithelialized. The patient notes a comfortable rehabilitation period.

Claims (4)

1. A method for stopping capillary bleeding after taking an autograft from the palate during soft tissue plastic surgery of the oral cavity, which is carried out as follows: at the first stage, using a carpule syringe, an anesthetic with a vasoconstrictor at a dosage of 1:100,000 is injected under the mucous membrane along the entire perimeter of the autograft collection site, to a depth of the periosteum, retreating from the donor site by 1-2 mm until the symptom of ischemia, to achieve temporary hemostasis; at the second stage, after 30 seconds, "Gemocompact" hemostatic glue is applied to the wound surface of the autograft collection site in drops of 0.05 ml, 0.5-1 mm thick. 2. The method according to claim 1, wherein adrenaline is used as a vasoconstrictor. 3. The method according to claim 1, wherein norepinephrine is used as a vasoconstrictor. 4. The method according to claim 1, wherein epinephrine is used as a vasoconstrictor.