RU2813047C2 - Method of eliminating nasal slope defect - Google Patents

Abstract

FIELD: medicine; reconstructive surgery and oncology.

SUBSTANCE: preliminary marking is applied and the preparation is removed in a single fascial skin block. According to the markings, an incision is made along the nasolabial fold. A buccal skin-fat flap is cut out. Next, the incision is extended along the back of the nose to the bridge of the nose. A fasciocutaneous flap of the nasal dorsum is formed. The flaps are then mobilized and rotated into the defect area. Plastic repair of the defect is performed and the flaps are fixed along the edges of the defect with separate interrupted sutures.

EFFECT: elimination of a defect in the skin of the nasal slope with a large tumour volume and achieve the most aesthetic result, avoiding deformation of the contours of the face and displacement of the nasal axis to the side.

1 cl, 6 dwg, 1 ex

Description

The invention relates to reconstructive plastic surgery in oncology, namely to rhinoplasty, in particular to a method for eliminating a defect in the skin of the clivus of the nose when it is excised up to 35 mm.

The external nose is located in the center of the facial relief, and therefore, deformations and defects of this structure affect the aesthetic perception of a person’s appearance.

The main reasons leading to defects in the area of the external nose are injuries and malignant tumor processes. When performing surgical treatment for skin cancer, it is customary to make a minimum distance of 0.4-1.0 cm on all sides from the visible boundaries of the tumor with the formation of extensive defects.

There is a known method for plastic surgery of clivus skin defects using a transposition flap (J. Zoltan, Skin grafting, p. 32). To carry out reconstruction using this flap, an incision is made from the edge of the formed postoperative defect along the medial edge of the flap in the nasolabial fold, then to the side of the incision, the skin of the cheek is peeled off widely in all directions, thus forming a skin-fat flap. The mobilized flap is formed in such a way that it is possible to close the postoperative defect without tension by moving it. Next, an incision is made along the outer edge of the flap, the flap on the cranial pedicle is rotated to the area of the removed tumor, where it is fixed with interrupted sutures along the entire perimeter.

However, the known method has a number of disadvantages:

- when forming a flap and suturing the donor wound, a significant amount of healthy skin is excised;

- the potential of this flap is limited by the size of the tumor; it may not be enough to cover large defects;

- when forming a large area flap, deformation of the cheek and infraorbital zone will occur.

The closest (prototype) is the method of surgical reconstruction using the Burow method (J. Zoltan, Skin grafting, p. 36). A round defect is formed, then two triangular flaps of different areas are formed on both sides of the round defect, which rotate towards each other.

However, the method has a number of disadvantages:

- this method is applicable to a greater extent for defects formed on a flat surface, and is not convenient in raised anatomical areas;

- not applicable for eliminating defects of the tip of the nose.

The technical result of the method is the elimination of skin defects on the clivus of the nose with a tumor size of 2 cm and a postoperative defect diameter of 3.5 cm, as well as achieving the most aesthetic result.

This problem is solved by the fact that, just as in the known method, preliminary marking is performed, retreating from the visible boundaries of the tumor by 0.5 cm, a skin incision is made surrounding the tumor and the drug is gradually mobilized and removed in a single fascial skin block.

A feature of this invention is that, according to the markings, as in figure 1, an incision is made along the nasolabial fold, a buccal skin-fat flap is cut out, then the incision is extended along the dorsum of the nose to the bridge of the nose, a fasciocutaneous flap of the nasal dorsum is formed, then the flaps are widely mobilized and They are counter-rotated into the area of the defect, plastic surgery of the defect is performed, and the flaps are fixed along the edges of the defect with separate interrupted sutures.

The method is accompanied by a detailed description, clinical example and illustrations, which depict:

Fig. 1 – scheme for eliminating the defect of the nasal clivus: a) preoperative marking: the proposed zone of tumor resection is highlighted, and the edges of the resection of skin-fat flaps that are planned to be used in subsequent plastic surgery are indicated; b) removal of the drug: type of formed postoperative defect, mobilized skin-fat flaps prepared for rotation into the wound area; c) closing the defect with counter sliding skin-fat flaps, layer-by-layer suturing of the wound.

Fig. 2 – photo illustration of patient K., before treatment: a) in a lateral projection; b) in direct projection.

Fig. 3 – photo illustration of preoperative markings, patient K.

Fig. 4 – intraoperative photo illustration of drug removal.

Fig. 5 – photo illustration: closing the defect with opposing sliding skin-fat flaps.

Fig. 6 – photo illustration of patient K. in the postoperative period: a) right view; b) left view.

The method is carried out as follows.

After preliminary marking (Fig. 1a), the neoplasm of the nasal slope is excised, then by extending the incision along the nasolabial fold on the right, a buccal skin-fat flap is cut out and the incision is extended along the dorsum of the nose to the bridge of the nose, and a fasciocutaneous flap of the nasal dorsum is formed (Fig. 1b). Next, the flaps are widely mobilized and counter-rotated into the defect area, after which they are used to perform wound repair (Fig. 1c). The flaps are fixed along the edges of the defect with separate interrupted sutures. Donor wounds are sutured in layers.

Clinical example.

Patient K., 50 years old, observed a formation in the area of the nasal slope on the right for a long time, but did not consult a doctor. Over the course of a year, I observed an increase in tumor formation in size, and therefore independently sought a consultation at the Department of Microsurgery of the Moscow Scientific Research Oncological Institute named after. P.A. Herzen - a branch of the Federal State Budgetary Institution "National Medical Research Center of Radiology" of the Ministry of Health of the Russian Federation, additional examination was recommended, scraping was performed. Basal cell carcinoma was cytologically verified. A clinical diagnosis was made of skin cancer of the right clivus, cT2N0M0, stage II.

Upon admission: the configuration of the head and neck was not changed. Upon examination, in the area of the nasal slope on the right, a weeping tumor formation of infiltrative-ulcerative growth, measuring 2.0x1.5 cm in diameter, covered with a crust, bleeding from contact, is determined (Fig. 2 a, b). When palpating the neck, there is no evidence of pathologically changed lymph nodes.

In order to achieve a satisfactory aesthetic effect, a decision was made to perform plastic surgery using counter-sliding skin-fat flaps.

Surgical treatment was performed to remove a tumor of the skin of the clivus on the right with the elimination of the postoperative defect with local tissues.

Under endotracheal anesthesia, after preliminary marking (Fig. 3), retreating 0.5 cm from the visible boundaries of the tumor, a skin incision was made bordering the tumor, the drug was gradually mobilized and removed in a single fasciocutaneous block (Fig. 4). Thus, a defect of 3.5 cm in diameter was formed. By extending the incision along the nasolabial fold on the right, a buccal skin-fat flap was cut out. Next, the incision was extended along the back of the nose to the bridge of the nose and a fasciocutaneous flap of the back of the nose was formed. The flaps were widely mobilized and rotated into the defect area, and they were used to eliminate the defect. The flaps were fixed along the edges of the defect with separate interrupted sutures. Donor wounds were sutured in layers (Fig. 5).

The postoperative period proceeded smoothly. The wounds healed by primary intention. Necrotic changes in the flaps were not observed in the postoperative period (Fig. 6 a, b).

The proposed method made it possible to eliminate a defect in the skin of the nasal clivus with a large tumor volume and achieve the most aesthetic result, avoiding deformation of the contours of the face and displacement of the nasal axis to the side.

Claims (1)

A method for eliminating a defect in the nasal slope, including applying preliminary markings and removing the drug in a single fascial skin block, characterized in that, according to the markings, an incision is made along the nasolabial fold, a buccal skin-fat flap is cut out, then the incision is extended along the back of the nose to the bridge of the nose, and the skin is formed -fascial flap of the nasal dorsum, then the flaps are mobilized and rotated into the area of the defect, plastic surgery of the defect is performed and the flaps are fixed along the edges of the defect with separate interrupted sutures.