ХИРУРГИЧЕСКОЕ ЛЕЧЕНИЕ ПОСЛЕОЖОГОВЫХ РУБЦОВЫХ ДЕФОРМАЦИЙ ЖЕНСКОЙ ГРУДИ

Abstract

Objective: Improving the results of surgical treatment of post-burn cicatricial deformities of the woman’s breast . Methods: The results of surgical treatment of 17 women with post-burn scar deformities of the mammary gland are analyzed. The average age of the patients was 21.6±3.2 years. Burns were obtained: with a flame in 9 (52.94%) cases, a hot stove in 2 (11.76%) observations, an electric stove in 3 cases (17.65%), hot fluid food in 2 cases (11.76%) and boiling water in 1 case (5.88%). The duration of the burn was from 3 to 36 years and was on average 14.0±2.0 years. Unilateral breast deformity was observed in 12 (70.6%) women (in 6 cases on the left and in 6 cases on the right). Five (29.4%) women had the post-burn cicatricial deformity of both breasts. In 6 (35.3%) cases, the nipple-areola complex (NAC) of the mammary gland was absent. As a result of a tightening scar on 11 mammary glands noted dystopia of NAC, caudally (n=4), laterally (n=4), caudally-laterally (n=2), cranially (n=1). The total area of scars ranged from 180 cm2 to 2400 cm2, averaging 694.4±39.6 cm2. Results: In the case of low-tightening scars of the mammary glands, local-plastic. Results: In the case of low-tightening scars of the mammary glands, local-plastic surgery, modified multi-patch Z-plastics methods were used, which, if necessary, were supplemented by auto-motive transplants. In patients with extensive tightening scars, the way of the resistant band was used (n=1) or fasciocutaneous flaps (n=2). Due to the dissatisfaction with the results of surgical treatment of post-burn cicatricial deformities of the woman’s breast, we developed and successfully introduced into clinical practice a method of subcutaneous rotation of NAC, which was used in the treatment of 5 patients. Complications in the early postoperative period were observed in 2 (11.7%) patients in the form of seroma around the displaced mammary gland (n=1) and marginal necrosis of scar-modified skin in the outer quadrant of the operated breast (n=1). These complications have prolonged the healing period of postoperative wounds without the need for additional surgical interventions. Long-term results in terms from 6 months to 15 years after surgery were tracked in 14 (82.3%) patients. In all cases, there was no need for additional corrective operations. When comparing the applied methods of surgical interventions, the best results were observed when using the NAC subcutaneous rotation method. Conclusion: Choosing of the method of surgical treatment of post-burn cicatricial deformities of the woman breast depends on the clinical options and the prevalence of tightening scars. The method of subcutaneous rotation of the mammary gland with a transposition of the NAC significantly expanded the possibilities of surgical treatment of these patients promotes symmetry of the mammary glands and their natural position. Keywords: Post-burn contracture of the mammary gland, deformation of the woman’s breast, nippleareola complex.