МОЖЛИВОСТІ КОМП’ЮТЕРНОГО ПЛАНУВАННЯ ПРИ ЛІКУВАННІ ОПІКІВ МЕТОДОМ ЕКСПАНДЕРНОЇ ДЕРМОТЕНЗІЇ

Abstract

The method of tissue expansion in plastic surgery of burns and other skin defects is based on the ability of the human skin to grow at mechanical stretching. The method is to insert a silicone cylinder (expander) under the patient's skin near the defect site and fill it with a physiological solution at intervals of approximately 1-2 weeks. After the stretched skin has reached required area, a new skin is cut and transfer on the defective part of the body. It has been demonstrated that the potential of the skin to stretch uneven in different directions. Much better, without fragmentation and discontinuities, it stretches in directions perpendicular to the so-called Langer's lines - collagen fibers that form bundles in the thickness of the skin. Consequently, the expansion of the expander with a longer axis in parallel with the Langer's lines (as the expander extends mainly along the short axis) will greatly facilitate and reduce the procedure of growing the new skin due to its faster stretching. We offer a prototype of a computer program for the visual planning of placement of the expander under the skin of the patient, taking into account the location of the Langer's lines near the defective site. The program accepts the schematic representation of the Langer's lines on the corresponding part of the body, the location and size of the wound, the size of the expander. The space around the wound is divided into eight areas where the expander location is possible. The optimal location is determined by the method of minimizing the scalar product of a normalized vector, which is parallel to each of the possible locations, with a normalized vector tangent to the Langer line in the nearest point to the given location. The best locations are marked with green, the worst ones are marked with red, and the intermediate ones marked with yellow. The proposed program tool will allow the surgeon to quickly and accurately find out the optimum location of the expander chamber relative to the wound and Langer's lines, taking into account the individual sizes of the wound and the affected part of the body. For the future it is planned to include in the program the patient database and images of various parts of the body with skin defects and wound sizes.