Mucous Flaps Research Articles

"In situ bone flap" combined with vascular pedicled mucous flap to reconstruction of skull base defect.

At present, neuroendoscopy technology has made rapid development, and great progress has been made in the operation of lesions in the saddle area of the skull base. However, the complications of cerebrospinal fluid and intracranial infection after the operation are still important and life-threatening complications, which may lead to poor prognosis. To investigate the method of in situ bone flap combined with nasal septum mucosal flap for reconstruction of enlarged skull base defect by endonasal sphenoidal approach and to discuss its application effect. Clinical data of 24 patients undergoing transnasal sphenoidal endoscopic approach in the Department of Neurosurgery, Affiliated 2 Hospital of Nantong University from January 2019 to December 2022 were retrospectively analyzed. All patients underwent multi-layer reconstruction of skull base using in situ bone flap combined with nasal septum mucosa flap. The incidence of intraoperative and postoperative cerebrospinal fluid leakage and intracranial infection were analyzed, and the application effect and technical key points of in situ bone flap combined with nasal septum mucosa flap for skull base bone reconstruction were analyzed. There were 5 cases of high flow cerebrospinal fluid (CSF) leakage and 7 cases of low flow CSF leakage. Postoperative cerebrospinal fluid leakage occurred in 2 patients (8.3%) and intracranial infection in 2 patients (8.3%), which were cured after strict bed rest, continuous drainage of lumbar cistern combined with antibiotic treatment, and no secondary surgical repair was required. The patients were followed up for 8 to 36 months after the operation, and no delayed cerebrospinal fluid leakage or intracranial infection occurred during the follow-up. Computed tomography reconstruction of skull base showed satisfactory reconstruction after surgery. The use of in situ bone flap combined with vascular pedicled mucous flap to reconstruction of skull base defect after endonasal sphenoidal approach under neuroendoscopy has a lower incidence of cerebrospinal fluid leakage and lower complications, which has certain advantages and is worthy of clinical promotion.

MINIMAL INVASIVE SURGICAL METHODS FOR TREATMENT OF CHRONIC PERFORATED SINUSITIS

MINIMAL INVASIVE SURGICAL METHODS FOR TREATMENT OF CHRONIC PERFORATED SINUSITIS

Comparative analysis of treatment of patients with chronic dacryocystitis in early and late postoperative periods

Chronic dacryocystitis (CD) is a common pathology of the lacrimal ducts. The search for the optimal method of endonasal endoscopic dacryocystorhinostomy (EEDCR), which would give a quick, high-quality and lasting effect, as well as a lower percentage of disease relapses, remains relevant. The aim: to analyze the effectiveness of treatment of patients with chronic dacryocystitis in the early and late postoperative periods with the use of various modifications of EEDCR. Materials and methods: The study group (1st group) consisted of 45 patients with CD, who underwent EED-CR according to the developed method, the comparison group (2nd group) included 36 patients who, after performing the developed EEDCRa polyvinyl chloride (PVC) conductor was installed in the area of the dacryorhinostoma. The control group (3rd group) included 28 patients who underwent EEDCR according to the generally accepted method: with preservation and plastic placement of mucous flaps and with the installation of a PVC conductor. Patients of 1stand 2nd groups were divided into 2 subgroups: 1A and 2A included patients who underwent computed tomography of the lacrimal ducts in the preoperative period according to the developed method, and patients of subgroups 1B and 2B – according to the traditional algorithm. In the postoperative period, the severity of lacrimation was assessed according to the Munk scale, the degree of visualization of the dacryorhinostoma was determined, and the lacrimal function was investigated by advanced West nasolacrimal test under endoscopic control. The final treatment efficacy was assessed 1 year after surgery. Results: The best results when tested according to the Munk scale were recorded in subgroups 1A and 1B with a statistically significant difference from subgroups 2A, 2B and 3rd group throughout the early postoperative period and 1 month after surgery (p<0.05).During the observation period of 3, 6 and 12 months, that is, after the removal of the implant from the lacrimal ducts, there was an improvement in the results in patients of subgroups 2A, 2B and 3rd group, and the difference from subgroups 1A and 1B was statistically insignificant (p>0.05).In the early postoperative period, visualization of the dacryorhinostoma was good in all patients. In the late postoperative period, the best results were in subgroup 1A, the worst in 3rd group, but without a statistically significant difference due to a small sample of patients (p>0.05).Reliably better results of the lacrimal function were obtained in subgroups 1A and 1B already from the 3rd day after surgery, as well as in the subsequent periods of the early postoperative period and 1 month after surgery (p<0.05).In subsequent periods of the late postoperative period, this indicator worsened in all clinical groups, the best results were in subgroup 1A, the worst in 3rd group, but due to a small sample of patients, there was no statistically significant difference (p>0.05).The maximum paces of deterioration in visualization of dacryorhinostoma and lacrimal function were observed from the 3rd to 6th months after the operation. The proportion of positive treatment results in 1st group was 97.8%, in 2nd group – 94.4%, and in 3rd group – 85.7%, while the difference between groups 1 and 3 was statistically significant (p<0,05). Conclusions: The developed technique of endonasal endoscopic dacryocystorhinostomy allows achieving stable remission in 97.8% of patients with chronic dacryocystitis, and the use of CT of the lacrimal ducts according to the developed technique allows to improve the results of surgical treatment.

COMPLICATIONS IN SURGICAL TREATMENT OF PATIENTS WITH CHRONIC DACRYOCYSTITIS

Relevance. Effective treatment of chronic dacryocystitis (CD) remains an urgent problem of modern ophthalmology and rhinology. When studying this issue, not enough attention is always paid to complications.
 Objective – to analyze the existing complications in the surgical treatment of patients with СD.
 Material and methods. The study group (1st group) consisted of 45 patients with CD, who underwent endonasal endoscopic dacryocystorhinostomy (EEDCR) according to the developed own method, the comparison group (2nd group) included 36 patients who after performing the developed EEDCR a polyvinyl chloride (PVC) conductor was installed in the area of the dacryorhinostoma. The control group (3rd group) included 28 patients who underwent EEDCR according to the traditional method: with the preservation and plastic placement of mucous flaps and with the installation of PVC-conductor. Patients of the 1st and 2nd groups were divided into 2 subgroups: 1A and 2A included patients who underwent computed tomography (CT) of the lacrimal ducts in the preoperative period according to the developed method and patients of subgroups 1B and 2B – according to the traditional algorithm. Statistical analysis was performed using the licensed program MedCalc (MedCalc Software bvba, Ostend, Belgium; 2017).
 Results. In patients of subgroups 2A, 2B, and group 3 in the period of 1.5 months after surgery, local complications of the eyeball were recorded: epiphora during implant wearing, severe conjunctivitis, prolapse and displacement of the implant, granulation in the lower lacrimal duct, ectopia of the lower lacrimal point. No such complications were observed in patients of subgroups 1A and 1B. In patients of subgroups 1B, 2B, and group 3 in the early postoperative period were recorded varying degrees of swelling of the lower eyelid, as well as nosebleeds after removal of tampons. No such complications were observed in patients of subgroups 1A and 2A, and the difference between the groups was statistically significant (p <0.05).
 Conclusion. CT of the lacrimal ducts and EEDCR according to the developed methods are effective and allow their combined use to avoid local complications from the nasal cavity and eyeball.

Single-stage feminization genitoplasty in girls with congenital adrenal hyperplasia in infancy

Introduction. Single-stage feminization genitoplasty under the age of 12 months is recommended by the international consensus on the treatment of girls with congenital adrenal hyperplasia (CAH).The study objective is to evaluate the results of feminization plasty of the external genitals in infancy.Materials and methods. The single-stage feminization genitoplasty results is performed in 11 patients from 6 to 18 months age old with various forms of CAH. The single-stage feminization surgery included clitoroplasty with preservation of the head, dorsal neurovascular bundle, labioplasty and various forms of introitoplasty depending on the level of hypospadias.Results. Recurrence of hypospadias and urethro-vaginal fistula were obtained in 3 (36 %) girls. Given the structural features of the small pelvis in girls at infancy and early age, a good result of single-stage feminization genitoplasty is possible when using an apron-shaped mucous flap with mild and middle hypospadias and urogenital mobilization with severe hypospadias in combination with prolonged glucoand mineralocorticoid compensation of CAH.Conclusion. Indications for single-stage feminization genitoplasty, given the large percentage of complications, should be placed with extreme caution. Surgical intervention is justified in case of recurrent urinary tract infection and dysfunctional urination.The authors declare no conflict of interest.There is given the parental informed consent to the children’s participation in the study.

PECULIARITIES OF THE MORPHOLOGICAL STRUCTURE OF THE ORAL MUCOSA FLAPS DURING REST AND STRETCHING

In modern dental practice, there is a tendency towards correction of secondary adentia by using bone augmentation and dental implant placement. One of the main types of postoperative complications is the bone augmentation exposure and its infection as a result of ischemic processes in the mucous flap, which covers the augmentation, resulting from its overstretching. This study was aimed at improving the efficiency of flap operations and bone augmentation in patients with secondary adentia and reducing the risk of postoperative complications caused by ischemic changes in mucous flaps due to their overstretching, identifying features of the morphological structure of mucous flaps at rest and stretching. We conducted an investigation of mucosa flap microslides of 40 laboratory rabbits taken from the lower alveolar bone. The preparations were stained according to Van Gieson's technique with haematoxylin and eosin at low magnifications of the light microscope. The structural features of the mucous membrane of the upper and lower alveolar processes after stretching within 5% revealed minimal, slightly differed from the intact mucosa of the corresponding anatomical region. Thus, in the epithelium, the basal, intermediate, and superficial layers were located one above the other; their structural organization was mainly the same as in the intact animals. Our studies have shown that the morphological structure of the mucous membrane of the gums of laboratory rabbits is similar to the structure of human gums. The data obtained suggests that stretching of the gingival mucosa flaps when performing flap operations in the oral cavity within 5% of the initial length is morphologically substantiated and can cause no complications.

The advantages of using auto-fat tissue in the reconstruction of defects of the skull base in patients with CSF leak

Relevance: At present, the method of repair of the cerebrospinal fluid fistula using mucous flaps according to the “overlay” technique is widely used in the reconstruction of the skull base and is generally accepted. We have developed an original method for reconstructing defects of the skull base in the presence of a cerebrospinal fluid fistula, using an auto-fat tissue and placing it in two layers. Objectives: To conduct a comparative assessment of methods for the reconstruction of the skull base defect in patients with CSF leak using endoscopic endonasal approach. Materials and methods: Under our supervision there were 46 patients with CSF leak. Depending on the technique of cerebrospinal fluid fistula repair, all patients were divided into 2 groups. The first group of 20 patients consisted of patients who underwent surgery with auto-fat tissue according to our proposed technique. The second group - 26 patients were patients who underwent repair of the skull base defect using the standard overlay technique - a mucous flap on the feeding vascular pedicle. The criterion for evaluating the effectiveness of surgical treatment was patient complaints and data from objective research methods (endoscopic examination of the nasal cavity). Results: After 3 months after surgical treatment, a patient of group 1 had a recurrence of liquorrhea, patients of group 2 after 3 months had a recurrence of liquorrhea in 3 patients, after 6 months in 2 patients of group 2 there was a recurrence of liquorrhea. Findings: When the size of the bone defect of the base of the skull is up to 0.6 cm, the original technique proposed by us for plastics of the cerebrospinal fluid fistula with an auto-fat tissue in two layers provides a tight closure of the bone defect and the defect of the dura mater. When using this method of plastics, the risk of the development of a recurrence of CSF leak is significantly reduced in comparison with the plastics of the cerebrospinal fluid fistula with the use of overlay grafts.

Anatomical closure technique of the nasal floor for patients with complete unilateral cleft lip and palate

We describe a new technique for the reconstruction of the nasal floor at the same time as cheiloplasty in patients with complete unilateral cleft lip and palate. We operated on patients aged between 3 and 36 months in public secondary and tertiary level institutions. None of these patients had had a previous operation for the correction of the cleft lip or palate. The operation required the design of two mucous flaps, one lateral and one medial to the defect, to reposition the tissues anatomically and repair the congenital deficiency. Three hundred and fifty-eight patients have been treated using this technique, most of whom (n = 233, 65%) were boys, and 288 (80%) presented with a right complete unilateral cleft. Postoperative evaluation showed that 22 patients (6%) had asymmetry of the nasal base equal to or less than 1 mm, 18 (5%) had nasovestibular fistulas, and 5 (1%) required revision. We conclude that this technique greatly reduces the number of asymmetrical nasal floors and the incidence of nasovestibular fistulas.

Functional reconstruction of total lower lip defect with mental neurovascular V-Y advancement island flap.

To introduce a method of functional reconstruction for total lower lip defects. Six patients with lower lip cancer were treated by surgery from November 2007 to February 2009. The full thickness defects with a size from eighty percent to total lower lip were reconstructed with two triangular mental neurovascular island flaps of chin. The musculocutaneous and mucous flaps with neurovascular pedicles were advanced in a V-Y manner to close the defect and reconstruct the orbicularis oris muscle. All flaps survived and no recurrence and complication were observed and showed excellent cosmetic and functional results over 6 months of follow-up. The reconstructed lower lips provided a wide-enough mouth opening, and the sensation of oral mucosa and the muscle function of oral sphincter were preserved. The technique of mental neurovascular V-Y advancement island flap can get satisfactory results in both functional and the aesthetic perspects.

Mucous-Flap Method for Cleft-Lip Revision Using Transverse Everted Full-Length Lower-Lip Flap

In patients who had undergone the first surgery for cleft lip and in whom the volume of tissue was smaller for the upper lip than for the lower lip, transfer of tissue from the lower lip using a full-length mucous flap allowed the tissue volume of the upper lip to be increased and external appearance of the lips to be improved. The subjects of this study were 6 patients who underwent this surgery between February and September 2001 and were followed for up to 3 years postoperatively. This surgery can be performed under topical anesthesia, without necessitating restriction on mouth opening and oral ingestion. Furthermore, it allows easy adjustment of the tissue volume in both upper and lower lips. This operative procedure is recommended for cases of cleft lip where surgical treatment has been performed before and the tissue volume is smaller in the upper prolabium than in the vermilion.

甲状腺弁による喉頭部分切除後の声門再建

Various surgical procedures such as mucous flaps, skin flaps and muscle flaps have been designed for glottic reconstruction following vertical partial laryngectomy. In order to obtain a good phonatory function, adequate glottic closure during phonatoon is necessary. A thyroid gland flap was devised and applied clinically to a case. This new surgical technique is described in this paper.The upper pole of the thyroid gland was dissected and elevated together with the superior thyroid artery and vein so as to make a thyroid flap. After removal of the cancerous lesion by vertical partial laryngectomy, the flap was placed in the wound to compensate for the loss of bulk and relined by an island cervical skin flap. Good phonatory function was obtained without any disturbance of respiration and deglutition.The thyroid gland flap can be adjusted to the size of the defect, easily placed in the larynx, and is less likely to shrink than other flaps because of its abundant blood suply. Therefore, the flap was assumed to be suitable to reconstruct the glottis after vertical partial laryngectomy.

Histologische Untersuchungen �ber die Einheilung freier Mundschleimhaut-Transplantate im Glottisbereich

In more than 50 oases of grafting free oral mucous flaps for glottic reconstruction we never found bad clinical results of healing.

ON THE USE OF EPITHELIAL GRAFTS FOR REPLACING THE OCULAR CONJUNCTIVA.

The unsatisfactory results obtained by the transplantation of rabbit's conjunctiva upon the eyeball, the laborious work of freeing from all shreds of submucous tissue the mucous flaps cut out with scissors or scalpels; and on the other hand, the ease with which Thiersch's skin grafts can be obtained and the certainty with which they grow in their new bed, have induced me many years ago to make use of Thiersch's grafts in operations for pterygium, symblepharon and other conditions where it was desirable to replace lost conjunctiva. The results obtained by these operations were very satisfactory; the grafts answered the purpose for which they were implanted; in many instances they became after some time as smooth and glossy as the surrounding conjunctiva; and though in other cases they continued producing a white coating of epidermis cells, I have never found this condition to cause any irritation. Still I have always