METHOD FOR CARRYING OUT AUTOLYPOFASCIOMUSCULAR RECOVERY PLASTIC REPAIR OF CICATRICIALLY SHRUNK RADIATION-EXPOSED ANOPHTHALMIC ORBIT

摘要

FIELD: medicine.;SUBSTANCE: method involves making skin incision 4 cm far behind the hair growth line. Skin flap is detached in a way that subcutaneous fat cell layer containing horizontal lymphatic and superficial arteriovenous network, remains on internal skin flap surface. The main subcutaneous fat cell layer, having vertical network of perforated blood vessels and deep arteriovenous network, is retained on the superficial leaflet of temporal fascia named fascia temporalis lamina superficialis. Skin flap detachment is carried out to lateral eyelid attachment and continued with its subperiosteal dissection. Orbit tissues are hydroseparated with orbicular muscle and tarsal eyelid plates. Oval subcutaneous autolypofasciomuscular flap with feeding pedicle is cut out in temporal region. Autolypofasciomuscular flap is stratified into two leaflets. The first leaflet having subcutaneous fat cell layer and superficial temporal fascia leaflet named fascia temporalis lamina superficialis is overthrown into the orbit over the feeding pedicle under the lateral eyelid ligament. The superficial temporal fascia leaflet is turned towards the internal eyelid surface under operation, the subcutaneous fat cell layer being turned towards the anophthalmic orbit surface under operation. The first leaflet is sutured to medial eyelid ligament region with U-shaped suture. Rectangular latex endoexpander Π(20x13) 5/20 is mounted on the superficial temporal fascia leaflet. Then the second superficial temporal fascia leaflet is also overthrown into the anophthalmic orbit surface, but it is brought above the lateral eyelid ligament, filling the operation surface with muscle of m.temporalis pars supeficialis and turning the deep temporal fascia leaflet of fascia temporalis lamina profunda towards the latex endoexpander. The whole second leaflet is sutured with mattress sutured all over the whole perimeter to orbicular round muscle of eyelid. Dosed staged dermotension is carried out to achieve 3-fold volume growth of orbital latex endoexpander. Blepharopharia sutures are taken off after having achieved maximum volume. The formed radiation-exposed anophthalmic orbit cavity is provided with prosthesis appliance. To cut out the subcutaneous autolypofasciomuscular flap, oval template is used, its vertical dimension corresponding to distance between inferior to superior orbit bone edge. The greater horizontal oval template size corresponds to distance from medial to lateral orbit edge.;EFFECT: one stage recovery of lost tissue volume and cosmetic eye prosthesis cavity; reduced risk of traumatic operation zone infection; accelerated treatment course.;2 cl, 3 dwg