DOI: https://doi.org/10.25305/unj.160502

A new way of plastic replacement of the skin defects in the surgical treatment of malignant extracerebral tumors located at the midline of the head

Michail S. Kvasha, Tengiz A. Morozov

Abstract


The wide incision of malignant extracerebral tumors of the skin located at the middle line of the head is often associated with a problem of closing the emerged defect. Local tissues are not sufficient and the implementation of free plastic is not desirable due to the unfavorable conditions for the free flap survival, due to the features of the graft bed and the difficulty of immobilization and fixation of the flap. We have developed the method for closing the wound of the middle line of the head, which is based on the use of four adjacent symmetrical flaps. Flaps are cut in the directions of greatest mobility and elongation of the skin of the head, the movement of which is angled to the direction of the greatest elongation of the skin of the arch of the skull, taking into account the branching of the blood supplying (nourishing) branches of the superficial temporal arteries of the head. Due to the proposed method, it becomes possible to close the defect of the skin of the middle line of the head cosmetically and most aesthetically and at the earliest, taking into account the blood supply and areas of innervation of this damaged area of the head. The advantage of using four relatively small skin flaps on a wide basis, taking into account the areas of blood supply and innervation compared to one or two large rotary flaps is that the smaller length of the flap creates more favorable conditions for preserving their blood supply, innervation and for the healing of the wound.


Keywords


malignant tumors; skin of the head; skin defects; surgical treatment; grafting

References


1. Belousov AE, Kuprin PE. Zazhivlenie rany i optimal’nyy rubets. In: Belousov AE. Plasticheskaya, rekonstruktivnaya i esteticheskaya khirurgiya. St. Petersburg: Gippokrat; 1998. p.106-114. Russian.

2. Zoltan Ya. Peresadka kozhi. Budapesht; 1984. 303 p. Russian.

3. Limberg AA. Planirovanie mestnoplasticheskikh operatsiy na poverkhnosti tela. Teoriya i praktika. Rukovodstvo dlya khirurgov. Leningrad: Medgiz; 1963. 595 p. Russian.

4. Mikhnin AE, inventor; FGBU «NII onkologii im. N.N. Petrova» Minzdravsotsrazvitiya Rossii (RU), assignee. Sposob plasticheskogo zameshcheniya defektov kozhi dvumya smezhnymi rotatsionnymi loskutami. Patent RF № 2460472. 2012 sent. 10. Russian.

5. Tigliev GS, Olyushin VE, Kondrat’ev AN. Vnutricherepnye meningiomy. St. Petersburg: Izd. RKhNI im. prof. A.L. Polenova; 2001. 560 p. Russian.

6. Yusevich MS. Amputatsii i protezirovanie. Leningrad; 1946. 168 s. Russian.

7. Avetikov DS. Methods of acceleration of peripheral neovascular revascularization of angiosomal shreds and autotransplants. Bulletin of Biology and Medicine. 2005;(2):42-44. Ukrainian.

8. Gorbunova VA. [New approaches in the treatment of soft tissue sarcomas]. Sarkomy kostey myagkikh tkaney i opukholi kozhi. 2009;(1):38-47. Russian.

9. Zozulya YuA, Vysotskiy NS, Kvasha MS, Kondratyuk VV, Sambor VK. Reconstructive and renewing operations results at locally spread extracerebral tumors of facial and cerebral cranial. Ukrainian Neurosurgical Journal. 2010;(2):34-38. Russian. [CrossRef]

10. Paches AI. Opukholi golovy i shei: ruk. Moscow: Prakticheskaya meditsina; 2013. 478 p. Russian.

11. Cohen PR, Schulze KE, Nelson BR. Basal cell carcinoma with mixed histology: a possible pathogenesis for recurrent skin cancer. Dermatol Surg. 2006 Apr;32(4):542-51. [CrossRef] [PubMed]

12. Kvasha MS, Zhernov AA, Molotkovets VY, Kvasha EM, Ukrainets OV, Dashchakovskyi AV, Mosiychuk SS. Reconstruction of complex soft tissues defects of the cranial vault in neurooncological patients. Ukrainian Neurosurgical Journal. 2017;(3):24-29. Ukrainian. [CrossRef]

13. Matyakin E.G. Rekonstruktivnye operatsii pri opukholyakh golovy i shei. Moscow: Verdana; 2009. 224 p. Russian.

14. Sedik N, Lourens N, Moy R, Khirsh RDzh. Kosmeticheskaya khirurgiya kozhi. Moscow: MEDpress-inform; 2009. 144 p. Russian.

15. Sherris DA, Larrabi UF. Rekonstruktivnaya plasticheskaya khirurgiya litsa: Differentsirovannyy podkhod s uchetom osobennostey esteticheskikh sub»edinits. Moscow: MED press-inform; 2015. 320 p. Russian.

16. Pompucci A, Rea G, Farallo E, Salgarello M, Campanella A, Fernandez E. Combined treatment of advanced stages of recurrent skin cancer of the head. J Neurosurg. 2004 Apr;100(4):652-8. [CrossRef] [PubMed]


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