METHOD FOR ORBITO-ORO-FACIAL DEFECTS SUBSTITUTION WITH COMPLEX-COMPONENT FLAP WITH ONE-MOMENT RECONSTRUCTION OF ORBIT LOWER WALL Russian patent published in 2017 - IPC A61F9/00 A61B17/00 

FIELD: medicine.

SUBSTANCE: necessary size and shape of the transplant are determined, a combined musculoskeletal flap consisting of two fragments is formed on a single vascular pedicle - thorocodorsal artery and vein, including: a fragment of the back latissimus muscle with a skin pad and a fragment of the scalenus with a skin pad and a rib fragment. The vascular pedicle of the formed flap is clipped and traversed, the flap is transferred to the defect zone of the orbito-oro-facial area, hard palate integrity is restored by the cutaneous muscle flap, the alveolar process of the upper jaw and the facial flora of the face are restored by the musculoskeletal portion of the flap, the vascular pedicle of the flap is directed in the subcutaneous tunnel of the cheek. Vascular anastomoses are formed between the thorocodorsal vein and the external jugular vein end-to-end, and between the thoracodorsal artery of the flap and the external carotid artery end-to-end. The donor wound on the chest wall is sutured. Modeling of the titanium mesh graft of the lower orbit wall is performed, the implant is placed in the lower orbit wall position, fixed to the nasal bone and the lateral wall of the orbit by titanium mini-screws. A free cortical bone autograft is formed from the parietal bone, one fragment is placed over the titanium graft and the lower orbit wall is reconstructed, the second is placed under the titanium graft and the anterior superior wall of the maxillary sinus is reconstructed. A fat flap is formed from the fat portion of the autotransplanted musculoskeletal flap, which is moved to the mesh implant area.

EFFECT: method allows to eliminate a complex end-to-end defect in the maxillofacial region with simultaneous elimination of a defect in the oral cavity, upper jaw, facial flora of the face and the lower orbit wall.

9 dwg, 1 ex