METHOD FOR ELIMINATION OF EXTENSIVE HARD PALATE DEFECT Russian patent published in 2020 - IPC A61B17/00 

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to maxillofacial surgery, and is applicable for elimination of extensive hard palate defect. Mucous membrane of the oral cavity is incised by 0.8–1.2 cm from the bony edges of the extensive hard palate defect on both sides, two mucous flaps are separated and cut out, which are tilted to the center of extensive hard palate defect, brought together and fixed with each other with the help of suture material. Access to recipient vessels – facial artery, facial and submental veins is performed through an incision of skin, subcutaneous fat, intrinsic fascia of neck in submandibular area, along upper neck fold. Recipient vessels are separated and transected. Tunnel is formed in a submucosal layer extending from the soft palate further parallel the wing-mandibular fold along an inner surface of the lateral mandibular side anterior to the projection of the anterior border of the masseter in the submandibular region. At preoperative preparation stage, preliminary projection of medial gastrocnemius artery is pre-marked, required shape and area of skin-fascial medial gastrocnemius autograft taking into account extensive hard palate defect in recipient area. Dissecting of skin-fascial medial gastrocnemius autograft on vascular pedicle – medial iliac artery and veins start with anterior approach. Skin and subcutaneous fat are incised along the medial border of the skin-fascial medial gastrocnemius autograft. Dissection is performed until a medial gastrocnemius artery is detected. Then, the fascia of the shin is dissected; along the direction of the medial gastrocnemius artery, it is released from the medial gastrocnemius muscle by intramuscular dissection. Small vascular perforators are alloyed and crossed during preparation. Dissection is continued in the proximal direction to the level of the projection of the popliteal fossa, where the mouth of the medial gastrocnemius artery is visualized in the popliteal artery. That is followed by a semi-oval incision of skin, subcutaneous fat and shin fascia preserving the vascular pedicle to extend it into a lateral border of a skin-fascial medial gastrocnemius autograft. Skin-fascial medial gastrocnemius autograft is modeled on a vascular pedicle with respect to the area and shape of the extensive hard palate defect. Vascular pedicle of the skin-fascial medial gastrocnemius autograft in the popliteal artery is excised by pre-ligating. Postoperative wound is closed in the donor zone. Vascular pedicle of the skin-fascial medial gastrocnemius autograft is inserted through a tunnel formed in the submucosal layer into a submandibular region. Skin-fascial medial gastrocnemius autograft on the vascular pedicle is fixed in the previously formed receptor bed to the mucous flaps by U-sutures. Using the microsurgical technique, the dermal-fascial medial gastrocnemius autograft is revascularized by imposing vascular anastomoses between the medial and frontal arteries, as well as by the medial gastrocnemius veins and the facial and submental veins in the submandibular region. Wounds are layer-by-layer closed in layers.

EFFECT: method enables reducing autograft autopsy injury, improving functional and aesthetic effects in donor area due to simpler anatomy of shin, defect closure of donor area without using splitted skin autograft and expanders, as well as location of donor area in less significant aesthetic zone.

1 cl, 5 dwg, 2 ex