METHOD FOR ELIMINATING PARALYSIS OF FACIAL MUSCLES Russian patent published in 2021 - IPC A61B17/42 

FIELD: medicine, plastic surgery.

SUBSTANCE: invention relates to medicine, namely to plastic surgery. On the side of the lesion, an arcuate incision is made, starting from the hairy part of the temporal region, continuing in the anterior region anteriorly from the tragus, skirting the earlobe, then passing horizontally in the posterior region and descending along the projection of the anterior edge of the nodding muscle, with a total length of up to 15 cm. Next, the skin-fat flap is mobilized, and they pass into the area of the nasolabial fold. A bed for an autograft is formed in the nasolabial fold, upper and lower lips, and recipient vessels: the facial artery and vein-are isolated at the anterior edge of the masticatory muscle. The sublingual nerve is isolated in the submandibular region. On the healthy side, an anterior incision is made, a skin-fat flap is mobilized, the buccal branch of the facial nerve is isolated, and then an autograft of the sural nerve is taken. Next, an autograft of the sural nerve is brought with the help of a neural conductor from injections from the vestibular surface of the upper lip from the healthy side to the hyoid nerve on the affected side; the previously performed autograft of the sural nerve is sewn to the buccal branch of the facial nerve of the healthy side; then, a gracilis muscle graft is taken by performing a linear incision of the skin, subcutaneous fat on the medial surface of the upper third of the thigh with a length of 11 cm, a gracilis muscle is isolated on the upper neurovascular bundle, represented by branches of the middle femoral artery and vein, the anterior branch of the obturator nerve. Next, a longitudinal cleavage of the gracilis muscle is performed along the fibers from the contralateral side from the point of entry of the neurovascular bundle, the muscle is stitched with U-shaped sutures and a transverse dissection of the muscle is performed distal to the vascular pedicle between the distal and middle third. Also, in the proximal part, the gracilis muscle is stitched with U-shaped sutures and cut off immediately after its tendon departs from the pubic symphysis with the formation of stumps for the upper and lower lip and modiolus. Then the vascular pedicle is legated and the nerve in the proximal part is cut off, the flap is cut off and transferred to the recipient zone on the face in the previously prepared autograft bed, the wound edges in the donor area are compared, sutured in layers. The gracilis muscle autograft is placed in a prepared bed in the recipient zone and fixed to the zygomatic arch and the superficial temporal fascia, the second end in the area of the commissura of the mouth, upper and lower lips. Next, the autograft of the gracilis muscle is revascularized by applying vascular anastomoses between the autograft artery and the facial artery in the “end-to-end” way and between the autograft vein and the facial vein in the “end-to-end” way. Reinnervation of the gracilis muscle autograft is performed by applying a nerve anastomosis: the distal end of the cross-facial autograft, the proximal end of the crossed fascicles of the hyoid nerve and the muscle nerve are compared, neurography is performed according to the “two ends to the end” type, stitching the distal end of the cross-facial autograft, the proximal end of the crossed fascicles of the hyoid nerve with the proximal end of the obturator nerve of the gracilis muscle, the wound edges are compared, they are sutured in layers.

EFFECT: method makes it possible to obtain satisfactory functional results due to synchronous contractions of the autograft of the gracilis muscle with the healthy side and its sufficient excursion.

1 cl, 1 ex, 2 dwg