METHOD FOR REPLACEMENT OF CONJUNCTIVAL DEFECTS (VARIANTS) Russian patent published in 2021 - IPC A61F9/07 

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely ophthalmology, maxillofacial and plastic surgery. Dissection and excision of scar tissue are performed and the graft is placed on the palpebral and/or bulbar wound surface and the wound surface of the bottom of the conjunctival cavity. After dissection and excision of scars and the formation of the musculoskeletal layer of the eyelid, the true size and configuration of the defect zone are determined, according to which at least one template is made from a sterile film or tissue so as to cover the entire defect zone. If the template exceeds the size of the hole of the terminal clamp used for cutting out grafts, it is divided into parts so that each of the parts does not exceed the size of the hole of the terminal clamp, according to which the necessary number of autografts are cut out to cover the entire area of the defect of the palpebral and bulbar conjunctiva. At the same time, each autograft should not go beyond the opening of the final clamp used and should correspond to the size and shape of the template according to which it was made; the cutting of autografts begins in the upper or lower lip area. Then the final clamp is sequentially applied to the cheek and to the opposite lip, leaving gaps with intact mucous membrane between the sites of removal of autografts, while with the eye intact, two types of autografts are cut out to replace defects in the palpebral and bulbar conjunctiva: split and full-layered; split autografts are fixed to the edges of the main or residual defect and to the episclera of the eyeball over the entire area and in the area of the conjunctival arch being formed at a distance of 12-15 mm from the limb with U-shaped sutures, and full-layer autografts are fixed to the costal edge of the eyelid and the edges of the main or residual defect of the palpebral conjunctiva with nodular sutures. In the area of the arch of the upper eyelid being formed, retreating by 13-20 mm, and the lower eyelid retreating by 9-10 mm from the free edge, full-layer autografts are fixed with U-shaped sutures brought to the surface of the skin and tied over compression plates. If several autografts of the same name are used, implanted with adjacency to each other, they are fixed at the sites of adjacency to each other, and dissimilar autografts fixed on the inner surface of the eyelid and fixed to the episclera, respectively, are not stitched together, or dissection and excision of scar tissue and graft laying on the palpebral and bulbar wound surface or wound surface of the bottom of the conjunctival cavity are performed. At the same time, after dissection and excision of scars and the formation of the musculoskeletal layer of the eyelid, the true size and configuration of the defect zone are determined, according to which at least one template is made from a sterile film or tissue so as to cover the entire defect zone, while if the template exceeds the size of the hole of the terminal clamp used for cutting out grafts, it is divided into parts so that each of the parts does not exceed the size of the hole of the terminal clamp, according to which the required number of autografts are cut out, to close the entire area of the defect of the palpebral and/or bulbar conjunctiva. Each autograft should not extend beyond the opening of the final clamp used and should correspond to the size and shape of the template according to which it was made. The cutting out of autografts begins in the upper or lower lip area. Then, the final clamp is applied sequentially to the cheek and to the opposite lip, leaving gaps with intact mucous membrane between the sites of removal of autografts, while in the absence of an eyeball, only full-layer autografts are used. In the area of defects of the palpebral conjunctiva, full-layer autografts are fixed in the same way as with a preserved eye, and in the area of the bottom of the conjunctival cavity - to the edges of the main or residual defect and over the entire area with U-shaped sutures to the soft tissues of the formed bottom of the conjunctival cavity, and their edges with U-shaped sutures conducted through the future conjunctival arch, retreating 1-2 mm from the edge of the autograft fixed in the area of the defect of the palpebral conjunctiva, brought to the skin and conducted through the holes of compression plates, while full-layer autografts fixed on the inner surface of the eyelid and fixed in the area of the bottom of the formed conjunctival cavity, located with an offset relative to each other in the area of the conjunctival arch being formed, they are not stitched together; then a conformer or an ocular cosmetic prosthesis is installed intraoperatively into the formed cavity.

EFFECT: method makes it possible, without donors’ damage, to obtain stable results when replacing conjunctival defects with the formation of conjunctival arches in patients with severe anatomical disorders: with partial or complete ablepharia with a preserved eye, as well as with defects and /or overgrowth of the conjunctival cavity in the absence of an eye, while covering extensive and multiple defects of the palpebral and bulbar conjunctiva or conjunctiva of the bottom of the conjunctival cavity with their own tissues, optimally suitable in properties and thickness to the recipient area tissues.

3 cl, 2 dwg, 2 ex