METHOD FOR SURGICAL TREATMENT OF ORAL CANCER WITH FUNCTIONAL RECONSTRUCTION Russian patent published in 2023 - IPC A61B17/24 

FIELD: medicine; reconstructive surgery; oncology.

SUBSTANCE: invention relates to medicine, specifically to reconstructive surgery and oncology and was designed for use in oral cavity and tongue tissue repair after the oncological phase of surgery and subsequent rehabilitation. Measure the length of the tongue from its tip to the root (x) and the distance between the right and left central molars of the lower jaw (y) at the preoperative stage. Organize parallel operation of two surgical teams - team No. 1 and team No. 2. Team No. 1 performs surgery on the head and neck. At the same time, perform lymph node dissection precisely with preservation of great auricular nerve, descending branch of the hypoglossal nerve, common, external and internal carotid arteries, internal jugular vein and its branches. At the same time, team No. 2 is performing surgery on the left thigh. Take musculocutaneous flap from the anterolateral surface of the thigh. For this purpose draw flap form interoperatively on sterile paper. In this case, the form has rectangular shape: the width ab corresponds to the length of the resected tongue x with addition of 20% of the length, the length bc is calculated using the formula bc=2.6⋅ y, where y is the distance between the right and left central molars of the low jaw. Place the prepared form on the anterolateral surface of the left thigh. Mark projection of the ground neurovascular bundle course over the form. Perform steps of isolating rectangular-shaped musculoskeletal flap with vascular-muscular pedicle with inclusion of two nerves: motor branch of the femoral nerve and saphenous thigh nerve. Next, the teams change surgical areas. Team No. 1 closes the donor wound in layers, fix two drains with active aspiration into the intermuscular and subcutaneous spaces. Team No. 2 prepares the flap. The flap is given the shape of complex three-dimensional geometric figure that combines cone as tip of the tongue, and half-cylinder as body of the tongue. The cone is formed with symmetrical wedge-shaped de-epidermization of the lateral rectangular triangles of the flap with angle of 22.5°. At the same time: in case of oral cavity damage predominantly on the right, connect points ad, in case of oral cavity damage predominantly on the left connect points bc. Then place the flap in the area of repaired defect in the oral cavity. Fix the flap at the base of lower alveolar ridge at two opposite points, place the vascular pedicle on the neck. Then, perform end-to-side arterial anastomosis of the donor descending branch of the lateral circumflex femoral artery to the recipient external carotid artery with Prolene 8/0 thread under microscopic magnification. Perform two venous anastomoses of the flap comitant veins to the internal jugular vein "end to side" or to the branches of the internal jugular vein "end to end" with Prolen 8/0 thread. Perform two epiperineural anastomoses of the donor femoral nerve motor branch to the recipient descending branch of the hypoglossal nerve and the donor saphenous thigh nerve to the proximal end of the great auricular nerve with Prolen 9/0 thread under microscopic magnification. Perform electrical stimulation of the great auricular nerve below the neural anastomosis zone in the postoperative period once a day with a frequency of 50 Hz, duration of 20 μs and a current of 30-40 mA for 10 minutes.

EFFECT: method allows to repair tissues of the oral cavity and tongue after the oncological stage of the surgery, to achieve an adequate recovery of swallowing and speech production functions, and to shorten the operative time.

1 cl, 2 dwg, 2 ex