OPTIMIZATION OF OPERATIVE ACCESSORIES OF MAXILLOFACIAL LOCALIZATION: REVIEW OF LITERATURE

Abstract

The article presents the analysis of literary sources concerning the features of the operative access of maxillofacial localization. The established the stress and relaxation lines of skin in different topographical and anatomical areas are indicated. Defects and deformities of the maxillofacial localization are an important and widespread problem of modern medicine. The significant increase in the number of patients with such pathologies causes the rapid development of reconstructive-restorative surgery of the maxillofacial area. An important problem in this section of medical science is the necessary to consider the aesthetic component during planning and conducting surgical treatment. Therefore, the study of ways to make the most optimal incisions is an urgent need. It is well known that the closure of wounds at the lowest tension leads to the best result. It is characterized by faster wound healing and reduced risk of pathological scarring. In this case, the lines of incisions lead to the lowest tension are often contradictory. Langer’s lines, which are widely used in the planning of surgical access in various topographic-anatomical areas of the head and neck, are lines of skin tension. But it is noted that in many publications their direction is indicated in various ways, which complicates the rational planning of cuts and increases their empirical. It is histologically proved that the collagen fibers underlying the Langer’s lines are irregularly interwoven and intertwined, parallel to the Kraissl’s lines. Elastic fibers can be parallel or perpendicular to the epidermis, but Kraissl’s lines are characterized by their exceptional perpendicular location. These histological studies have determined the separation of the face into three zones, depending on the direction of the desired incisions. Namely: incisions along to Kraissl’s lines, along both lines and regardless of the direction of the lines. The incisions according to the Kraissl’s lines extend along the direction of the greatest stretching of the skin and the smallest divergence of the wound, also due to the fact that the collagen of the newly formed scar is organized in accordance with the surrounding structures. The enlargement of the wound on the scalp and the tension at the closing of its edges are particularly related, which is conditioned by biomechanical research data. The overwhelming reduction of tension and, accordingly, the improvement of reparative processes in the skin, occur when the incision lines correspond to the so-called “golden spiral”. To improve the cosmetic result during closing the defects of the skin, some authors recommend the so-called “Acute tissue expansion”, which is carried out with the help of special expanders. This manipulation when combined with flap mobilization contributes to an increase in skin volume of up to 25% than using only skin flap mobilization. Moreover, long-term tissue expansion in the experiment yielded minimal differences in cosmetic results. Thus, the analysis of literary sources indicates the relevance of the selected topic, the ambiguity of the use of conventional incisions and necessitates further studies of biomechanical and histological substantiation of incisions in the head and neck to create optimal conditions for wound healing.

Keywords

• operative accesses
• lines of relaxation
• lines of stress.