Demonstration of the possibilities of reconstructive surgical interventions for closure of the exposed bones of the facial skeleton and cranial vault due to extensive defects of various etiologies

Abstract

Introduction Surgical treatment of patients with tissue defects of the scalp and face is challenging for surgeons. It is an integral part of the social and labor rehabilitation of such patients. Exposure of the skull bones after extensive polyetiological resections creates a difficult task for reconstruction of complete or partial loss of soft tissues of the head. Autologous dermoplasty, simple in its technical implementation, is impractical on the bones of the facial and cerebral skull because insufficient vascularization of the wound bed creates a risk of early rejection of the graft. The aim of the study was development and evaluation of the effectiveness of the method of restoring the integrity of the skin of the head and face inh extensive defects with exposure of the bones of the skull. Materials and methods Аnalysis of the methods and results of reconstructive surgical treatment of three patients with extensive defects in the tissues of the scalp and face at the Research Institute of the Ochapovsky Regional Clinic Hospital No.1 in 2018-2020. Results The immediate result of surgical treatment was a complete restoration of the skin with the maximum possible preservation of underlying deep anatomical structures after a radical one-step removal of non-viable tissues, both soft and bony. Subjectively, the patients were satisfied. The aesthetic result obtained in all cases satisfied both the patients and the surgical team. Conclusion The treatment of extensive defects of the soft tissues of the face and bones of the skull is a doable task, provided certain conditions are met. Removal of the affected tissues with simultaneous plasty of the resulting wound defect with a autologous greater omentum and skin autografts allows one to simultaneously solve the problem of plastic closure of wound defects of such localization. When performing osteonecrectomy of the outer cortical plate of the skull to the bleeding layer, conditions are created for survival of a free skin autograft on the bone.

Keywords

• wound
• head
• skull
• face
• greater omentum
• plastic autodermoplasty
• vacuum system
• wound covering