Kinds of plastics of a skull defects and firm meninx
The plastics of defect of bones of a skull, firm meninx allow to eliminate: danger of damage of a brain and sine, pavor of the patient before possibility of damage of a brain, cosmetic defect; to warn development of cicatrical-adherent process.
The plastics of defects of bones and firm meninx are spent to directions: with prosthetics by abiological stuffs of the organic both inorganic nature and tissues of a biological parentage.
According to the modern classification, existing methods of plastics are sectioned into an autoplasty(for plastics tissues of the patient), an alloplasty (preserved, the biological nature stuffs), xenoplasty the(stuffs taken from animals ) and explants(stuffs of abiological character of the organic and inorganic nature) are used.
Xenotransplantation. A plastic stuff of defects of a skull are the bones taken from animals, auks.
The explantation uses stuffs of abiological character and the inorganic nature for plastics of defects of a skull. Along with gold, silver, platinum, stainless steel, zirconium, tantalum, vitalium and derivatives of acrylic pitches were applied.
Abroad with success are applied and positively derivatives of acrylic pitches - a X-ray negative polacos K and radiopaque Refobacinum polacos P estimate.
That allows to occlude defect a dense stuff, protecting a brain from choronomic damages.
However stuffs applied to plastics though are inert, are not deprived some disadvantages, they render mechanical, biological, chemical and physical and chemical action on surrounding tissues.
Depending on operative measure terms distinguish primary (in terms about 2 days after a trauma), initially-delayed (about 2 weeks after a trauma), early (about 2 months) and serotinal (over 2 months) plastics of defects of bones of a calvaria.
Among biological methods of plastic closure of osteal defects the autoplasty with graft use on the leg binding to a maternal tissue is excreted. The graft at this method is well supplied with blood and quickly begets. A serious disadvantage of a method is the impossibility such by to occlude defects of the big dimensions. Besides, there is a necessity of carrying out of additional operations.
The method of a free autoplasty of the bones taken in the neighbourhood with osteal defect or from a remote part of an atomy, is not deprived the same disadvantages.
Alloplasty. Grafts of a bone, the firm meninx, taken from a corpse, subjected to pretreatment (boiling down, a decalcifying, conservation, freezing, etc.), have found the widest application.
At the decision of a question on carrying out of the initially-delayed, early and serotinal reconstructive operation the general condition of the patient, full value of a primary surgical treatment, presence or absence of a prolapse of a brain in defect of a bone, a condition of integuments in the field of a wound is considered. Bone Safety the method of treatment of the splintered, is comminuted-pressed, linear fractures with a depression of edge of a bone can be carried out in the absence of extremely grave condition of patients, disturbance of vital functions, an edema and a swelling with a brain prolapse in defect of a bone
The glutinous osteosynthesis has found wide application in clinical practice, providing strong bracing of a graft. The method allows to bridge together fragments of bones of any form and the dimensions, simplifies and accelerates operative measure carrying out. It is necessary to consider necessary conservation of osteal fragments of the crest displaced in a head cavity with a periosteum, that is essential affects their further neogenesis. Fine osteal fragments are usually remote from a periosteum and consequently they are completely taken from range of fragmented fracture, treated by antibiotics (Kanamycinum, etc.) then the glutinous osteosynthesis is carried out.
Bone-plastic trepanation with including in an osteal flap of region of fracture is perspective. Thus osteal fragments are bridged to the basic flap by means of the glutinous osteosynthesis supplemented with silk seams.
The special value is deserved by a method of crushing of freely laying osteal fragments with the subsequent packing of an osteal shaving on the intact firm meninx, fibrinous Membranula, a gold foil, etc. Auto bone like pillow the shaving can be admixed with clots a biopolmer of medical appointment KL-3. As kind Bone Safetyоперации auto bone like pillow can be received at extraction from a wound of osteal fragments, at the is comminuted-pressed fractures and their crushing. Fragments of an osteal shaving become the centres of an island osteosynthesis,
The basic demands to plastic stuffs are reduced to, that they:
- did not render harmful influence on organism tissues, first of all on a brain and its covers
- possessed property of good engraftment
- could be modelled easily, quickly and simple methods to be treated
- conveniently and absolutely to be sterilised
- to be accessible and cheap for use by a wide range of neurosurgeons.
Competing stuffs for plastics are auto - and the allotransplants preserved by various methods, and explants. Reception of biologically high-grade grafts became possible in connection with application enough low temperatures. Freezing and storage in the refrigerated condition or a snap-freezing under vacuum the/lyophilization / provides conservation not only morphological structure of a graft, but also a deoxyribonucleic acid that plays the important role in osteal neogenesis. The cool-dehumidified tissue is low-toxic, replacement to it of the greatest on the dimension of defects of bones of a calvaria is possible. In urgent surgery explants - a plastic stuff of derivative acrylic pitches can be used. Preparations which do not render appreciable toxic influence on surrounding tissues are most comprehensible, are easily modelled, are accessible to a wide range of surgeons. . Fixed at edges of a bone the graft from self-hardening acrylic plastic provides with glue tightness of fastening of osteal defect. In process of hydrolysis and a resorption gluing the plate from derivative acrylic pitches acquires a connective tissue capsule which fixs plastic to a bone after a resorption of agglutinant material.
Problem of plastic replacement of defect of a firm meninx. In the absence of tightness of a subdural space there is a danger of occurrence of a liquorrhea, infectious complications, developments of adherent process, epileptic attacks. Therefore hermetic closure of a subdural space is a vital importance problem. Cover scission is comprehensible at small defects, absence of a prolapse of a brain. The aponeurosis of a temporal muscle for plastics of a firm meninx does not allow to occlude the big defects and quite often leads to the expressed adherent process. Use of fibrinous Membranula for plastics of defects of a firm meninx of little use because of frequent occurrence of a liquorrhea, formation likvorn pillows, and sometimes and appearances of epileptic attacks. Associated application of fibrinous Membranula and a fascia provides sufficient tightness of a subdural space, but demands carrying out of additional operation.
The cool-dehumidified firm meninx taken from a corpse, is enough effective, provides closure of the greatest on the dimensions of defects, is easily filed to edge of defect of a firm meninx, reliably protects from liquorrhea development. In the conditions of the emergency surgical help for closure of defects of a firm meninx it is convenient to use polyethylene Membranula.
Thus, the primary cranioplasty and a firm meninx should be applied at victims as the closing stage of the surgical treatment effected in early terms. Contraindications to primary plastics can be:
- a grave condition of the patient about the vital functions expressed by disorders, an edema and a brain swelling with its prolapse in osteal defect
- unextracted foreign bodys, a porencephalia
- presence of signs of a purulent infection contamination in a wound, big scalp defect of soft integuments of a skull, when there is no possibility tightly to take in a dermal wound
- a combination of damages of bones of a calvaria and its pneumatic sinuses
The initially-edged cranioplasty provides replacement of defects of a calvaria in terms from 2 days till 2 weeks after a primary surgical treatment. The wound adnation by this time descends to formation of fragile cicatrix and wound edge easily get divorced stupid by and by means of hydraulic preparation by Novocainum solution. The plastics in these terms are effected by that patient at whom the primary cranioplasty is not effected and which do not have contraindications to plastic operation.
The early cranioplasty is carried out about 2 months after a trauma. By this time conditions for carrying out of plastic closure of defect of a calvaria are usually framed. At operation in this season expressed enough adherent process is found.
The serotinal cranioplasty should be spent not later than 6-12 months after a trauma if there are no contraindications. Terms of its carrying out are defined in each concrete case. Contraindication to it can be: a brain protrusion in the osteal defect, the foreign bodys found in a head cavity, the expressed mental disturbances, long inflammatory changes from head integuments.
Defect of a bone of a skull in the remote season is usually filled by a cicatrical tissue. This tissue is densely adherent in outside parts with a muscle, aponeurosis and a skin, a periosteum and edges of defect of a bone, and also with edges of defect of a firm meninx, soft and arachnoidal, a damaged field of a brain. We will notice, that the subdural space in the field of cicatrix usually is completely obliterated.
Small defects of a firm meninx occlude by means of an is capsulate-cicatrical tissue by its stratifying, at the big defects use allotransplants, explants.
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