Bezrukov S.G., Grigorieva T.S.

Crimea state medical university named after S. I. Georgievsky, Simferopol.

Comparative characteristics of postoperative inflammatory and recovery reactions in surgical treatment of atheroma of the face

Is known, any surgical intervention (causing the injury for the human body) associated with the occurrence of cascade the inflammatory and recovery reactions and also with possibility of well-known complications development in postoperative period. The method of surgical treatment of atheroma is not the exception. And besides any of local complications (excessive edema, hematoma, wound festering, wound dehiscence) significantly affect the qualitative characteristics of postoperative scar, what lead to deformation of soft tissues.

The material and methods

The material of investigation were the results of examination and treatment of 123 patients,which consulted in the surgical department of dental clinic in Simferopol for atheroma removal in maxillofacial area. The patients were divided into two groups.The first group (the control) composed of 60 patients, which were carried out the surgical removal of atheroma by common method. The second (main) group composed of 61 patients, which were carried out the surgical treatment of atheroma by our developed method(cystotomy) (the diameter of atheroma not more than 2,5 cm). After carrying out the infiltration anesthesia performed the section skin over atheroma, incision obviosly was passing through indrawing (the duct of sebaceous gland). The length of section depended on the diameter of atheroma , but was not over 5 mm. The capsule of cyst released. Atheroma is scraped with a curette and cyst size decreased. The inner surface treated with an antiseptic solution. The margins of the wound cauterized by electro- and thermocoagulation, forming round opening of the linear section. Aseptic bandage was putting on the wound.

Results of investigation and discussion of it.

During the registration and estimation of local inflammatory reactions, which develop in early postoperative period in ptients of two groups found , that the intensity in patients of main group was less expressed. But such indicators as infiltration, spontaneous pain and pain during palpation, hyperemia of surrounding tissues have significant difference compared to control (P<0,05).

It should be noted, that against the background of identified significant differences in manifestation of studied indicators, which attested in favor of efficiency of method used in main group, the exception was just one sign – the intensity of exudation. But such results wasn't for us unexpected, because the prototype of our suggested method of atheroma treatment was method of cystotomy. The one of significant advantage of this method is noticeably less size of traumatized tissues, no need to use suture (for both buried sutures and surface sutures). Also we considered that postoperative wound healing would be by second intention, that accordingly would be accompanied with more exudate than by first intention. The character of exudate was serous in all the patients. In despite of different mechanisms of healing of postoperative wound and initial differences in amounts of wound exudate in favor of control group, by 5^th day this gap had narrowed, and by 7^th day wasn't traced at all.

All the rest indicators of clinical course of wound processes (hyperemia, edema, spontaneous pain and pain during palpation, infiltration of paravulnar area tissues) were noticeably different in favor of the main group the entire observation period. The rapid abatement of local inflammatory reactions contributed to the optimization recovery processes conditions , that affected the timing of wound epithelialization, aesthetics of postoperative scars and in generally showed the advantged of proposed by us method of atheroma surgical treatment over the common method (radical).

By 7^th day the complete wound epithelialization registrated in the majority of patients. In control group the wounds healed by first intention in 49 (70,03%) of the patients. In 9 (14,51 %) - the healing was by second intention , and in 4 (6,45%) by forming scab. In all members of main group (61 persons) the wound healed by second intention, which was determined by method of surgical intervention. The average time of wound epithelialization in main group was 8,7 ± 0,18 days ,in control 8,3 ± 0,22, P<0,05.

Conclusions

1. The submitted analysis of results of clinical investigation allows to conclude , that the proposed method of application of face atheroma surgical treatment promotes the significant reduction in the severity of early postoperative reactions, that optimizate the conditions for functionally qualitative and aesthetically valuable postoperative scar formation.

2. The significant differences in used surgical approaches to atheroma treatment not lead to significant intergroup difference in time of wound epithelialization. The relatively fast process of epithelialization in main group is probably due to small surface of tissues trauma, adequate drainage and effective prophylaxis of of infectious and inflammatory complications development(by effective aeration of the wound and effective local antisepsis)