Bezrukov S. G.,
Khomenko E.V.
The department
of dentistry (the head of department – prof. Bezrukov),Crimea state medical
university named after S. I. Georgievsky, Simferopol.
The clinical
estimation the efficiency of the
intradermal reinforced suture use in the dental surgery.
Is known, that the result of postoperative
wound healing is the scar formation, aesthetic and functional properties of
which significantly determined by operating machinery, atraumatic handling of
tissues, right choice the way of wound
edges joining. The achievement of optimical conditions for
wound healing and aesthetic
scar formation are possible in case if the used method of suture respond the following
requirements: accurate and complete comparison of the wound edges throughout
and uniform compression , original cosmetic effect, ease of applying and
removing.The cosmetic suture, which correspond the all requirements does not
exist yet. Therefore improvement of existing methods of suture and the creation the new method is promising
direction of investigation in maxillofacial surgery.
The purpose of work: comparative
issue of the results of intradermal reinforced suture and continuous
intradermal cosmetic suture use in
maxillofacial surgery by data of clinical and instrumental methods of
investigation.
The material and
methods. The clinical part of work is the examination and operative
treatment of 101 patients.Were carried out 101 operations about benign growth
in maxillofacial area, using combined anesthesia. The main stage of
operation, associated with the
elimanation of pathological formation
was typical, the same for both groups of comparison. The superficial sutures
were applied accordingly to the group. After operation completion the patients
of both group were closed the wound by aceptic compressive bandage. In
postoperative period prescribed therapy by standard scheme. For estimation the
influence of comparative methods of
wound suturing on regenaration
processes of injured tissues used the
following methods of investigation : clinical, local thermometry of skin, ultrasound scan of paravulnar area.
Results
The clinical signs of inflammation in the
postoperative wound area in patients of main group registrated less on the average and were less expressed, than
in control. The inflammatory processes in patients of main group were absent in
100%of cases on 7th day
after intervention, and at the same
time in 12,2% patients of control group still noticed mild soreness in
paravulnar area. The increase of local temperutare of skin in postoperative
wound area was noticed in both groups. The amplitude of modification in control
group( +0,64°C till +2,83°C) was higher than in main group (+0,15°C till +2,49
°C).The normalization of local temperutare became faster in patients of main
group : on 5 day differences of average
indexes in groups lost their credibility. In control group the pointed
differences were significant until 7th day after operation (p<0,05). During
the ultrasound scan determined ultrasound
density of formating scar, and calculated the individual relatival indexes ( G%
- ratio the density of the scar to the density of the intact dermis in ^ and
H - ratio the density of the border of the dermis and hypodermis to
density of formating scar. The most informative, in our opinion, is G% index,
because it clearly demonstrates how much the formating scar close to intact
dermis by it structure. The differences of averange value of the index in grops
of investigation
became statically significant
(p<0,05) after 6 month after operation . After ultrasound investigation year
after surgery the differences of G% in
main group (97,3±1,6%) and the level of the norm (100%0 were losing
reliability. At the same time the averange index in control group(91,7±1,0%) significantly different from the both the
level of norm and the same index in main group.
Conclusions:
1.
In clinic the
wound healing , applied by the intradermal reinforced suture in early
postoperative period ,passes on the background of less expressive phenomenon of
hyperemia, edema and pain component.
2.
The data,
received during the thermometric investigation , point out the more favorable
condition of wound healing in patients of main group , the amplitude of change
of the index of local temperature in patients of main group lower that the
control and normalization of index become faster.
3.
Result of
ultrasound scanning point out that after applying intradermal reinforced suture
the scars formed faster and almost
indistinguishable from the intact skin by it structure.