| 摘要 |
FIELD: medicine. ^ SUBSTANCE: invention refers to medicine, namely surgery and aims at reconstruction of a central lower jaw. Skin is incised on a side surface of the thorax in the form of an ellipse. A thoracodorsal neurovascular fascicle is separated in an axillary region. The wide separation of wound edges, a muscular portion of the flap that is a broadest muscle of back to the level of required rib is formed. The rib fragment is included in the flap by resection of the appropriate rib (8th or 9th) and adjoining intercostal muscles. It is followed by resection of a scapula angle with the resected fragment being congruent with a genian lower jaw. The inclusion of the scapula fragment into the flap is completed. Herewith an artery passing to the scapula angle is preserved to provide an appropriate blood supply. It is followed by forming a proximal portion of the muscular portion of the autotransplant that is a fragment of the broadest muscle of back. A flap pedicle is transected. The formed flap is carried on a low face defect. A donor wound on the thorax is closed in layers with active drainage of a pleural cavity. With using previously separated recipient vessels - an external maxillary artery are used, and microvascular anastomosis with vessels of the 'end-to-end' flap. After blood supply start-up and autotransplant viability recovery, the rib fragment is modeled after the form of a central portion of the alveolar process of the lower jaw. The scapula fragment is positioned at the genian lower jaw and rigidly fixed in such position. If required, a fragment of the broadest muscle of back and a skin area of the flap are used to restore soft tissues of face and oral cavity. The wound is closed in layers. ^ EFFECT: method provides restoring the alveolar process of the required height that is followed by osteointegration of dental implants and tooth replacement ensured by autotransplantation of the integrated osteomyocutaneous flap with the rib fragments and the scapula angle. |
