The author describes the successful restoration of the anatomical structure of the nose in a child 5 years after 5-6 hours after his complete loss, which happened during a traffic accident. He describes in detail surgical treatment tactics, which is important in clinical practice.
Keywords:Nose; 5-6 Hour Cutoff; Successful Replantation
The aim of the study shows the opportunity to make a successful replantation of completely lost nasal tissues after 5-6 hours of facial injury.
There is now an increase in injuries, especially road traffic. This is accompanied by an increase in the number of different damages to organs and systems. Incidents often result in the loss of cover tissues (skin, mucosa), which requires immediate closure of the wound to eliminate the access of the infection to the body [1-3]. For this purpose, usually use two methods - either Italian, or Indian. In Italian, the wound is usually closed by moving one of its edges in the opposite direction, by lateral relaxing incisions, that is, it retains a vascular nourishing leg. In the Indian case, the completely delisted tissues are replantation - by returning them to their mother’s place with stitches or only a pressure bandage [1-3]. This method was called Indian because in India there was a way to punish criminals by cutting off the nose. And so, when this happened, the man grabbed his severed nose and ran to the esculapus, and he returned it to his mother’s place. All other methods of free skin transplantation (Tyrsha and others) have only slightly modified the technique of this operation and are usually used in the granular wound . The success of emergency replantation largely depends on the statute of limitations of the injury - the more time has passed from the moment of the accident to the replantation, the worse the prognosis. This period is usually limited to 90-120 minutes . For this reason, a successful replantation, made in a longer time frame, deserves attention.
Materials and Methods
A 5-year-old girl with a complete absence of all the soft tissues of the nose was taken to the trauma department of the Temryuk CRB of the Krasnodar region two hours after the road accident. From the upper lip to almost to the nose at the cheek level there was a circular wound in the center of which both nasal passages gaped. It was clear that plastic restoration of the nose at the expense of the surrounding soft tissues is simply impossible to do, and moreover this attempt will lead to additional deformity of the child. He was threatened with becoming an outcast of humanity. The girl’s mother understood this and looked at me with horror and hope. The only way to save this child was to replant the severed nose, but he was absent. I told her about it and advised her to go to the scene of the accident immediately, find the cut-off tissue, save and in the cold and take her to the hospital. I was hoping that these fabrics remained viable, as there was a sub-zero temperature outside. The mother and the father of the child did not return until about 4 hours later. The tissues were heavily contaminated, which required their sanitization in a larger amount of 1% hydrogen peroxide solution, and then in and filled with dry penicillin (this antibiotic is most acceptable in this situation). It took about 30 minutes. And now the replantation took place with the use of a submersible mattress seam. The nose configuration has been fully restored. The nose and both aisles were powdered with dry penicillin. A sterile wire mask was applied to the nose, which used to be used to give ethereal anesthesia, and it was fixed to the skin of the face with two ribbons of a band-aid. Then a dry aseptic napkin was placed on top of it. The girl’s hands were fixed so that she did not accidentally destroy the created structure above the nose, but she behaved calmly. The first visual inspection of the operation area was carried out in 2-3 hours.
The inspection showed that there was no necrosis of returned tissue. The girl’s mother was convinced of this, which improved her mental status, and she began to take care of her daughter more calmly. The dressings were reduced to the replacement of the napkin over the mask and to the periodic powdering of the seam with dry penicillin. The child had normal nasal breathing - the mask did not bother him. Tubes and rubber bands were not injected into the nasal passages, as they feared increased mucus secretion and mechanical effect on the nasal mucosa. On the second day on the skin of the right wing of the nose there was a zone of dry necrosis with a diameter of 0.2-0.3 cm. In the days that followed, there was no expansion of the necrosis zone. The stitches were removed for day seven. The independent rejection of necrosis came on the 18- 19 this. The girl was discharged perfectly healthy 4 weeks after the operation. She was consulted after 5-6 months and introduced herself as a lovely girl with blue eyes and a subtle linear scar at the nose. During this time, not only the inertia of the nose skin, but also the senses of smell have recovered [4-6].
The success in replanting the child’s nose can be explained by the fact that during the accident, which occurred by hitting the bumper in front of the car, the girl from the back seat flew over the head of the mother and hit the windshield. As a result, the outer fragments of the nose were completely cut off, and they fell under the seat of the car (this was established when searching for the nose). So, the tissues immediately got into the cold environment, and hypothermia prolonged their vitality. Everything else was already due to my experience in helping the victims.
In winter, accidentally cut off nasa tissues remain viable for up to 5-6 hours. This factor should be used in the replantation of lost tissues. This relieves victims of long-term plastic surgery, using the stalk of Filatov, which usually occurs in these types of trauma. People with a disfigured face become outcasts of society. On the correct tactics of treatment sometimes depends on their fate. This treatment algorithm will allow the novice surgeon to be more determined to navigate in the same situation, if it appears in his practice.
Conflict of Interest
No conflict of interest.
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