Thesis for acquisition of scientific degree of candidate in medical sciences for speciality 14.01.19 – otorhynolaryngology. – Institute of Otolaryngology named after prof. O.S. Kolomiychenko of Academy of Medical Sciences of Ukraine, Kyiv, 2008.

The thesis is dedicated to the issues of optimization of the clinical results of the patients’ with traumatic nose defects in acute period after traumas treatment by defect plastic surgery methods improvement, the development of the way of correction of ischemic metabolic disorders in plastic materials and by the optimization of the choice of different nose defect types reconstruction methods.

It is found out that the application of the methods of the replantation and autotransplantation of tissues into the through (full-thickness) nose defect zone does not give positive tissue engraftment results. It is discovered also that the clinical effectiveness of the application of nose defect primary plastic method using nutrient pedicle flaps is more than twice more effective than one of the application of the tissue replantation and transplantation methods in the case of similar defects, and that is undoubtedly connected with the ischemic metabolic disorders that develop in tissues, transplanted without their own blood supply source. Ischemic metabolic disorders in tissues cause tissue reperfusion syndrome (TRS) development that leads to the transplanted tissues necrosis while their revasculization.

In the experiment on the Vistar line rats it is proved that it’s possible to correct the ischemic metabolic disorders in full-thickness skin grafts by the treatment of the grafts with an anti-oxidant action medications mixture (AOAMM) that consists of 0.25% lipin solution, 0.005% ascorbic acid solution, 0.0025% verapamil (isoptin) solution and 0.125% unithiol solution. The AOAMM application in vitro and in vivo contributes to decreasing of content of the lipid peroxidation final product – malonic dialdehyde – in transplanted tissues, reduces the negative morphologic changes in rats’ skin grafts preparations and improves these skin grafts’ engraftment. The best results of the AOAMM use may be received by its application during the first 6-12 hours after the skin graft separation. During the next 12 hours the effectiveness of the AOAMM use is two-three times less.

A new method of onestage reconstruction of the full-thickness wing and tip nose defects in acute period is worked out, registered and applied in practice. It is one with the application of a nasolabial constant nutrient pedicle flap and with the reconstruction of the 3 main nose wall levels. It reduces the patients’ recovery terms and gives permanent cosmetic results.

The algorithm of the traumatic nose defects primary reconstruction methods choice is grounded and developed. It takes into consideration the nose defect species, size and localization in anatomical zones, and also the possibility of the seized fragment of tissues replantation. The algorithm allows to receive more predictable and more cosmetically successful results of the treatment of this pathology.

Key words: traumatic nose defects, acute period, primary reconstruction of defects, replantation, autotransplantation, reconstruction by nutrient pedicle flaps, ischemic metabolic disorders in tissues, tissue reperfusion syndrome, correction of tissue ischemic disorders, algorithm of the nose defects primary reconstruction methods.

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