CRANIOPLASTY (Greek kranion a skull + plastike sculpture, plastics) — operational closing of defects of a skull with various materials. Need in To. arises at various bone defects of a skull at patients with a craniocereberal injury, and also after decompressive trepanations in connection with various intracranial pathology or after forced removal of bone operational rags. Distinguish primary To., to-ruyu make at primary surgical treatment of craniocereberal damages, and secondary, or delayed, to-ruyu make after improvement of a condition of patients and stopping of the inflammatory phenomena. At the uncomplicated course of a cherepnomozgovy injury secondary To. it is reasonable to make not earlier than in 6 — 8 months after an injury. At operation in earlier terms the dozing infection in a hem can become the reason of failure To.
Need of carrying out To. is defined by the fact that existence of defect of a skull, especially extensive, causes various distsirkulyatorny disturbances in a brain bringing to funkts and to organic frustration. The connective tissue hem which is formed in the field of defect badly resists to fluctuations of intracranial and atmospheric pressure that promotes emergence of epileptic seizures. Besides, defect of a bone creates danger of traumatizing the unprotected brain, and sometimes and considerably deforms a skull, disfiguring the patient. To. creates favorable conditions for normalization of blood circulation and cerebrospinal liquid, promotes improvement of function of a brain.
Many ways K are offered. and plastic materials for closing of defect of a skull.
Autotransplantation. Distinguish To. an autograft on a leg when the transplant keeps communication with adjacent fabrics, and To. free bone rag. For To. an autograft on a leg use the outside bone plate taken in the neighbourhood with defect; for free To. take the split edge, a fragment of a shovel, clavicle, ileal or a femur.
Despite positive takes at use of bone autografts with preservation of a periosteum, the bone autoplasty has essential shortcomings: need of carrying out the second operation for capture of an autograft and impossibility of receiving a large amount of plastic material for closing of extensive defects of a skull.
Xenotransplantation it was for the first time applied at the person in 1670 when Mackren closed defect of a skull a bone of a dog. In the subsequent for To. goose and bull bones, a cow horn, fragments of bones of a skull of a monkey were used. This technique attracts with simplicity of preparation of transplants and their unlimited number, however because of a large number of complications, it was not widely adopted danger of a sensitization of the recipient.
Explantation (closing of defects with various inorganic and organic materials), known from an extreme antiquity, entered a wedge, practice in the 40th 20 century when new plastic materials were received.
From organic materials compounds of alcohols and acrylic to - you most were widely adopted: polymethyl methacrylate, stirakrit, AKR-7, AKR-100 and especially plexiglass (organic glass). Simplicity of use, small injury of operations and existence of almost unlimited number of plastic material — the main advantages of a way. Organic glass (polimetilkrilat BSE3-20/205) 3 mm thick during the heating higher than 120 ° becomes plastic and is easily modelled during operation. Its fixing to edges of defect of a bone is carried out by silk ligatures. Until recently plexiglass is the most widespread material for To.
Abroad from implants use metals and their alloys more often (vitalliya, stainless steel, tantalum, gold, silver, ticks, etc.).
However all implants have a number of essential shortcomings. Being a foreign body, they render though not really expressed, but nevertheless adverse action on surrounding fabric and on an organism in general that is the reason of unsatisfactory results of a cranioplasty in 8 — 15% of observations.
Allotransplantation (homotransplantation) — substitution of defects tissue of the same biol, a look (from the person to the person). Finds application in To. apprx. 100 years. In the beginning the fresh allovitalny transplants received during operations were used, but in view of limited opportunities of receiving plastic material of considerable distribution they did not receive.
Development by domestic researchers of theoretical justifications and methods of conservation of cadaveric fabrics opened new opportunities of allotransplantation.
Advantage allotransplants is first of all that the gomokost does not cause considerable reaction from an organism; the bone rag rezorbirutsya gradually and replaced with tissue of the recipient. The transplant is only a biostimulator and a framework for new fabric. Simplicity of receiving bone rags, low cost, and also the developed ways of sterilization and storage allowed a gomokost (see. Conservation of bodies and fabrics ) to become the most widespread plastic material.
Technology of operation, irrespective of a type of the used plastic material, it is essentially identical. In the beginning prepare a transplant. During the use more difficult of the modelled materials carry out primary modeling of a transplant by the extent of defect. The second and essentialest stage is preparation of a bed. Cut a periosteum and shift in the parties from defect. Edges of bone defect straighten, and in case of long existence of defect «refresh» that provides big reparative activity of a bed. Shell and brain hems exsect with the subsequent plastics of a cover. The plastics of a firm meninx prevents development of hems and commissures between a brain, a bone and soft tissues. Then start final modeling of a transplant. If necessary at first produce the template from a prokipyachenny x-ray film corresponding to a form and the extent of bone defect, and already on it prepare a transplant. At the edges of a transplant do a small bevel which allows to lay it on edges of defect level with them. In a transplant do several openings for outflow of the wound (fig.) separated from a head cavity. During the use auto-or allotransplants it is necessary to try to obtain that the transplant put a nek-swarm pressure upon edges of bone defect that strengthens reparative process. The transplant is fixed silk ligatures or an inert wire through the openings imposed at edges of a transplant and defect of a bone. The wound is sewn up tightly. In the postoperative period under a skin rag the intercellular lymph often accumulates, to-ruyu it is necessary to suck away periodically.
Bibliography: Balabanov A. R. Primary plastics of defects of a skull, M., 1966, bibliogr.; The imam of l and e in A. S., In I l-tsev V. V. ileybzonn. D. Kranioplastika gomokost, Baku, 1973, bibliogr.; Lebedev V. V. Plastics of defects of bones of a skull and firm meninx, Vopr, neyrokhir., No. 1, page 49, 1973; Leybzon N. D. Plastics of defects of a skull, M., 1960, bibliogr.; The guide to neurotraumatology, under the editorship of A. I. Arutyunov, p.1, page 359, M., 1978; Arseni C. §i About p r e s with u I. Tran-matologia cranio-cerebrala, Bucure§ti, 1972; B a d o Z. u. Tari G. Neue Wege in der Kranioplastik, Zbl. Chir., Bd 102, S. 1313, 1977.
A. P. Romodanov.