MORPHOLOGICAL GROUNDS FOR PLASTIC SURGERY IN THE MASTOID AREA

This article presents the data on the structural peculiarities of the mastoid region, the dependency between the thickness of the epidermis, dermis, subcutaneous fat, and size of the structural elements of the skin at various stages of its deformation that allows us to determine the digital indices for the depth of skin peeling and skin amount dissected when planning plastic and reconstructive operations skin that is carved. In order to achieve the optimal result of plastic operations, and, in particularly, of cosmetic otoplasty and lower rhytidectomy, and to minimize the development of postoperative complications, the manual skills of the surgeon are not sufficient. It is essential to know exactly morphofunctional characteristics of layered structure of certain topographic and anatomical sites, especially within mastoid area, where the main incisions are made when performing on the above-mentioned surgical interventions. After stretching the test samples of the skin taken from the mastoid region within 5 mm, we observed subtle differences between them even in the state of physiological rest. The study of the structure of the skin-fat flap samples after stretching within 15 mm demonstrated the occurrence of pathological processes in the skin epithelium and dermis. The morphological picture indicated the development of balloon dystrophy that is known as the morphological equivalent of focal necrosis. Investigation of microslides of the skin taken from and exposed to stretching within 20 mm made it possible to reveal the intensification of the previously described changes and the development of qualitatively new pathological changes both in the epidermis and in the dermis. The results obtained enable us to conclude that during operations in the mastoid area, the biomechanical properties of the skin-fat flaps should be taken into account. When the skin was stretched within 5 – 10 mm, irreversible changes did not occur, and these are optimal indicators during surgical interventions. With a flap deformation within 15-20 mm, pathological changes were observed, in some cases they were classified as irreversible that led to necrosis in the postoperative period.