—————Капсулярная контрактура после круропластики
Капсулярная контрактура после круропластики
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Капсулярная контрактура после круропластики
Несмотря на большой практический опыт по выполнению круропластики, после операции могут развиться осложнения, которые не всегда можно предсказать и предупредить.
Одно из таких осложнений - капсулярная контрактура – плотная фиброзная ткань, формирующаяся вокруг установленного имплантата.
Что же такое капсулярная контрактура и почему она опасна?
Она представляет собой структуру из рубцовой, гладкой фиброзной ткани в виде капсулы, которая плотно покрывает имплантат.
Человеческий организм при попадании инородного тела включает специальные функции защиты, формирующие специальную оболочку в месте проникновения предмета извне. Таким образом, образование фиброзной оболочки — это естественная
реакция организма на инородное тело.
Капсула начинает формироваться сразу после хирургического вмешательства и продолжается в течение нескольких месяцев после. Толщина ее в норме — десятые доли миллиметра. Но у некоторых пациентов капсула начинает чрезмерно
утолщаться, кальцинироваться, становится твердой и сжимает имплантат, приводя его к деформации и вызывая болезненные ощущения. Такие изменения могут привести к разрыву имплантата.
Именно в таких случаях и говорят о наличии капсулярной контрактуры.
Симптоматика осложнения
Чаще всего сжатие имплантата происходит в течение первого года после операции, но может начаться и через несколько лет после проведенной операции.
1. Уплотнение мягких тканей голени в области установки имплантата.
Формирующаяся капсулярная контрактура более плотная чем капсула, которая должна быть в норме. Таким образом голень в этом месте более плотная. Так как формирование капсулярной контрактуры происходит только с одной стороны,
сравнить плотность голеней не представляется сложным.
2. Деформация контура голени.
Процесс сжатия капсулой имплантата приводит к его деформации. В результате чего контур голени становится неровным.
3. Отек.
Иногда в месте установки имплантата отмечаются отеки мягких тканей голени. Определяется это по следу, который оставляет резинка носка. В этом месте след более глубокий. Также отеки хорошо видны на фотографиях.
4. Боль.
Характерным признаком капсулярной контрактуры на голени являются болевые ощущения. Боль периодически дает о себе знать усиливаясь при ходьбе, долгом стоянии на ногах и другой физической нагрузке
Причины
1. Индивидуальная непереносимость имплантата пациентом и его неправильное рубцевание.
Это самая частая причина. К сожалению, невозможно заранее предугадать развитие реакции непереносимости. Организм может отреагировать усиленным формированием грубой соединительной ткани. Этот процесс непредсказуем.
2. Грубое воздействие на ткани.
Грубая техника операции также может быть причиной развития капсулярной контрактуры. Операция круропластика является малотравматичным вмешательством, поэтому агрессивная хирургическая техника маловероятная причина образования
капсулярной контрактуры.
3. Попадание в открытую рану инфекций.
Попадание инфекции в полость имплантационного кармана во время операции может стать причиной образования грубой капсулы. Кроме того, возможно попадание инфекции гематогенным или лимфогенным путем, то есть с током крови или лимфы
4. Несоответствие размера имплантатов сформированному карману, предназначенному для установки имплантата;
Если имплантат больше кармана, то происходит его деформация, усиливается давление на окружающие мягкие ткани. В этом случае неизбежной ответной реакцией организма будет развитие контрактуры.
5. Влияние вредных привычек на организм пациента, использование не подходящих человеку медикаментов.
Сюда можно отнести хроническую интоксикацию никотином или некоторыми медицинскими препаратами.
6. Внешние факторы, зависящие от образа жизни пациентки.
Травмирование голени, чрезмерные физические нагрузки на икроножные мышцы.
7. Разрыв оболочки и проникновение силикона в пространство между имплантатом и капсулой.
Капсулярная контрактура после увеличения голеней встречается очень редко – в 0,1-0,5% случаев. Из всех операций с установкой силиконовых имплантатов это самая низкая частота возникновения такого осложнения.
Лечение
Решением проблемы служит повторное хирургическое вмешательство и удаление имплантата, которое проводится в два этапа:
Первый этап
На первом этапе хирург удаляет имплантат из голени, где сформировалась капсулярная контрактура. Повторная операция проводится не ранее, чем через 3-6 месяцев. В некоторых случаях через год после удаления.
Второй этап
На втором этапе устанавливается новый имплантат. Операция проводится стандартным способом с соблюдением мер по профилактике образования капсулярного фиброза.
Как правило, результаты лечения капсулярной контрактуры положительные. Повторное образование крайне редко. Но, если же капсула образовалась повторно, то в этом случае говорят о стойкой непереносимости материала из которого
изготовлены имплантаты.
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Птозом груди называется опущение молочных желез и потеря их объема, которое сопровождается растяжением кожи.
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[TEXT] => Противопоказания к подтяжке груди
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[TEXT] => Возможные осложнения после круропластики
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[TEXT] => Асимметрия после круропластики
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[1] => Array
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[TEXT] => Гематома после круропластики
[LINK] => /plastika-tela/kruroplastika/vozmozhnye-oslozhneniya-posle-kruroplastiki/gematoma-posle-kruroplastiki/
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[2] => Array
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[TEXT] => Грубые рубцы после круропластики
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[3] => Array
(
[TEXT] => Дистопия имплантатов после круропластики
[LINK] => /plastika-tela/kruroplastika/vozmozhnye-oslozhneniya-posle-kruroplastiki/distopiya-implantatov-posle-kruroplastiki/
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[4] => Array
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[TEXT] => Капсулярная контрактура после круропластики
[LINK] => /plastika-tela/kruroplastika/vozmozhnye-oslozhneniya-posle-kruroplastiki/kapsulyarnaya-kontraktura-posle-kruroplastiki/
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[5] => Array
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[TEXT] => Нагноение после круропластики
[LINK] => /plastika-tela/kruroplastika/vozmozhnye-oslozhneniya-posle-kruroplastiki/nagnoenie-posle-kruroplastiki/
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[TEXT] => Серома после круропластики
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[PERMISSION] => R
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[TEXT] => Информированное согласие на круропластику
[LINK] => /plastika-tela/kruroplastika/informirovannoe-soglasie-na-kruroplastiku/
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[TEXT] => Подготовка к круропластике
[LINK] => /plastika-tela/kruroplastika/podgotovka-k-kruroplastike/
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[PERMISSION] => R
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[TEXT] => Информированное согласие на липосакцию
[LINK] => /plastika-tela/liposakciya/informirovannoe-soglasie-na-liposakciyu/
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[TEXT] => Липофилинг
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[TEXT] => Подтяжка бедер
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[TEXT] => Договор на подтяжку бедер
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[PERMISSION] => R
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[TEXT] => Информированное согласие на подтяжку бедер
[LINK] => /plastika-tela/podtyazhka-beder/informirovannoe-soglasie-na-podtyazhku-beder/
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[LINK] => /plastika-tela/udalenie-rubcov/
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[TEXT] => Договор на удаление рубцов
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[TEXT] => Информированное согласие на удаление рубцов
[LINK] => /plastika-tela/udalenie-rubcov/informirovannoe-soglasie-na-udalenie-rubcov/
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О докторе
За 20 лет в пластической хирургии я выполнил сотни различных операций и выработал собственный подход и техники их исполнения.
