VẠT CÂN - CƠ TỰ THÂN ỨNG DỤNG CHE PHỦ LỖ MỞ XƯƠNGTRONG PHẪU THUẬT BƠM RỬA MÁU TỤ DƯỚI MÀNG CỨNG MẠN TÍNH

Abstract

Objectives: Describe the technique and evaluate the initial effectiveness of using an autologous fascial-muscle flap to cover the osteotomy hole in surgical chronic subdural hematoma. Subjects and methods: A cross-sectional, descriptive and retrospective study was conducted on 35 patients who were performed closed system drainage of chronic subdural hematoma using an autologous fascial-muscle flap at E Hospital from Jan 2022 to Jan 2024. Result: Mean age was 63,4 ±15,4; male/female: 4/1. 22.9% of patients arrived at the hospital in a conscious state, 77.1% had impaired consciousness, of which 11.4% were in a coma. Unilateral hematoma accounts for 85.7% and bilateral 14.3%. Preoperative coagulation function recorded 1 patient with decrease platelet count and coagulation function due to cirrhosis, 1 patient with coagulation disorder due to use of anticoagulants, 1 patient with coagulation disorder due to use of heparin after dialysis. Surgery time for unilateral is 43.2±8.9 minutes, bilateral hematoma is 87±14.3 minutes. Local anesthesia method accounts for 94.3%. Consciousness 24 hours after surgery: 91.4% were awake, only 2 patients were still in a coma after surgery due to brain edema and sequelae of brain hemorrhage from before surgery. Early complications after surgery: Acute subdural hematoma recorded 1 case of a patient with coagulation and platelet disorders due to cirrhosis treated conservatively, no cerebrospinal fluid leakage was recorded through the incision after surgery, no recorded post-operative infection. All patients were re-examined at 1 and 2 months, and no cases of hematoma recurrence were recorded. Conclusion: The closed system drainage in chronic subdural hematoma is safe and effective technique. Autologous fascial-muscle flap covering the craniotomy hole is a technical improvement that is safe, easy to perform and helps reduce the rate of bleeding complications, cerebrospinal fluid leakage, and post-operative infection.