Influence of pharmacological preconditioning on the results of lifting operations efficiency.

The main aim of the study is to determine the effectiveness and safety of lifting operations in women with varying degrees of involuntary changes of facial skin, in particular when applying pharmacological conditioning, with the objectification of the role of the latter.

Materials and methods: A research and surgical treatment were conducted to eliminate involutional changes of various degrees in the facial skin of 461 women aged 35-75 years. Surface lifting was performed in 20.2% of patients, SMAS-lifting - 49.0%, SMAS-lifting with a three-level endoscopic assist lift of the lower face zone was performed in 30.8% of women. Before the surgery in 13.2% of cases, I degree of involutional changes in facial skin was registered, 47.9% - grade II, 38.9% - grade III. Patients were divided into two comparable groups. With the standard preparation without additional drug correction, 299 women (64.9%) were operated on in the preoperative period, they made up a comparison group. The main group included 162 (35.1%) women who underwent therapeutic conditioning before the lifting operation (Cytoflavin, n = 86; Actovegin n = 23; Ethylmethylhydroxypyridine succinate, n = 32; Meldonium, n = 21; Pentoxifylline, n = 31; Vinpocetine n = 27). Instrumental evaluation of the skin dermal microcirculation was performed using laser Doppler flowmetry and estimation of transcutaneous oxygen tension. In the blood plasma, the parameters of free radical processes (FRP) were studied. FRP were studied in terms of generation of active oxygen forms by leukocytes - intensity of chemiluminescence basal and intensity of chemiluminescence stimulated, as well as antiperoxide plasma activity and malondialdehyde. Early postoperative complications were analyzed, the number of repeated lifting surgical corrections on the face was studied for 5 years.

Results: The role of FRP in the pathogenesis of involuntary changes in the facial skin has been established. The imbalance of FRP was expressed in the intensification of the reactive oxygen species generation and products of lipid peroxidation. This correlated with disorders of cutaneous microcirculation and a decrease in the saturation of the facial tissues with oxygen, manifested by an increasing energy deficit and the severity of involutional skin changes. The obtained data justify the expediency of using pharmacological conditioning with energy correcting antioxidant medicine. Preoperative conditioning allowed to reduce the number of early postlifting complications associated with tissue trophism in a quarter, especially during surface lifting. In addition, in the preconditioning group, the scar was more cosmetic already at the seventh day after the operation. Based on the study of postoperative catamnesis, self-assessment data and laboratory-instrumental methods of skin system examination in people of different ages, it was revealed that while using SMAS-lifting with a three-level endoscopic-assisted lifting of the lower part of the face, the lowest frequency of complications and the best 5-year effectiveness were established.