RU2192793C2 - Method for applying an adapting uninterrupted suture of skin wound - Google Patents

Abstract

FIELD: medicine, surgery. SUBSTANCE: needle is punctured into a derma of wound's edge with out-puncture onto the skin at 2-3 mm against the edge. Then skin is punctured at 1 cm against an out-puncture by forming cutaneous part of suture. A needle is withdrawn into a wound through subcutaneous cellular tissue. Suture is continued at subcutaneous cellular tissue of an opposite side. A needle is intradermally withdrawn. One should step-by-step repeat the stage of suture formation till complete wound closing. EFFECT: higher strength of the scar developed, improved cosmetic characteristics of suture. 3 dwg, 1 ex

Description

 The invention relates to medicine, namely to plastic surgery.

 In surgical practice, different types of sutures are used to connect the edges of the skin wound: simple nodal, vertical mattress suture Donati, as well as continuous intradermal (Golikov AN Theory and practice of surgical suture. Moscow, 1953; Y. Zoltan. Operational technique and optimal healing conditions Run. Budapest, 1983). Also known are a through plate suture (Roman L.I. Surgery, 1985, 5, S. 133-138) and a knotless adaptive cosmetic skin suture (Kochnev OS, Izmailov S.G. Surgery, 1988, 4, S. 126 -130).

The most commonly used is a simple nodal seam. It has the following disadvantages:
1) The formed node exerts noticeable pressure on the edge of the wound, which leads to a violation of the microcirculation of this zone and a decrease in resistance to infection.

 2) When tightening the knot, it is difficult to achieve perfect adaptation of the edges of the wound, especially on the sides of the suture. In some cases, a roll-like inversion of the wound edges occurs, which further complicates the adaptation of tissues. All this violates and slows down the normal regeneration and healing of the wound.

 3) After removal of the sutures from pressure sores, strangulation bands are formed, perpendicular to the lines of the main scar. This significantly affects the cosmetic characteristics of the scar.

 If the edges of the wound are excessively raised, it is advisable to use Donati's vertical mattress seam of unequal thickness. It is also called a knot adaptive seam. When applied, a more complete comparison of the edges of the wound is achieved. However, it also has the disadvantages (1 and 3) of a simple nodal seam.

 The best characteristics (by cosmetic effect, by the strength of the formed scar) are continuous intradermal suture. This is ensured by the passage of the thread in the dermis parallel to the vasculature, while there are no significant microcirculation disorders. The seam is made with one thread. Its use is limited mainly by routine surgery, where the likelihood of purulent complications from the side of the wound is minimized. Otherwise (when suppuration), the removal of the thread is necessary, which leads to the divergence of the entire wound.

 Through lamellar sutures are used to close the wounds of the abdominal wall according to special indications (suppuration of the wound, eventration, relaparotomy). In this case, the cosmetic properties of the resulting scar are sacrificed to its strength.

 A knotless adaptive cosmetic seam is free from the drawbacks (1, 3) of the nodal seam, however, its use is associated with the involvement of additional material (rubber tube shock absorbers) and an increase in the application time (compared to a continuous seam). To achieve perfect adaptation of the edges of the wound is possible only with frequent application of these sutures.

 The accumulated practical experience in the use of various types of skin sutures made it possible to single out the main requirements for their application: accurate comparison of the edges of the wound, the creation of moderate tensile strength in stitched tissues, the complete removal of suture material after wound healing, and the ability to control the opening size of the surgical wound during partial suppuration .

 For the prototype, we have chosen a method for suturing the surgical wound (USSR author's certificate 1387994 AI, published in B.I. 15.04.1988), "including a zigzag continuous seam, characterized in that the thread is carried out in order to prevent the formation of" blind pockets "and the displacement of homogeneous tissues through the edge of the dermis and subcutaneous fat with the capture of the bottom of the wound, for which the tissue is punctured within the wall perpendicularly, and when switching to the next stitch, the tissue is punctured at an acute angle with respect to the cut line, while "the edges of the dermis have the same puncture and injection points."

 The disadvantage of this continuous suture is that this suture does not allow you to control the size of the opening of the wound with partial suppuration for adequate therapy.

 The technical result of the proposed method is that when this suture is applied, part of the thread passes intradermally and in the subcutaneous tissue, and part on the surface of the skin, on the side of the skin wound. This makes it possible to control the size of the opening of the wound with partial suppuration.

 The purpose of the invention is to improve the cosmetic characteristics of the sutures used in both planned and emergency surgery. An increase in the strength of the resulting scar is achieved by a partial arrangement of the thread on the skin.

 In FIG. 1 shows a diagram of a thread through a wound. The method is as follows.

 For suturing, it is advisable to use modern suture material (monofilament threads with an atraumatic needle). A needle with a thread is injected into the skin at a distance of 0.5 cm from the corner of the wound (1), carried out subdermally and withdrawn intradermally (2) into the wound. After this, a needle is injected into the dermis of the other edge of the wound with a puncture on the skin at a distance of 2-3 mm from the edge (3). The point of injection of the needle into the dermis should be located exactly opposite the place of injection of the dermis, so that when tightening the thread, these two points coincide. Then, the skin is punctured at a distance of 1 cm from the puncture (4), while the cutaneous part of the suture is formed, and the needle is removed into the wound through the subcutaneous tissue. The suture is continued, passing to the subcutaneous tissue of the opposite side (the depth of the passage of the thread in this case depends on the thickness of the subcutaneous fat). After that, the needle is withdrawn again intradermally (5) and the stage of suture formation is repeated successively until the wound is completely closed. The suture ends with a needle sticking out onto the skin at the opposite corner of the wound.

 In FIG. 2 shows the final view of the sutured wound (1). The cutaneous sections of the thread (2) are located between the puncture points (3) and the puncture points (4) of the needle. The ends of the thread are fixed on pieces of plastic tubes (5).

 Example: Patient S., 43 years old, had an emergency operation performed on a perforated duodenal ulcer, local unlimited peritonitis - laparotomy (upper middle), suturing of the perforated duodenal ulcer, debridement and drainage of the abdominal cavity. The skin and subcutaneous tissue sutured by the proposed method. A needle with a thread was injected into the skin at a distance of 0.5 cm from the corner of the wound, held subdermally and brought out intradermally into the wound. After that, a needle was inserted into the dermis of the other edge of the wound and brought to the skin at a distance of 2-3 mm from the edge. The injection site of the needle into the dermis was located exactly opposite the injection site from the dermis. When tightening the thread, these two points coincided. Then they pierced the skin at a distance of 1 cm from the puncture point (a skin stitch was formed) and the needle was brought out into the wound through subcutaneous tissue. The suture on the subcutaneous tissue of the opposite side was continued (the depth of the passage of the thread depended on the thickness of the subcutaneous fat). After that, the needle was withdrawn intradermally into the wound and the stage of suture formation was repeated successively until the wound was completely closed. The suture was completed by puncturing the needle on the skin at the opposite corner of the wound with fixing the ends of the thread on the segments of plastic tubes. In FIG. 3 (photo) shows a finally sutured wound. The postoperative period was complicated by partial suppuration of the wound. In the area with hyperemia, edema, tissue infiltration (length of about 6 cm), the thread was removed. The wound is revealed, pus is removed. The ends of the remaining thread near the purulent cavity are fixed on an elastic tube with a wedge-shaped slot. After rehabilitation of the abscess, the wound in this area healed by the type of secondary tension. The main part of the postoperative wound healed with the formation of a cosmetic, subtle, linear scar.

 The technique of applying the proposed skin suture is simple, safe, accessible to any surgeon. The proposed skin suture was applied in 29 patients after operations on the organs of the abdominal cavity and chest, on the limbs.

The proposed seam has the following advantages:
1) Despite the fact that part of the thread is located on the surface of the skin, there are no strangulation bands after removal of suture material. This is achieved by uniform dosed tension of the thread, in which there is no violation of local blood circulation. A cosmetic, linear scar is formed.

 2) The technique of suturing allows you to create a thorough adaptation and metered compression of tissues throughout and deep in the wound, which ensures the formation of a more complete and lasting scar.

 3) This seam is applicable in both planned and emergency surgery. In case of partial suppuration of the wound, a thread is removed from this site for the full treatment and treatment of purulent complications. The rest of the postoperative wound remains a fixed thread and heals according to the type of primary tension.

Claims (1)

 The method of applying an adaptive continuous suture of the skin wound, including holding the thread in the dermis and subcutaneous tissue of both edges of the wound, fixing the ends of the thread, characterized in that they inject the needle into the dermis of the wound edge with a puncture on the skin at a distance of 2-3 mm from the edge, then pierce the skin at a distance of 1 cm from the puncture, forming the cutaneous part of the suture, the needle is removed into the wound through the subcutaneous tissue, the suture on the subcutaneous tissue of the opposite side is continued, the needle is withdrawn intradermally, and the seam formation step is repeated in full wound closure.

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