RU110981U1 - STENT-OBTURATOR FOR DENTISTRY - Google Patents

Abstract

 1. A stent-obturator containing a housing in the form of a carrier thermoplastic tube, characterized in that the housing is equipped with at least one inflated cuff and a gas supply channel for inflating it. ! 2. The stent-obturator according to claim 1, characterized in that the gas supply channel is cut along the axis of the housing. ! 3. The stent-obturator according to claim 1, characterized in that the outer and inner surfaces of the body are made smooth. ! 4. The stent-obturator according to claim 1, characterized in that it is made of an intratracheal tube with an inner diameter of 7.5-8.5 mm, the corresponding fragment of which is cut 75-85 mm long. ! 5. The stent-obturator according to claim 1, characterized in that it is made of an endotracheal tube with an inner diameter of 7.5-8.5 mm, the corresponding fragment of which is cut off with a length of 75-85 mm.

Description

The utility model relates to the field of medicine, including oncology, namely, devices for arthroplasty, and can be used to close extensive defects of the anterior and lateral walls of the larynx and trachea that occur after removal of some of these organs in connection with their tumor lesion, as well as after an injury.

One of the many difficulties in laryngeal surgery is the cicatricial narrowing of its lumen after organ-preserving operations. The scar process inevitably arising after an operating injury leads to deformation of the lumen both circularly and along the axis of the organ. And this process, in the absence of additional obturators, stents or other devices that form the lumen of these organs, leads to stenosis or even atresia of the lumen.

A variety of devices are known from the prior art - stents installed in the lumen of the larynx, trachea, which perform a skeleton function until tender scars form.

Known obturator from the finger of a surgical glove filled with cotton balls or foam rubber (A.I. Yunina 1972), a biological obturator (A.G. Pilipenko 1970), an obturator from a section of a drainage tube of a suitable diameter sewn with a ligature and fixed by it from the outside, an obturator made of inflated air rubber ball (A.G. Feigin, V.I. Egorov 1963).

All these technical means have disadvantages, for example, an obturator made of a swollen rubber ball does not perform the frame function enough and causes pressure sores. In addition, when using such stent dilators, it is difficult to control the epithelization of a mucosal defect.

Known stent used to enter into the lumen of the airways during arthroplasty during plastic surgery of the trachea using a revascularized skin-bone autograft containing a tubular fragment. It can be a tubular silicone endoprosthesis manufactured by the Russian company Medsil or a section of a thermoplastic endotracheal tube (part of any length can be cut from the endotracheal tube). Such stents are mainly made individually from thermoplastic endotracheal tubes with a siliconized coating or from a tube of silicone rubber. Classical mechanical ventilation is performed through an orotracheal tube, the caudal end of which is inserted into the cranial end of the stent. Moreover, the outer diameter of the endotracheal tube is less than the inner diameter of the stent. It is preferable to use stents with a smooth outer surface and fixation with a ligature to the soft tissues of the neck. (Zenger V.G., Nasedkin A.N., Parshin V.D. Surgery of injuries of the larynx and trachea. - M .: Medkniga, 2007. - 210, 211, 235, 236, 239, 247, 248, 250-256 from.). This decision was made as a prototype.

The most common complications of endoprosthetics are pressure sores with endoprosthesis of the tracheal wall with the formation of anastomosis with adjacent organs and vessels, spontaneous displacement of the stent and its obstruction with bronchial secretions.

The variety of stents known for dilatation indicates that none of them is ideal. In this regard, it is important to find stents that are more suitable for their requirements (Zenger V.G., Nasedkin A.N., Parshin V.D. Surgery of injuries of the larynx and trachea. - M .: Medkniga, 2007. - 232 p. )

The problem to be solved in the claimed proposal is to increase the efficiency and improve the functional results of plastics and postoperative recovery during the formation of the lumen of the larynx and / or trachea during the closure of a defect in the larynx and / or trachea by creating a stent-obturator for temporary arthroplasty.

The technical result consists in increasing the efficiency and improving the functional results of plastics and postoperative recovery, including increasing the viability of plastic surgeries, reducing trauma, minimizing surgical intervention and risks, reducing the likelihood of complications in the postoperative and long-term periods when closing the larynx and / or trachea defect

The essence of the utility model is that in the stent-obturator containing the body in the form of a carrier thermoplastic tube, the feature is that the body is equipped with at least one inflated cuff and a gas supply channel for inflating it. It is advisable to cut the gas supply channel along the axis of the housing. It is advisable to make the outer and inner surfaces of the body smooth. The peculiarity is that the stent-obturator can be made of intratracheal or intubation tubes with an inner diameter of 7.5-8.5 mm, the corresponding fragments of which are cut with a length of 75-85 mm.

The combination of these essential features allows to obtain a technical result.

The execution of the body in the form of a carrier thermoplastic tube provides a sufficient frame function, which eliminates the need to excessively inflate the cuff to create rigidity. The carrier thermoplastic tube allows you to hold the lumen of the larynx from vertical deformation, and the inflated cuff ensures the maintenance of the diameter of the lumen. Using a cuff with a gas supply channel to inflate it provides metered and controlled compression, which reduces the likelihood of pressure sores. Therefore, a stent-obturator is more physiological in contrast to an obturator from a hollow prosthesis tube. After removal of the tracheostomy tube (patient decanulation), the stent-obturator provides the possibility of natural respiration. Thus, the viability of plastic surgery is increased, trauma is reduced, surgical intervention and risks are minimized, the likelihood of complications in the postoperative and long-term periods is reduced, and therefore, the efficacy and functional results of plastic surgery and postoperative recovery are improved.

Our experience of using a stent-obturator stent for temporary arthroplasty, the casing of which is made in the form of a supporting thermoplastic tube and is equipped, in particular, with one inflated cuff and a gas supply channel for inflating it, confirmed in opinion of such advantages as: maintaining the lumen of the larynx and trachea both along the axis due to the tube, and along the circumference due to dosed compression by the inflated cuff, the possibility of continuing mechanical ventilation.

Figure 1 presents a drawing of a stent-obturator; figure 2 - stent-obturator, General view;

The housing 1 of the stent-obturator (not specified) is made in the form of a carrier thermoplastic tube and is equipped with at least one inflated cuff 2 and a gas supply channel 3 for inflating it. A stent-obturator can be made, for example, from an intratracheal or endotracheal tube (these tubes are traditionally used for intratracheal anesthesia) with an internal diameter of 7.5-8.5 mm, the corresponding fragments of which are cut 75-85 mm long. In particular, they were cut off at the level of the inflated cuff 2 and the corresponding fragments were obtained and used as stent-obturators.

Thus, a two-element system is created: the first element is formed by the housing 1 in the form of a carrier thermoplastic tube, which holds the lumen of the larynx from vertical deformation; the second element is formed by an inflated cuff 2, which provides elastic support for the diameter of the lumen.

It is important to note that:

a) there is no need to excessively inflate the cuff to create rigidity (which apparently leads to pressure sores), since the frame is supported by the tube cylinder;

b) unlike an obturator from a hollow prosthesis tube, a stent obturator is more physiological due to the elasticity of the outer wall;

c) the compression created by the cuff is metered and controlled;

d) after removal of the tracheostomy tube (patient's decanulation), natural breathing is possible.

Actually closing the defect was carried out as follows:

Antibiotic prophylaxis was started an hour before the operation by intramuscular administration of third-generation cephalosporins.

Anesthesiological aid - intratracheal anesthesia using an orotracheal tube.

According to traditional technology, soft tissues were collected from a donor site using fascial-fascial or muscular-skin (chest or deltopectoral flaps).

A stent-obturator was placed inside the lumen of the larynx and trachea, which was a body 1 in the form of a carrier thermoplastic tube with smooth external and internal surfaces, equipped with at least one inflated cuff 2 with a gas supply channel 3 for inflating it. For example, a stent-obturator from a segment of a thermoplastic intratracheal tube with a cuff and a channel cut along the axis. The caudal (lower) end (not shown) (oro) of the intratracheal tube (not shown) was inserted into the oral (upper) end (not indicated) of the stent-obturator stent. The stent-obturator was fixed to the soft tissues of the neck with threads 4, which were brought out, continued the classic mechanical ventilation. Channel 3 for inflating the cuff 2 with a ligature was fixed to the endotracheal tube and was extracted through the mouth during extubation.

The inner lining of the laryngotracheal defect was performed due to the surrounding neck skin. The flap used was transferred to the already covered laryngotracheal defect, the graft was fixed to the inner lining, for example, the skin of the flap was sewn with the incision edges on the neck using latex glue or 2/0-3/0 threads.

By hemming the skin of the chin to the skin of the chest wall, the head was fixed in a given physiological position to prevent stress on the sutures when the neck was extended.

We have experience using a stent-obturator in 30 patients. No complications were noted. All restored natural breathing, purulent-inflammatory complications, there was no bleeding. There are no signs of stenosis at the follow-up period of six to nine months.

The stent obturator is easy to manufacture and convenient to use. Its use reduces possible complications and functional disorders even when closing a large defect (more than 4X1 cm). It allows expanding the possibilities of plastic surgery of the larynx and trachea when choosing the optimal solution for surgical intervention with the maximum consideration of the individual characteristics and needs of each individual patient for the rational restoration of the volume and functions of the damaged organ with minimal complications. Increases the effectiveness of surgical treatment and improves functional results.

REFERENCES:

1. V.G. Zenger, A.N. Nasedkin, V.D. Parshin M .: Medkniga, 2007.364 s.

2. Bonnette P. et al., 1998 Srikishna S.V. et al., 1998 Tsubota N. et al., 1998; Grundmann T / et al /, 1998.

3. Shape memory biomaterials and implants proceedings of international conference June 28-30, 2001 Tomsk, Russia.

Claims (5)

1. A stent-obturator containing a housing in the form of a carrier thermoplastic tube, characterized in that the housing is equipped with at least one inflated cuff and a gas supply channel for inflating it. 2. The stent-obturator according to claim 1, characterized in that the gas supply channel is cut along the axis of the housing. 3. The stent-obturator according to claim 1, characterized in that the outer and inner surfaces of the body are made smooth. 4. The stent-obturator according to claim 1, characterized in that it is made of an intratracheal tube with an inner diameter of 7.5-8.5 mm, the corresponding fragment of which is cut 75-85 mm long. 5. The stent-obturator according to claim 1, characterized in that it is made of an endotracheal tube with an inner diameter of 7.5-8.5 mm, the corresponding fragment of which is cut off with a length of 75-85 mm.