RU172255U1 - FASCIOT WITH REMOVABLE SURGICAL BLADE - Google Patents

Abstract

Fasciotome refers to medical equipment, namely to surgical instruments, and can be used to perform closed fasciotomy of limb segments in acute interstitial hypertension compartment syndrome of various etiologies. The purpose of the utility model is to reduce the morbidity during fascia dissection and to shorten the time of fasciotomy surgery. Fasciotome consists of two jaws with rings fixed to each other by a toothed clemeler, and a working part. The branches are bent in the sagittal plane at an angle of 135 °, the length of the vertical part of the branch is 70 mm, the length of the horizontal part of the branch is 85 mm. The working part is formed by a sole, a removable pointed surgical blade and a limiter. The sole is a metal rectangle with rounded corners 38 mm long, 8 mm wide and 1 mm thick. The bottom surface of the sole is smooth, the upper surface of the sole has longitudinal grooves. A removable surgical fasciothoma blade is perpendicularly fixed by means of a slide mechanism with a stopper to the upper surface of the sole along its length with the edge of the non-cutting part parallel to the horizontal plane. During the operation, the guiding distal end of the sole through a short incision 1-2 cm long is inserted under the fascia of the musculoskeletal case. Dissection of the fascia on its further extent is carried out by a surgical blade when the sole of the fasciotome moves along the surface of the muscle. Due to the presence of a limiter located above the removable surgical blade, damage to the subcutaneous fatty tissue and skin located above the fascia is excluded when the fasciotome is advanced along the longitudinal axis of the limb segment.

Description

The device relates to medical equipment, namely to surgical instruments used to perform closed fasciotomy on limb segments.

In assisting patients with acute acute compartment syndrome, timely and atraumatic fasciotomy is the main treatment measure. Minimal trauma to surrounding tissues during the operation of closed fasciotomy increases the rehabilitation potential, reduces the period of disability in the treatment of patients with acute interstitial hypertension syndrome.

To perform closed fasciotomy, various modifications of fasciotomes have been proposed, essentially consisting of a handle and a working part represented by a cutting tool and a drill for separating surrounding soft tissues from the fascia.

Known by the fasciote [RU 2232553 C2, dated 11.06.2002, A61B 17/32] containing a handle connected by a conductor to a working part formed by a hoist and a drill, interconnected by a blade. The conductor is made to move the working part parallel to the longitudinal axis of the limb segment. The hoist and drill are located at an angle of 45 ° relative to the longitudinal axis of the tool and are made club-shaped. The blunt end of the drill is 0.5 cm away from the blunt end of the elevator, and the distance between the inner convex part of the drill and the longitudinal axis of the tool is 2 mm. The disadvantages of this invention are: the cutting tool is made in the form of a non-removable structure, which requires periodic sharpening of the tool.

Known by the fasciote [RU 138879 U1, dated 10.12.2013, A61B 17/32], consisting of a housing, which is a cylinder having on its distal part a slot for a blade movably fixed in the cavity of the housing by means of a fastening pin. In the proximal part, the casing ends with a finger rest and an opening for passage into the cavity of the stem casing having a cutout for the blade at its end part and a guide rod that passes through the cutout located in the blade. The principle of operation of this utility model is as follows: the surgeon dissects the skin and subcutaneous fat, then, holding the device so that the I finger is located in the ring of the retracted rod, and II and III - on the stops, introduces the body through a small incision on the fascia devices. Then, setting the fasciote to the length of the required cut, the operator, bringing the I finger to II and III, advances the rod forward so that the blade movably fastened to the rod, by means of a guide rod passing through the cutout, is extended by its cutting surface from the body. After the blade comes into contact with the overlying fascia, the doctor, without relaxing the I, II and III fingers, slowly displays the device through the inlet. This fasciote has the following disadvantages: the cutting tool is made in the form of a non-removable structure, which requires periodic sharpening of the tool; when fascia is dissected due to the absence of any limiter above the cutting edge of the instrument, there is a high risk of damage to the proper soft-tissue structures.

Known by the fasciote [RU 2118130 C1, dated 19.12.1995, A61B 17/32], the working part of which is formed by a hoist and a blunt drill connected by a cutting tool. This fasciote has the following disadvantages: the cutting tool is made in the form of a non-removable structure, which requires periodic sharpening of the tool; due to the design of the fasciotome handle, which consists of one ring with a stop (one fixation point of the instrument) located on its lower surface, during the operation reliable and stable fixation of the instrument in the hands of the surgeon is impeded and uncoordinated rotational movements of the instrument are not excluded, which queue can lead to additional trauma to the surrounding soft tissue; the presence of this invention a pointed spear on the working part creates the prerequisites for additional trauma to the underlying structures (muscles, blood vessels, nerves); the extension cord and the conductor of this tool are made straight, which necessitates the use of a fasciotome at an angle to the working surface and eliminates the possibility of working in a plane parallel to the surface of the underlying muscles.

This fasciote is taken as a prototype.

The purpose of creating a utility model is to create an easy-to-use tool that provides fast and atraumatic closed fasciotomy.

The goal is achieved as follows.

The proposed fasciote with a removable surgical blade (Fig. 1) includes:

1) a conductor (1), which consists of two branches (2) with rings (3), fixed between each other by a lock (4) with a toothed cleamer (5), the branches are bent in the sagittal plane at an angle A, which is 135 °, the length of the vertical part of the jaw (6) 70 mm, the length of the horizontal part of the jaw (7) 85 mm;

2) the working part (8), consisting of a sole (9), a removable surgical blade (10), fixed in a slide with a stopper (11), and a club-shaped limiter (12). The sole (9) is a metal rectangle with rounded corners with a length of 38 mm, a width of 8 mm and a thickness of 1 mm. The bottom surface of the sole (9) is smooth, the upper surface of the sole has longitudinal grooves. To the upper surface of the base of the sole (9), the distal end of the lower horizontal jaw (7) is fixedly fixed, on which there is a slide lock with a stop (11). In this lock, a removable surgical blade (10) is fixed perpendicular to the upper surface of the sole (9) with the edge of the non-cutting part parallel to the horizontal plane. The club-shaped stop (12) is a continuation of the distal end of the upper horizontal jaw (7), is rigidly fixed to it and is located over the cutting edge of the removable surgical blade (10) along its entire length.

The principle of work with the proposed utility model is as follows (Fig. 1, Fig. 2). A removable pointed surgical blade (10) is fixed in a slide with a stopper (11) perpendicular to the upper surface of the sole (9) with the edge of a non-cutting part parallel to the horizontal plane. Due to the fingers of the surgeon compressing the rings (3) of both tool branches, the club-shaped limiter (12) is opposed to the cutting edge of the removable surgical blade (10) along its entire length. The distance between the lower surface of the limiter (12) and the cutting edge of the removable surgical blade (10) is chosen arbitrarily depending on the anatomical features of the limb segment on which the closed fasciotomy operation is performed. The set position of the tool is fixed by the toothed clamper (5).

After preparing the instrument for operation (Fig. 3), during the operation, the guiding distal end of the sole (9) is inserted through a 1-2 cm long incision under the fascia of the musculoskeletal case. In this case, the rounded part of the limiter (12) abuts against subcutaneous fat together with the superficial fascia. With this introduction of the fasciotome into the wound, the relationship between the working part of the instrument and the surrounding tissues is as follows: the own fascia is detached from the underlying muscle by the distal end of the sole (9) and is placed in the distance between the sole (9) and the limiter (12), the limiter (12) is in contact with its rounded part with overlying subcutaneous fat and superficial fascia. The dissection of its own fascia on its further extent is carried out by the cutting edge of a removable surgical blade (10) when the fasciotome sole moves in a plane parallel to the longitudinal axis of the segment. Due to the presence of a limiter located above the removable surgical blade and an adjustable distance between them, damage to the subcutaneous fatty tissue and skin located above the fascia is excluded when the fasciotome is moved along the longitudinal axis of the limb segment. Removing a fasciotome from a wound due to its design features is atraumatic and unobstructed.

The proposed fasciote meets the modern requirements of one-time use of cutting and stitching surgical instruments due to the available removable surgical blade. The utility model provides the convenience of work due to the presence of two opposed points of fixation of the instrument in the surgeon's hand. This fasciote can be used in the surgical treatment of acute interstitial hypertension syndrome of various etiologies (prolonged squeezing syndrome, gunshot wounds to the extremities, trauma with extensive crushing of soft tissues, limb lymphostasis, thrombophlebitis with soft tissue edema, frostbite of the extremities, condition after late (more than 6 hours) or failed arterial reconstruction). Closed fasciotomy using the proposed device can reduce the invasiveness of surgical intervention, expand the scope, create the most convenient working conditions, perform segmental fasciotomy from peripheral skin incisions, without additionally injuring the skin.

Claims (6)

1. Fasciota with a removable surgical blade, consisting of two jaws with rings fixed to each other by a toothed cleamer, and a working part formed by the sole, a slide mechanism with a stopper, a removable pointed surgical blade and a limiter having a club shape, and the limiter is fixed at the distal end the upper horizontal jaw and is located above the cutting edge of a removable surgical blade. 2. Fasciotome under item 1, characterized in that it has two branches, curved in the sagittal plane at an angle of 135 °, the length of the vertical part of the jaw 70 mm, the length of the horizontal part of the jaw 85 mm. 3. Fasciot according to claim 1, characterized in that the sole of the working part 1 mm thick is made in the form of a rectangle with rounded corners 38 mm long and 8 mm wide. 4. Fasciot according to claim 1, characterized in that the slide mechanism with a stopper for changing the blade is located at the distal end of the lower horizontal jaw and is fixed to the upper surface of the sole parallel to the horizontal plane. 5. Fasciot according to claim 1, characterized in that the two tool rings and the toothed clamp are located on the vertical part of the tool branch, while the toothed clamp is fixed at an angle of 90 ° to them. 6. Fasciot according to claim 1, characterized in that the removable pointed blade is located in the center of the upper surface of the sole along its long axis and is fixed perpendicular to it.

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