RU176730U1 - LIGATURE CONDUCTOR - Google Patents

Abstract

The ligature jig refers to medicine, namely to surgery. The technical result of using the utility model is the possibility of simple fixation of any part of the ligature in a stretched, straightened state, at any thickness of the ligature and summing it up by performing movements not only translational, but if necessary in any other directions when introducing ligatures into hard-to-reach sections of body cavities and into wounds with a narrow wound channel, it was also easier to extract the ligature brought in a straightened state into one another e tools. The device consists of a working plate, a rod and a handle, the working plate having a configuration in the form of a plug 10.0 mm wide, 20.0 mm long, 3.0 mm thick, the outer edges of the working plate have an arcuate narrowing in the direction of the rod, in the center of the working plate there is a parabolic recess 8.0 mm deep, the width of the ends of the fork is 3.0 mm, the ends of the fork along the front surface with a level length of 5.0 mm have a bevel relative to the plane of the front surface to a thickness of 1.5 mm along the ends of the fork, along the inner edges of the parabolic recess is located the plates are 2.0 mm wide, 0.5 mm thick, 7.0 mm long, fixed at the base of the notch of the fork in the plane of its front surface and 1.5 mm shorter than the ends of the fork, on the back of the working surface of the working plate, the edges of the notch bevel from a distance of 1.0 mm from the outer edges of the fork to its central part, with a thickness of the inner edges of the fork of 0.5 mm, all edges of the parts of the working plate have rounding edges, the tool rod 100.0 mm long in the form of a truncated cone with a distal diameter of 4 , 0 mm and proximal 6.0 mm, proximally the rod is connected to a figured p chkoy vytyanutokaplevidnoy configuration, length 85.0 mm. Fig. 3.

Description

To bring ligatures into hard-to-reach sections of body cavities and into wounds with a narrow wound channel that impedes the manipulation of conventional surgical instruments, two-horned plugs are used, for example, the Vinogradov ligature guide. The ligature, drawn through the opening of the fork and fixed in a stretched position along the tool with a hand, is inserted into the wound. After that, the ligature is released by hand and used for dressing in a fairly wide surgical field.

The disadvantage of using the tool for bringing ligatures to hard-to-reach areas of the surgical field, which works like a two-horned fork, is the need to hold the ligature with your hand constantly in a taut state. The second disadvantage is the inconvenience of gripping the failed ligature, since it is in a state thrown through the tool fork, in addition, the ligature is fed to the middle part, and this complicates the use of the ligature, since they usually begin to work at one end of the ligature.

As a prototype of a tool for drawing up ligatures, a “Fork for entering and tying knots” (code: 10.0502) was used (Tool for applying ligatures [Electronic resource] / LLC NPF Krylo. - http://krylo.ru/instrument/instrument- dlya-nalozheniya-ligatur (accessed: 07/05/2016)), which is used to summarize ligatures in the body cavity and tie knots.

The disadvantage of the prototype is the need to summarize the ligature, thrown through the plug of the tool in the middle part, be sure to stretch the entire ligature, and there are difficulties in capturing the failed ligature with tools deep in the wound.

The technical result is the simplification of the ligature using a conductor, since the ligatures are not thrown through the tool fork, and any part of the ligature is fixed in a stretched tensioned position along the width of the tool fork and does not require additional manipulations to hold it, fixing the ligatures is made of any thickness and in any area along the length of the ligature. Extraction of the ligature is carried out in different ways depending on the task to be performed: with hands, a clamp or a hook needle, it is better to traction towards the ends of the fork.

The technical result is ensured by the fact that the master alloy conductor has a working plate in the form of a plug 10.0 mm wide, 20.0 mm long, 3.0 mm thick, the outer edges of the working plate have an arcuate narrowing in the direction of the rod, there is a parabolic recess in the center of the working plate a depth of 8.0 mm, the width of the ends of the fork is 3.0 mm, the ends of the plugs on the front surface with a level length of 5.0 mm are beveled relative to the plane of the front surface to a thickness at the ends of the fork 1.5 mm, along the inner edges of the parabolic recess are plates of width 2 , 0 mm, 0.5 mm thick, 7.0 mm long, fixed at the base of the recess of the fork in the plane of its front surface and 1.5 mm shorter than the ends of the fork, the edges of the recess on the back of the working surface of the working plate are beveled from a distance of 1.0 mm from the outer edges of the fork to its central part, with a thickness of the inner edges of the fork of 0.5 mm, all the edges of the parts of the working plate have rounding edges, the tool rod 100.0 mm long in the form of a truncated cone with a distal diameter of 4.0 mm and proximal 6.0 mm, proximal to the stem connected to a curly handle idnoy configuration, length 85.0 mm.

The technical result is ensured by the fact that in order to bring any necessary section of the ligature, of different diameters, into hard-to-reach areas of wounds, canals, cavities in the straightened, stretched state, the ligature is inserted into the gap of a narrow triangular configuration between long and short plates of the fork in a stretched state across the width of the fork and is fixed in it in a straightened state, due to jamming. The failed ligature is removed from the tool by traction of the stretched part of the ligature in any way towards the ends of the tool fork.

USEFUL MODEL EXPLAINED BY FIGURES (Figs. 1-3).

In FIG. 1. View of the device in isometry.

In FIG. 2. General view of the device, top view.

In FIG. 3. General view of the device, side view.

The device consists of a working plate, rod and handle; the working plate (1) is presented in the form of a fork 10.0 mm wide, 20.0 mm long, 3.0 mm thick, the outer edges of the working plate have an arcuate narrowing in the direction of the rod, in the center of the working plate there is a parabolic recess 8.0 mm deep , the width of the ends of the fork (2) 3.0 mm, the ends of the fork on the front surface with a level length of 5.0 mm, are beveled relative to the plane of the front surface to a thickness at the ends of the fork 1.5 mm, plates are located along the inner edges of the parabolic recess (3 ) 2.0 mm wide, 0.5 mm thick, 7.0 mm long, fixed at the base the recess of the fork in the plane of its front surface of the fork and 1.5 mm shorter than the ends of the fork, on the back from the front surface of the working plate, the edges of the recess have a bevel (6) from a distance of 1.0 mm from the outer edges of the fork to its central part with a thickness of the edges of the plug are 0.5 mm, all the edges of the parts of the working plate have rounding edges, the tool stem (4) is 100.0 mm long in the form of a truncated cone with a distal diameter of 4.0 mm and a proximal diameter of 6.0 mm, the proximal stem is connected to a figured with a handle (5) an elongated drop-shaped configuration 85.0 mm long (Fig. 3).

THE DEVICE WORKS AS FOLLOWS.

The ligature jig device is charged by the ligature, by fixing it and one ligature parallel to the ligature rod and using the fingers of the other hand to hold the ligature and using the tool to clamp between the long and short ends of the working plate fork with an effort that allows you to feel the fixation of the thread. The failed ligature is removed in one of the ways, by a clamping tool or a hook needle, brought into the recess of the jig with a fixed ligature, by traction of the ligature towards the ends of the tool plug.

CLINICAL APPLICATION EXAMPLES

The clinical part of evaluating the effectiveness of the use of the instrument included its use in 50 patients with laparotomy at the stages of suturing of the peritoneum, aponeurosis, subcutaneous fat, and muscles. Gastrotomy openings were sutured in 7 patients, in 4 patients with a high degree of operational risk, chronic gastric ulcers complicated by bleeding were stitched, hernias with endoprosthetics were performed in 8 patients.

Patient G., 48 years old. She was hospitalized at the Municipal Clinical Hospital of the Nursing Unit of the Nursing School of Kursk from 09/13/2015 to 09/22/2015. Diagnosis: postoperative ventral hernia. September 15, 2015 operation: hernia repair with endoprosthetics of the anterior abdominal wall, drainage of subcutaneous tissue. Under spinal anesthesia, the old postoperative scar was excised, the aponeurosis was exposed. In the lower corner of which is a hernial sac measuring 8.0 × 7.0 × 6.0 cm in which there is a fixed large omentum and loops of the small intestine. The contents of the bag are viable, immersed in the abdominal cavity. The hernial sac is excised. The hernia gate is sutured: the peritoneum with catgut using a small soft tissue stitcher and the ligature conductor with a continuous suture, aponeurosis with nodular sutures with fluorescence, subcutaneous tissue with catgut. Endoprosthetics of the anterior abdominal wall were performed by Esfil mesh endoprosthesis of LLC Linteks with dimensions of 10.0 × 15.0 cm, on lay. Nodal sutures with catgut on subcutaneous tissue with the help of a stitcher of small soft tissues and a ligature conductor. Hemostasis during the operation. Tubular drainage into the subcutaneous tissue. Nodal nylon seams on the skin. Aseptic dressing. The postoperative period was uneventful. The sutures were removed on an outpatient basis on September 24, 2015. Healing by primary intention.

Patient B., 67 years old. Hospitalized in the Municipal Clinical Hospital Municipal Clinical Hospital SMP in Kursk 11/01/15. Diagnosis: Penetrating wound of the abdominal cavity with damage to the right lobe of the liver, intraperitoneal bleeding of 1 degree. 11/01/15, Operation - PHC wounds of the abdominal wall, laparotomy. Diathermocoagulation of a liver wound, tamponade with an omentum, suturing of a liver wound, debridement and drainage of the abdominal cavity.

During laparotomy, after revision of the abdominal cavity, up to 150 ml of blood with convolutions was found in the right lateral canal and pelvic cavity. Drained. A torn wound 2.5 × 1.5 × 1.0 cm in size with a slight leakage of blood was found along the diaphragmatic surface of the right lobe of the liver. Excreted areas of the edges of the wound of the liver are excised. Hemostasis was performed by electrocoagulation. The edges of the liver wound are stitched using a soft tissue stitcher of a large and ligature jig with 2 catgut suture sutures that are tied over a strand of a large omentum inserted into the wound. Sanitation of the abdominal cavity. Tubular drainage into the subhepatic space. Rubber strip to the wound of the liver. Layered seams on the wound of the abdominal wall using a large soft tissue stitcher and a ligature conductor. The peritoneum is sutured with a continuous suture with catgut, the aponeurosis with nodular sutures of nylon, the subcutaneous tissue with nodular sutures with catgut. The skin is traditionally sutured - with a cutting needle, nodal seams nylon. Iodine. Aseptic dressing. 11/05/15, the drainage tube is removed. The postoperative period was uneventful, the sutures were removed 11/11/15, healing by primary intention.

Patient N., 52 years old. He was hospitalized at the Municipal Clinical Hospital Municipal Clinical Hospital SMP in Kursk on 10/03/15. Diagnosis: Mellori-Weiss syndrome, complicated by recurrent bleeding of 2-3 degrees. Operation 05.10.15, - laparotomy, gastrotomy, flashing of a subcardia crack, drainage of the abdominal cavity.

Under endotracheal anesthesia, a mid-median laparotomy was performed. The stomach is plugged with blood; in the loops of the small and large intestine there is fragmentary dark blood. An anterior superior gastrotomy was performed. Blood clots removed. During the audit, a crack of the mucous membrane of the posterior wall 1.5 × 0.5 cm under the fibrin was found in the subcardial zone, with a bleeding venous vessel in the center. Hemostasis by flashing the fissure with two interrupted sutures by fluorescence using a large soft tissue stitching tool and a ligature conductor. There are no other sources of bleeding. The gastrotomy opening is sutured with a continuous stitching catgut suture, applied with the help of a soft tissue stitch and a ligature conductor. Peritonization of the stitching suture is performed by nodular serous-muscular sutures, atraumatic needles with PHA threads. Remediation, drainage of the abdominal cavity by tubular drainage in the right hypochondrium. With the help of a large soft tissue stitcher and a ligature conductor, layered stitches were placed on the wound of the abdominal wall. The peritoneum is sutured with a continuous catgut suture. Aponeurosis is sutured with nodular sutures with nylon, nodal sutures on the subcutaneous tissue with catgut. The skin is sutured with nodular sutures with nylon cutting needles. Iodine. Aseptic dressings. Drainage from the abdominal cavity was removed on 10/08/15. The sutures were removed on 10/15/15. Healing by primary intention. In satisfactory condition, was discharged on October 16, 2015 for aftercare by a gastroenterologist.

Thus, the analysis of the use of the ligature conductor device in patients showed that the technique was simplified and the duration of the surgical intervention was reduced, the ligature flow rate increased, the safety of working with suture material deep in the tissues, in limited spaces of the abdominal and chest cavities, as the tool allows threading not only progressively, but also in any other directions when working in hard-to-reach departments of the surgical field, the fence simplified in straightened ligature condition in other tools.

Claims (1)

The master alloy conductor, consisting of a working plate, a rod and a handle, characterized in that it has a working plate in the form of a plug 10.0 mm wide, 20.0 mm long, 3.0 mm thick, the outer edges of the working plate have an arcuate narrowing in the direction of the rod , in the center of the working plate there is a parabolic recess 8.0 mm deep, the width of the ends of the fork is 3.0 mm, the ends of the forks along the front surface with a level length of 5.0 mm are beveled relative to the plane of the front surface to a thickness at the ends of the fork 1.5 mm, along the inner edges of the parabolic recess located the plates are 2.0 mm wide, 0.5 mm thick, 7.0 mm long, fixed at the base of the notch of the fork in the plane of its front surface and 1.5 mm shorter than the ends of the fork, on the back of the working surface of the working plate, the edges of the notch bevel from a distance of 1.0 mm from the outer edges of the fork to its central part, with a thickness of the inner edges of the fork of 0.5 mm, all edges of the parts of the working plate have rounding edges, the tool rod 100.0 mm long in the form of a truncated cone with a distal diameter of 4 , 0 mm and proximal 6.0 mm, proximal to the stem connected to the figured ru with an elongated drop-shaped configuration 85.0 mm long.

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