RU2063173C1 - Method for preserving umbilicus in extensive reparative operations on the occasion of musculus rectus abdominis diastasis - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves suturing skin border are to the underlying aponeurosis with catgut stitches, two on each side 1 cm distant one from another, after performing plastic operation on the abdominal wall using one of the known operation methods. The remained skin part is sutured as usually. EFFECT: improved cosmetic effectiveness. 2 dwg

Description

 The invention relates to medicine, namely to surgery of the anterior abdominal wall.

 Due to the increase in the number of operations for abdominal hernias, the problem of cosmetic requirements for them becomes urgent. Plastic surgery of the anterior abdominal wall in patients with large hernias of the white line of the abdomen is associated with excision of excess skin and subcutaneous tissue along with the navel. The absence of a navel after surgery in patients causes cosmetic inconvenience. Therefore, searches aimed at preserving or forming a new navel during reconstructive operations on the anterior abdominal wall are of interest.

 B. A. Barkov (1956), proposing a method of surgery for diastasis of the rectus abdominis muscles, recommended saving the navel on a nourishing skin graft, which we took as a prototype. This method for storing the navel is schematically depicted in FIG.

 The essence of the prototype method is as follows.

 During removal of excess skin and subcutaneous tissue, a navel is kept on the skin graft from the anterior abdominal wall. It is separated from the underlying tissues. When the surgical wound is sutured, the navel on the nourishing skin is applied to the wound and sutured to the edges of the skin.

 This method of preserving the navel has disadvantages. As you know, the blood supply to the umbilical region is carried out by the branches of the superficial, upper and lower epigastric, upper cystic, as well as umbilical arteries, which maintain patency in a certain part and in the postnatal period. A skin flap does not provide blood supply to the umbilical region. Isolation of the navel from the underlying tissues, as provided for by B.A. Barkov, is associated with the intersection of arterial branches that feed the umbilical region, which can lead to its neurosis and infection of the surgical wound.

 The aim of the proposed invention is to achieve the cosmetic effect of plastic surgery on the anterior abdominal wall and the prevention of purulent complications of surgical wounds.

 This goal is achieved by the prototype method: when removing excess skin and subcutaneous tissue, the navel is kept on the skin flap from the anterior abdominal wall. The navel on the feeding leg is separated from the underlying tissues. When the surgical wound is sutured, it is applied to the wound and sutured to the edges of the skin, and according to the proposed method, the navel is removed along with excess skin and subcutaneous tissue, when the skin wound is sutured, its edges in the region of the excised navel are sewn with catgut sutures to the aponeurosis, two on each side on each side 1 cm apart.

 The proposed method of beam formation is schematically depicted in figure 2.

 Its essence is as follows: after plastic surgery of the anterior abdominal stack, according to one of the methods of operations, when suturing the surgical wound, the edges of the skin in the region of the excised navel are sewn to the underlying aponeurosis with catgut sutures, two on each side at a distance of 1 cm from each other. The rest of the skin is sutured as usual.

 Within 7 to 10 days after plasty, a skin defect above the aponeurosis is covered with granulation tissue, which is subsequently epithelized.

 An example of a specific implementation.

 B-naya K., 35 years old, history. Disease 10/247, an employee, was admitted to the clinic on April 21, 90, complaining of the presence of a large hernial protrusion on the anterior abdominal wall, pain in it, especially when walking and physical activity, limitation of working capacity. The patient considers himself 6 years old. The size of the hernial protrusion is gradually increasing.

 The general condition of the patient is satisfactory. Proper physique, increased nutrition. Pulse 72 per minute, A / D 130/70 mm RT. Art. Heart sounds are clean, vesicular breathing in the lungs. On the anterior abdominal wall along the white line of the abdomen, when straining, a hernial protrusion of 25x12 cm appears, freely rotating in the abdominal cavity. The contours of the aponeurosis defect are clearly palpated along the white line of the abdomen with the coverage of the umbilical region measuring 20x20 cm.

 Diagnosis: large hernia of the white line of the abdomen.

 Under endotracheal anesthesia on April 29, 1990, plastic surgery of the anterior abdominal wall was performed according to the Napalkov method. When the surgical wound is sutured, the edges of the skin in the region of the excised navel are sewn to the underlying aponeurosis with catgut sutures, two on each side at a distance of 1 cm from each other. The rest of the wound is sutured in the usual way.

 The postoperative period was uneventful. Within 10 days, the area of the designated navel was covered with granulation tissue, which was subsequently epithelized.

 Examined 1 year after surgery. Satisfactory condition, no complaints. The shape of the navel is not different from the natural one.

 By the proposed method, a navel was formed in 9 patients with large hernias of the white line of the abdomen, operated on using different methods of plastic surgery of the anterior abdominal wall. All of them were examined 1 3 years after the operation. The examined patients did not present complaints, they were satisfied with the navel shape, and no recurrences of hernia were found.

 Signs that are distinguished from the prototype: the edges of the skin in the region of the excised navel are sewn to the underlying aponeurosis with catgut sutures, two on each side at a distance of 1 cm from each other.

 Positive result: cosmetic effect and prevention of purulent complications of the surgical wound.

Claims (1)

 The method of forming the navel during extensive reconstructive operations on the anterior abdominal wall, characterized in that the edges of the skin in the region of the excised navel are sutured to the aponeurosis by catgut sutures, two on each side at a distance of 1 cm from each other.

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