RU2143231C1 - Method for putting-in aponeurotic sutures - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves tying knots and bringing free ends of tied threads outside through skin wound. Catching dissected aponeurosis with sutures is carried out from both sides 1.0-2 cm aside from the aponeurosis edges. The aponeurosis is sutured with separate interrupted sutures that are put in 1.5-2 cm one from another. Every second knot is tied with loops created. Monolith thread is brought through the loops and the loops are tightened thereon. EFFECT: provided wound exudate discharge; easily removed sutures. 6 dwg

Description

 The invention relates to medicine, namely to surgery, and can be used for suturing laparotomy wounds.

 Suppurations of laparotomic wounds are especially common in surgery of peritonitis, as well as after interventions on the colon and rectum, reaching 11 - 13% and higher (Savchuk B.D. Purulent peritonitis. - M .: Med., 1979; Bachev I.I. Prevention of suppuration of laparotomic wounds // Bulletin of Surgery, 1988, N 3, pp. 136 - 140; Knysh V.I., Ananyev V.S. Purulent complications after surgery for colon cancer // Surgery, N 3, 1985 , p. 138 - 143).

 Deep suppuration of the laparotomy wound is dangerous by the development of eventation, which is a real danger to life. Superficial suppurations lengthen the treatment period, and in the case of the formation of ligature fistulas, they drag it out for weeks and even months. With a known microbial contamination of the laparotomy wound, which always happens with extirpation of the rectum, resection of the rectum and colon, rinsing and drainage of subcutaneous tissue, antibiotics, delayed sutures are used to prevent suppuration.

 There are methods for suturing a laparotomic wound with removable sutures using a continuous suture, however, due to the shortcomings inherent in any continuous suture, they can be the cause of eventing (Kochnev OS, Gaynullin U.S. Removable continuous layerwise suture of the abdominal wall // Surgery, N 9 , 1985, pp. 38 - 42; Ivanov V.I.On a continuous removable and submersible mattress seam by Prof. A.I. Lebedev for glancing, // 1911, St. Petersburg). V.F. Babko et al. (Babko V.F., Shermet I.V., Pikhut P.I. Method of wound closure // Bulletin of Surgery N 3, 1988, pp. 136-140) several variants of removable aponeurotic sutures involving removal of threads were proposed out with a puncture through the skin on the side of the laparotomy wound. In this case, the non-draining skin wound is sutured, which can negate the benefit of removable sutures in case of suppuration of the subcutaneous tissue. N.N. Kanshin et al. (Kanshin N.N., Nikolaev A.V., Yakovlev S.I. et al. A differentiated approach to the healing of a laparotomy wound // Herald of Surgery, N 11, 1986, pp. 33 - 37) used removable aponeurotic sutures, supplementing them rare sutures on the skin. As a result, the number of postoperative suppurations decreased by 2 times. However, a special tool is required to remove these aponeurotic sutures.

 For the prototype, we accepted the proposal of S.S. Yudina (Nikolaev G.Yu., Titov V.I. The Experience of Soviet Medicine in the Great Patriotic War of 1941 - 1945, vol. 12, p. 103 - 105), which used a removable aponeurotic suture of the laparotomy for gunshot wounds of the abdominal cavity wounds. To do this, lay the usual nodal sutures on the aponeurosis, but the ends of the threads are not cut, but brought out. The skin wound remained open until the aponeurotic sutures were removed. This proposal, which significantly reduced the number of postoperative complications, was undeservedly forgotten.

 The disadvantages of these proposals are the need to manufacture a special tool for removing sutures, the duration of healing of the laparotomy wound in cases of non-suturing of the skin wound, suturing of non-draining skin wounds.

 The aim of the invention is to prevent suppuration of the laparotomy wound associated with it, the prevention of the formation of ligature fistulas and the healing of the abdominal wall wounds according to the type of primary tension.

 Tasks: connecting homogeneous tissues, ensuring the outflow of wound exudate from cell spaces, unhindered removal of aponeurotic sutures after healing of a laparotomy wound.

 The essence of the invention lies in the fact that the method of applying aponeurotic sutures involves tying knots and removing the free ends of the tied threads out through the skin wound. Moreover, in contrast to the closest analogue, after sewing the aponeurosis with separate sutures, in which the sutures are nodal at a distance of 1.5 - 2 cm from each other, and the dissected aponeurosis is seized with sutures, departing from its edges on both sides by 1 - 2 cm, the second knots are knotted with the formation of loop bows, a monolithic thread is passed through the loop loops and bow loops are tightened on it.

 The invention is illustrated by drawings, where in FIG. 1 shows a diagram of tying a second removable assembly to a loop, and FIG. 2 - nodes of the removable seam are tied with the formation of a bow-loop, in FIG. 3 - conducting monofilament yarn through the loop-bows of removable seams, in FIG. 4 loops-bows of removable seams are tightened on a monofilament yarn, in FIG. 5 - the ends of the threads of the aponeurotic seams brought out. Skin sutures were applied, in FIG. 6 - removal of aponeurotic sutures: a) cutting of a monofilament suture, b) extraction of a monofilament suture, c) cutting of one thread of an aponeurotic suture at the skin level, d) removal of a removable suture from tissues.

 The method is as follows: the edges of the aponeurosis, with or without muscle and peritoneum, are stitched with a strong non-absorbable thread NN 6-8, for example, from mylar fiber. The seizure of the dissected aponeurosis with seams should be wide enough: 1 - 2 mm departing from its edges on both sides. Nodal sutures are applied at a distance of 1.5 - 2 cm from each other. The threads of each stitched seam are tied to one knot and tightened, bringing the stitched fabrics together until they are in complete contact. The second knot is tied with the formation of a bow-loop at one of the ends of the thread so that when pulling at this end it would be possible to untie the knot.

 As suturing along the entire wound to prevent self-loosening of the knots, slippery monofilament thread, for example, polyamide fishing line, with a diameter of 0.8 - 1.0 mm, is passed through all the loop-bows.

 Then the threads of the seams are pulled sharply and sufficiently strongly, as a result of which the bow-loops firmly close around the fishing line drawn through them. Due to this closure, the nodes become non-untwisting.

 The ends of the fishing line are brought out above the skin level through separate punctures near the corners of the wound, fixing them with separate sutures. Skin with subcutaneous fatty tissue is sutured with rare interrupted sutures, which are applied between the outward-facing ends of the threads of removable aponeurotic sutures.

 The ends of the threads of these aponeurotic sutures are connected in groups of 3-4 pairs, which facilitates the care of them during dressings. These strands of thread are laid on small gauze napkins and the wound is closed with an aseptic sticker.

 In the future, with daily dressings, special attention is paid to ensuring free outflow from the wound through the spaces formed by the removed threads of removable aponeurotic sutures. For this, the threads and the surface of the sutured wound with daily dressings are freed from the crusts of the drying exudate that are formed. Then, each pair of threads is moved back and forth along the skin wound between two adjacent skin sutures. Thanks to this technique, the adhesion of the edges of the skin wound is disrupted, a gap is formed between them, through which a serous or purulent wound exudate flows freely. The described manipulation is attached crucial to ensure smooth healing and prevent suppuration of the skin wound. After 3 - 8 days, the hydration period ends, exudation disappears, which is a signal to stop the separation of the edges of the skin wound by moving the threads of the aponeurotic sutures. The skin wound sticks together and, as a rule, heals as a primary tension.

 10 to 12 days after surgery, skin sutures are removed in the usual way. Aponeurotic seams are stored for 18 to 20 days, after which they begin to be removed. To do this, the ends of the monofilament support line protruding above the skin are freed from the skin sutures holding it. One of these ends is cut at the level of the skin and, pulling at the other end, the entire supporting thread is removed. Thereby loops of bows of aponeurotic seams are released.

 Loop bows are untied by traction for one of the threads of each aponeurotic suture, after which one of these threads is cut at the skin level.

 Sipping at the end of the second thread, the completely aponeurotic suture is removed.

 The proposed sutures were tested in clinical conditions for 17 patients who underwent surgery for colorectal cancer (9), colon cancer (6) and Crohn's disease (2).

 Example. Patient M., 63 years old, medical history N 10143, was admitted for treatment to the proctology department of the Krasnodar Regional Clinical Hospital named after prof. Ochapovsky 6.03.95, with a diagnosis of colorectal cancer of the middle ampullar department 3 tbsp. 2 cl. column T3NoMx. After preoperative remote gamma-therapy at a dose of 19.5 Gy on March 16, 1995, an abdominal-anal resection of the rectum with reduction of the sigmoid was performed. The entire wound of the anterior abdominal wall from the pubis to the middle of the distance between the navel and the xiphoid process is sutured with removable aponeurotic seams. Skin with subcutaneous tissue is sutured with rare sutures with a wide grip of tissues. In the postoperative period, dressings were made, during which the aponeurotic sutures moved longitudinally with respect to the wound, were released from the crusts and the skin was treated with an antiseptic. 10 days after surgery, skin sutures were removed, after 16 removed and aponeurotic. The wound of the anterior abdominal wall healed by primary intention. After 3 weeks, the patient was cut off the excess of the reduced intestine. Discharged in satisfactory condition after 10 days. Examined 2 months after surgery: on the anterior abdominal wall - postoperative scar, ligature fistulas and hernial protrusions no. The patient's condition is satisfactory.

 The method allows to reduce the number of purulent complications from the side of the laparotomy wound in planned and emergency surgery of the abdominal organs, and also to eliminate the formation of purulent ligature fistulas.

Claims (1)

 A method of applying aponeurotic sutures, including tying knots and releasing the free ends of the tied threads out through the skin wound, characterized in that after flashing the aponeurosis with separate sutures, in which the sutures are nodal at a distance of 1.5 - 2 cm from each other, and the capture of a dissected aponeurosis seams are carried out, departing from its edges on both sides by 1 - 2 cm, the second knots are tied with the formation of loop-bows, a monolithic thread is passed through the loop-bows and the loop-bows are tightened on it.

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