RU2187338C2 - Method for cutaneous ligation of subcutaneous blood vessels - Google Patents

Abstract

FIELD: medicine, surgery. SUBSTANCE: the method deals with suturing a subcutaneously situated vessel through the skin with a multi-colored, multiple-strand, for example, double, thread at external wrapping one strand of similar color of every stitch. Suturing material is preimpregnated for 24 h with xymedone-hydrocortisonoboric solution at the following ratio of components, weight%: xymedone 0.8- 1.4, hydrocortisone hemisuccinate 0.09-0.13, boric acid 1.5-2.5, distilled water - up to 100.00. Before the onset of operation and during 3-wk-long postoperational period the limb under operation is applied with a bandage impregnated with aqueous xymedonohydrocortisonoboric solution. The method favors to obtain reliable fixation of captured part of a vessel, provide a guaranteed hemostasis, increase cosmetic effect and improve results of operation. The method could be successfully applied in operative treating varicosis of lower limbs. EFFECT: higher efficiency of therapy.

Description

 The invention relates to medicine, in particular to vascular surgery.

 Ligation of the saphenous vessels by flashing is more often carried out with varicose veins (Volobuev N.N. Clinical surgery - 1976. - N 6.-P. 71; Chervyakov I.V. Herald of surgery - 1985.- N 10. - p. 111) as an auxiliary treatment for varicose veins, aimed at the overall improvement of the results of surgical correction. Of great importance in this surgical intervention is the need to achieve a cosmetic effect.

Known methods for skin flashing of saphenous vessels, such as veins, have significant disadvantages. So, the described venoraphy method (Polyakov P.I., Trofimenko S.S. Bulletin of Surgery - 1988. - N 7. - p. 76-78), taken by us as a prototype, provides for multiple transdermal ligation of the veins with separate sutures with tying and leaving knots over the skin. The prototype has disadvantages:
- a significant increase in operation time;
- the development of a pronounced cosmetic defect due to the high specific pressure of the suture thread on the skin with the formation of multiple strangulation grooves;
- the inevitable inflammatory reaction and local allergic changes due to the lack of biological inertness in the suture material without additional processing;
- uneven distribution of the degree of compression of the vein does not guarantee a complete cessation of blood flow along the entire length of the vein;
- unreliability of fixation of the vessel due to the possible untying of a single thread or its rupture;
- the restriction of the use of monofilament synthetic yarn due to the need for three times knotting, which leads to a large waste of time;
- due to the high risk of the formation of disfiguring strangulation grooves on the surface of the skin and the possible eruption of sutures, it is necessary to remove them early, which leads to recanalization of the veins, which negates the success of the operation. The surgeon’s rush to remove the sutures at a time when only a red blood clot forms on them after compression of the veins, interruption or slowdown of blood flow, leads to the fact that there is a resorption of a loose blood clot, which ends with the restoration of blood flow through the vein. With early removal of ligatures, moderate bleeding is always observed from places of puncture with a needle, from a wound suture canal.

 In order to reliably fix the captured part of the vessel to the skin, create guaranteed hemostasis, increase the cosmetic effect of the operation and reduce the time of its implementation, we proposed a percutaneous-subcutaneous continuous suture "lap" for ligation of the saphenous vessels.

 The goal is achieved by the fact that the vessel is flashed through the skin with a multi-colored, multi-strand thread with an external overwhelming of one thread of the same color. This method provides a uniform distribution of the efforts of the suture threads on the skin, which reduces injury to the latter and, as a result, increases the cosmetic effect of the operation with reliable fixation of the captured portion of the vessel to the skin.

To increase indifference to surrounding tissues, to reduce the pronounced inflammatory reaction and allergic local changes that constantly occur with varicose veins, the sterilized suture thread is pre-impregnated for 24 hours with a solution of the composition, wt.%:
Xymedon - 0.8-1.4
Hydrocortisone-hemisuccinate - 0.09-0.13
Boric acid - 1.5-2.5
Distilled Water - Else
The processing of filaments with a xymedono-hydrocortisone-boron aqueous solution of the specified composition also gives them antibacterial properties, the ability to enhance regeneration processes in the suture canal and in adjacent tissues.

 Each component of the solution has a positive therapeutic effect, has no toxic properties and is approved for clinical use (Ksimedon. Edited by G. Izmailov - Kazan: Publishing House of the A.E. Arbuzov Institute of Organic and Physical Chemistry, Kazan Scientific Center of the Russian Academy of Sciences . -1986; Mashkovsky M.D. Medicines. - M .: Medicine. - 1988. -T. 1-2).

 Our studies have shown that the total effect of these drugs in the proposed ratio exceeds each individually. There were no complications with local use of the proposed solution.

 The proposed method of operation is as follows.

 On the eve of the operation, after taking a hygienic bath, a gauze bandage moistened with the xymedono-hydrocortisone-boron aqueous solution that we have proposed is applied to the operated limb. The bandage is removed immediately before the operation.

After the stages of the Troyanov-Trendelenburg and Babkokok operation are completed, the superficially located lateral branches of the major and minor saphenous veins are sutured with multicore threads pre-impregnated with xymedono-hydrocortisone-boron aqueous solution at T ^o 0 + 2 ^o C for a day. Near the projection of the venous trunk marked with dye (see the drawing), a needle 1 with a double thread 2 is injected through the skin 3 to the depth of the required grasp of the lateral branches of the main trunk of the vein 4. The puncture is made from the opposite side of the vein. Tie a knot 5 on the skin 3 at the same time with a double multi-colored thread. Retreating 1.5-2.0 cm from the first nodal suture, along the vein, make a second similar injection of needle 1 with a double thread 2 and hold it under the vein perpendicular to the last, after which they puncture from the opposite side of the vein 4. Extending the entire double thread to failure overlap one core of the same color of the thread of the previous stitch in the middle part and pull it to the puncture point. At the same time, a rectangular triangle of single strand 6 is formed on the skin surface, and double strand 2 runs along one perpendicular line under the vein. The base of the triangle is parallel to the venous trunk, and the apex is on the opposite side of the vein. Then, in the same way, the required number of cutaneous turns are applied to the affected vein. After stitching the veins along the entire length, at the final stage, a stitching stitch is applied similarly to the first with double overlapping so that a knot is formed. Along the entire line of seams, napkins are impregnated with a xymedono-hydrocortisone-boron aqueous solution with the strengthening of their classic gauze circular dressing. In the postoperative period, such dressings-applications with xymedono-hydrocortisone-boron aqueous solution were used daily until the sutures were removed (for 10-12 days), for a total of 3 weeks. During this period, the formation of a subtle cosmetic postoperative scar without signs of hypertrophy ended.

 Clinical experience using the proposed method for cutaneous ligation of subcutaneous blood vessels with suture material previously impregnated with xymedono-hydrocortisone-boron aqueous solution in 18 patients with varicose veins showed clear advantages over the prototype. The operation time was reduced, the reliability of hemostasis was carried out, the cosmetic effect was significantly increased, despite the later dates (10-12 days) of removing the cutaneous continuous suture than in the control (4-6 days). Relatively late removal of squeezing cutaneous sutures led to the formation of an intravascular thrombus of a white type, not susceptible to resorption. False recurrence of varicose veins is registered in one patient.

 Patient A., 45 years old, was admitted on 7.10.94 to a surgical clinic with severe varicose veins of the saphenous veins of the lower extremities in the compensation phase. A dressing was applied 12 hours before the operation with the proposed xymedono-hydrocortisone-boron aqueous solution. Under epidural anesthesia, large and small saphenous veins were extracted from precision incisions in the ankles and groin. Their main trunks are crossed and safenextractors are introduced into the lumen in the antegrade direction with their subsequent fixation to the vein. The lateral branches of the large and small saphenous veins pre-marked before surgery with dye are stitched by cutaneous ligation with a double thread impregnated with an xymedono-hydrocortisone-boron aqueous solution according to the proposed method. The stripping of the main trunks of the major and minor saphenous veins by Babcock was carried out. Dressings with the specified solution. The postoperative period was uneventful. The wound sutures were removed on the 8th day, continuous cutaneous sutures on the 12th day. Strangulation furrows on the skin at the locations of the thread are not expressed, there are no signs of inflammation of the skin in the suture area. Bleeding after removing ligatures from puncture sites was not noted. Home was discharged on the 14th day in a satisfactory condition. Inspected after a year. There is no relapse of the disease. The cosmetic effect is good.

 The control group consisted of 20 patients with a similar diagnosis, who, along with safenectomy, performed traditional cutaneous ligation of the lateral branches. In the postoperative period, a longer pain reaction in the suture area with edema and hyperemia was noted. When the sutures were removed, there was moderate bleeding from the sites of skin punctures, which indicated the absence of a stable and fixed formation of an intravascular thrombus. Small ligature grooves remained at the ligature locations, mainly due to skin reaction to suture material. Relapse of the disease in the long term was detected in 4 patients.

Claims (1)

A method for cutaneous ligation of subcutaneous blood vessels, including flashing veins through the skin with a multicore thread impregnated with an antiseptic composition, characterized in that the vessel is stitched with a multi-colored multicore thread with an external overwhelming of one thread of the same color, and the thread is pre-impregnated for 24 hours with a solution of the composition, wt.%% :
Xymedon - 0.8-1.4
Hydrocortisone-hemisuccinate - 0.09-0.13
Boric acid - 1.5-2.5
Distilled Water - Else
and on the operated limb the day before and within 3 weeks after the operation, a dressing is applied moistened with a xymedono-hydrocortisone-boron aqueous solution of the specified composition.

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