RU2299693C1 - Method for preventing early post-surgical complications of skin sutures during microsurgical operations upon the limbs - Google Patents

Abstract

FIELD: medicine, surgery.

SUBSTANCE: it is necessary to apply an interrupted skin suture, infiltrate derma and subcutaneous fatty fiber of wound's walls with 0.25%-novocain solution from several punctures in along both sides against the suture, at 0.5 cm against the suture line till the stoppage of capillary hemorrhage out of the wound. The innovation enables to provide hemostasis, activate the withdrawal of tissue degradation product and accelerates wound's healing.

EFFECT: higher efficiency of prophylaxis.

1 ex

Description

The invention relates to medicine, in particular to surgery, and for the prevention of early postoperative complications during microsurgical reconstructive operations on the extremities.

A known method for the prevention of early postoperative complications of skin sutures during microsurgical operations on the extremities by applying aseptic dressings to the suture (Usoltsev E.V., Mashkara K.I. Surgery of diseases and injuries of the hand. - 3rd ed., Rev. And add. - L .: Medicine, 1986. - S.237-238) or sterile dressings using antiseptic solutions (Fundamentals of surgical surgery. / Under the editorship of A.S. Simbirtsev, - St. Petersburg: Publishing house "Hippocrates", 2002. - S.62)

The disadvantages of the methods is that when this technique is performed, the effect of immobilization of damaged tissue, the closure of the edges of the wound, which is fraught with bleeding of the wound and the development of severe post-traumatic edema, worsening the healing process of the wound and contributing to the development of coarse scar tissue, does not provide for the activation of the drainage function of the lymphatic system to reduce the negative impact on the reparative processes of post-traumatic edema and excretion of tissue races Hell, that is, conditions are not created that prevent the formation of gross scars, involving surrounding tissues in the cicatricial process and worsening the reparative processes of damaged anatomical formations (muscles, tendons, nerves, blood vessels).

The aim of the invention is to ensure the closure of the edges of the wound, hemostasis, enhance the drainage function of the lymphatic system to reduce the negative impact on the reparative processes of post-traumatic edema and remove tissue decay products from the surgical intervention zone, create conditions for faster healing of the wound and the formation of soft scar tissue.

The essence of the method for the prevention of early postoperative complications of the skin suture during microsurgical operations on the extremities is that the dermis and subcutaneous fatty tissue of the walls of the sutured skin wound are infiltrated with a 0.25% solution of novocaine from several injections on both sides of the suture, departing 0.5 cm from the line suture, until capillary bleeding from the wound stops, after which an aseptic dressing is applied.

The creation of artificial edema leads to the effect of tissue immobilization, tightening of the wound edges, less wound gaping, stopping of capillary bleeding, and a decrease in suture pressure on the tissue at the injection sites due to the uniform distribution of pressure force by infiltrate, which reduces trophic disorders. In addition, artificial edema enhances the drainage function of the lymphatic system, reduces the phase and severity of post-traumatic edema (Ham's rule for loose connective tissue), removes under-oxidized metabolites from tissues, cleanses tissue from tissue breakdown products, and has a positive effect on reparative processes, i.e. creating conditions for better healing of the postoperative wound. Wound healing with the formation of a tender scar contributes to better healing of sutures placed on other anatomical formations located deep in the wound. Positive are the analgesic and vasodilator effects of novocaine, proven by the studies of A.V. Vishnevsky.

Example.

Patient P., 27 years old, with a cut wound of 1 finger of the right hand with damage to the long flexor and digital nerve along the ulnar side of the finger, underwent surgery, which consisted of revising the wound, removing the hematoma, highlighting the distal end of the tendon of the long flexor and stitching it with nylon thread No. 3 . After that, the proximal end of the tendon and both ends of the tendon, which were stitched according to Kessler-Kazakov capron No. 3, were isolated from an additional linear transverse section of 3 cm long in the lower third of the forearm. The ends of the digital nerve were mobilized and stitched with two epineural sutures with a 6/0 thread from Etikon firm with Esculap micro-tool. A 0.25% solution of novocaine was administered under epineuria. Kapron No. 2 nodular sutures were applied to the skin, after which, retreating 0.5 cm from the suture line on both sides, the dermis and subcutaneous fatty tissue of the wound walls were infiltrated in symmetrical areas with a 0.25% solution of novocaine from several injections on both sides of suture to stop capillary bleeding from the wound. An aseptic dressing was applied to the wound area. In the postoperative period, it was noted that the dressing practically does not get wet with blood and exudate, tissue swelling was not already observed by day 5, wound epithelization occurred by 9 days, by 29 days the postoperative scar is weakly contoured, soft, elastic, and shifted, the skin easily shifts on palpation to as much as the natural folds of the palmar surface of the brush allow.

To stimulate the healing process of sutured wounds on the tendon and nerve from 1 day after the operation, acetylsalicylic acid was given per os for a month, 2 ml daily of mexidol was administered intramuscularly for 5 days.

The operations were performed on 2 groups of patients with injuries of the hand and lower third of the forearm, in which surgical interventions were accompanied by the use of microsurgical technique.

There were 5 patients in the control group: a) with post-traumatic cicatricial flexion contracture of 3 and 4 fingers of the left hand, b) a cut wound of the lower third of the left forearm with damage to the tendons of the flexors of 2, 3, 4 and 5 fingers, the ulnar flexor of the hand, ulnar nerve, in ) with a cut wound of the lower third of the left forearm with damage to the tendons of the deep flexors of 2, 3, 4 and 5 fingers, superficial flexors of 4 and 5 fingers, the ulnar nerve, ulnar flexor of the hand, d) with a cut wound of 3 fingers of the right hand with damage to the tendons of the flexors and pal total nerves, e) with a cut wound of the left hand with damage to the tendons of the flexors of the 2 fingers and the common finger nerve.

After performing operations using microsurgical technique, aseptic bandage was applied to all patients of the control group after skin surgery at the final stage of the operation, and Mexidol 2.0 ml was injected intramuscularly for 5 days, for 1 month and acetyl was given to stimulate reparative processes -salicylic acid 0.25 per mouth once a day.

Observation of the sutured skin wound showed that in all patients of the control group, as a rule, severe edema persists for up to 10-14 days, blotting of the dressing with blood and exudate lasts up to 4-5 days, after removal of skin sutures for 10 days, edema of scar tissue is expressed, disappearing only by 14 days.

In the main group there were 3 patients: a) with a cut wound of 1 finger of the right hand with damage to the long flexor and digital nerve along the ulnar side of the finger, b) with a lacerated scalp wound of the right hand with damage to the flexor tendons of the 3rd, 4th and 5th finger and the median nerve in the area of the carpal canal, c) with a cut wound of the lower third of the left forearm with damage to the radial flexor of the hand, partially long flexor of 1 finger, the median nerve.

After all operations using the microsurgical technique, all patients of the main group had an aseptic dressing applied to the area of skin sutures at the final stage of the operation. To stimulate reparative processes in the wound, Mexidol 2.0 ml was administered intramuscularly for 5 days, acetylsalicylic acid 0.25 per mouth was given 1 time per day for 1 month.

In contrast to the control, in the patients of the experimental group, at the final stage, after nodal sutures were applied to the skin, the dermis and subcutaneous fatty tissue of the skin wound walls were infiltrated with 0.25% novocaine from several injections on both sides of the suture, 0.5 cm indent from the suture line to the stop of capillary bleeding from the wound.

Observation of the sutured skin wound showed that in all patients of the main group, as a rule, the dressing does not get wet with blood and exudate, the edema persists for no more than 4-6 days, epithelization is noted by 10 days, the postoperative scar is poorly contoured by 29-31 days, soft, elastic, displaceable, the skin easily shifts during palpation as much as the natural folds of the palmar surface of the brush allow.

Studies have shown that conservative stimulation of reparative processes in the wound in the early postoperative period does not exclude the development of pronounced and long-term post-traumatic tissue edema that persists even after removal of skin sutures. It is possible to achieve a reduction in the phase and severity of post-traumatic edema by infiltration of the wound walls with a 0.25% solution of novocaine after the application of a nodular skin suture, which positively affects the healing of the postoperative wound and promotes the formation of better scar tissue.

The advantages of this method are as follows:

- infiltration of the edges of the skin wound with 0.25% novocaine solution after suturing dramatically reduces the number of postoperative complications during surgical interventions using microsurgical equipment on the limbs;

- artificially created tissue edema activates the drainage function of the lymphatic system, contributing to the elimination of tissue decay products that have a toxic effect on the tissues, helps to shorten the phase of post-traumatic tissue edema, which negatively affects reparative processes, worsens the wound healing process and promotes the development of coarse scar tissue with involvement in the scar anatomical formations (muscles, tendons, nerves, blood vessels), injured;

- artificially created tissue edema, performing the function of immobilization of soft tissues and blocking the nerve plexuses, creates conditions for functional rest of damaged tissue and thereby also has a positive effect on reparative processes, promotes faster healing of the wound with the formation of soft scar tissue, which is especially important during operations on the brush;

- hydraulic protection of the suture line reduces the number of manipulations aimed at stopping bleeding from the edges of the wound, has a pronounced effect of sealing and hemostasis;

- the simplicity of the method allows the widespread use of the proposed technique for microsurgical surgical interventions not only on the limbs, but also in cosmetology and plastic surgery.

Claims (1)

A method for the prevention of early postoperative complications of the skin suture during microsurgical operations on the extremities, comprising applying an aseptic dressing to the area of the skin suture, characterized in that after applying the nodular skin suture, the dermis and subcutaneous fatty tissue of the wound walls are infiltrated with 0.25% novocaine solution from several injections on both sides of the suture, 0.5 cm backward from the suture line, until capillary bleeding from the wound stops.