RU2307599C2 - Method for surgical treatment of hygroma - Google Patents

Abstract

FIELD: medicine, surgery.

SUBSTANCE: it is necessary to fulfill the access in hygroma's projection, isolate a capsule, dissect the capsule at forming two folia, fix the free edge of the first folium towards the bottom of the second one with sutures, form duplicature in defect's area with the second folium. In peculiar case, the defect should be additionally strengthened with reticular endoprosthesis within the boundaries of healthy tissues. The innovation enables to strengthen tissues and prevent the relapse of hygroma.

EFFECT: higher efficiency of therapy.

1 cl, 5 dwg, 2 ex

Description

The invention relates to medicine, namely to traumatology and orthopedics, and can be used for surgical treatment of hygroma.

A known method of surgical treatment of hygroma, involving puncture removal of the cyst from numerous punctures (Sazhin V.P., Konovalov A.S., Komov Yu.A. Treatment of ganglia and hygroma in the clinic // Outpatient surgery. - 2004. - No. 1-2 . - S.78-80). As the authors themselves note, the disadvantage of this method is the lack of visual control, resulting in possible damage to blood vessels and nerves, the formation of hematomas and neuritis, the abandonment of daughter hygroma, which leads to the development of a relapse of the disease.

Closest to the invention is a method of surgical treatment of hygroma, including excision of a cyst within healthy tissues (Specialized outpatient surgery. A practical guide for doctors. / Ed. By Prof. B. G. Apanasenko. St. Petersburg, 1999. - P. 241). For this, transverse access is carried out in the projection of the formation, the capsule is isolated to the base, ligated, and then excised.

However, insufficient tissue strengthening in the area of the defect leads to a high relapse rate (up to 30%).

The technical result achieved by the invention is to improve the strengthening of tissues in the area of the defect.

In order to achieve the indicated technical result in the method of surgical treatment of hygroma, including accessing the projection of formation and isolating the capsule, according to the invention, the capsule is dissected to form two sheets, the free edge of the first sheet is fixed to the base of the second seams, and a duplicate is formed in the defect area with the second sheet.

To obtain a better result, the defect is additionally strengthened with a mesh endoprosthesis within healthy tissues.

The plastic of the defect with two sheets of local tissues formed during dissection of the capsule, with the formation of duplicature in the area of the defect provides sufficient strengthening.

Additional fixation of the defect by mesh endoprosthesis within healthy tissues improves the outcome of treatment.

Figure 1-5 shows a diagram of the operation.

The method is carried out, for example, as follows.

For the purpose of bleeding, an elastic tourniquet is applied to the limb. Under infiltration anesthesia, a transverse incision 1 in the projection of the formation layer by layer dissect the tissue. Capsule 2 is isolated, dissected by section 3 to the base with the formation of two sheets 4 and 5, the contents are evacuated. The free edge of the first leaf 4 is fixed to the base of the second leaf 5 with a continuous seam 6. The second leaf 5 forms a duplicate 7 in the area of the defect. In order to further strengthen, the capsule defect is fixed around the perimeter by a mesh endoprosthesis 8 within healthy tissues. The postoperative wound is sutured, the limb is immobilized with a plaster cast.

The method is illustrated by the following clinical examples.

1. Patient N., 24 years old, sought medical attention for hygroma of the dorsal surface of the right hand. Sick for 4 years. Previously, puncture of the formation with the introduction of glucocorticosteroids was repeatedly performed. The patient noted a short-term effect, after which the formation progressively increased in size, the range of motion in the wrist joint was limited.

Under infiltration anesthesia of a 0.5% lidocaine solution and a tourniquet applied to the middle third of the forearm, the skin, subcutaneous tissue were cut in a transverse section in the projection of formation, a capsule was isolated, and it was cut to the base with the formation of two leaves. The distal (lower) leaf of the capsule was hemmed with a continuous suture to the base of the proximal. The proximal (upper) leaf was coated with the distal in the form of duplicature and fixed with nodular silk sutures to the joint capsule. The capsule defect was further strengthened by the ESFIL mesh bioendoprosthesis, which was fixed with sutures within healthy tissues. After removing the tourniquet, hemostasis was monitored. The postoperative wound was sutured with an intradermal cosmetic 3 suture. An aseptic dressing and palmar plaster cast were applied from the metacarpophalangeal joints to the middle third of the forearm.

2. Patient R., 39 years old, sought medical help for a recurrent hygroma of the left ankle joint. The patient had a history of an ankle injury 3 years ago, after which a tumor formation appeared in the projection of the ankle joint, causing discomfort to the patient: swelling, pain, limiting joint mobility. Hygroma was excised twice by known methods, but after a short period of time the latter was resumed.

Under infiltration anesthesia of a 0.5% lidocaine solution and a tourniquet applied to the lower third of the lower leg, tissues were dissected layerwise in a section in the projection of the formation. A hygroma capsule was isolated, cut to the base with the formation of two leaves. The distal (lower) leaf was fixed with a continuous interrupted suture to the upper. The proximal (upper) was coated with the distal in the form of duplicature and fixed with interrupted sutures to the joint capsule. In order to further strengthen the capsule defect, the ESFIL mesh bioendoprosthesis was hemmed within healthy tissues. Hemostasis was checked, sutures, an aseptic dressing, a plaster cast were applied to the wound.

According to the claimed method, 162 patients with hand hygroma and 64 patients with ankle hygroma were operated on. Long-term results were traced in 83% and 70% of those operated, respectively, up to 3 years. All showed a positive result of treatment, the functions of the hand and ankle joint were fully restored. Relapse of the disease was not observed.

The method allows to improve the strengthening of tissues in the area of the defect, which prevents relapse of the disease.

Claims (2)

1. A method of surgical treatment of hygroma, including access to the projection of education and the selection of the capsule, characterized in that the capsule is dissected with the formation of two sheets, the free edge of the first sheet is fixed to the base of the second seams, and the second sheet forms a duplicate in the area of the defect. 2. The method according to claim 1, characterized in that the defect is further strengthened by a mesh endoprosthesis within healthy tissues.

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