RU2325858C2 - Device for non-invasive sealing of soft tissues - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention concerns medical technology and can be used in surgery. The device for non-invasive sealing of soft tissues looks like a gripping forceps with a lateral sphenoidal cut on working pads. Working pads are located under an angle of 145 degrees to branches and have the area of 132 mm². The cut is focused to branches under an angle of 35 degrees and dilated to the centre.

EFFECT: efficiency and quality upgrading of soft tissues ligation of operated patients.

2 cl, 1 ex, 5 dwg

Description

The invention relates to medical equipment, namely to medical devices used in surgery.

Tweezers is a device that is widely used in surgical practice and relates to auxiliary instruments. It is designed to grip and hold various fabrics, materials and small tools. The tweezers consist of two springy steel plates, welded or brazed together at one end; the free ends of the plates (branches) are wedge-shaped diverging and are called working jaws or paws. The outer sides of the jaws of the tweezers are usually finely grooved, and the working surfaces of the jaws are transverse notch. In special surgical instruments, forceps are used.

As a prototype device, we present the tabbed tweezers described in the manual of M.P.Burykh "General principles of the technology of surgical operations" (Rostov n / A: Publishing House "Phoenix", 1999. - 544 p., Pp. 76-77 ) Toothed-tabbed (Russian) tweezers (Fig. 1, a) 150 mm long has an extension in the form of a tab (Fig. 1, b), the size of which is 5 by 7 mm (and the area is 35 mm), on which there are notches (denticles) ) The tool has a better fixing ability than surgical tweezers, as it has a large grip area and a larger number of teeth. It is designed to hold dense and easily injured tissues.

Thus, the advantages of the prototype device are as follows:

1) a large area of the working jaws, and therefore, less load per unit area of the tissues captured by the tool;

2) the best fixation ability due to the presence of teeth.

However, there are drawbacks, the main of which is the lack of effectiveness of the prototype in the capture, retention and suturing of easily injured soft tissues. This is due to the fact that when stitching these tissues, the needle meets tangible resistance at the time of injection, to overcome which an adequate anti-collapse with a tissue-fixing tool is required. Moreover, the smaller the area of the working surface of the legs of the latter, the greater the load per unit area and, accordingly, the trauma of captured tissue. However, the use of forceps tweezers, intended mainly to prevent this drawback, also does not guarantee against soft tissue injuries. This is due to the fact that the injection of the needle is possible only on the periphery of the foot - either under it (Fig. 2, a), or on the side of it (Fig. 2, b). When creating tweezers with a needle against the needle during piercing of tissues (Fig. 3, a, b), the maximum pressure of the pincer legs falls on a narrow section of the captured tissue closer to their puncture with a needle (Fig. 3, a). At the same time, a sickle-shaped imprint remains on the area of soft tissues captured by the tweezers (for example, on the skin) (Fig. 3, b), which eliminates the main advantage of the tabular forceps - atraumatic.

To address these shortcomings and increase the effectiveness of treatment of patients requiring surgical treatment, a device is proposed, which is a clamp-shaped tweezers (Fig. 4, a) 170 mm long, which differs from the traditional one, firstly, by a triple prevalence of the area of the legs, the dimensions of which are 11 by 12 mm (132 mm); secondly, the fact that the paws of the tweezers are located at an angle of 145 degrees to the branches of the tool and, thirdly, that they are equipped with a wedge-shaped widening from the periphery to the center of the side slot at an angle of 35 degrees with respect to the length of the tweezers (Fig. 4, b ) The unevenness of the cut of the legs with a predominance of its width in their central part (4 mm) and a decrease on the periphery (2 mm) is due to the fact that the diameter of the needle is usually greater than the thickness of the suture material. A 145-degree tilt of the working part of the tool is convenient for a wider grip of tissues. The angle of the slot (35 degrees with respect to the jaws of the tweezers) is dictated by the fact that when the tool is in the working position (while holding the sutured tissues), the vertical location of the slot is optimal, providing the surgeon with a wide range of choice of level (depth) of the needle in the tissue (Fig. 5, but). An injection with a needle is performed in the center of the legs of the tweezers through the slot (Fig. 5, b), which facilitates its passage through the tissues and ensures uniform distribution of pressure per unit area.

The proposed device is repeatedly used in surgical and trauma-orthopedic operations with results exceeding those using traditional tools. As an example of the application of the proposed device, the following observation.

Patient V., 17 years old, was admitted to the Republican Orthopedic Traumatology Center (Makhachkala) on April 15, 01 with a diagnosis of a cut wound on the posterior surface of the lower third of the left lower leg with damage to the Achilles tendon. From the anamnesis: household injury (cut his leg with glass of a broken tin can) 20 minutes before admission. On examination, there is a complete absence of active plantar flexion of the left foot with the presence of staggered retraction during the Achilles tendon at the level of the ankle joint. Diastasis between tendon fragments more than 4 cm.

An emergency operation was performed: primary surgical treatment of the wound and restoration of the integrity of the Achilles tendon. During the operation, fragments of the Achilles tendon were compared and sutured with U-shaped nylon sutures. At the same time, the ends of both fragments of the tendon were captured and held by the proposed device, which is tabbed tweezers with an area of its working legs equal to 132 mm, the location of the legs at an angle of 145 degrees to the branches of the instrument and the presence of them wedge-shaped expanding from the periphery (2 mm) to the center ( 4 mm) of the lateral slot at an angle of 35 degrees to the length of the tweezers. The use of this tool allowed, despite the density and vulnerability (predisposition to razvolennosti) of the tendon, to suture atraumatically and without significant effort when holding the needle. This was due, firstly, to a larger foot area in comparison with traditional clamp-shaped tweezers and, accordingly, a lower load per unit area of captured tissue; secondly, the rational angle of the paws in relation to the tool length and the slots on them with the optimal anti-stop angle. The needle was injected in the center of the legs through the incision, which significantly facilitated its passage through the dense tendon tissue and ensured uniform pressure distribution per unit area. The wound was sutured and the anterior plaster cast was applied to the limb from the middle third of the thigh to the toes of the foot in the position of flexion of the lower leg (at an angle of 160 degrees) and plantar flexion of the foot (at an angle of 140 degrees). Primary healing. After removal of the sutures, the patient was discharged for outpatient treatment on April 22, 01, with recommendations to shorten the longet to the upper third of the lower leg in a week, and after another 2 weeks to remove and start dosed mechanotherapy. Limb function recovered completely. The result of treatment is regarded by us as good.

Thus, the structural differences and advantages of the proposed device from the prototype are the following:

1) triple prevalence of the area of the legs and, accordingly, a decrease in the load per unit area of the tissue captured by the tweezers;

2) uniform distribution of the load over the entire area of the tissue captured and held by forceps;

3) the optimal angle of the tweezers paws and the cuts of the paws with respect to the tool length, which, when the tool is in the working position, provides a vertical arrangement of the cuts, providing the surgeon with a wide range of choices for the level of needle injection into the tissue;

4) unevenness of the cut of the legs with a predominance of its width in the central part (4 mm) and a decrease on the periphery (2 mm);

5) a rational anticorrosion to the corner, the injection of which is performed in the center of the legs, through the side slot in them, which greatly facilitates the passage of the needle through dense tissue.

Thus, the proposed device can improve the efficiency and quality of surgical treatment of operated patients.

Claims (2)

1. Device for atraumatic suturing of soft tissues during surgical operations in the form of claw tweezers with a slit expanding towards the center placed on the working legs, characterized in that the working legs are located at an angle of 145 ° to the branches and have an area of 132 mm ² , while the slot oriented to the branches at an angle of 35 ° and is made lateral and expanding wedge-shaped. 2. The device according to claim 1, characterized in that the slot on the periphery has 2 mm, and in the central part 4 mm.

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