RU2327424C1 - Method of wound edges immobilisation applied for patients with extensive resections of mouth cavity, jaw, pharynx, larynx, and performed reconstruction - Google Patents

Abstract

FIELD: medicine; surgery.

SUBSTANCE: invention can be applied for immobilisation of wound edges following extensive resections of mouth cavity, jaw, pharynx, larynx and performed reconstruction. Substance of invention implies that for the first 10 days after operation head is fixed to chest wall with two silk sutures-holders of such length to limit voluntary movement of head.

EFFECT: method enables to prevent suppurative complications during postoperative period due to adequate immobilisation of wound edges within first days.

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Description

The invention relates to medicine, namely to surgery.

Extended-combined operations on the neck are accompanied by the removal of large volumes of tissue. This leads to the formation of extensive defects and tension of the anastomosed sutures with their frequent failure in the postoperative period (Ogoltsova E.S., 1984; Maw et. Al., 1972). The immobilization of the edges of the wound after such operations in most cases is carried out only by tight bandaging and aspiration of the wound contents through active drainage (analogue, it is also a prototype). Excessive turns and tilting of the head to patients can lead to additional mechanical tension and ischemia of anastomosed tissues, which disrupts the repair process and leads to failure of sutures and the development of purulent complications. All this relates to the disadvantages of these methods of immobilization.

The objective of the invention is the prevention of purulent complications by developing a method of adequate immobilization of the edges of the wound in the first days after surgery in patients with extensive resections of the oral cavity, jaw, pharynx, larynx and performed reconstruction.

The task is achieved using the proposed method: for adequate immobilization of the edges of the wound in the first 10 days after surgery, the head and neck of the patient are fixed with silk threads - holders to the chest wall.

After the operation, far from the main wound, a piercing of the skin with a surgical needle with a ligature in the region of the lower jaw edge (projection of the attachment of the masticatory muscle) and the skin of the anterior chest wall is performed on both sides. Stretched individual lengths of the ligature are fixed by interrupted sutures, the purpose of which is to limit voluntary head movements to the patient for 10 days. During dressings, injection sites are treated with an antiseptic solution.

The invention is illustrated in the drawing.

The drawing shows a diagram of the immobilization of the edges of the wound on the neck in the first days after surgery by fixing the patient's head and neck with silk threads - holders to the chest.

The method is as follows.

After an extensive resection of the oral cavity, jaw, pharynx, and suturing on the wound, far from the main operation, the skin is pierced with a surgical needle with a ligature in the region of the lower jaw edge (projection of the masticatory muscle attachment) and the skin of the anterior chest wall on both sides. Stretched individual lengths of the ligature are fixed by interrupted sutures, the purpose of which is to limit arbitrary movements of the patient’s head.

An example of clinical application.

Patient P., born in 1962, medical history No. 1759. Date of admission - March 24, 2005. Diagnosis - oropharyngeal cancer, art. IIIB kg IIa T3N1M0 condition after preoperative radiation therapy in SOD 66 Gy. After preoperative preparation, March 30, 2005, an extended combined operation was performed - tracheostomy, resection of the lower jaw, oropharynx, tongue on the left, Crail surgery on the left, plastic closure of the defect with a skin-muscle autograft with inclusion of the pectoralis major muscle on the left while maintaining axial blood supply, closing of the common carotid artery the same transplant. After the operation, far from the main wound, a piercing of the skin with a surgical needle with a ligature in the region of the lower jaw edge (projection of the attachment of the masticatory muscle) and the skin of the anterior chest wall is performed on both sides. Stretched individual lengths of the ligature are fixed by interrupted sutures, the purpose of which is to limit voluntary head movements to the patient for 10 days. Thus, the proposed technique for fixing the head to the chest wall proved to be a reliable way to adequately immobilize the edges of the wound to prevent the development of purulent postoperative inflammation.

Claims (1)

A method of immobilizing the edges of a wound after extensive resections of the oral cavity, jaw, pharynx, larynx and performed reconstruction, characterized in that the head is fixed to the chest wall with two silk thread-holders of calculated individual length in order to limit arbitrary head movements for the first 10 days after surgery.