RU2330624C1 - Forceps - Google Patents

Abstract

FIELD: medicine; surgery.

SUBSTANCE: invention can be used for fixing of damaged tissues dissected within surgical processing of traumatic wound which is formed by mechanical damages and gunshot wounds of various parts of body. Forceps contain two branches. Branches are bent, interconnected with hinge axis, furnished with rings for fingers, handles and working parts in the form of clamping inserts. Clamping insert of one branch is provided with longitudinal through groove. Clamping insert of another branch is provided with pinned ridges. Pinned ridges are penetrating to slot of one branch insert as forceps closed. Inserts are provided with elastic covering on working surface.

EFFECT: more reliable fixation of tissue layer within dissection process.

6 dwg, 3 ex

Description

The invention relates to medicine, namely to emergency surgery and traumatology, can be used to fix damaged tissues during excision during surgical treatment of a traumatic wound formed by mechanical damage and gunshot wounds of different parts of the body.

A wound is a violation of the integrity of tissues due to damage by various factors, and depending on the type of acting force, the shape of the edges of the wound may be different.

The goal of treating wounds is to restore the integral structure of damaged tissues and organs, as well as their shape and function. To achieve these goals, it is necessary to eliminate factors that impede normal wound healing. At the same time, the causative agents of infections that were initially brought into the wound are removed by surgical treatment of the wound, the removal of foreign bodies, necrotic and non-viable tissues, which are a nutrient medium for microorganisms, and the prevention of secondary infection by applying aseptic dressings.

Any wound received outside the operating room is initially considered to be infected. The edges of the wound with lacerations, squashed, bruised and gunshot wounds are uneven and have foci of necrosis, and even if there are no signs of infection, wound healing by first intention is possible only after the initial surgical treatment of the wound. The most important role in the fight against focal infection belongs to the surgical surgical treatment of the wound, which is performed to prevent the development of wound infection and acute suppuration of the wound.

The primary surgical treatment of a traumatic wound is an surgical intervention, during which a wound is cut, non-viable and dead tissue are excised, foreign bodies are removed, hemostasis, wound drainage and restoration of damaged tissue integrity. During this operation, it is necessary to determine the direction of the wound channel, the depth of the wound and, if possible, to audit and treat the bottom of the wound.

The first stage of the primary surgical treatment of a wound is a wound dissection. The size of the skin wound does not always correspond to the extent of damage to the underlying tissues. Therefore, to assess the anatomical destruction and free vision when performing surgical procedures, it is necessary to dissect the wound. The direction and size of the dissection should be oriented by the size of the wound channel and the topography of this area. Fascia and aponeurosis are dissected along the fibers. This allows you to open the hematomas formed under them and excise areas of damaged muscles. In addition, dissection of fascia and aponeurosis is a preventive measure aimed at restoring blood flow and reducing post-traumatic edema of the underlying tissues in the postoperative period.

The second stage of the operation is the excision of the edges and the bottom of the wound (figure 1). At the same time, crushed non-viable tissues, blood clots, contaminated tissues, and foreign bodies are removed. The positive outcome of the operation, not only the healing of the wound, but also the functional result, largely depends on the correct implementation of this stage.

The skin is excised with a narrow strip no more than 2-3 mm wide from the edge of the wound. With absolute conviction of non-viability of the skin, it is removed in a single block with the underlying tissues. Subcutaneous fatty tissue contaminated with hemorrhages is excised widely, since it is not very resistant to infection.

Damaged muscles are excised carefully and carefully, determining its viability, focusing on fibrillar twitching of muscle fibers, elastic resistance when dissected, pinpoint bleeding on the surface of the excised muscle and a normal pink-red color. An indicator of the dubious viability of muscle tissue is a dull dark cherry color, the absence of contraction and bleeding, and a decrease in elasticity during dissection. As many authors indicate (Diagnosis and treatment of wounds. Edited by Yu.G. Shaposhnikov. M .: Medicine. 1984. 344 p .; Isakov Yu.F., Nemsadze V.P., Kuznechikhin E.P., Ginodman G. .A. Treatment of wounds in children. M: Medicine. 1990. 192 p .; Wounds and wound infection. A guide for doctors. Edited by M.I. Kuzin, B.M. Kostyuchenok. Publishing house 2, pererab and add. M .: Medicine, 1990, 592 pp.), surgical treatment of muscles is a difficult procedure, associated with the difficulty of determining dead and viable tissue, as well as the fact that muscle fibers contract, individual strands of which go inside and carry away but dirt, foreign bodies, microflora.

Non-viable muscle tissue is excised from the superficial to deep layers with the simultaneous removal of hematomas and the removal of pockets in muscle spaces. Sites of contaminated damaged fascia and aponeurosis are completely removed with their partial dissection outside the damage in order to prevent muscle compression in the fascial-aponeurotic case with developing post-traumatic edema.

Excessive enthusiasm and uneven excision of tissues can cause significant damage to the natural ratio of the anatomical structures of the lesion area and limb function, and insufficient excision of non-viable tissues causes purulent complications, which requires repeated operations and increased treatment time.

For excision of wounds use sharp cutting tools. The skin and aponeurosis are excised with a scalpel, muscles with a scalpel and sharp scissors. The work is carried out with the help of surgical and clamp forceps. Excised tissues should be maintained on weight when excised, avoiding their contact with a freshened wound surface.

It should be noted that the technical implementation of the excision of contaminated edges and the bottom of the wound is very difficult. This is due to the fact that the edges of the wound do not consist of homogeneous tissues, where the skin, subcutaneous tissue, superficial and intrinsic fascia, muscle cases, muscle tissue have different densities, elasticities, they are not firmly connected to each other, some tissues slip off against others when holding them together or stretching. As is known, when excising tissues, tweezers are used to hold them, which are then excised with a scalpel (figure 2) or scissors (figure 3). Fixation with tweezers in the pulling position of a limited area of tissue and its excision with a scalpel is made repeatedly and thoroughly until the edges and bottom of the wound are completely excised. However, this device cannot reliably hold tissue, which creates certain difficulties during the operation.

Known bent clamp No. 1 (of Billroth type) 158 mm long, consisting of two articulated jaws with finger rings and 150 ° bent jaws with notches on the working surface (see List of medical instruments: Medical Instruments Catalog, Kazan, 1994 . - p. 44).

Closest to the claimed one is a clamp (see patent RU (11) 1017314, IPC7 AB 17/28) containing two articulated jaws with finger rings and curved jaws with notches on the inner surface, and above the connecting axis on one of the jaws a longitudinal through groove is made.

However, it is inconvenient to use this clamp during surgical treatment of a traumatic wound, when it is necessary to excise tissue damaged in the wound, since it does not allow reliable fixation and pushing of the removed part of the tissue before its excision into the groove of the sponge, which negatively affects the efficiency of the operation.

The claimed invention solves the problem of creating a device with which a layer of tissue is held securely during its excision.

The technical result achieved by using the claimed invention is a more reliable retention of the tissue layer during its excision.

This technical result is achieved in that in a clamp containing two curved jaws connected by a hinge axis, having finger rings, handles and working parts in the form of clamping jaws, moreover, a longitudinal through groove is made on the clamping jaw of one of the jaws, on the clamping jaw of the other jaw needle-like protrusions are made with the possibility of their entry into the groove of the jaw of the first jaw when the clamp is closed, and the jaws are made with an elastic coating on the working surface.

Figure 4 shows the inventive clip. It consists of two branches (1 and 2) connected by a hinge axis (3). The clamping jaws have clamping jaws (4 and 5), handles with a rack (8) and rings (9) for the fingers of the surgeon's hands. The jaw of the clamp can be made oval, curved, straight (figure 5, 6). In this case, it is advisable to have a set of such jaws of various sizes, so that, depending on the configuration of the edge of the wound undergoing excision, apply a clamp with the appropriate configuration. Above the hinge axis, a through groove 6 is made in the clamping jaw 4, forming a longitudinally windowed lumen for placement of the tissue part removed by excision in the closed state of the clamp, needle protrusions 7 are made on the jaw 5 with the possibility of them entering the groove of the jaw 4 when the clamp is closed, and the jaws are made with an elastic coating 10 on the working surface.

The clamp works as follows. Holding the rings (9), the clamp is applied with the working jaws (4) and (5) to the tissue layer highlighted in the wound edge. This layer is placed in the groove of the sponge, and it fits well into this groove due to its capture by needle protrusions and pushing into the groove. Since in the closed state the clamp is pressed by another sponge, the layer protrudes from the groove and is easily removed with a scalpel. When performing excision of the wound edge, the clamp is sequentially applied to one and several layers of the wound wall, which are then excised with a scalpel, and then excision of another (adjacent) section of the wound edge is performed. Using a clamp, in which one of the jaws is made with a through groove, and the other with needle protrusions with the possibility of entering them in the groove of the first sponge, allows you to hold the fabric even more reliably.

Thus, the use of clamps allows you to firmly fix heterogeneous and homogeneous tissue, the dissection of the edges of the wound occurs along a predetermined line to a certain thickness and depth of tissues, the dissection stage during the primary surgical treatment of the wound is fast and efficient.

The use of clamps helps to ease the technique of excision of wounds and reduce the time of surgery.

The clamp was tested in the clinic in the treatment of 30 patients with various injuries with a positive result.

When using it, no complications of the execution technique were observed. The advantages are the availability, simplicity and safety of the production equipment of the indicated stage of the operation, the injuries are significantly reduced and thereby the efficiency of surgical treatment of patients is increased.

Example 1. Patient Ch-on I.N., 37 years old (Medical record No. 891), on July 20, 2006, was admitted to the traumatology department No. 1 of the Central City Hospital of Cheboksary with a diagnosis of: A bruised wound of the posterior-medial region upper third of the right lower leg. After examining the patient, the operation was performed: Primary surgical treatment of the wound. Excision of crushed non-viable tissue of the wound edges was performed using the clips we designed. Hemostasis. Wound drainage. Stitches. Aseptic dressing.

The wound healed by primary intention. There were no local complications.

Example 2. Patient Fev V.A., 46 years old (Medical record No. 897), was admitted to the traumatology department No. 1 of the Municipal Health Institution “Central City Hospital” in Cheboksary with a diagnosis of Torn wound of the anterior lateral region of the upper third of the right forearm. After examination, the patient underwent surgery: Initial surgical treatment of the wound. The torn, uneven edges of the wound are dissected using the elastic fixation clips we offer. Hemostasis. Wound drainage. Layered seams. Aseptic dressing.

Primary wound healing without complications.

Example 3. Patient L-va N.V., 34 (Medical record No. 1184), was admitted to the traumatology department No. 1 of the Central City Hospital of Cheboksary on July 27, 2006 with a diagnosis of a stab wound in the front region middle third of the left forearm. After the examination, the operation was performed: Primary surgical treatment of the wound. Contaminated and non-viable wound edges are excised with the clamps we offer. Hemostasis. Drainage of the wound with a PVC tube. Stitches. Aseptic dressing.

The drainage tube is removed on the third day. Wound healing by primary intention without complications.

Thus, examples of using the claimed clamp for tissue excision in the clinic during the primary surgical treatment of a wound in a clinic show that in this case a complete uniform excision of non-viable and contaminated tissue of the wound edges occurs, therefore, optimal conditions are created for its primary healing.

Claims (1)

A clamp comprising two curved jaws connected by a hinge axis, having finger rings, handles and working parts in the form of clamping jaws, wherein a longitudinal main groove is made on the clamping jaw of one of the jaws, characterized in that needle protrusions are made on the clamping jaw of the other jaw with the possibility of their entry into the groove of the jaw of the first jaw when the clamp is closed, and the jaws are made with an elastic coating on the working surface.

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