RU2340292C1 - Method of sealing extensive wound of soft tissues - Google Patents

Abstract

FIELD: medicine; surgery.

SUBSTANCE: place top-flatted sututers of the first row towards each other with mutual overlapping of a part of a zone of capture. Impose on distance not less than 2.5 cm from the first row of top-flatted seams on all extent of the wound the second row of the top-flatted seams which knots fastened over the inserts placed on the skin. Pass threads of top-flatted seams of the first row through top-flatted seams of the second row of an opposite side and fasten them. Pull together each pair of top-flatted seams of the first row with separate threads with a possibility of adjustment of force of rapprochement of edges of the wound.

EFFECT: reduction of disturbance of circulation in a zone of a wound and prevention of tucking of wound edges.

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Description

The present invention relates to medicine, namely to surgery, and can be used to suture an extensive soft tissue wound during surgical operations.

The progress of surgery observed in recent years is largely associated with the development of technology, the introduction of new materials, devices and devices, the development of more advanced surgical instruments. However, the problem of suturing the skin wound remains relevant. Of particular importance is the problem of surgical closure in the presence of extensive infected soft tissue defects, especially under difficult conditions, such as abdominal eventing, impaired blood supply to tissues due to diabetes mellitus, or chronic venous insufficiency. With an imperfect technique for closing postoperative and post-traumatic wounds, it leads not only to unsatisfactory aesthetic results, but also to the formation of gross functionally inconsistent scars that do not heal ulcerations and postoperative hernias for a long time. Moreover, 20% of cases of postoperative inflammatory complications are the main cause of all deaths.

A known method of suturing soft tissue wounds, including applying a simple nodal suture to the connected edges of the wound (see Kuzin M.I. Treatment of purulent wounds / M.I. Kuzin, B.M. Kostyuchonok, V.A. Karpov // Wounds and wound infection: A guide for doctors / Edited by M.I. Kuzin, B.M. Kostyuchonok. - M., Medicine, 1981. - S.325-485). With this simplest type of suture, a satisfactory adaptation of the wound edges and a good comparison of its walls are created.

However, with a deep or widespread wound or a wound with a pronounced tension of the edges, this seam may be untenable. When teething threads on the skin, pressure sores are formed. In addition, currently there has been an increase in the number of patients with purulent wounds of different localization. In some wounds, suturing is not only difficult but also impossible. Marked tissue tension occurs after radical excision of the tumors and initial surgical treatment, which leads to the formation of gaping wounds that turn into long-time non-healing wound surfaces.

To avoid these complications, gauze swabs are applied under the threads along the entire length of the wound, which perform the function of passive drainage. In order to prevent teething, various types of mattress seam are used, while gauze rollers, sticks, gaskets, plates, etc. are used as fuses. To apply this type of suture, a needle with a double thread is injected, retreating 3 cm from the edge of the skin, then held under the bottom of the wound and punctured on the opposite side. The sutures are tied with a tension sufficient to completely contact the edges of the wound (Aryev T.Ya. Treatment of complications of infected wounds // Experience of Soviet medicine in the Great Patriotic War of 1941-1945. - M., 1951. T. 1. - chap. V. - S.139-167).

To lay plate seams, a wire or thick silk is passed through holes in metal plates with a rubber or gauze pad, and after tightening, the wire is twisted and the silk is tied over a metal plate. In order to avoid pressing the plates into the skin with a strong tension of the joints and the formation of pressure sores, instead of separate plates, two metal plates along the length of the wound are used for each joint. This allows you to increase the supporting plane and reduce pressure on the tissue. The plates are brought together by a wire drawn through the openings in them, the ends of which are twisted and fixed with a seal. Sutures are carried out under the bottom of the wound, providing good contact of its edges. With a significant tension of the edges of the wound, their rapprochement is carried out in 2-3 stages. After comparing the deep layers of the wound with plate sutures with incomplete contact of the skin layers, additional surface silk sutures are applied (Sazontov V.I., Shvartsberg E.M. On the secondary and stepwise approximation of the edges of the wounds. - L., 1943. - No. 2. - P. 12-16).

There is a method of suturing an extensive wound in cases where it is not possible to suture through the bottom of the wound (E. Stysin. A new technique for applying secondary sutures. // Military Medical Journal. - 1953. - No. 7. - P.53 -54). The method consists in taking two strings 30-32 cm long each and injecting them with a needle at a distance of 1.5-2 cm from the edge of the wound. The thread is pulled through one of the walls of the wound 15-16 cm and removed from the needle. Do the same on the opposite side of the wound. Such paired sutures are applied at an appropriate distance from each other along the entire length of the wound. Then proceed to the binding of oppositely arranged double, pre-pulling them.

For the prototype of the invention, a well-known method for suturing an extensive wound of soft tissues, including reducing the edges of the wound, applying a series of U-shaped sutures, tying them and additional mixing with a separate thread (V. Struchkov et al. Purulent wound. M., Med., 1975 .-- p. 311).

The known method is as follows.

Having departed from the edges of the wound by 1 cm, the thread with a cutting needle is carried out parallel to the edge, wall and bottom of the wound with a puncture on the opposite side at a distance of 1 cm from the edge of the wound. With the same thread, the same stitch is carried out in the opposite direction, departing from the first one by 1.5-2 cm. In the same way, the required number of stitches is applied depending on the length of the wound and after that the stitches are tightened. A separate thread additionally brings together sections of each U-shaped suture above the wound.

The known method has the following disadvantages:

1. It leads to tucking of the edges of the wound, with a strong tension of the tissues, their sufficient adaptation is not achieved in the depth of the wound, which leads to the formation of cavities, which are foci of inflammation.

2. Suture threads significantly compress the tissue in the region of the edge, thereby disrupting blood circulation, causing the development of ischemia, which increases the risk of purulent-inflammatory complications and, as a result, worsen wound healing.

3. The applied pads, applied near the edges of the wound, absorb wound, serve as a microflora depot and make it difficult to change dressings and the wound's toilet.

4. The main disadvantage of this method is that the method does not allow to dynamically bring together the edges of the wound during treatment without imposing new sutures. It is known that a prerequisite for suturing an extensive wound is the ability to adequately compare the edges of the wound without excessive tension, and optimal conditions are created with a pulling force of threads up to 1 kg.

The objective of the invention is to provide the possibility of controlled convergence of the edges of the wound, the exclusion of tucking of the edges of the wound and the prevention of ischemia in the region of the edges of the wound.

The problem is solved in that in the known method of suturing an extensive wound of soft tissues, including the application of a number of U-shaped sutures, their tying and their additional reduction by a separate thread, additionally at a distance of at least 2.5 cm from the first row of U-shaped sutures throughout during the wound, a second row of U-shaped sutures is applied, the knots of which are tied over the gaskets placed on the skin, while the U-shaped sutures of the first row are placed towards each other with mutual overlap of a part of the capture zone, the threads of the U-shaped sutures of the first p the poisons are tied up, after passing them through the U-shaped seams of the second row of the opposite side, then each pair of U-shaped seams of the first row is additionally brought together by separate threads, with the possibility of regulating the force of convergence of the edges of the wound.

The proposed method meets the criteria of the invention of "novelty" and "inventive step", since in the process of conducting patent information research, no sources of patent and scientific literature were found that would discredit the novelty of the proposed method, as well as solutions with essential features of the proposed technical solution .

U-shaped seams of the first row perform a guiding function, that is, they bring the edges of the wound closer to each other. U-shaped seams of the second row perform a supporting function, since they hold U-shaped seams of the first row. Each pair of U-shaped sutures of the first row is additionally brought together by individual threads, with the possibility of regulating the force of convergence of the edges of the wound.

The invention is illustrated in graphic materials.

Figure 1 shows the imposition of the U-shaped seams of the first row with the mutual overlapping part of the capture zone and the imposition of the U-shaped seams of the second row tied to gauze rollers.

Figure 2 shows the tying of the U-shaped seams of the first row with the passage of threads through the supporting seams of the second row.

Figure 3 shows the reduction of the edges of the wound with individual threads.

In figure 1 is indicated:

1 - thread of a U-shaped seam of the first row;

2 - sections of the mutual overlap of the zones of capture of the seams of the first row;

3 - threads of the U-shaped seam of the second row.

In figure 2 is indicated:

4 - rollers on which the seams of the second row are tied;

5 - threads of the first row, passed through the U-shaped seams of the second row.

In figure 3 is indicated:

6 - threads, additionally bringing together the U-shaped seams of the first row.

On the extensive wound of soft tissues (figure 1) impose the first row of U-shaped sutures (1). In this case, the first row of U-shaped seams are arranged towards each other with mutual overlap of a part of the capture zone (2). The ends of the threads of the first row are left free. At a distance of not less than 2.5 cm from the first row of U-shaped sutures (Fig. 1), a second row of U-shaped sutures (3) are placed throughout the extensive wound. The ends of the threads of the U-shaped seams of the second row are tied into knots above the gaskets (4) placed on the skin (Fig. 2). The threads of the U-shaped seam of the second row, tied over the gaskets, bear the main load and are supporting. The threads of the U-shaped seams of the first row (1) are tied, having previously passed them through the U-shaped seams of the second row of the opposite side (5) (Fig. 2). The resulting connection is additionally brought together by individual threads (6) while maintaining the ability to adjust the tension force (figure 3). The threads connecting the U-shaped seams of the first and second rows serve to gradually approach the edges of a wide wound.

The method is as follows.

U-shaped seams of the first row are laid in pairs in such a way that they mutually overlap part of the capture zone. Injections are performed by retreating from the edge of the wound by at least 1.5 cm. With a large depth of the wound, U-shaped sutures of the first row are applied at different levels. Having retreated at least 2.5 cm from the first row of U-shaped seams, impose supporting U-shaped seams of the second row and tied them over gaskets of gauze balls or PVC tubes with an interval between the seams of at least 20 mm. The threads of the first row of the U-shaped seams are tied, having previously passed them through the U-shaped seam of the second row. Power yarns are passed through the U-shaped guides of the first row and, tightening them, bring together the edges of the wound. At the next dressing, the edges of the wounds are brought closer together, gradually tightening the power threads until the wound edges are completely matched.

The proposed method allows to obtain when using the following positive effect.

The method allows to bring together the edges of the wound defect, excluding the tucking of the edges of the wound. Since the main load goes to the seams located at a distance of more than 2.5 cm from the edges of the wound, tissue ischemia does not develop in the region of the edges of the wound itself. An additional rapprochement of the edges of the wound is carried out due to the power threads not drawn through the tissue, which provides the possibility of a phased rapprochement of the edges of the wound. If necessary, these threads can be replaced. It also provides non-invasive wound care.

An example of a specific performance is given in the form of an extract from a medical history.

Patient O. 22 years old 5 days after amputation in the / 3 lower leg, produced due to frostbite IV tbsp. feet, legs, focal necrosis of the stump developed. After necrectomy, a rounded wound with a diameter of 4 cm was formed. It was not possible to tighten the edges of the wound due to deficiency of stump tissue, due to the complex configuration of the anatomical region, which was almost a sphere with a diameter of 100 mm, it was impossible to produce dermatotension using traditional methods. 7 days after amputation, the wound was sutured again by the proposed method. The wound edges are reduced by 2 cm. After a day, an additional rapprochement of the edges was carried out at a speed of up to 3 mm / day. A week later, the edges came closer to contact, adaptation seams were laid. After 3 days, the dermotension suture was removed. After another 14 days, the adaptation seams were removed. There was a linear scar. The total duration of wound healing was 24 days from the time of suturing.

Claims (1)

A method of suturing an extensive wound of soft tissues, including the application of a series of U-shaped sutures, characterized in that the U-shaped sutures of the first row are arranged towards each other with mutual overlap of a part of the capture zone, additionally at a distance of at least 2.5 cm from the first row of P- along the wound along the entire length of the wound, a second row of U-shaped sutures is applied, the knots of which are tied over the pads placed on the skin, the threads of the U-shaped sutures of the first row are passed through the U-shaped sutures of the second row of the opposite side and tied, then each a pair of U-shaped joints of the first row further bring together individual filaments with ensuring the possibility of regulating power approximation of the wound edges.

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