RU2464943C1 - Method of closing wound defect after radical excision of epithelial pilonidal tract by krivonosov-brezhnev - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to surgery and can be applied for closing wound defect after radical excision of epithelial pilonidal tract. With 1.2 cm indent from wound edge, puncture of needle with thread into skin and submucous cellular tissue is made. Needle is passed through wound bottom under fibres of sacrococcygeal fascia with applied on it uninterrupted suture on the other side of wound and punctures out through skin on the opposite side at the distance 1.2 cm from wound edge. After that, it is punctured in at the distance 1.5 cm sideways from puncture-out and 0.3 cm from wound edge. Needle with thread is passed through skin, subcutaneous fatty cellular tissue, fascia fibres under applied on them uninterrupted suture, and through wound bottom, subcutaneous cellular tissue of the other side, and pinctures out through skin at the distance 0.3 cm from wound edge and 1.5 cm sideways from the first puncture-in. After that, needle with thread is punctured in at the distance 1.5 cm sideways from puncture-out and 0.3 cm from wound edge. Needle is passed back through subcutaneous cellular tissue, under applied on fascia uninterrupted suture on the opposite side, and punctured out at the distance 0.3 cm from wound edge and 1.5 cm from the point of puncture-in parallel to wound edge. The following puncture-in is made at the distance 1.2 cm from wound edge and 1.5 cm from points of puncture-in. Needle with thread is passed through skin and subcutaneous cellular tissue, through wound bottom under applied on fascia uninterrupted suture on the other side of wound, and punctured out through skin on the opposite side at the distance 1.2 cm from wound edge and 1.5 cm from points of puncture-in. After that, sutures are tightened, wound edges are moved closer to the middle and tied up.

EFFECT: method makes it possible to reduce risk of cutting through of sutures, accelerate wound healing.

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Description

The invention relates to medicine, namely to coloproctology, and can be used to treat patients with acute and chronic inflammation of the epithelial coccygeal passage. The aim of the invention is the development of methods for strengthening the sacro-coccygeal fascia, as well as the development of new original methods for suturing a wound after excision with an ECC in a single unit with skin and altered tissues.

The presence of an extensive postoperative wound is of particular difficulty in reducing its edges, therefore, to date, scientists have proposed a significant number of ways to close a postoperative wound. Some authors, after excision of the coccygeal passage and pathologically altered tissues, suggest wounding openly (V.K.An, 2003), while others sutured it partially in the area of corners or only in the lower corner (M.S. Alekseev, 1990; G.A. Seropyan, 2002), some hem the skin edges of the wound to the bottom (V. A. Vrublevsky, 1976; S. B. Dubov, 1993; G. I. Vorobyov, 2001) or sutured the wound “tightly” (OK Skobelkin, 1989; T.Z Danilov, 2000; N.A. Bashankaev, 2003; R.S. Bashirov, 2005; A.A. Vorobey, 2005; A.A. Kartashev, 2011). Recently, considerable attention has been paid in the literature to plastic methods of closing a wound after excision of an ECC (A.P. Starostin, 1987; V.L. Denisenko, 2004; Darwish A.M, 2009). However, to date, there is no single approach to the choice of tactics and method of surgical benefits for this disease (V.L.Denisenko, 2008).

Many researchers consider the optimal method for excision of ECX to be a single unit with skin and altered tissues, followed by suturing the wound “tightly”. According to some authors, this method significantly reduces the hospitalization time and prevents the development of gross deforming scars (M.M. Kanshin, 1981; A.V. Kulyapin, 1989; V.E. Khrenov, 1995; N.A. Bashankaev, 2003; Nahas SC, 1997). Most often, an adaptation suture according to Donati and its modifications is used for wound closure. The main disadvantage of this method is the excessive tension of the stitched tissues, which leads to further eruption of the sutures either on the skin or on the sacrococcygeal fascia. Cavities are formed in the depths of the wound, which can lead to further suppuration of it.

There is a method of surgical treatment of suppurative epithelial coccygeal passage (RF patent No. 2277864, IPC A61B 17/00, 2006), according to which, after excision of the epithelial coccygeal passage and its branches, the surgical wound is closed by suturing, and the thread is passed through the sacral-coccygeal bone at the first injection. ligament, with the second injection, the thread is also carried out along the bottom of the wound, through the sacrococcygeal ligament, as in the first injection. Behind a number of sutures in the upper and lower parts of the wound in the skin, departing from the suture by 2-3 cm, make incisions-punctures to the cavity formed during excision of the coccygeal passage. Silicone drainage tubes are introduced into the formed sections along the joints. A gauze napkin is laid between the edges of the wound to the bottom. Next, through the drainage, sanitation of the focus of inflammation is carried out. Napkins are systematically changed until the end of exudation from the wound. Then the napkin and drainage are removed. Knotted stitches.

The disadvantage of this method of treatment of suppuration ECC is an excessive load on the fibers of the sacro-coccygeal fascia, which can lead to the eruption of sutures on it and the formation of a cavity in the wound. Also, when tying sutures, suture jumpers are formed on the skin along both edges of the wound, located along the axis of tissue tension, which can lead to eruption of sutures on the skin.

The objective of the invention is to develop a method for closing a wound defect after radical excision of the epithelial coccygeal passage, which allows to prevent the occurrence of complications and thereby accelerate wound healing and the patient's recovery time.

The technical result is the achievement of complete reduction of the edges of the wound without cutting suture ligatures on the skin or sacrococcygeal fascia, healing of the wound by first intention, increasing the cosmetic properties of the scar.

The technical result is achieved by the fact that in the method of closing a wound defect after radical excision of the epithelial coccygeal passage, including the application of a continuous twisting suture to the fibers of the sacrococcygeal fascia and the application of the original sutures to the edges of the wound, according to the invention, 1.2 cm from the edge of the wound are made injecting a needle with a thread into the skin and subcutaneous tissue, pass through the bottom of the wound under the fibers of the sacrococcygeal fascia with a continuous suture placed on it on the other side of the wound and puncture the needle through the skin against the right side at a distance of 1.2 cm from the edge of the wound, then make an injection at a distance of 1.5 cm laterally from the puncture and 0.3 cm from the edge of the wound, and draw a needle with thread through the skin, subcutaneous fat, fascia fibers under the applied on them with a continuous suture, and through the bottom of the wound, the subcutaneous tissue of the other side is punctured through the skin at a distance of 0.3 cm from the edge of the wound and 1.5 cm laterally from the first injection, then a needle with a thread is injected at a distance of 1.5 cm laterally from puncture and 0.3 cm from the edge of the wound, conduct the needle back through the subcutaneous tissue, under the superimposed fascia a seam on the opposite side, and a puncture is made at a distance of 0.3 cm from the edge of the wound and 1.5 cm from the injection point parallel to the edge of the wound, the next injection is made at a distance of 1.2 cm from the edge of the wound and 1.5 cm laterally puncture points, a needle with a thread is passed through the skin and subcutaneous tissue, through the bottom of the wound under a continuous suture placed on the fascia on the other side of the wound, and the needle is punctured through the skin on the opposite side at a distance of 1.2 cm from the edge of the wound and 1.5 cm from points of injection, then, tightening the seams, bring together the edges of the wound to the middle and tie.

The invention is illustrated by drawings, where figure 1 shows a method of strengthening the sacrococcygeal fascia; figure 2 is a technique for suturing a postoperative wound; figure 3 is a view in section of a technique for suturing a postoperative wound.

Description of the technique

After treating the surgical field with a 70% solution of ethyl alcohol, in the position of the patient according to Depage, through the primary fistulous opening, we stain the epithelial coccygeal passage with a brilliant green solution with a hydrogen peroxide solution of 3%. Next, we conduct an audit of the cavity with a probe to clarify the boundaries of the removal of the coccygeal passage. Two semi-oval skin incisions conduct an economical excision of the epithelial coccygeal passage with pathologically altered tissues within healthy ones. We perform a thorough hemostasis. Next, we strengthen the sacro-coccygeal fascia according to the proposed method: along the midline of the wound bottom, departing 0.2 cm to each side of the midline, we apply a simple continuous twisting stitch with 2 Vicryl Rapid thread 3/0 (PHA-Rapid, Safil-kvik) with an atraumatic needle 3 on the sacrococcygeal fascia 1 (Fig. 1). Control for hemostasis. Then we make the wound suturing according to the new method: retreating 1.2 cm from the edge of the wound, make a needle with a thread into the skin and subcutaneous tissue (Fig. 2), pass through the bottom of the wound under the fibers of the sacro-coccygeal fascia with a continuous suture on it the other side of the wound (Fig. 3) and puncture the needle through the skin on the opposite side at a distance of 1.2 cm from the edge of the wound, then make an injection at a distance of 1.5 cm laterally from the puncture and 0.3 cm from the edge of the wound (Fig. 2), and we pass the needle with the thread through the skin, subcutaneous fatty tissue, fascia fibers under continuous a jerk seam, and through the bottom of the wound, subcutaneous tissue of the other side (Fig.3), puncture through the skin at a distance of 0.3 cm from the edge of the wound and 1.5 cm laterally from the first injection. Next, we stick the needle with the thread at a distance of 1.5 cm laterally from the puncture and 0.3 cm from the edge of the wound so that this stick is on the same line with the first perpendicular to the edge of the wound (Fig. 2), we draw the needle back through the subcutaneous tissue, under fascia with a continuous suture placed on it on the opposite side (Fig. 3), and a puncture is made at a distance of 0.3 cm from the edge of the wound and 1.5 cm from the injection point parallel to the edge of the wound. Next, the injection is done at a distance of 1.2 cm from the edge of the wound and 1.5 cm laterally from the puncture points (Fig. 2), a needle with thread is drawn through the skin and subcutaneous tissue, through the bottom of the wound under the sacrococcygeal fascia fibers superimposed on it continuous suture on the other side of the wound (figure 3) and puncture the needle through the skin on the opposite side at a distance of 1.2 cm from the edge of the wound and 1.5 cm from the points of injection (figure 2). Next, tightening the seams, bring the edges of the wound closer to the middle and tie. In the same way, all subsequent seams are tied, which ensures complete contact of the edges of the surgical wound.

Thus, a continuous suture on the fascia strengthens it, preventing the eruption of sutures on it in the postoperative period. The seams on the skin do not have suture jumpers parallel to the tissue tension lines, which makes it possible to avoid the eruption of sutures on the skin. Thus, the proposed technique for closing the surgical wound after radical surgical treatment of ECX allows to prevent the occurrence of complications and thereby accelerate the healing of the wound and the timing of the patient's recovery.

With an uncomplicated course, the wound heals by primary intention for 7-10 days. As a rule, the sutures are removed on the 10th day, and the next day the patient is discharged home. Control inspection is carried out in a week.

Claims (1)

A method of closing a wound defect after radical excision of the epithelial coccygeal passage, including the application of a continuous twisting seam to the fibers of the sacro-coccygeal fascia and suturing the edges of the wound, characterized in that 1.2 cm from the edge of the wound, inject the needle with a thread into the skin and subcutaneous tissue is passed through the bottom of the wound under the sacrococcygeal fascia fibers with a continuous suture placed on it on the other side of the wound and a needle is punctured through the skin on the opposite side at a distance of 1.2 cm from the edge of the wound, then they inject the injection at a distance of 1.5 cm laterally from the injection and 0.3 cm from the edge of the wound, and draw a needle with thread through the skin, subcutaneous fatty tissue, fascia fibers under a continuous suture placed on them, and through the bottom of the wound, another subcutaneous tissue hand, puncture through the skin at a distance of 0.3 cm from the edge of the wound and 1.5 cm laterally from the first injection, then inject a needle with a thread at a distance of 1.5 cm laterally from the puncture and 0.3 cm from the edge of the wound, hold the needle back through the subcutaneous tissue, under the continuous suture on the opposite side, imposed on the fascia, and the puncture is done at a distance 0.3 cm from the edge of the wound and 1.5 cm from the injection point parallel to the edge of the wound, the next injection is made at a distance of 1.2 cm from the edge of the wound and 1.5 cm laterally from the puncture points, a needle with thread is passed through the skin and subcutaneous tissue, through the bottom of the wound under the continuous suture applied to the fascia on the other side of the wound, and a needle is punctured through the skin on the opposite side at a distance of 1.2 cm from the wound edge and 1.5 cm from the injection points, then tightening the sutures, bring the wound edges closer together to the middle and knotted.

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