RU2474389C1 - Method of temporary rib fixation in programmed rethoracotomy and device for implementing it - Google Patents

Method of temporary rib fixation in programmed rethoracotomy and device for implementing it Download PDF

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Publication number
RU2474389C1
RU2474389C1 RU2011121136/14A RU2011121136A RU2474389C1 RU 2474389 C1 RU2474389 C1 RU 2474389C1 RU 2011121136/14 A RU2011121136/14 A RU 2011121136/14A RU 2011121136 A RU2011121136 A RU 2011121136A RU 2474389 C1 RU2474389 C1 RU 2474389C1
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RU
Russia
Prior art keywords
wound
braces
lock
programmed
ribs
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RU2011121136/14A
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Russian (ru)
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RU2011121136A (en
Inventor
Рушан Абдулхакович Сулиманов
Рамиль Рушанович Сулиманов
Сергей Валерьевич Бондаренко
Валерий Дмитриевич Новиков
Дмитрий Викторович Сеничев
Каруанчо Юрий Джонатан Рабанал
Original Assignee
Государственное образовательное учреждение высшего профессионального образования Новгородский государственный университет имени Ярослава Мудрого
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Priority to RU2011121136/14A priority Critical patent/RU2474389C1/en
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Abstract

FIELD: medicine.
SUBSTANCE: group of inventions refers to medicine, namely thoracic surgery, and aims at surgical management of diffuse purulent mediastinitis. The used device consists of two locked braces. Each of the braces is made of titanium alloy; it has a blunt and rounded lateral end and a medial end whereon a flange for lock fixation is presented in the form of an oval ring. The method consists in the fact that when closing a wound, the braces are brought behind the adjoining ribs alternatively, positioned in inversed manner, clinched and locked. After final suturing, the braces are removed, and the wound is closed in layers.
EFFECT: use of the given group of inventions enables providing reduced soft tissue injuries, reduced risk of potential infection of the incisional wound, higher surgical rate.
2 cl, 2 dwg, 1 ex

Description

The invention relates to medicine, namely to thoracic surgery, and is intended for the surgical treatment of diffuse purulent mediastinitis.

A known method for the surgical treatment of purulent mediastinitis, including thoracotomy, dissection of the mediastinal pleura throughout, evacuation of pus and the location of drainage tubes in the mediastinal tissue and pleural cavity, in which programmed retoracotomy is performed every 48 hours along the postoperative wound with subsequent opening of the delimited inflammation of the purulent and removal of necrotic tissue, replacement and repositioning of drainage tubes and preventive methods of hemostasis (see RU No. 231845 4, IPC A61B 17/00, A61M 27/00).

The disadvantages of the method are: the occurrence of a purulent-necrotic process due to the capillary mechanism of suture material, which leads to the melting of intercostal soft tissues and is accompanied by the transition of the purulent process to bone tissue; injuries, since each injection increases the likelihood of damage to the intercostal artery, and the low speed of the operation.

The objective of the invention is to reduce the risk of infection of the surgical wound, reduce trauma to soft tissues and increase the speed of the operation.

The task is achieved by the fact that during the suturing of the wound at the stage of programmed retoracotomy, a device is used consisting of two brackets connected by a lock made of titanium alloys, each of the brackets has a blunt and rounded lateral end and a medial end on which there is a protrusion for fixing the lock made in the form of an oval ring. The staples are alternately turned on by the adjacent ribs, positioning them in a mirror, reduced by a clamp and fixed with a lock, and when the stitching is final, the staples are removed and the wound is sutured in layers.

To explain the invention, the proposed image.

Photo 1 shows a disassembled device, where:

1 - bracket;

2 - lock (top view and side view);

A - lateral end of the bracket;

B - the medial end of the bracket.

Photo 2 shows the device assembled, where:

1 - bracket;

2 - lock (side view);

A - lateral end of the bracket;

B - the medial end of the bracket;

In - ribs (section).

During suturing of the wound by the adjacent ribs B (photo 2), rib braces 1 are alternately turned on, brought together with a clamp and fixed with a lock 2. The braces are made of titanium alloys. Each bracket has a lateral A and a medial B end (photo 2). The lateral end is blunt and rounded for better fixation of the rib. There is a protrusion on the elongated medial end that locks the lock. Depending on the anatomical features of the patient’s chest, braces and locks of different sizes are used. At the final stitching, the staples are removed and the wound is sutured in layers.

With a programmed retoracotomy using temporary ribs of the ribs, the ribs that were previously allotted for the operation are reduced. After sanitation is performed with antiseptic solutions of the pleural cavity and mediastinum, the ribs are temporarily fixed (for subsequent sanitation) and sutured in fatty tissue and in the skin in layers.

The puncture of the intercostal muscles is performed by the medial end of the bracket B, which runs around the rib, and the lateral end A fixes the rib. The medial ends come together to insert a lock. After installing a temporary fixator for the ribs with antiseptic solutions, the surgical wound is washed. The operation ends with suturing the skin and an antiseptic dressing.

Clinical example.

Patient B., 65 years old, was admitted with a diagnosis of diffuse suppurative mediastinitis. Received 3 days after a stab wound to the chest with damage to the esophagus. The planned operation is thoracotomy in the 4th intercostal space, mediastinotomy, mediastinal debridement, excision of necrotic tissues of the esophagus wall, suturing of the esophagus wound. A thoracotomy wound was closed using a rib clamp for subsequent programmed retoracotomy.

4 programmed retoracotomies were performed, every 48 hours, closing of the thoracotomy wound with the help of the ribs. There was a positive trend; clinical manifestations of mediastinitis have disappeared. Closed thoracotomy wounds - stitching tissue in layers.

The proposed invention can reduce the risk of infection of the surgical wound, reduce soft tissue trauma and increase the speed of the operation.

Claims (2)

1. A method of temporary fixation of ribs with a programmed retoracotomy, characterized in that during the closure of the wound around the adjacent ribs, brackets are alternately inserted, each of which has a blunt and rounded lateral end and a medial end on which there is a protrusion for fixing the lock, made in the form of an oval the rings, positioning them in a mirror, are clamped and fixed with a lock, and when the stitching is final, the staples are removed and the wound is sutured in layers.
2. A device for fixing ribs with a programmed retoracotomy, consisting of two brackets connected by a lock made of titanium alloys, each of the brackets has a blunt and rounded lateral end and a medial end on which there is a protrusion for fixing the lock, made in the form of an oval ring.
RU2011121136/14A 2011-05-25 2011-05-25 Method of temporary rib fixation in programmed rethoracotomy and device for implementing it RU2474389C1 (en)

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Application Number Priority Date Filing Date Title
RU2011121136/14A RU2474389C1 (en) 2011-05-25 2011-05-25 Method of temporary rib fixation in programmed rethoracotomy and device for implementing it

Applications Claiming Priority (1)

Application Number Priority Date Filing Date Title
RU2011121136/14A RU2474389C1 (en) 2011-05-25 2011-05-25 Method of temporary rib fixation in programmed rethoracotomy and device for implementing it

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RU2011121136A RU2011121136A (en) 2012-11-27
RU2474389C1 true RU2474389C1 (en) 2013-02-10

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Citations (10)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
SU605611A1 (en) * 1977-01-11 1978-05-05 Ворошиловградская Областная Клиническая Больница Apparatus for positioning bone fragments at transverse fractures
SU663394A1 (en) * 1977-09-26 1979-05-25 В. П. Косарев Device for reposition and fixation of ribs
RU1819578C (en) * 1991-02-28 1993-06-07 Новосибирский медицинский институт Mental region bone holder
WO2000016709A1 (en) * 1998-09-17 2000-03-30 Synthes Ag Chur Repositioning instrument for the fixation of bone fractures
RU66179U1 (en) * 2007-04-23 2007-09-10 Государственное образовательное учреждение высшего профессионального образования "Тверская государственная медицинская академия Федерального агентства по здравоохранению и социальному развитию" VOLKOV-TSAYA CLAMP FOR FIXING AND REPAIRING BONE FRACTURES IN Fractures of the lower jaw
US20080027471A1 (en) * 2006-07-31 2008-01-31 Bernhard Hauri Clamp for attaching surgical aids to bone during a surgical procedure and system for doing the same
RU2318454C1 (en) * 2006-06-19 2008-03-10 Государственное образовательное учреждение высшего профессионального образования Новгородский государственный университет имени Ярослава Мудрого Method for surgical therapy of diffuse purulent mediastinitis
US7361178B2 (en) * 2000-07-27 2008-04-22 Synthes (U.S.A.) Cranial flap clamp and instrument for use therewith
US20090248090A1 (en) * 2007-12-28 2009-10-01 Pronto Products, Llc Rib bone tissue clamp
EP2316363A1 (en) * 2009-10-27 2011-05-04 Zimmer Spine Bone holding device

Patent Citations (10)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
SU605611A1 (en) * 1977-01-11 1978-05-05 Ворошиловградская Областная Клиническая Больница Apparatus for positioning bone fragments at transverse fractures
SU663394A1 (en) * 1977-09-26 1979-05-25 В. П. Косарев Device for reposition and fixation of ribs
RU1819578C (en) * 1991-02-28 1993-06-07 Новосибирский медицинский институт Mental region bone holder
WO2000016709A1 (en) * 1998-09-17 2000-03-30 Synthes Ag Chur Repositioning instrument for the fixation of bone fractures
US7361178B2 (en) * 2000-07-27 2008-04-22 Synthes (U.S.A.) Cranial flap clamp and instrument for use therewith
RU2318454C1 (en) * 2006-06-19 2008-03-10 Государственное образовательное учреждение высшего профессионального образования Новгородский государственный университет имени Ярослава Мудрого Method for surgical therapy of diffuse purulent mediastinitis
US20080027471A1 (en) * 2006-07-31 2008-01-31 Bernhard Hauri Clamp for attaching surgical aids to bone during a surgical procedure and system for doing the same
RU66179U1 (en) * 2007-04-23 2007-09-10 Государственное образовательное учреждение высшего профессионального образования "Тверская государственная медицинская академия Федерального агентства по здравоохранению и социальному развитию" VOLKOV-TSAYA CLAMP FOR FIXING AND REPAIRING BONE FRACTURES IN Fractures of the lower jaw
US20090248090A1 (en) * 2007-12-28 2009-10-01 Pronto Products, Llc Rib bone tissue clamp
EP2316363A1 (en) * 2009-10-27 2011-05-04 Zimmer Spine Bone holding device

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Effective date: 20140526