RU2483685C2 - Device for obtaining full-layer skin transplants - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to surgical instruments for skin transplantation and can be used in skin transplantation to children. Device for obtaining full-layer skin transplants contains working case, curved in accordance with the shape of lateral wall of cylindrical segment and made in form of two plates. Plates are connected to each other and have possibility of mutual travel and fixation with stopper or stoppers. Stopper or stoppers are intended for interaction with skin flap holders. Holders or fixers of skin flap are made in form of equidistant from each other ligature cuts. Ligature cuts are located on edges of plates and have terminal extensions for stopper or for stoppers. Distance between equidistant from each other ligature cuts equals 10-20 mm. Length of each ligature cut 4 is equal 5-15 mm.

EFFECT: device makes it possible to obtain: high-quality sampling of autotransplant and reduction of its retraction due to complete transplant fixation; minimisation of damage to autotransplant during its sampling, reduction of its processing time with application of different methods; possibility of sampling flaps of various length and size; careful handling of transplant; reduction of surgery time.

4 cl, 2 dwg

Description

The invention relates to surgical instruments for skin grafting and can be used for skin grafting in children.

Currently, when restoring the skin with burns and in reconstructive surgery, a free skin transplant is used with a full-layer flap. A complete skin flap contains a dermis layer under the epidermis, which creates the most complete anatomical and functional skin.

Thin split grafts in the first time after surgery are very sensitive to all kinds of irritants - pressure, mechanical injuries, exposure to heat and cold. They often crack and ulcerate. A disadvantage of plastic surgery for a split skin graft is also wrinkling of the wound bed due to scarring and a rather significant reduction in the graft in relation to its initial area, in addition, the split graft will change color, i.e. becomes hypo- or hyperpigmented, which leads to a pronounced cosmetic deficiency.

A full-layer skin graft has several advantages over split skin, but no specialized surgical instruments have been developed to obtain such grafts.

It is known, for example, a device for alloplastics SU 1666081 A1, 07/30/1991, comprising, in particular, a case in the form of a frame with a window provided with a flap retraction element made in the form of a curtain with needles. A disadvantage of the known device is the flat shape of its body, which leads to the imposition of the edge of the cut skin flap on the needle of the blind and to the rectilinear movement of the blind to lead the graft.

Closer to our invention can be considered a device for fixing a cut skin flap to a manual dermatome of the Krasnogvardeets plant, known from the description to the author's certificate SU 122843 A, 1959. A device for fixing a cut skin flap SU 122843 contains holders of a skin flap in the form placed on the bar needles and a working body, curved in the shape of the side wall of the cylindrical segment.

The disadvantage of the device SU 122843 is its trauma, which arises due to the impossibility of changing the dimensions of the body in accordance with the size of the graft to be grafted and the need to fix the cut skin graft on needles placed on an element separate from the body, i.e. on the bar.

The problem to which the present invention is directed is to create a tool that provides very careful handling of the flap, prevents damage to the flap during its collection (especially in children, because their skin is very thin) and allows for thorough processing of the last from subcutaneous tissue.

The technical result of the invention is manifested in the fact that the developed device for producing full-layer skin grafts allows to obtain:

- high-quality autograft sampling and reduction of its retraction due to complete fixation of the graft;

- minimization of damage to the autograft during its collection;

- reduction of processing time using various methods;

- the ability to pick up flaps of various lengths and sizes;

- careful attitude to the transplant;

- reduction of surgical treatment time.

The invention is expressed in the aggregate essential features, in which a device for producing full-layer skin grafts containing skin flap holders and a working body curved in the shape of the side wall of a cylindrical segment differs from the closest analogue in that the working body is made in the form of two plates connected by planes between each other and having the possibility of mutual movement and fixation by stoppers made to interact with the skin flap holders, or by a stopper made for I interact with the skin flap holders, while the skin flap holders are made in the form of ligature slots equally spaced from each other at the edges of the plates and have end extensions under the stopper or under the stoppers, the distance between equidistant ligature slots being 10-20 mm, and the length of each ligature the slot is 5-15 mm.

In particular cases of its implementation or use, the device may include a stopper that has a wedge-shaped or screw stop for interacting with end extensions or stoppers having wedge-shaped or screw stops for interacting with end extensions. The handle of the device can be oriented along the side wall of the cylindrical segment of the housing or across the side wall of the cylindrical segment of the housing.

The influence of the essential features of the invention on its technical result is manifested in the fact that the execution of the working case in the form of two plates connected by planes to each other and having the possibility of mutual movement and fixation by stoppers allows you to change the dimensions of the case in accordance with the size of the graft.

To connect the plates when changing the dimensions of the case, one stopper is sufficient, which can have a wedge-shaped or screw stop for interaction with end extensions, but an increase in the number of stoppers with wedge-shaped or screw stops increases the reliability of the connection.

The implementation of the stopper or stoppers for interacting with the skin flap holders in the form of ligature slots equidistant from each other, placed on the edges of the plates and having end extensions under the stopper or under the stoppers, allows to simplify the connection of the plates when preparing the device for operation, stopper or stoppers interact with ligature slots of two plates at once.

The distance between equidistant ligature slots is 10-20 mm and corresponds to the distance between ligatures on the inner edges of the wound, and the length of each ligature slit 5-15 mm is optimal for ligatures used in such operations, which are usually 6-8 cm long .

The invention is illustrated by the drawing, where Fig. 1 shows a general view of a device for producing full-layer skin grafts with a stopper having a wedge-shaped stop, and Fig. 2 shows an enlarged image of its ligature slots.

A device for producing full-layer skin grafts contains a working body, curved in the shape of the side wall of the cylindrical segment and made in the form of two plates 1 and 2. Plates 1 and 2 are connected by planes to each other and have the ability to move and fix with a stopper 3 or stoppers 3. Stop 3 or stoppers 3 are designed to interact with skin flap holders. The skin flap holders are made in the form of ligature slots 4. The ligature slots 4 are located on the edges of the plates 1 and 2 and have end extensions 5 under the stopper 3 or under the stoppers 3. The distance between the equally spaced ligature slots 4 is 10-20 mm The length of each ligature slot 4 is 5-15 mm.

In particular cases of its implementation or use, the device may include a stopper 3, which has a wedge-shaped or screw stop 6 for interacting with end extensions 5 of the ligature slots 4, or stoppers 4, having wedge-shaped or screw stops 6 for interacting with end extensions 5 of the ligature slots 4. The device may have a handle (not shown), oriented along the side wall of the cylindrical segment of the housing, made in the form of two plates 1 and 2, or across the side wall of the cylindrical segment a housing configured in the form of two plates 1 and 2.

During the operation, the boundaries of the graft are outlined and a bordering incision is made within the entire thickness of the skin to subcutaneous fat. On the inner edges of the resulting wound impose nylon ligatures 6-8 cm long at a distance of 1-2 cm from each other. The ends of the ligatures are fixed on the clamps.

The working body of the device for receiving full-layer skin grafts, made in the form of two plates 1 and 2, is formed by the size of the bordering section. To give the housing the desired dimensions, plates 1 and 2 are moved towards each other (or spread apart) and set so that part of the ligature slots 4 of plate 1 coincide with part of the ligature slots 4 of plate 2. Ligature slots on plate 1 and on plate 2 are located at an equal distance from each other and to connect the plate 1 and plate 2, it is sufficient to check the alignment of one ligature slot 4 on the plate 1 with one ligature slot on the plate 2. Wedge-shaped or screw stop 6 of the stopper 3 or Bearing 3 is introduced into the end extensions 5 reciprocally ligature slits 4 and the plates 1 and 2 are bonded.

Then, a device for producing full-layer skin grafts is placed on the graft. In the free ligature slots 4 carry out the ligature of the graft and pull them. Due to the irregular shape of the last flap, during its collection, it is placed on plate 1 and plate 2, which allows you to separate the graft from the donor site. Without moving the fixed flap to other working surfaces, the remaining subcutaneous fatty tissue is cut with scissors from the skin graft. Adherence and damage to the skin graft to plates 1 and 2 is excluded. After processing, the prepared skin graft is applied to a granulating wound or skin wound formed after excision of the scar area, and sutured to its edges with separate interrupted sutures.

Example: Patient Yu., 11 years old, was hospitalized in the surgical department with a diagnosis of Combined trauma. Bruise of the brain. Fracture of the left parietal bone. Closed fracture of the surgical neck of the left humerus with displacement of fragments. An extensive scalped-lacerated wound of the left lower leg in n / 3 and the left foot.

She was injured in an accident, was hit by a car.

Surgical treatment was performed: "Closed reduction and intramedullary retrograde metal osteosynthesis of the left humerus with Beck spokes."

In connection with extensive soft tissue necrosis in the region of the left lower leg in n / 3 and the left foot, the operation was performed: "Tangential necrectomy in the region of the left lower leg in n / 3 and the left foot." As a result of surgical treatment in the area of the left lower leg in n / 3 and the left foot along the back surface and the calcaneal region, wound surfaces measuring 16 × 10 cm were formed.

The operation was performed: “Plasticization of granulating wounds of the left lower leg and foot with a full-layer autoderm graft”.

To take skin grafts with dimensions of 16 × 10 cm in the region of the left thigh, the borders of the grafts were marked along the inner surface and a bordering incision was made within the entire thickness of the skin to subcutaneous fat. On the inner edges of the wound formed, kapron ligatures 6-8 cm long were applied at a distance of 1-2 cm from each other. The ends of the ligatures were fixed on the clamps.

The working body of the device for receiving full-layer skin grafts was formed according to the size of the bordering incision. To give the housing the desired dimensions, plates 1 and 2 were parted in opposite directions and set so that part of the ligature slots 4 of the plate 1 coincided with part of the ligature slots 4 of the plate 2. A screw stop 6 of the stopper 3 was inserted into the end extensions of 5 aligned ligature slots 4 and plates 1 and 2 fastened. After that, a device for producing full-layer skin grafts was placed on the graft. In the free ligature slots 4, ligatures of the graft were carried out and pulled. Due to the irregular shape of the last flap, during its collection, it was placed on plate 1 and plate 2, which made it possible to separate the graft from the donor site.

Without moving the fixed flap to other working surfaces, the remaining subcutaneous fat was cut with scissors from the skin graft. After treatment, the prepared skin graft was placed on a granulating wound in the left lower leg in n / 3 and the left foot and fixed to the edges with separate interrupted sutures.

As a result of using the device to obtain full-layer skin grafts, its damage during the collection process was minimized; there was no retraction of the latter due to its fixation in the device; a reduction in surgical treatment time was noted.

Claims (4)

1. A device for producing full-layer skin grafts containing skin flap holders and a working body curved in the shape of the side wall of a cylindrical segment, characterized in that the working body is made in the form of two plates connected by planes to each other and having the ability to move and fix with stoppers, made to interact with the holders of the skin flap, or a stopper made to interact with holders of the skin flap, while the holders of the skin flap are made in the form equidistant ligature slots on the edges of the plates and have end extensions under the stopper or under the stoppers, the distance between equidistant ligature slots is 10-20 mm, and the length of each ligature slot is 5-15 mm. 2. The device according to claim 1, characterized in that the stopper has a wedge-shaped or screw stop for interacting with end extensions or the stoppers have wedge-shaped or screw stops for interacting with end extensions. 3. The device according to claim 1, characterized in that it further comprises a handle. 4. The device according to claim 2, characterized in that the handle is oriented along the side wall of the cylindrical segment of the housing or across the side wall of the cylindrical segment of the housing.

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