RU2498782C1 - Method for wound closure - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, specifically to surgery. A wound is closed in layers by a multiple continuous fixed suture. Two counted filaments are sequentially brought in each line. A needle is stuck in and out in the same strictly symmetrical points of the opposite wound walls perpendicularly to the layer to be closed. The stitches are strictly opposite. The first line filaments are brought in and out at 1 cm from the wound edge and 3-5 cm from the wound angle. The next line filaments are brought in and out at the same distance from the wound edge and 1-2 cm close to the wound angle then the previous line filaments. The filaments are tightened up until the wound walls are brought together and adjusted completely. The filament ends of each line are introduced into a discharge device and tightened together.

EFFECT: method enables sealing the wound and adjusting the wound walls in the integrated treatment of the patients suffering a paraprosthetic infection of hip joint.

Description

The invention relates to medicine, namely to surgery, traumatology, orthopedics, and can be used for overlaying a delayed secondary suture in the complex treatment of patients with paraprosthetic infection in the hip joint.

A known method of suturing a wound using a nodal vertical suture with a massive capture of the underlying tissues and adaptation of the edges of the wound (Donatti suture) (Semenov G.M., Petrishin V.L., Kovshova M.V. Surgical suture // St. Petersburg, Moscow, Kharkov, Minsk. 2001). This suture is effectively used when suturing deep wounds with large diastasis of the edges. It is superimposed using a large cutting needle as follows: make a deep injection on one side of the wound so that the first stitch grips its bottom if possible, and the injection on the other hand is symmetrical to the injection. Then make an injection from the same side close to the edge and a puncture from the opposite side, also near the edge of the wound. The points of injection and puncture are positioned symmetrically, external by 1.5-2 cm, and internal by 0.4-0.5 cm from the edges of the wound, while the first stitch provides a massive grip of the underlying tissue, eliminating the residual cavity, and the second, held superficially adapts the edges of the wound. The disadvantages of the Donatti suture include the fact that the suture is carried out and is tightened perpendicular to the axis of the wound, which leads to squeezing of blood vessels, this can cause soft tissue ischemia and a decrease in tissue regenerative capacity. In addition, when carrying out and tying single seams in a large array of loose tissue, altered by the inflammatory process, there is a high probability of thread cutting through the fabric, i.e. seam insolvency.

Closest to the claimed is a method of suturing a wound by applying a two-row continuous removable suture (suture Halsted-Zoltan) (Abelevich A.I. Suturing of skin wounds // Nizhny Novgorod, 2003).

The method is proposed for suturing the skin and excess subcutaneous tissue and is used to suture deep wounds in order to eliminate the residual cavity and better adaptation of the edges of the wound. The seam is used in clean wounds of class I. The method consists of superimposing 2 rows of longitudinal sutures, one of which is applied to the subcutaneous tissue, the second to the skin, and the threads bind together. When tensioning the threads, the force propagates in the direction of the asymmetric layers of the wound, which does not allow full control over the adaptation of each tissue layer. With pronounced inflammatory changes, hydrophilicity and friability of tissues, the likelihood of their eruption, secondary infection increases due to the inability to accurately adapt the edges of the wound. In this regard, such a suture cannot be used for the application of a delayed secondary suture in the treatment of a para-prosthetic infection.

The objective of the invention is to develop a method of suturing a wound, providing a complete reduction and maximum adaptation of the walls of the wound without cutting through the threads of the tissues with their pronounced inflammatory changes.

The problem is solved due to the fact that they perform layer-by-layer suturing of the wound with a multi-row continuous removable suture starting from a deeply located tissue layer; in each row, two counter threads are sequentially carried out within the tissue layer, while the needle is punctured and punctured at the same strictly symmetrical points of the opposite walls of the wound perpendicular to the stitched layer, with the stitches strictly opposite each other; filaments of the first row are introduced and brought out onto the skin, departing 1 cm from the edge of the corresponding side of the wound and 3-5 cm from the corresponding corner of the wound; the threads of each subsequent row are introduced and brought to the skin at the same distance from the edge of the corresponding side of the wound and 1-2 cm closer to the corner of the wound than the threads of the previous row; tension of the removed threads is performed with the direction of the force vector longitudinally to the wound axis until the wound walls are fully adapted and adapted after each row of two opposing threads in the array of the stitched fabric layer is inserted, the ends of the threads of each row are introduced into the unloading device and bind them together, the skin is sutured with a continuous intradermal suture a thread from absorbable material.

The solution of this problem allows us to reduce significant arrays of soft tissues, altered by the inflammatory process (including during a prosthetic infection), without plastic defect, to reduce the risk of formation of residual cavities, ligature abscesses and secondary infection. The seam provides a reduction in tissue ischemia. Hermetic reduction of the edges of the wound eliminates drainage of the wound through the suture.

Complete reduction and adaptation of the wound walls without the formation of residual cavities is achieved by multi-layer layer-by-layer suturing of the wound by conducting in each row within the same layer two opposite threads parallel to the axis of the wound. Strictly symmetrical (against each other) arrangement of stitches during threading provides a snug fit. This arrangement of stitches also allows to reduce the force when tightening the threads, which, in combination with the direction of the force vector along the axis of the wound, reduces the effect on tissues changed by the inflammatory process and the risk of eruption. The location of the threads parallel to the axis of the wound and the sources of blood supply does not lead to crushing of blood vessels, positively affects the local trophic soft tissues and their regenerative ability. The removal of the ends of the threads on the skin and their complete removal after wound healing allows you to reduce the risk of ligature fistula formation in the postoperative period.

The method is as follows.

In the proposed surgical method for suturing a wound, it is important to observe a precision approach with the mandatory observance of the principle of layering.

The method is illustrated by drawings.

Figure 1 - diagram of a series of oncoming threads in one layer of fabric.

Figure 2 is a schematic illustration of a wound after tightening one row of oncoming threads.

Figure 3 is a schematic illustration of a wound after pulling together two rows of held oncoming threads.

The first row (Figure 1) of a continuous suture is superimposed on deep tissue, for example muscle tissue. Injection (1) of the needle with the first thread is done by 1 cm from the edge (2) of the corresponding side of the wound and 3-5 cm from its corner (3), and the injection (4) in the depth of the wound in the array of stitched fabric layer directly through the granulation tissue at a distance of 1-2 cm from its angle (3). An injection (5) inside the wound into the opposite wall is made perpendicular to the stitched layer at a point symmetrical to the puncture point (4). Continue to sew in the same way, capturing the same amount of fabric in each stitch (6). Injection and puncturing of the needle is performed at symmetrical ("mirror") points of the opposite walls of the wound perpendicular to the stitched layer. The stitch width depends on the radius of the needle. The thread is removed to the skin through an array of tissues from the side of the opposite corner of the wound at a distance of 3-5 cm from it and about 1 cm from the edge of the wound.

The second thread is carried out similarly and symmetrically to the first. A needle with a second thread is injected from the opposite side of the wound symmetrically into the first thread, at the same distance from the corner (3-5 cm) and the edge (about 1 cm) of the wound. Puncture deep in the wound (in the same layer of tissue) through the injection point (5) of the first thread. A counter symmetrical (“mirror”) seam is made through the puncture and puncture points of the first thread so that the stitches in the opposite walls of the wound are strictly opposite to each other. On the skin, the second thread is brought out on the opposite end of the wound, on the opposite side and symmetrically to the output of the first thread: at a distance of 3-5 cm from the corner of the wound and 1 cm from its edge. The tension of the withdrawn ends of the threads is made longitudinally to the axis of the wound in opposite directions. After tensioning, the ends of the threads are fixed with a clamp, adaptation and reduction of the wound walls are controlled. In case of incomplete information and adaptation of the walls of the wound, the threads are additionally tightened. After achieving complete information of the tissue, the ends of the threads are connected with each other (Figure 2). To avoid excessive pressure of the threads on the skin, the ends of the threads are previously held in the unloading devices (7) in the form of silicone tubes 2-3 cm long and 1 cm in diameter.

The second row is the suturing of the overlying tissue layer, such as the fascia of the thigh. If it is not possible to adapt the edges, an additional mobilization of the fascial flap is performed. Suturing is performed similarly to suturing the underlying layer: with two oncoming threads passing through the same points of injection and puncture, which are located on the opposite walls of the wound symmetrically to each other, so that the stitches are strictly opposite to each other. The ends of the threads are displayed on the skin about 1-2 cm closer to the corner of the wound relative to previously removed threads, taking into account the possible development of necrosis of the underlying tissues (Figure 3). The threads are also stretched longitudinally to the axis of the wound in opposite directions. After achieving complete tissue information, the ends of the threads are connected together in a similar way.

Subcutaneous fatty tissue is also sutured as described above. With severe subcutaneous fatty tissue, vinyl chloride drainage tubes are additionally installed, which are connected to the active aspiration system. If necessary, suturing of fiber is performed in several rows.

For maximum sealing of the wound, the skin is sutured with the maximum adaptation of the skin edges of the wound with a continuous intradermal suture with a thread of absorbable suture material.

In the postoperative period, dressings are performed daily. Drainage is removed with a wound discharge of less than 50 ml per day. Suture removal is performed in two stages under dressing conditions. After 2 weeks, muscle sutures and sutures on the subcutaneous tissue are removed, and after 3 weeks, sutures on the fascia.

Activation of patients is carried out on the 5-6th day after suturing the wound with a delayed secondary suture. Patients are allowed to sit in bed, hang their legs from the bed for 1-2 days. Then, together with the exercise therapy instructor, the patient adapts to vertical loads, orthopedic training is given, walking is allowed with crutches with a measured load on the limb of about 50% of body weight. A full load on the limb is allowed after 6 weeks from the moment of wound closure.

Claims (1)

A method of suturing a wound by applying a longitudinal continuous removable suture, characterized in that a layer-by-layer suturing of the wound with a multi-row continuous removable suture is performed starting from a deeply located tissue layer; in each row, two counter threads are sequentially carried out within the same tissue layer, while the needle is punctured and punctured at the same strictly symmetrical points of the opposite walls of the wound perpendicular to the stitched layer, placing the stitches strictly opposite to each other; filaments of the first row are introduced and brought out onto the skin, departing 1 cm from the edge of the corresponding side of the wound and 3-5 cm from the corresponding corner of the wound; the threads of each subsequent row are introduced and brought to the skin at the same distance from the edge of the corresponding side of the wound and 1-2 cm closer to the corner of the wound than the threads of the previous row; pulling the withdrawn threads with the direction of the force vector longitudinally to the wound axis until the wound walls are fully adapted and adapted after each row of two opposing threads in the array of the stitched fabric layer is carried out, the ends of the threads of each row are introduced into the unloading device and connected to each other; the skin is sutured with a continuous intradermal suture with a thread from absorbable suture material.

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