RU2550279C1 - Method for creating vascular anastomosis in finger replantation - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: vessel is clipped, and its edges are incised by scissors to reach an intact structure. Thereafter, an atraumatic suture needle is brought in from the direction of intima, from a proximal end of the vessel; after bringing it out, it is brought in again into a lumen of the other distal end of the anastomosed vessel also from the direction of intima to the outside. The needle passes over a free end of the suture from below to bring the needle in from the direction of intima of the proximal end of the vessel and bring it out and in from the direction of intima of the distal end of the vessel; the needle is brought out, which is followed by making three knots between the suture ends to form three guide traction sutures thereby from the opposite ends of the anastomosis. Keeping the suture ends uncut until creating the anastomosis is completed, the traction suture ends are held from three sides, and turning the anastomosis about the vessel axis, interrupted sutures are applied between the above sutures in number required to make the microvascular anastomosis leak-proof.

EFFECT: method enables preventing post-replacement thrombosis of finger blood vessel anastomosis by anatomical mating of the vessel wall edges, avoiding suture needle-induced injuries of the intima of the opposite vessel wall.

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Description

The invention relates to medicine, namely to surgery, microsurgery, and can be used for traumatic amputation of a finger during replantation.

A known method of restoring the vascular wall by applying a vascular suture, characterized in that after separation of the vessel from the surrounding tissues and stopping blood flow through it, nodal sutures are applied to the wall defect [Novikov Yu.V. Emergency angiosurgical care / Yu.V. Novikov, M.P. Vilyansky, N.V. Protsenko et al. - M.: Medicine, 1984. - 261 p.].

This method has significant drawbacks: when restoring vessels of small diameter, technical difficulties arise in applying the first three nodal sutures, the injection and puncture of the needle is not perpendicular, but at a smaller angle to the vascular wall, as a result, the distance between the injection and puncture of the suture material increases, the likelihood increases the needle does not pass through all layers of the vascular wall, as a result of which the adaptation of the edges of the vascular anastomosis is impaired, the risk of damage to the suture needle of the endothelium increases of the opposite wall of the collapsed vessel, which leads to thrombosis of this anastomosis.

The closest analogue of the invention is a method of revascularization of the fingers after traumatic amputation [O'Brien B. Microvascular reconstructive surgery: Trans. from English M .: Medicine 1981; 422], characterized in that in case of trauma, which is accompanied by a detachment of the finger, the following type of reconstruction is used. After revision of the neurovascular bundles and determination of the length of the defect, osteosynthesis is performed with crossed knitting needles, a suture is placed on the extensor extensor tendon, resection of the damaged edges of two back anastomosed veins with Westcot straight scissors to normal vascular wall and washing of the lumen of the vessels with heparinized Ringer's solution / 1000 IU ml) with the subsequent application of individual nodal sutures with an atraumatic needle 10/0 in an amount of 6 to 8 sutures per anastomosis. After that, the nerve suture is performed. Then, with Westcot scissors, the damaged edges of the artery are excised and individual nodal sutures are applied with an atraumatic needle 10/0 in an amount of 6 to 8 sutures on the anastomosis. After recovery of the flexor tendons, the wounds are sutured. Soft dressing, plaster immobilization.

This method, taken as a prototype, has significant drawbacks: when nodal sutures are applied to small-caliber vessels, due to the technical difficulty of performing this anastomosis, the risk of damage to the opposite wall of the vessel with a suture needle increases, which in turn leads to thrombosis of vascular anastomoses.

The technical result when using the invention: the prevention of thrombosis of the vascular anastomosis due to the anatomical comparison of the edges of the vascular wall and the exclusion of trauma to the needle with suture material of the intima of the opposite vessel wall.

The proposed method is illustrated in the drawing, which shows a diagram of the proposed vascular anastomosis.

The proposed method for the formation of a vascular anastomosis during finger replantation is carried out as follows: during the standard stages of finger replantation, including primary surgical treatment of the wound, osteosynthesis, tendon suture, vascular anastomoses are applied to restore the integrity of one finger artery and two veins. After applying clips and excising the edges of the vessel with scissors to the intact structure on the intima side, a needle 1 is inserted with the atraumatic suture material “prolene” 10/0 from the proximal edge of the vessel; after a needle is punctured, its needle 2 is inserted into the lumen of the other distal end of the anastomosed vessel also from the side intimacy out. Then, bypassing the free end of the thread with a needle from below, an injection 3 is made in the same way from the intima of the proximal end of the vessel, followed by an injection and 4 from the intima of the distal end of the vessel, followed by a puncture and tying three knots between the ends of the thread. In this way, three guides of the retaining suture 5 are made on opposite sides of the anastomosis, without cutting the ends of the threads until the end of the anastomosis application. After the assistant takes over the edges of the holder threads from three sides, turning the anastomosis along the axis of the vessel, between these sutures interlock sutures 6 are made with a needle with a 9/0 Prolen thread in the amount necessary to ensure the tightness of the vascular anastomosis.

The method allows to reduce the risk of thrombosis of vascular anastomoses in the early postoperative period after replantation of a finger of the hand due to the anatomical nature of the comparison of the edges of the vascular wall and the exclusion of trauma to the needle with suture material of the intima of the opposite vessel wall.

This method was applied in 15 patients with traumatic amputation of the fingers.

Clinical example. Patient S., 27 years old, was admitted to the hospital with traumatic amputation of the 1st finger of the right hand. The patient one hour before admission to the admission diagnostic department received a household injury with a circular saw at the level of the main phalanx of 1 finger of the right hand. On clinical examination, the 1st finger of the right hand was removed at the level of the main phalanx and delivered by the patient in an ice pack. Active bleeding from the digital arteries continued from the proximal side wound. Under general anesthesia on the main phalanx, in the area of injury, osteosynthesis with Kirschner spokes was performed crosswise, the superficial flexor was removed from the bone-fibrous canal. Then, in the area of injury, a suture of the tendon of the deep flexor of the finger according to Kessler was performed. Then, the extensor tendon suture was made. Two back veins of the finger and the digital artery were distinguished, clips were superimposed on them, the injured edges of the vessels were resected and the ends of the vessels were extracted from adventitia for the application of an anastomosis. Then, microvascular anastomoses of the isolated veins and then the arteries began to overlap as follows. From the intima side, from the proximal edge of the vessel, a needle was injected with atraumatic suture material “Prolen” 10/0, after the needle was punctured through the outer surface of the vessel wall, freed from adventitia, it was injected into the lumen of the other distal end of the anastomosed vessel, also from the intima side, with a puncture through all layers of the vessel wall to the outside. Then, bypassing the free end of the thread with the needle from below, the needle was injected in the same way from the intima of the proximal end of the vessel, then punched out through all layers of the vessel wall to the outside and injected from the intima of the distal end of the vessel, followed by puncture through all layers of the vessel wall out and tying three knots between the ends of the thread. In this way, three guiding retaining sutures were made on opposite sides of the vascular anastomosis, without cutting the ends of the threads until the end of the anastomosis application. After the assistant took over the edges of the holder threads from three sides, turning the anastomosis along the axis of the vessel, one nodal suture was inserted between these sutures with a needle with a 9/0 Prolen thread to ensure the tightness of the vascular anastomosis. After that, the thread-holders were cut, leaving the nodes wealthy. Similarly, all microvascular anastomoses, two dorsal veins and one digital artery of 1 finger of the right hand were performed. After removing the clips from the veins and then from the artery, making sure that the blood flow is adequate, a suture of the finger nerves with the thread “Proline” 8/0 was performed for 15 minutes. Stitches to the skin. Aseptic dressing. Gypsum immobilization for a period of 4 weeks with subsequent development. The postoperative period was uneventful. The patient was examined after 1 year. The function of 1 finger of the right hand is good (according to V.I. Rozov). The patient works as a driver in his specialty.

Claims (1)

A method of forming a vascular anastomosis during finger replantation, including a suture of two posterior veins and a finger artery, characterized in that after applying clips and excising the edges of the vessel with scissors to the intact structure from the intima from the proximal edge of the vessel, a needle is injected with an atraumatic suture material, after the needle is punctured its injection is carried out into the lumen of the other distal end of the anastomosed vessel, also from the intima side outward, then, bypassing the free end of the thread with a needle from below, in the same way l from the intima of the proximal end of the vessel, followed by puncture and injection from the intima of the distal end of the vessel, followed by puncture and tying three knots between the ends of the thread, thus forming three guiding retaining sutures on opposite sides of the anastomosis, after which, without cutting the ends of the threads to the end overlapping anastomosis, take over the edges of the filament-holders on three sides and, turning the anastomosis along the axis of the vessel, between these sutures impose nodal joints in the amount necessary to ensure the tightness of the Distin anastomosis.

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