RU2631644C1 - Minimally invasive method for strengthening and contracting skin and subcutaneous tissue of human anterior abdominal wall - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: absorbable surgical sutures are injected and fixed in soft tissues, the used surgical sutures have fixing means in the form of counter-directed incisions, which are injected through skin punctures into the investing tissues of the anterior abdominal wall to form a rectangular lozenge-shaped collagenous framework in the problem zone with 3-5 sutures on each side with a distance between the sutures of 1.5-2 cm.

EFFECT: strengthening and contraction of the skin and subcutaneous tissue of the human anterior abdominal wall.

3 dwg

Description

The invention relates to the field of plastic surgery and cosmetology and can be used to strengthen and reduce the skin and subcutaneous tissue of the anterior abdominal wall of a person.

With age, the skin and subcutaneous tissue lose their turgor, elasticity, scleroses, becomes flabby. These involutional changes are defeated both the face and body. Various minimally invasive techniques for correcting these changes include various hardware techniques, mesotherapy, etc., which, unfortunately, do not give the desired pronounced tissue strengthening at the level of hypodermis.

One of the ways to solve this problem, which is proposed in this technical solution, is to use an affordable and minimally invasive method based on filament technologies, which allows you to realize an extremely important effect - reducing the skin flap due to the tightening of the skin and subcutaneous tissue.

The known method [RU 2503417, C1, A 17B 17/00, 01/10/2014], including autoalloplasty of the anterior abdominal wall by suturing the peritoneum, then in the muscular-aponeurotic space on the sutured peritoneum and posterior leaf of the aponeurosis, the mesh endoprosthesis is fixed, after which the anterior prosthesis is fixed sheets of aponeurosis followed by covering the endoprosthesis with a flap of their own skin, previously excised before surgery and processed according to Yanov.

The disadvantage of this method is the relatively narrow scope, limited to use in the treatment of postoperative ventral hernias.

In addition, the known method [RU 2390309, C1, A61B 17/00, 05/27/2010], which consists in the fact that after immersion of the eventual organs in the abdominal cavity, a double-row purse string suture is applied - first, a purse-string muscular-aponeurotic non-absorbable suture material, retreating to 0 , 2-0.3 cm from the edge of the defect, and then a purse string suture along the edge of the defect with a non-absorbable suture material.

The disadvantage of this method is the relatively narrow scope, limited to use in the treatment of congenital malformations of the anterior abdominal wall.

In addition to the above, a method is known [RU 2324438, C1, A61B 17/04, 05/20/2008], comprising cutting out oncoming flaps from the aponeurosis of the rectus abdominis muscle from opposite sides, and, departing from the medial edge of the rectus muscle of the abdomen, a flap is cut from the outer sheet of the aponeurosis, the same flap is cut from the opposite side on the inner surface, the flap is taken from the aponeurosis from the outer surface to the inner portion of the field to be cut out from the opposite side and sutured with a continuous seam, straight lines are connected with separate nodal seams shtsy abdomen, inner layer rectus fascia outputted to the front surface cuts out the opposite side of the field and fix continuous suture.

This method is also characterized by a relatively narrow scope, limited to the plasticity of the anterior abdominal wall.

Closest to the proposed one is the method [RU 2465844, C2, АВВ 17/04, 10.11.2012], which is implemented using a device including threads from non-absorbable material and means for fixing the threads in the soft tissues of the face and neck, and means for fixing the threads in soft tissues of the face and neck are fragments of a synthetic net of non-absorbable material of various shapes and sizes, to which the ends of the threads of non-absorbable material are attached.

The essence of the method implemented using this device is that, after placing the device in the subcutaneous tissue by the second stage, after 2 months, the threads are pulled and the tissue sagging is eliminated, and the degree of tissue tension can be changed at any time and their repeated sagging can be corrected without replacement devices several times.

The disadvantage of the closest technical solution is the relatively low reliability and relatively short duration of tissue fixation, which explains the requirement of the need for multiple repetition of the procedure after relatively short periods of time.

The problem that is solved in the invention is aimed at creating a traumatic safety minimally invasive method of plastic surgery to strengthen the surface tissues of the body, namely the subcutaneous tissue of the anterior abdominal wall, in order to eliminate defects in the appearance of the abdomen (its rejuvenation), characterized by the reliability and duration of the results of plastic changes.

The required technical result is to increase the safety, reliability and increase the duration of the preservation of the results of plastic changes.

The problem is solved, and the required technical result is achieved by the fact that according to the method, absorbable surgical sutures are inserted and fixed into soft tissues, according to the invention, surgical sutures with fixing means in the form of counter-directed notches are introduced that are inserted through skin punctures into the integumentary tissues of the anterior abdominal wall for the formation of a rectangular rhomboid collagen frame in the form of a dense grid in the problem area of 3-5 threads on each side with a distance between the threads of 1.5-2 cm.

The drawing shows:

in FIG. 1 is a diagram of the installation of threads;

in FIG. 2 - used materials and tools when implementing the method;

in FIG. 3 is an example of the result of using the proposed method for strengthening and contracting the skin and subcutaneous tissue of the patient's anterior abdominal wall.

A minimally invasive method of strengthening and contracting the skin and subcutaneous tissue of the anterior abdominal wall of a person is implemented as follows.

In general, absorbable surgical sutures are inserted into the soft tissues and fixed according to the scheme of FIG. one.

To do this, use surgical sutures with fixing means in the form of counter-directed notches (Fig. 3), which are inserted through skin punctures into the integumentary tissues of the anterior abdominal wall to form a rectangular diamond-shaped collagen frame in the problem area, 3-5 threads on each side with a distance between threads 1.5-2 cm.

The indicated parameters of the installation of threads according to the scheme of a diamond-shaped collagen frame in the problem zone of 3-5 threads on each side with a distance between the threads of 1.5-2 cm were determined experimentally. The mesh-shaped diamond pattern gives reliability and durability to the collagen backbone. A smaller number of threads and a greater distance between them does not ensure the reliability of strengthening and contraction of the skin and subcutaneous tissue, and a larger number of threads and a smaller distance between them is unnecessary and does not improve the desired effect.

The method is based on the use of absorbable threads Aptos Excellence Body. Usually used is 2/0 USP, 24 cm (10 pieces), 19 G cannulas, 20 cm (10 pieces), 18 G needle, 4 cm (1 piece).

Aptos Excellence Body are made of caprolactone and L-lactic acid and have notches, securely fixing the thread in soft tissues until a new collagen frame is formed. Over time, the threads are completely absorbed by hydrolysis, and in their place a framework of their own collagen is formed, since the L-lactic acid, which is part of the thread, provides an additional anti-aging effect.

When working on the body, patients with signs of sclerosis and sagging of the skin and subcutaneous tissue should be selected, all variants of lipodystrophy should be considered (especially in the initial stage), because always the main symptom will be a thinning (and therefore sagging) of the superficial integumentary tissues of the abdomen.

When making a diagnosis, refer to the ICD-10:

- atrophic changes in the skin (class XII - L90.0, L90.6, L90.8, L90.9).

Contraindications for thread lifting include:

- inflammatory phenomena and tumor diseases in the area of the proposed intervention;

- a tendency to form keloid and hypertrophic scars;

- blood diseases (hemophilia), taking anticoagulants;

- exacerbation of any chronic diseases;

- pregnancy, lactation;

- individual intolerance to the drugs used.

The thread implantation procedure is carried out in a treatment room that meets the requirements of SanPin 2. 1.3. 1375-03. For work, they use a set of sterile instruments (scissors, needle holders), sterile dressings, ethyl alcohol 70 ° for skin treatment, solutions of anesthetics in ampoules (1% lidocaine or 2% novocaine), physiological solution of sodium chloride in ampoules.

The procedure of thread reinforcement of the surface tissues of the body does not require special preparation for the patient. It is advisable to refuse to take antiplatelet agents and dietary supplements that affect blood coagulation about a week before the procedure.

Before the procedure, the patient is introduced to the materials and method, the expected results and possible adverse events. After that, the patient signs a protocol of voluntary informed consent to the procedure.

Stages of the procedure:

1. Preliminary marking (marking);

2. Aseptic processing of the correction zone;

3. Anesthesia (local infiltration according to the alleged vector of thread insertion). In order to prevent the formation of hematomas, we recommend carrying out skin infiltration detachment;

4. Introduction of threads;

5. Tension and fixation of threads (in the area of excess skin);

6. The application of sterile strips to the puncture and cannula sites.

The reinforcement procedure takes approximately 15 to 50 minutes.

An example implementation of the method

Patient L., 55 years old. In the photo (Fig. 3) before the procedure, atrophy of the superficial tissues and excess skin-fat flap is noticeable. In the photo (Fig. 3) after the procedure, a reduction in the skin flap and compaction of the superficial tissues are noticeable. Observations of the patient were carried out during the year. Noticeable changes that worsen the condition of the superficial tissues and excess skin-fat flap were not observed.

Analyzing the results of this and other performed procedures, it can be noted that the expected result is obvious immediately after the operation. Within a month, it is enhanced by restoring the elasticity and firmness of the skin, no scars remain. Thanks to non-surgical implantation, the rehabilitation period is practically not noticeable both for the patient and for others, and the effectiveness of the procedure is obvious - the skin noticeably tightens, becomes elastic and dense. Reinforcement with Aptos Excellence threads gives a more lasting result compared to existing conservative methods of rejuvenation, it is as radical as possible, so it does not need to be followed by a course, just one procedure is enough.

Claims (1)

A minimally invasive method of strengthening and contracting the skin and subcutaneous tissue of the anterior abdominal wall of a person, which consists in the fact that absorbable surgical sutures are introduced and fixed into soft tissues, characterized in that they use surgical sutures with fixing means in the form of counter-directed incisions that are introduced through skin punctures into the integumentary tissues of the anterior abdominal wall to form a rectangular rhomboid collagen frame in the form of a dense mesh in the problem area of 3-5 threads on each side with a melting between threads 1.5-2 cm.

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