RU2661800C1 - Method of applying an intradermal q-shaped cosmetic suture - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to surgery. Suture consists of separate nodal sutures. Needle is injected through the side wall of the wound. Pass the thread in the thickness of the skin. Pin is inserted into the side wall of the wound from the same side, without touching the upper layers of the epidermis, and the thread is led to the opposite side of the wound. Needles are injected into the dermis layer, and the injection into the sidewall of the wound. After the knot is knotted, the short end of the thread is cut off, and the long one with the needle at the end is punctured into the skin on the opposite side of the wound, as shown in FIG. 5, while sutures are applied at a distance of 0.9–1.2 cm from each other, using a resorbable suture material.

EFFECT: method allows you to most accurately compare the edges of the skin, minimize and reduce the duration of wearing postoperative dressings, if necessary, you can remove the suture from the wound site for its drainage or other manipulations, the suture can be applied to wounds of any length and configuration.

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Description

The invention relates to medicine and can be used in any branch of surgery to close surgical wounds.

From the existing level of technology there is a known method for applying a simple nodal suture, which consists in injecting a surgical needle into the skin surface at the edge of the wound, departing from it a short distance (3-4 mm), holding the needle obliquely in the subcutaneous tissue, moving away from the edge of the wound, turning needles in the direction of the midline at the base of the wound, pricking at the deepest point on the opposite side of the wound, holding the needle obliquely in the subcutaneous tissue, moving away from the base of the wound and puncturing percutaneously at the edge of the wound at the same distance t injection sites with the capture of the same amount of soft tissue into the suture on one and the other side (see Belousov AE Plastic reconstructive and aesthetic surgery. 1998, pp. 117-118).

The disadvantages of this technical solution is that a feature of the execution technique and design flaws of this suture are the reasons for the formation of a rough postoperative scar (Fig. 1). So, when tying a thread held perpendicular to the length of the wound around the circumference of the needle, there is a high probability of significant tissue compression inside the circular thread with a tendency to eruption, ischemia and necrosis. Due to the mismatch between the stable rigid design of the circular suture and the volumetric dynamic properties of the edges of the wound (rapidly growing edema with an immovable ring-like design of the suture), local circulation is impaired in the tissues, followed by focal necrosis and the formation of ugly transverse stripes (Fig. 2) located along the entire length of the surgical scar (the effect of the "railway track"), which can cause patients not only moral, but also physical suffering.

Closest to the claimed technical solution is the closure of surgical wounds by applying an intradermal suture according to Halstead (Zoltan Y. Operational technique and conditions for optimal healing of wounds. 2nd. Published by Kiado Academy - Budapest, 1977. Buyanov VM, Egiev V. I., Udogov OA Surgical stitch. Rapid - Print, 1993).

The disadvantages of this technical solution (seam according to Halstead) are:

- the impossibility of removing the suture site if it is necessary to evacuate a hematoma or wound exudate;

- cutting the thread in one of the sections and diluting the edges of the wound leads to the failure of the entire complex of thread - an operational wound, which requires re-applying a suture and leads to wound healing by secondary intention, resulting in a significant reduction in cosmeticity.

- on wounds of complex configuration during one or two turns of the operating wound, the thread breaks when it is removed;

The problem to which the claimed invention is directed is to develop a method for applying an intradermal Q-shaped cosmetic suture, in which it remains possible to probe the wound in any of its sections with subsequent adaptation of the edges of the wound, without compromising the cosmeticity of the intradermal suture, thereby reducing the time inpatient treatment of patients.

The task is implemented as follows:

The suture is applied intradermally, extra epidermally, from individual nodal sutures. During the application of the intradermal suture on the wound, the needle is injected into the thickness of the skin of FIG. 3 (1), injection - into the side wall of the wound from the same side of FIG. 3 (2), being careful not to affect the upper layers of the epidermis of FIG. 3 (3), then similarly injected into the side wall of the wound of the opposite side of FIG. 4 (1), FIG. 4 (2), in contrast, in the thickness of the skin of FIG. 4 (3). After tying the knot, the short end of the thread is cut off in FIG. 5 (1), and the long one with the needle at the end of FIG. 5 (2) - punctures in the thickness of the skin of FIG. 5 (3) on the opposite side and excess yarn is cut off in FIG. 5 (4). In this case, the knot tied with this method of suturing is immersed in the layers of the dermis of FIG. 6 (1), thereby ensuring the greatest cosmeticity of the postoperative wound. Such seams are superimposed at a distance of 0.9-1.2 cm from each other.

The method requires the use of absorbable suture material of small diameter with a pricking needle, for example, 4/0 Vicryl.

The method allows to probe a wound in any of its sections, provides the greatest cosmeticity compared to analogous sutures, and reduces the hospitalization time for inpatients.

It allows you to most accurately match the edges of the skin, which provides better tissue fusion. In this suture, the thread is not connected with the external environment, which minimizes the risk of developing infectious complications, in addition, it does not require long dressings and reduces the duration of wearing postoperative dressings.

As a result, the use of this suture reduces the time of hospitalization of patients, reducing the costs of the medical institution, contributes to the quickest recovery of patients and their return to work.

If necessary, you can remove the suture from the wound site for drainage or other manipulations. This suture can be applied to wounds of any length and configuration.

The advantages of the proposed method of suturing:

- the ability to remove a portion of the seam;

- the possibility of cutting the thread in one area, which does not lead to insolvency of the complex thread - wound;

- wound healing by primary intention;

- the greatest cosmeticity in comparison with a usual cosmetic seam;

- prevention of thread breakage on wounds of complex configuration;

- minimizes the risk of developing infectious complications

- does not require long dressings and reduces the duration of wearing postoperative dressings.

- contributes to the quickest recovery of patients and their return to work.

A clinical example of the implementation of a technical solution.

Example No. 1.

Patient V., 52 years old, was admitted for treatment to the Department of Vascular Surgery, GBUZ OKB, Tver, with a diagnosis of Atherosclerosis of brachiocephalic arteries. Blockage and stenosis of the carotid artery. Stenosis of the internal carotid artery on the left 86%, hemodynamically significant. Chronic cerebrovascular insufficiency of the III st. ". Surgical intervention was performed as planned - eversion carotid endarterectomy on the left. The wound was sutured in layers, the skin wound was sutured according to our method. On the 1st day after the operation, the suture is clean, without signs of infiltration and inflammation, the edges of the wound are compared, discharged on the 4th day.

Patient V. was examined after 6 months, the scar was pale pink, without signs of hypertrophy, does not rise above the surface of the skin, there are no cutaneous changes in the circumference of the scar.

Example No. 2.

Patient A., 44 years old, was admitted for treatment to the Department of Vascular Surgery, GBUZ OKB, Tver, with the diagnosis: Varicose veins of the lower extremities in the large saphenous vein system on the left. Chronic venous insufficiency C 3-4 according to CEAP ". A surgical procedure was performed as planned - venectomy on the left (Fig. 7). Suturing of the postoperative wound was performed in layers, suturing of the skin wound was carried out according to our methodology. In the near postoperative period, there were no complications received.

On the first day of the postoperative period - the wounds are probed, there is no discharge from the wounds. Seams are wealthy, without signs of infiltration and inflammation.

Discharged from the department on the 4th day of the postoperative period.

Claims (1)

A method of applying an intradermal cosmetic suture, including an injection of the needle intradermally, extra epidermally, characterized in that the suture consists of separate nodal sutures, the injection of the needle is carried out through the side wall of the wound, the thread is carried out in the thickness of the skin, the puncture is carried out in the side wall of the wound from the same side, not affecting the upper layers of the epidermis, the thread is brought to the opposite side of the wound, the needle is injected into the dermis layer, and the puncture is injected into the side wall of the wound, after tying the knot, the short end of the thread is cut off, and the long one with the needle at the end is punctured I am in the thickness of the skin on the opposite side of the wound, as shown in FIG. 5, while the seams are applied at a distance of 0.9-1.2 cm from each other, using absorbable suture material.

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