RU2720831C1 - Method of vacuum dressing application - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medical equipment, namely to a vacuum dressing application method. Method implies immobilizing an upper limb in a position of bringing the shoulder to the body and bending in the elbow joint. Method involves a stage of applying a vacuum patch on the body and an upper extremity. Spongy wound coating of the vacuum dressing is applied on the body along the wound contour, and the spongy wound coating of the vacuum bandage is applied to the wound of the upper extremity simultaneously, or the wound of the upper extremity is circularly bandaged with Kerlix AMD gauze of Lohmann & Rauscher. After bringing the upper limb to the body from above, the film is tightly glued with a single block on the body and upper extremity. On the film, an incision is made in front or in the back between the shoulder and a body to fix one drain tube-connector on the area, which is fixed on the film in front or behind between the shoulder and body and connected by means of a connecting hose to the apparatus for vacuum therapy of wounds.

EFFECT: technical result is immobilisation of the upper extremity by fixing it to the body, reducing the risk of purulent complications, enabling the patient to lie on the wound surfaces, reducing the cost of treatment, increased area of vacuum dressing application, acceleration of preparation of wounds to plastic closure and engraftment of skin grafts, improved functional results of surgical treatment.

3 cl, 8 dwg

Description

The present invention relates to medicine, namely to surgery, combustiology, traumatology and orthopedics, and can be used in patients who require a vacuum dressing simultaneously on the trunk and upper limb.

Acute wounds are widely found in the practice of surgeons of various specialties. The standard for the treatment of acute wounds is the surgical treatment of the defect, followed by the management of the wound under a dressing. A wound closed with a vacuum dressing is protected from secondary infection. The use of vacuum treatment of wounds allows to reduce the time of wound cleansing, to achieve early relief of the inflammatory process and faster healing of the wound, and also allows to prepare wound defects for skin plasty in a short time (Guidelines for the treatment of wounds by controlled negative pressure. Edited by S.V. Goryunova, 2nd ed., Moscow: April, 2016, 267 p.).

In the treatment of patients with extensive deep wounds, the correct positioning of patients to accelerate the preparation of wounds for plastic closure is relevant. To do this, use bandage and plaster dressings, hanging limbs, fluidizing beds, various ways of laying patients in beds, eliminating pressure on wounds.

An analogue of the alleged invention is the Deso dressing, used to fix the upper limb in fractures and dislocations of the shoulder (Smirnov V.P., Vokhmyanina O.A. Desmurgia: Training Manual. Publishing House of the Nizhny Novgorod State Medical Academy, 2004, p. 70 -71). When applying a Deso dressing, a roller is placed in the armpit, the forearm is bent at the elbow joint at a right angle, the hand is transferred to the chest, the tour is held to the sore arm around the body, tightly pressing their shoulder to the chest. Next, the bandage is led through the armpit of the healthy side along the front surface of the chest obliquely to the shoulder of the patient’s side, from there the bandage is lowered down the back of the patient’s shoulder under the elbow, around the elbow joint, and supporting the forearm, the bandage is directed obliquely upwards into the axilla of the healthy side, then obliquely up the back of the chest to the shoulder girdle of the injured side. A bandage is passed along the front surface of the sore shoulder under the elbow and around the forearm, the bandage is sent to the back surface of the chest into the axilla of the healthy side. Bandage tours are repeated until the shoulder is completely fixed.

The disadvantages of the method include:

1. The method only allows you to fix the upper limb to the body, but does not create conditions for the evacuation of the wound, which can lead to secondary infection of wounds.

2. When the dressings applied to the wounds of adjacent areas (the inner surface of the shoulder and torso) come into contact, the risk of purulent-septic complications when preparing wounds for plastic closure increases, as well as the risk of regression of skin grafts when performing free skin grafting of these wound surfaces.

3. When fixing the upper limb to the body using the Deso bandage, visual monitoring of the condition of the bandages on the adjoining sections of the trunk and upper limb is difficult, which determines the frequency of changing the bandages.

As the closest analogue, we have adopted a method for applying a vacuum dressing using a sponge, film and port connector (Guidelines for the treatment of wounds by controlled negative pressure. Edited by S.V. Goryunov. Ed. 2-nd, add., M .: April, 2016, - p. 39). After removal of necrotic tissues, foreign bodies, residues of dressings, exudate and complete hemostasis, a sponge is cut out according to the size and shape of the wound, placed in a wound so that the foam does not come into contact with healthy tissues in order to avoid irritation. The dressing is closed with a film, a small incision is made in the center of the dressing and a drain-connector is fixed to this area, which is connected to a connecting hose that goes to the container of the vacuum apparatus.

The disadvantages of the method include:

1. The method allows you to apply one vacuum dressing on one anatomical region (limb or trunk). For two areas, respectively, two isolated vacuum dressings and two separate vacuum apparatuses are required, which increases the cost of treatment.

2. The method does not provide for the possibility of applying a vacuum dressing in the presence of adjoining extensive wounds of adjacent anatomical regions.

3. The method does not allow immobilization (positioning) of the upper limb and its fixation to the body.

Tasks:

- to improve the treatment of extensive wounds of the trunk and upper limb;

- reduce the risk of purulent-septic complications of preparing wounds for plastic closure, as well as the risk of regression of skin grafts when performing free skin plasty of wound surfaces of the trunk and upper limb;

- to ensure the immobilization of the upper limb by fixing it to the body and at the same time create conditions for the evacuation of the wound discharge in the presence of adjoining extensive wounds of adjacent anatomical areas;

- reduce the cost of treatment through the use of one vacuum system simultaneously on two anatomical areas;

- increase the area of application of the vacuum dressing by bringing the upper limb to the body;

- create optimal conditions for the healing of split skin grafts on the wounds of adjacent anatomical areas;

- to improve the functional and aesthetic results of surgical treatment in the presence of extensive wounds of the trunk and upper limb due to the shorter immobilization of the joints of the upper limb.

The essence of the invention, including the immobilization of the upper limb in the position of bringing the shoulder to the torso and flexion in the elbow joint, applying a vacuum dressing to the trunk and upper limb, is as follows: a spongy wound dressing is applied to the trunk along the wound contour and simultaneously circularly applied to the wounds of the upper limb the spongy wound dressing of a vacuum dressing or wounds of the upper limb is bandaged circularly with Lohmann & Rauscher Kerlix AMD gauze, after bringing the upper limb to the trunk, the film is hermetically glued onto the trunk and upper limb with a single block, one drain connector is used, which is fixed to the film in front or behind between the shoulder and torso.

Technical result: this method allows for the immobilization of the upper limb by fixing it to the torso, to reduce the risk of purulent complications in the presence of adjoining extensive wounds of the trunk and upper limb, to allow the patient to lie on wound surfaces, to reduce the cost of treatment by using one apparatus for vacuum treatment of wounds simultaneously in two anatomical areas, increase the area of application of the vacuum dressing by bringing the upper limb to the trunk, accelerate the preparation of wounds for plastic closure, accelerate the healing of skin grafts with autodermoplasty of adjacent areas on the trunk and upper limb, improve the functional results of surgical treatment due to the shorter duration immobilization of the joints of the upper limb.

The implementation of the method of applying a vacuum dressing is as follows. 2-3 days after the injury in the operating room, after standard preparation and processing of the surgical field, necrectomy is performed on the wounds of the upper limb and trunk, hemostasis. According to indications, autodermoplasty of wounds is performed. Next, the wounds are covered with a mesh wound cover Branolind. A spongy wound cover of a vacuum dressing is applied to the body along the contour of the wounds. At the same time, a spongy wound cover of a vacuum dressing is circularly applied to the wounds of the upper limb or the upper limb is bandaged circularly with Lohmann & Rauscher Kerlix AMD gauze. Immobilization of the upper limb is carried out in the position of bringing the shoulder to the body and flexion in the elbow joint. Then, the film is hermetically pasted on top with a single block on the trunk and upper limb. A small incision is made on the film front or back between the shoulder and the body to fix one connector drainage on this area, which is connected using a connecting hose to the apparatus for vacuum therapy of wounds. Aspiration of the wound is carried out with a constant pressure of 110-120 mm Hg Additional fixation of the upper limb for immobilization was not required. The first dressing is performed on days 4-5, and the adaptation of skin grafts is evaluated if skin grafting or the condition of the bottom of the wound and the prospects for delayed skin grafting have been performed. According to the testimony in the dressing, a vacuum dressing according to the proposed method is applied repeatedly.

According to this method, 4 patients were operated on under clinical conditions.

Example 1 (see Appendix 1). Patient D., 58 years old, was admitted to the burn department of GBUZ "Research Institute - KKB No. 1 named after prof. S.V. Ochapovsky "with a diagnosis of thermal burn (flame) of the trunk, limbs 8% II-III degree (Fig. 1). On the 3rd day after the injury in the operating room, after standard preparation and processing of the surgical field, necrectomy was performed on wounds of the upper limb and trunk in an area of 6% (Fig. 2), hemostasis (Fig. 3). Autodermoplasty of wounds was not performed. Further, the wounds were covered with Branolind mesh wound dressing (Fig. 4). A spongy wound cover of a vacuum dressing was applied to the body along the contour of the wounds. At the same time, a spongy wound cover of a vacuum dressing was circularly applied to the wounds of the upper limb (Fig. 5). Immobilization of the upper limb was carried out in the position of bringing the shoulder to the body and flexion in the elbow joint. Then, the film was hermetically pasted on top with a single block on the trunk and upper limb. A small incision was made on the front or rear of the film between the shoulder and the body to fix one connector drainage on this area, which was connected using a connecting hose to the apparatus for vacuum treatment of wounds (Fig. 6). The wound was aspirated with a constant pressure of 110-120 mm Hg. Additional fixation of the upper limb was not required for immobilization (Fig. 7). The first ligation was performed on day 5 (Fig. 8). At the same time, the bottom of the wound was without signs of purulent inflammation, granulation growth was noted. The preparation of wounds for delayed skin grafting was continued.

Example 2. Patient M., 36 years old, was admitted to the burn department of GBUZ "Research Institute - KKB No. 1 named after prof. S.V. Ochapovsky "with a diagnosis of thermal burn (flame) of the trunk, upper extremities 12% II-III degree, burn disease. On the 3rd day after the injury in the operating room, after standard preparation and processing of the surgical field, necrectomy was performed on the wounds of the upper limb and trunk in an area of 7%, hemostasis. Carried out autodermoplasty of wounds. Further, wounds with skin grafts were covered with Branolind mesh wound dressing. A spongy wound cover of a vacuum dressing was applied to the body along the contour of the wounds. At the same time, the wounds of the upper limb were bandaged with a Kerlix AMD gauze from Lohmann & Rauscher. Immobilization of the upper limb was carried out in the position of bringing the shoulder to the body and flexion in the elbow joint. Then, the film was hermetically pasted on top with a single block on the trunk and upper limb. A small incision was made on the front or back of the film between the shoulder and the body to fix one connector drainage on this area, which was connected using a connecting hose to the apparatus for vacuum treatment of wounds. The wound was aspirated with a constant pressure of 110-120 mm Hg. Additional fixation of the upper limb for immobilization was not required. The first ligation was performed on day 4, while the adaptation of skin grafts was satisfactory. Additional plastic closure of the operated wounds was not required.

Claims (1)

The method of applying a vacuum dressing, including immobilization of the upper limb in the position of bringing the shoulder to the body and flexion in the elbow joint, applying a vacuum dressing to the body and upper limb, characterized in that a spongy wound dressing of the vacuum dressing is applied to the body along the wound contour and simultaneously to the wounds of the upper dressing limbs are circularly applied with a spongy wound cover of a vacuum dressing or wounds of the upper limb are bandaged circularly with Lohmann & Rauscher Kerlix AMD gauze, after bringing the upper limb to the trunk, the film is hermetically glued with a single block onto the trunk and upper limb, on the film in front or behind between the shoulder and the trunk they are made an incision for fixing one connector drainage on this area, which is fixed on the film in front or behind between the shoulder and the body and connected using a connecting hose to the apparatus for vacuum treatment of wounds.

Images