RU2748129C2 - Method for intradermal adaptive skin suture - Google Patents

Abstract

FIELD: medicine.SUBSTANCE: invention relates to medicine, namely to surgery, and can be used to apply an adaptive nodular skin suture. The needle is injected into the skin at a distance of 2 cm from the edge of the wound, then the needle is passed to the bottom of the wound and brought out to the middle of the dermis on the opposite side of the injection and 2 cm from the edge of the wound, then the needle is turned parallel to the dermis and the needle is passed along the dermis to the side of the first injection , after which an injection is made 2 mm from the injection.EFFECT: allows to provide a lower likelihood of developing septic complications, a satisfactory cosmetic effect, lower trauma in comparison with other interrupted sutures, the strength of the suture is not inferior to analogues, the use of this suture allows to reduce the consumption of suture materials.1 cl, 4 dwg

Description

The invention relates to medicine, namely to surgery, and can be used to apply an adaptive nodular skin suture.

State of the art.

In surgical practice, various types of sutures are used to connect the edges of a skin wound: a simple nodal, vertical mattress suture, as well as a continuous intradermal suture (Zoltan J. Operating technique and optimal conditions for wound healing. Budapest, 1983; Buyanov V.M., Egiev V.I. ., Udotov OA Surgical suture. - M .: LLP "Rapid-Print", 1993. - 104 p.).

In addition, there is a through plate suture and a knotless adaptive cosmetic skin suture (Kochnev O.S., Izmailov S.G. Surgery, 1988, 4, S. 126-130; Struchkov V.I., Grigoryan A.V. and Gostishchev V.K. Purulent wound, M., 1975).

The most commonly used simple interrupted suture, however, has the following disadvantages:

- when tightening the knot, it is difficult to achieve perfect adaptation of the wound edges, especially on the sides of the suture;

- a roller-like eversion of the edges of the wound outward is possible, which also complicates the adaptation of tissues;

- all this disrupts and slows down the normal regeneration and wound healing.

Known through plate sutures, however, they are used to close wounds of the abdominal wall in case of complications that require repeated closure of the wound, reoperation (Wounds and wound infection // Ed. By academician MI Kuzin and prof. BM Kostyuchenok. M .: Medicine, 1981 - 688 S.), while the cosmetic properties of the resulting scar are low.

The knotless adaptive cosmetic suture is devoid of some of the disadvantages of the knotted suture, but its use is associated with the use of additional material (rubber shock absorber tubes) and a longer application. At the same time, a qualitative adaptation of the wound edges is possible only with frequent application of these sutures.

Known suture Donati - vertical U-shaped nodal adaptive suture (Fig. 1) (Topographic anatomy and operative surgery / Ed. By Academician RAMNYu.M. Lopukhin. In 2 volumes. M.: GEOTAR - MED, 2002, Vol. 1. P.64-67).

The closest is a cosmetic surgical suture (RU 2360624 C1), which is applied in the following way: the needle is inserted into the skin, the needle is inserted intradermally parallel to the skin at a distance of 2 to 5 cm from the edge of the wound, the needle is turned and brought to the bottom of the wound, after which it is carried out an injection through all layers to the middle of the dermis from the opposite side, 2-5 cm from the edge of the wound, then the needle is turned and taken out intradermally to the injection site (Fig. 2).

However, in all the listed solutions for suturing, its formation leads to the formation of scars with higher cosmetic characteristics in comparison with the interrupted suture due to more perfect adaptation of the wound edges, as well as the formation of transverse scars at the incision site.

The technical result of the claimed invention is the development of a method for an intradermal adaptive skin suture with a simplified suture technique, a decrease in trauma, a decrease in consumable suture material, and an improvement in the cosmetic effect.

The technical result is achieved by the fact that, as in the known method, a needle is injected into the skin, the needle is inserted intradermally parallel to the skin at a distance of 2 cm from the edge of the wound.

A feature of the claimed invention is that the needle is passed to the bottom of the wound and taken out to the middle of the dermis from the opposite side of the injection and 2 cm from the edge of the wound, then the needle is turned parallel to the dermis and the needle is passed along the dermis to the side of the first injection, after which the injection is made in 2 millimeters from the injection.

The invention is illustrated by a detailed description, a clinical example and illustrations, which depict:

FIG. 1 - Donati's seam.

FIG. 2 - scheme of a cosmetic suture (RU 2360624 C1): 1 - epidermis and dermis, 2 - subcutaneous fatty tissue, 3 - bottom of the wound, 4 - space between the edges of the wound, 5 - skin-subcutaneous flap.

FIG. 3 - a diagram of the imposition of an adaptive skin suture (the distance between the edge of the wound is indicated by the places of the first injection and injection on the opposite side): 1 - dermis and epidermis; 2 - subcutaneous fatty tissue; 3 - the bottom of the wound; 4 - the space between the edges of the wound; 6 - suture thread (arrows indicate the direction of the needle); 7 - the edge of the wound; 8 - the place of the first injection.

FIG. 4 - photo of patient L., after the imposition of an intradermal adaptive suture.

The technique of applying this skin suture is simple and feasible for any surgeon. This suture was used in 30 patients who underwent surgical interventions on the abdominal organs at the Moscow Oncological Research Institute. P.A. Herzen.

The method of intradermal adaptive skin suture is performed as follows.

The needle is injected into the skin at a distance of 2 cm from the edge of the wound, and the needle is passed to the bottom of the wound and brought out to the middle of the dermis on the opposite side 2 cm from the edge of the wound, then the needle is turned parallel to the dermis and the needle is passed along the dermis to the side of the first injection, after which produce a puncture, departing 2 millimeters from the injection (Fig. 3).

Clinical example.

This suture was used in patient L., 54 years old. Which was treated at the Moscow Oncological Institute. P.A. Herzen diagnosed with cancer of the head of the pancreas T4N0M0, pancreatoduodenal resection was removed, access - median laparotomy. The revision of the abdominal cavity organs, mobilization and removal of the neoplasm were performed, followed by reconstruction, and the Roux-en-Y anastomosis was applied.

When suturing a skin wound, it was decided to apply the proposed method of imposing an intradermal adaptive suture to improve the adaptation of the wound edges and achieve a cosmetic effect.

A needle was injected into the skin at a distance of 2 cm from the edge of the wound, and the needle was held to the bottom of the wound and brought it out to the middle of the dermis from the opposite side, 2 cm from the edge of the wound. Then the needle was turned parallel to the dermis and passed it along the dermis to the side of the first injection, after which an injection was made, 2 millimeters away from the injection (Fig. 4). The postoperative period was uneventful, skin cancer healed by primary intention. After removing the stitches, the scar is 0.5 cm thick. The patient was discharged on the 19th day after the operation.

The use of the proposed suture in clinical practice has shown:

- a lower likelihood of developing septic complications;

- satisfactory cosmetic effect;

- lower invasiveness in comparison with other interrupted sutures;

- the strength of the seam is not inferior to analogs;

- the use of this seam allows you to reduce the consumption of suture materials.

Claims (1)

The method of intradermal adaptive skin suture, including the injection of a needle into the skin, the needle is carried out intradermally parallel to the skin at a distance of 2 cm from the edge of the wound, characterized in that the needle is passed to the bottom of the wound and withdrawn to the middle of the dermis from the opposite side of the injection and 2 cm from the edge of the wound , then the needle is turned parallel to the dermis and the needle is passed along the dermis to the side of the first injection, after which an injection is made 2 mm from the injection.

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