RU2769845C1 - Method for drainage of sutured wounds of various localization - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to surgery. Triangular fragments of foam rubber are placed between the sutures, their apex to the bottom of the wound. Inside each fragment there is a longitudinally cut tubular drainage, so that the lower end of the foam rubber starts from the bottom, and the upper end is 2 cm above the skin. Skin vacuum bandage is applied over the wound and installed drains — a layer of foam rubber with a drainage tube, an incise film is applied over the foam rubber, thereby sealing the structure. Drain tube is connected to vacuum system with negative pressure of 125 mm Hg. Dressing is removed according to indications in 3–6 days.

EFFECT: due to the action of directed negative pressure not only on the edges, but also on the walls and bottom of the wound, the method enables to provide a permanent good drainage effect, prevents complete adhesion of wound edges during operation of drainage, promotes stabilization of wound edges, prevents suture divergence and distributes the drainage effect force evenly on each wound area, easy installation of the structure, allows its use in almost all anatomical areas, where it is possible to carry out its sealing, and when using the compact vacuum therapy apparatus, provide the patient with activity and high rehabilitation potential.

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Description

The present invention relates to medicine, namely to surgery, and can be used for drainage of sutured wounds of various localization.

Wound infection is currently the main type of complications in surgery, there is an increase in the frequency of purulent diseases and postoperative suppuration, which is 23-60% (Infection in surgery: a guide / A.N. Kosinets, Yu.V. Struchkov. - Vitebsk: VSMU , 2004.). Efficient drainage, reduction of the invasiveness of the operation and its duration, adequate hemostasis, the use of modern suture material, thorough sanitation of wounds and cavities with antiseptics, adequate antibiotic therapy, can reduce the risk of postoperative complications (Shabad A.L., Klimova T.Z., Sinyukhin V. N., Shirshov V.A., Rumyantsev V.B. Prevention of infectious and inflammatory complications during operations on the kidney // Urology and Nephrology. 1990. - No. 3. - P. 19-23).

A known method of drainage of a postoperative wound using a perforated tube (Davydov Yu.A., Larichev AB "Vacuum therapy of wounds and wound process". M.: Medicine, 1999, 160 s), consisting in the following. For drainage, the authors used silicone or polyvinylchloride tubes with a diameter of 0.4-0.5 cm. On the side surface of the tube located in the wound cavity, holes are cut out throughout, after which the tube is placed on the bottom of the wound. One of the ends of the tube is brought out through a separate skin puncture and fixed to it with an interrupted suture. The other end is left in the wound. Then, partially, until contact, the subcutaneous tissue is sutured and the skin is hermetically sealed. A vacuum aspirator is connected to the end of the tube that is brought out, which works continuously or intermittently. Drainage from the wound is removed for 3-4 postoperative days. Disadvantages:

1) High probability of obturation of the drainage holes with fiber and surrounding tissues, which prevents adequate drainage, accompanied by pain and the risk of fiber necrosis

The closest analogue is the method of drainage of a laparotomic wound by closed aspiration-flushing treatment of contaminated and purulent wounds (Kanshin N.N. "Principles of closed aspiration-flushing treatment of contaminated and festering wounds". Surgery, 1989, No. 6, p. 112-115) . The closed aspiration-washing treatment used by him provides isolation of the wound cavity from the external environment. Sutures are applied only to the skin, leaving all other layers of the purulent wound not sutured. Before suturing the skin edges of the wound, a double-lumen drainage tube is inserted into the cavity through a separate puncture of the skin and underlying tissues. A drip infusion system is connected to the microchannel of the tube, and an aspiration system is connected to the wide channel. With the help of specially designed software devices and pinch valves that turn off aspiration for a specified time, the wound cavity is automatically washed 50-100 times a day.

Disadvantages:

1) requires specially designed programming devices and pinch valves;

2) complicates the activation of patients, reducing motor activity in the early postoperative period;

3) there is a risk of obstruction of the drainage holes by fiber and surrounding tissues, which prevents adequate drainage, accompanied by pain.

Tasks:

1) provide comfort for the patient and ease of use of the method;

2) to maximize the application of the method, with various localizations of extensive wound defects of soft tissues;

3) increase the effectiveness of the method, minimize the risk of complications;

4) ensure the possibility of early rehabilitation.

The technical result is achieved due to the action of directed negative pressure not only on the edges, but also on the walls and bottom of the wound, providing a constant good drainage effect. Soft longitudinally cut tubular drainage inside the triangular fragments of foam rubber prevents complete gluing of the wound edges for the duration of the drainage. Skin vacuum dressing - a layer of foam rubber with a drainage tube, applied over the edges of the wound, helps to stabilize the edges of the wound, prevents the sutures from coming apart and distributes the strength of the drainage effect evenly to each area of the wound. The simplicity and speed of installation of the structure allows it to be used in almost all anatomical areas where it is possible to seal it, and when using compact devices for vacuum therapy, to provide the patient with activity and a great rehabilitation potential. In parallel with drainage, all known therapeutic effects of vacuum therapy on the wound appear.

The essence of the method lies in the fact that between the sutures of the sutured wound, triangular fragments of foam rubber are installed, with the top to the bottom of the wound, inside which a soft longitudinally cut tubular drainage is carried out, so that the lower end of the foam rubber starts from the bottom, and the upper one rises above the skin by 1-2 cm. , then a skin vacuum bandage is applied over the wound and installed drains - a layer of foam rubber with a drainage tube, an incise film is applied over the foam rubber, thereby sealing the structure, the drainage tube is connected to a vacuum system with a vacuum of 125 mm. Hg, the bandage is removed according to indications, on average after 4-6 days.

The method of drainage of sutured wounds was tested on 19 patients treated in the department of purulent surgery of the Regional Clinical Hospital and 12 patients of the surgical department of the Central District Hospital, and showed good results. Of the 31 patients using this method, suppuration did not occur in any patient. All wounds healed by first intention.

The method is shown in the figure (see Appendix) - a general view of the method when used, where 1 - anterior abdominal wall with a wound, 2 - separate interrupted sutures, 3 - triangular pieces of foam rubber between the sutures of the wound 4 - soft longitudinally cut tubular drainage, 5 - skin foam layer, 6 - drainage tube, 7 - to vacuum, 8 - incise film

The method of treatment is performed as follows: The wound is sutured, according to the canons of purulent surgery, in order to prevent suppuration, using rare wide-angle separate interrupted sutures with a monofilament thread with the capture of all walls and bottom. Between the seams of the sutured wound, with the help of anatomical tweezers, triangular fragments of foam rubber are installed, with the top to the bottom of the wound, inside which a soft longitudinally cut tubular drainage is carried out, so that the lower end of the foam rubber starts from the bottom, and the upper end rises above the skin by 1-2 cm. wounds and installed drains, a skin vacuum bandage is applied - a layer of foam rubber with a drainage tube, an incise film is applied over the foam rubber, thereby sealing the structure, the drainage tube is connected to a vacuum system with a vacuum of 125 mm Hg, the bandage is removed according to indications, on average after 4 -6 days.

Example 1. Patient Z., 62 years old.

On September 12, 2020, the patient was transferred for treatment to the Regional Clinical Hospital from the hospital for the mammary gland with a diagnosis of Suppuration of the operating laparotomic wound of the anterior abdominal wall (02.09.20 was operated on in the hospital for the mammary gland in the volume of laparotomy, debridement of the abdominal cavity, enterolysis, due to adhesive intestinal obstruction)

Upon admission to the hospital, the patient's condition was of moderate severity. NPV=20 per min. Pulse 104 bpm in 1 minute. BP=140/90 mm Hg The tongue is dry, with a white coating at the root. The abdomen is painful on palpation in the area of the laparotomic wound, takes part in the act of breathing to a limited extent. Symptoms of peritoneal irritation are questionable.

On examination, an unsutured laparotomic wound of the anterior abdominal wall with signs of suppuration was revealed, the skin around the wound was moderately hyperemic. The thickness of the subcutaneous adipose tissue in the n/c wound max 13 cm.

Surgical intervention was urgently performed: surgical treatment of a purulent wound of the anterior abdominal wall with excision of all necrotic and infiltrated tissues. A vacuum bandage was applied to the wound. On 09/15/20 and 09/18/20, staged surgical treatment of the wound was performed with the change of the vacuum dressing. On September 21, 21, at the next dressing, complete cleansing of the wound, the appearance of mature granulation tissue, and relief of inflammation were noted. Under the conditions of the operating room, the wound was sutured with sparse wide-angle separate interrupted sutures with a monofilament thread with the capture of all walls and the bottom. Between the sutures of the sutured wound, with the help of anatomical tweezers, triangular fragments of foam rubber were installed, with the top to the bottom of the wound, inside which a soft longitudinally cut tubular drainage was carried out, so that the lower end of the foam rubber started from the bottom, and the upper one rose 1-2 cm above the skin.

A skin vacuum bandage was applied over the wound and installed drains - a layer of foam rubber with a drainage tube, the structure was sealed with an incise film, the drainage tube was connected to a vacuum system with a vacuum of 125 mm. Hg

09/25/20 the design was removed. The wound is clean with no signs of inflammation, scanty serous discharge between the sutures. A bandage with iodopyrone aqueous 1% was applied, the change of which was carried out daily. On September 30, 2020, the patient was discharged in a satisfactory condition. Wound healing by primary intention.

Example 2. Patient B., 64 years old

On August 12, 2020, the patient underwent laparotomy, debridement, revision of the abdominal cavity, and enterolysis at the central district hospital. After suturing the laparotomic wound, the latter is drained as described in example 1 method. On August 15, 2020, the drainage system was removed. The wound is clean with no signs of inflammation, scanty serous discharge between the sutures. A bandage with iodopyrone aqueous 1% was applied, the change of which was carried out daily. On February 23, 2020, the patient was discharged in a satisfactory condition. Wound healing by primary intention.

Claims (1)

A method for draining sutured wounds, which consists in placing between the seams of triangular fragments of foam rubber with the top to the bottom of the wound, while inside each fragment a longitudinally cut tubular drainage is carried out, so that the lower end of the foam rubber starts from the bottom, and the upper one rises above the skin by 2 cm, then over the wound and installed drains, a skin vacuum bandage is applied - a layer of foam rubber with a drainage tube, an incise film is applied over the foam rubber, thereby sealing the structure, the drainage tube is connected to a vacuum system with a vacuum of 125 mm Hg, the bandage is removed according to indications after 3-6 days.

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