RU82538U1 - DEVICE FOR FIXING SOFT TISSUES OF OPERATING Wounds - Google Patents

Abstract

A device for fixing soft tissues of an operating wound, consisting of an Octopus-2 myocardium stabilizer with a fixer, characterized in that a shortened hook is attached to the flexible part of the stabilizer with a screw to fix soft tissues of an operating wound.

Description

The utility model relates to medicine, namely to cardiovascular surgery.

Known myocardial stabilizer company Medtronic "Octopus-2" (USA) [1], fixing a certain portion of the myocardium for applying a distal anastomosis during coronary artery bypass grafting on a working heart. It consists of a flexible part with the possibility of rigid fixation in the required position with a tightening screw. Suction cups are attached to the flexible part, which, by means of vacuum, are attached to the epicardium of the ventricle of the heart, which makes the part of the myocardium immobile and allows the distal anastomosis of the coronary bypass to be applied to the working heart. From the opposite end, fasteners are attached to the flexible part, with the help of which the "Octopus-2" is fixed to the thoracic retractor.

This device is the closest to the declared technical essence and the achieved result and is selected as a prototype.

The objective of the proposed device is the ability to fix the soft tissues of the surgical wound (abdominal organs during operations on the abdominal aorta, soft tissues of the neck during operations on the carotid arteries, skin flap during minimally invasive operations for CHD, the walls of the atria during valvular surgery and surgery some CHD, lung tissue - with lateral thoracotomies).

The problem is solved using a device for fixing soft tissues of the surgical field. This device consists of the Octopus-2 myocardial stabilizer, in which instead of the paws with suction cups to the flexible part of the myocardial stabilizer, a hook is fixed with a screw to fix the soft tissues of the surgical wound. The mobility of the holder is possible 360 degrees.

New in the device proposed as a utility model is the fastening of the shortened hook to the end of the flexible part of the Octopus-2 using a fixing screw.

As a result of this, the hook has acquired the ability to use the unique mobility of the stabilizer body along with the rigidity of fixation. This allows you to position it without interference to the activities of the surgeon. The stabilizer can be mounted on any sternal or abdominal retractor.

Free movement and the possibility of rigid and simple fixation in any planes in the device proposed by the authors allows us to adapt it to the anthropometric parameters of a particular patient, as well as to a specific situation that arose on the operating table. This device allows you to improve the configuration of the surgical field, making it convenient for the surgeon. All this allows to reduce surgical trauma and intraoperative complications.

Due to this, it is possible to fix the soft tissues of the surgical wound (abdominal organs during operations on the abdominal aorta, soft tissues of the neck during operations on the carotid arteries, skin flap during minimally invasive operations for CHD, the walls of the atria during valve surgery and during surgery of some CHD lung tissue - with lateral thoracotomies), this allows you to expand the surgical field for the convenience and safety of the operation.

Using the device proposed as a utility model, it is possible to quickly adapt the configuration of the surgical field to the anthropometric parameters of a particular patient, as well as to the specific situation that arose on the operating table. In addition, the assistant (s) is exempted (s) from the need to hold hooks in their hands throughout the operation, fixing the soft tissue of the surgical wound for

the ability to perform the main stage of the operation by the surgeon. This, in turn, leads to an increase in security, acceleration of the operational process and, consequently, to a reduction in the morbidity of the surgical intervention itself.

The proposed device will be clear from the following description and the drawings attached to it.

Figure 1 shows a diagram of a device for stabilizing the soft tissues of the surgical field:

1 - stabilizer myocardium firm Medtronic "Octopus-2"

2 - fixing screw

3 - Shortened hook for fixing soft tissues

The device proposed as a utility model (Fig. 1) consists of a shortened hook for fixing soft tissues 3, attached with a fixing screw 2 to the mytocardial stabilizer of Medtronic "Octopus-2" 1.

The proposed device works as follows (Fig. 1): During surgical intervention, a standard thoracic or abdominal retractor is first installed. Then, the Medtronic Oktopus-2 myocardial stabilizer 1 is fixed to it with a hook 3 attached to it (the type of hook depends on the type of surgical intervention) using the fixing screw 2. After that, the hook is installed as it is necessary to fix the soft tissue of the surgical wound. The flexible part of the myocardial stabilizer is fixed with a lingering screw. Perform the main stage of the operation.

Example 1. Patient B., 64 years old. Diagnosis: Atherosclerosis of the aorta and its branches with damage to the arteries of the lower extremities. According to descending aortography, lesions at the level of the common iliac arteries are more than 75% on the left, subtotal stenosis on the right. Distant arteries are passable, minor stonoses in the femoral arteries of 10-15% on both sides. Bifurcation operation performed

aortic femoral bypass grafting Gore-tex 18 * 9 * 9. Access - Median laparotomy using a device for fixation of soft tissues of the surgical field. Isolation of the common femoral artery, femoral artery, deep femoral artery in the upper 1/3 of the thighs on both sides. After isolation of the abdominal aorta, heparin is introduced distally to the renal arteries. Lateral aortic release. Imposition of a proximal anastomosis m / y with a Gore-tex 19 * 8 * 8 prosthesis and an aorta of the end-to-side type. The branches of the prosthesis are held in sections of the upper 1/3 of the thighs. Imposed distal anastomoses m / y with branches of the prosthesis Gore-tex 19 * 8 * 8 and femoral arteries on both sides. The operation is completed as usual. The postoperative period was uneventful. According to ultrasound examination, blood flow in the femoral arteries, popliteal arteries and arteries of the foot is the main. In the intensive care unit, the patient spent 2 days. During this period, narcotic analgesics were prescribed once, twice - non-narcotic. On day 15, the patient was discharged from the hospital.

Example 2. Patient S., 13 years old. Diagnosis: congenital heart disease. Atrial septal defect. According to an ultrasound scan of the heart, the defect is located in the lower part of the atrial septum. Defect size up to 18 mm. For plastic surgery of the defect, an operation was performed under cardiopulmonary bypass. Access - minimally invasive median sternotomy using a device for fixation of soft tissues of the surgical field. After connecting the cardiopulmonary bypass, the aorta is pinched and cardiac activity is stopped by the introduction of a cardioplegic solution. The right atrium is opened. The detected defect, up to 20 mm in size in the lower part of the interatrial septum, was made of the defect plastic with a patch from the autopericardium with a single-row suture. After atrial suturing and air embolism prevention measures, cardiac

activity restored. The operation is completed as usual. The size of the skin suture was 9 cm. The postoperative period was uneventful. According to the ultrasound examination, the correction of the defect is complete. The patient spent 2 days in the intensive care unit. During this period, narcotic analgesics were prescribed once, twice - non-narcotic. On day 10, the patient was discharged from the hospital.

Example 3. Patient K., 60 years old. Diagnosis: Atherosclerosis of the aorta and its branches with damage to the brachiocephalic arteries. Critical ICA stenosis on the left. According to ultrasound, stenosis at the mouth of the ICA on the left is 90%. The operation was performed - carotid endaterrectomy. A section along the front edge of the sternocleidomastoid muscle on the left with the use of a device for fixing soft tissues of the surgical field. The lumen of the left carotid artery was opened. Detected plaque with subtotal narrowing of the lumen. Performed carotid endaterrectomy on the left with autovenous artery wall plasty. After artery plastic surgery and measures to prevent air embolism, hemostasis was performed. The operation is completed as usual. The postoperative period was uneventful. According to the ultrasound examination, there is no residual stenosis at the ICA level on the left. In the intensive care unit, the patient spent the 1st day. During this period, narcotic analgesics were not prescribed, once non-narcotic were prescribed. On day 10, the patient was discharged from the hospital.

The device proposed by the authors was used in 15 patients and allows performing operations from minimally invasive sternotomy access, operations on the main vessels, heart valve replacement surgery, surgery using lateral thoracotomy with the least surgical risk.

List of used literature.

1.MEDTRONIC, INC.

710 Medtronic Parkway

Minneapolis, Minnesota 55432-5604 PHONE: (763)514-4000

United states FAX: (763)514-4879

Claims (1)

A device for fixing soft tissues of an operating wound, consisting of an Octopus-2 myocardium stabilizer with a clamp, characterized in that a shortened hook is attached to the flexible part of the stabilizer with a screw for fixing soft tissues of the operating wound.