SU1616621A1 - Method of thoracoplasty - Google Patents

Abstract

The invention relates to medicine, namely to surgery, and can be used in elevation thoracoplasty. The purpose of the invention is to reduce postoperative complications by providing postoperative fixation of the detached periosteum to the displaced ribs. After a skin incision on the concave side of the curvature above the depression and penetration to the sunken ribs and sufficient separation from the periosteum, the ribs are elevated and stabilized reliably in the position reached. Then, drainage tubes are inserted transcutaneously into each intercostal space, which are laid along the ribs throughout the entire skeletonization region and fixed with catgut to the ribs. In each delaminated sub-bottom bed is placed on one drainage tube of smaller diameter with mandrel. The most rigid and sunken soft tissues are stitched with yarns, on which marks are left with a height equal to the thickness of the chest wall, and their free ends are pulled out and the tissues are sutured in layers. The drains of the subperiosteal bed overlap, and the drains of fragmented tissues are connected to the vacuum system and negative pressure is maintained until labels appear on the ligatures and when evacuated drains are removed, biological adhesive is inserted into these spaces to fix the periosteum to the displaced ribs. The method avoids postoperative complications.

Description

The invention relates to medicine, namely to surgery, and can be used with an elevation thoracoplasty.

The purpose of the invention is to reduce postoperative complications by providing postoperative fixation of the detached periosteum to the displaced ribs.

The method is carried out as follows.

After the patient is put into anesthesia with controlled breathing in a position on the abdomen, a longitudinal incision is made with

the concave side of the curvature over the westward; dissection of the skin, subcutaneous tissue. Stupidly exfoliate and displace the underlying muscles and penetrate to the most sunken ribs. After sufficient separation of the periosteum from the ribs, they are elevated and reliably stabilized in the position reached. Then, drainage tubes are inserted transcutaneously into each intercostal space, which are laid along the ribs throughout the entire skeletal area and fixed with catgut to the ribs, B of each delaminated subperiosteal bed,

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one smaller drainage tube with mandrel is laid. The most rigid and sunken soft tissues are stitched with mylar filaments, on which the thickness of the chest wall and their free ends are drawn out with paint from the base. After that, the wound is sutured in layers. Immediately after this, the drains inserted into the subperiosteal beds block, and the drains introduced into the tissue separation zone are connected to a vacuum system. The evacuation starts from zero and is gradually adjusted to 0.20-0.25 atm. Such negative pressure is maintained continuously (usually 3-5 days) until the filament marks appear on the skin, with free tightening. The appearance of tags is an indication of raising the most rigid and distant areas and adapting to the ribs. After that, biological glue is inserted into all the separated periosteal beds through the tubes located in them, followed by removal of the tubes. After 2-3 min. Vacuuming is stopped. Reliability of gluing is checked by the absence of reverse migration of the label on the ligatures.

Example. B-Noah, born in 1965 Elevated thoracoplasty was performed. Under general anesthesia, in position on the abdomen, the skin and subcutaneous cellulose are dissected, the back muscles are stupid, the sunken 7 ribs are skeletal. Their elevation was made to a height of 4.5 cm. Then, perforated drainage tubes were inserted into each intercostal space, laid over the entire length of the skeletonization of the ribs, fixed with catgut to the ribs. In all detached periosteal beds of a tube of smaller diameter with mandrins. The most rigid and spaced areas of the sunken tissue from the ribs are stitched with mylar filaments, on which marks are applied (reflecting the thickness of the soft tissues above the ribs). The wound is carefully sutured in layers. After aseptic dressing and sealing of the catheters inserted into the periosteal beds through vacuum drainage, vacuuming under pressure of 0.25 atm (i.e., 190 mm) was started. The vacuuming lasted 4 days, until the appearance of all over the skin

labels of indicator threads. After that, as thin tubes were removed from the periosteal beds, the biological cyanoacrylate glue MK-7 was introduced from a syringe.

Vacuuming is stopped after 4 minutes. The absence of migration of filaments with marks back was noted, which was proof of the occurrence of gluing of the periosteum with the ribs and allowed to remove the vacuum drainage. The postoperative period was uneventful, without any signs of impaired respiratory function. The patient was discharged from the clinic on the 10th day after the operation, after removing the sutures. In this case, the patient noted

subjectively, some improvement (relief) in breathing.

After a month, during the follow-up examination, the patient was examined the same way as before the operation. The performed spirography showed a number of positive changes, i.e. compared with the preoperative period, the function of external respiration has improved.

The method showed high efficiency in the postoperative period, as in

nearest and distant periods and is recommended for use in practical health care.

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Claims (1)

Invention Formula The method of elevation thoracoplasty, including the paravertebral subperm. ribs crossing and moving them to the bone graft, laid down along the spinous processes of the vertebrae, characterized in that, in order to reduce postoperative complications by ensuring postoperative fixation of exfoliated the periosteum to the displaced ribs, and the detached space to the intercostal muscle is fixed a removable ligature, the base of which is labeled with a label equal to the thickness of the chest wall, and output out into the subperiosteal bed, drainage is introduced into them and negative pressure is created in them, and when a mark appears on all derived ligatures, the periosteum is finally fixed to ribs biological glue.