SU1736444A1 - Method of prosthetics of soft tissue - Google Patents

Abstract

Usage: the invention relates to medicine, namely to reconstructive surgery. The goal is to prevent complications in the late postoperative period. The essence is that after an economical surgical treatment within the defect, a bed for the prosthesis is formed from the patient's local and displaced tissues, and the prosthesis is performed using a knitted prosthesis made of at least two monofilaments with different terms of biodegradation. The proposed method allows plastic surgery in the presence of a source of purulent infection, to prevent the development of relapses and complications in the form of suppurations, ligature fistulas, abscesses, infiltrates, etc. The method is It provides maximum reliable and gentle surrounding tissue, which allows covering extensive defects of soft tissues, regardless of their genes. (Ls

Description

This invention relates to medicine, namely to reconstructive surgery.

There is a known method for closing defects of soft tissues with the help of an implantable marlex prosthesis.

However, with this method it is impossible to perform implantation under conditions of infection, to prevent such complications as seroma, suppuration, infiltrates, ligature fistulas, etc. The use of synthetic prostheses, including and marlex, even with clean plastic surgeries, gives 8–18% of hernia recurrences and 7–8% of postoperative wound suppurations.

The purpose of the invention is the prevention of complications in the postoperative period.

The method consists in that the prosthesis is carried out with the help of a knitted prosthesis made of synthetic monofilament yarns with different biodegradation times.

The method is carried out as follows.

After an economical surgical treatment, a bed for a prosthesis is formed from the patient’s local or displaced tissues within the defect, and then using the noncapillary filaments, the prosthesis is tightly fixed to the tissues, leaving no voids and cavities underneath.

In the proposed method, the closure of soft tissue defects uses prostheses consisting of materials with different biodegradation periods, which allows, in the first months after the operation, to create a reliable mechanical structure that allows you to create

four

withstand heavy loads (internal abdominal pressure, etc.). The presence in the mesh structure of rapidly degrading monofilaments minimizes undesirable body reactions during longer periods of the presence of a foreign body in the patient's tissues when the skeleton function is provided by an unresolved or long-lasting absorbable fragment of the prosthesis.

Example 1. Patient P., 57 years old, was admitted to the clinic with a giant evening, trophic lumens of the abdominal wall. Related diseases: hypoxic encephalopathy, postresuscitation syndrome, hypertensive disease Art. II, stage III obesity, varicose dilatation of the saphenous veins of the lower extremities, huge in the logranulatory bedsore of the sacrocococcyteal region.

The patient is a disabled person of group I, transferring a planned cholecystectomy for chronic calculous cholecystitis. At the end of the operation, hemodynamic disturbances and cardiac arrest occurred, resuscitation measures were performed against the background of acute cerebral circulation disturbance. The clinic of acute cerebrovascular accident was associated with bilateral pneumonia, phlegmon of the abdominal wall, and a sore in the sacrococcygeal region. Within 2 months the patient was on artificial ventilation of the lungs, 7 months. breathed through the tracheostomy. After repeated surgical treatments of the postoperative wound for phlegmon, subcutaneous eventration was formed with localization predominantly in the right half of the abdomen.

Upon admission to the clinic - a state of moderate severity. A sick corpulent (124 kg), with a huge deformed abdomen, an unstable, uncoordinated gait, right-sided hemiparesis, an extended interrupted speech. In the sacrococcygeal region, a deep sore 21x14x8 cm with lye in the secreteing granules. The right half of the abdomen is deformed by a huge eventration with dimensions of 45x40 cm, the latter is displaced into the abdominal cavity. The size of the defect is 30x24 cm. The skin along the old postoperative scar is atrophied, there were five trophic spikes from 2x3 to 5x6 cm. In the sowing, aureus staphylococcus and augerdermous staphylococcus to 2x10 per 1 cm of wound surface, sensitive to gentamicin and carbenicillin. After a long preparation, the patient underwent a reconstructive plastic surgery.

All weak areas abruptly atrophied outside the defect of the abdominal wall were reinforced with corrugated sutures from the partitial peritoneum. The upper edge of the defect throughout was represented by a ruber arc. In order not to reduce the volume of the abdominal cavity due to the enormous size of the defect, the latter is closed with the most valuable Cicatricial tissues of the hernial sac after their prior surgical treatment. Then, to the periosteum of the ribs and the most healthy part of the aponeurosis, 3-4 cm from the edges of the defect, hemlock allogeneic tinned dura mater (TMO) 18x30 cm in size, and on top all weak areas of the anterior abdominal wall, including and above TMT, is strengthened by a knitted prosthesis of the basics of a knitted interlacing of polypropylene (PP) and polycaproamide (PKA) monofilaments.

The postoperative period is smooth. The wound healed by primary tension. Monitoring carried out after 6 months. The patient feels good. There are no complaints related to the postponed surgery. Postoperative scar in good condition. No recurrence.

Example 2. Ill F., 50 years old, was admitted with a giant postoperative mid ventral hernia, ligature fistula. Concomitant diseases: hypertensive disease Art. III, osteochondrosis of the lumbar spine, obesity IV stage. History of laparotomy for cervical pregnancy. In the postoperative period, bleeding, supravaginal amputation of the uterus, and then suppuration and subcutaneous eventration. On admission, she is obese, obese, with a body weight of 140 kg and an increase in height of 168 cm. For many years, hypertensive disease with a rise in blood pressure up to 220-240 / 120-140 mm Hg. The abdomen is deformed in the lower half, where there is, a hernia 50x35 cm, right. In the course of the postoperative scar above the hernial bulge, ligature fistulae with abundant purulent discharge. Proteus and Staphylococcus aureus are sensitive to gentamicin and kefol in crops.

The patient underwent a reconstructive plastic surgery. A transverse incision is dissected with a skin fat apron (90x40 cm) together with ligature fistulas. The bag is opened, multiple spikes are separated. On the midline there are a lot of defects, the abdominal wall is atrophied and thinned on an area of 3500 cm. The combined defect in the abdominal wall (40x28 cm) is sutured after

preliminary cost-effective surgical treatment of cicatricial tissues of the hernial sac with a combination of variable, immersion and cosmetic sutures without reducing the volume of the abdominal cavity. A knitted prosthesis of the basics of tangled interlacing of polypropylene and polyglycolide monofilaments is stitched to the formed bed and healthy areas of the aponeurosis. The size of the prosthesis is 40x22 cm. Two vacuum drainage into the subcutaneous tissue. Suturing skin tightly. During the operation, measures were taken to prevent wound suppuration.

The postoperative period was uneventful. Wound healing by primary tension. Viewed through 2 years after surgery. Hernia recurrence is not. Works in the specialty.

Example 3. Ill, Ch., 42 years old, was admitted with a giant recurrent lower-middle postoperative hernia, abscesses of the anterior abdominal shift, obesity, III degree. A history of 3 operations: laparotomy for ectopic pregnancy and two hernia sections in connection with postoperative hernia. During the previous operations, the postoperative period proceeded with purulent complications from the wound. The abdomen is deformed in the lower half by a huge hernial protrusion (35x40 cm). Palpation in the tissues around the hernia gate revealed dense infiltrates of various sizes. Hernia is not allowed.

The patient performed the operation. Incision of the skin in the transverse direction with excision of the skin and fat apron together with postoperative scars. The dimensions are 90x40 cm. A multi-chamber hernial sac is isolated from the subcutaneous tissue, the scar tissue adjacent to it is changed, sharply thickened and infiltrated. When separating coarse Cicatricial tissues in several places, abscesses cavities were opened with purulent contents: Microbial seeding of the material studied - 10 microbial bodies per 1 g of tissue (Staphylococcus aureus sensitive to gentamicin). After opening the hernial bag, its numerous chambers are separated, the adhesions are separated. The tissues of the abdominal wall at a distance of 8–10 cm from the hernial ring are thickened to 4–6 cm due to both the previously applied duplicates and the chronic inflammatory process. During two thirds of the combined defect (24x20 cm), multiple granulomas and abscesses of the abdominal wall were revealed. Considering availability

purulent foci, primary surgical treatment of the tissues of the anterior abdominal wall within the hernial ring was performed. After this, a defect in the abdominal wall

increased to 28x24 cm. The latter was able to close without tension and reduce the volume of the abdominal cavity by the following method. The internal organs are isolated from the subcutaneous tissue by stitching the remnants of the scar tissue of the hernial sac and moving healthy areas of the aponeurosis, after relaxing cuts to it. The weakest area in the sheltered defect is supported by allogeneic TMO

7x18 cm in size, and then all weak areas of the abdominal wall, incl. over TMT, reinforced with a knitted prosthesis fixed to them, basics of a knit interlacing of nylon and polyglycolide monofilaments. The size of the prosthesis is 35x27 cm. The operation was completed by introducing vacuum and through-drainage into the periprosthetic space for fractional washing of the wound with antiseptic solutions. During the operation, measures were taken to prevent purulent complications in the wound. The postoperative period was uneventful. The patient was discharged from the hospital on the 14th day after

operations. The wound healed by primary tension. The patient was examined after 6 months. Hernia recurrence is not.

Thus, the proposed method allows to perform plastic surgery in the presence of a source of purulent surgical infection, to prevent the development of relapses and weaknesses in the form of suppurations, ligature fistulas, abscesses, infiltrates, etc., since

reliable and gentle surrounding tissues, reliably covering the extensive defects of soft tissues, regardless of their origin, minimize the adverse reactions of the body in response to the long-term presence of a foreign body in the tissues of patients by performing a prosthetic knit prosthesis at least least of two synthetic monofilaments with different biodegradation in the body.

Claims (1)

The invention The method of prosthetics of soft tissues by knitted mesh prosthesis, which means that, in order to prevent complications, the prosthesis is carried out with the help of a prosthesis made of at least two synthetic monofilaments. . threads with different terms of biodegradation.