WO2012014567A1 - 創離開防止用補助具 - Google Patents
創離開防止用補助具 Download PDFInfo
- Publication number
- WO2012014567A1 WO2012014567A1 PCT/JP2011/062767 JP2011062767W WO2012014567A1 WO 2012014567 A1 WO2012014567 A1 WO 2012014567A1 JP 2011062767 W JP2011062767 W JP 2011062767W WO 2012014567 A1 WO2012014567 A1 WO 2012014567A1
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- WIPO (PCT)
- Prior art keywords
- wound
- separation
- preventing
- opening
- prevention
- Prior art date
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/08—Wound clamps or clips, i.e. not or only partly penetrating the tissue ; Devices for bringing together the edges of a wound
- A61B17/085—Wound clamps or clips, i.e. not or only partly penetrating the tissue ; Devices for bringing together the edges of a wound with adhesive layer
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F13/00—Bandages or dressings; Absorbent pads
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61L—METHODS OR APPARATUS FOR STERILISING MATERIALS OR OBJECTS IN GENERAL; DISINFECTION, STERILISATION OR DEODORISATION OF AIR; CHEMICAL ASPECTS OF BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES; MATERIALS FOR BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES
- A61L33/00—Antithrombogenic treatment of surgical articles, e.g. sutures, catheters, prostheses, or of articles for the manipulation or conditioning of blood; Materials for such treatment
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
- A61B17/0482—Needle or suture guides
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B2017/00831—Material properties
- A61B2017/00867—Material properties shape memory effect
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/08—Wound clamps or clips, i.e. not or only partly penetrating the tissue ; Devices for bringing together the edges of a wound
- A61B2017/081—Tissue approximator
Definitions
- the present invention relates to an auxiliary tool for preventing dehiscence to prevent dehiscence (opening of the wound).
- a wound formed by scratching a part of the body is called a wound.
- the wound is a wound when it is bruised with a blunt instrument, etc. It can be roughly divided into “scratches” that refer to closed flaws without cuts.
- Conventionally, for wounds that are open to the wound if the wound floor is shallow, the wound is prevented from being opened and closed by means of closing and fixing the wound with adhesive bandages or bandages, etc. Has closed the wound by means of suturing with a suture or the like to prevent the wound from opening and closing.
- a thicker suture is selected from a plurality of sutures of appropriate thickness in order to prevent the wound from opening and closing due to the suture being cut by an external force or the like.
- the means used is universal.
- the use of a thick suture is not preferable because the stitches of the suture are easily noticeable.
- the thicker the suture the stronger the tissue surrounding the wound is pulled and the stronger the suture is, the worse the circulation of blood, etc. to the surrounding tissue of the sutured wound, and necrosis gradually occurs in the surrounding tissue of the sutured wound. Occurs.
- suturing by open surgery or the like is performed by pulling the tissue around the wound. Therefore, the suture and the tissue surrounding the wound wound are attracted. If an external force is applied in this state, if the suture is thin, the suture is cut, and if the suture is thick, the tissue around the sutured wound is torn. That is, even if a suture having an appropriate thickness is selected and used, it is difficult to prevent the wound from opening and closing.
- a suturing device has been proposed to relieve pain of a patient by preventing the wound from opening at the time of suturing after incision surgery, and preventing compression, necrosis, etc. of the sutured skin by the suture thread.
- Patent Document 1 in order to prevent stress from acting intensively on the affected tissue with a thin suture thread, an applicator having a large contact area to the affected area is prepared, and an elasticity imparting shape for applying tension to the thread is provided.
- a wound separation preventing applicator provided with a guide slit and a thread fixing slit for facilitating winding of a thread has been proposed.
- the conventional wound break-opening prevention tool including the above, it is indispensable to learn in advance a technique for mounting the wound separation-opening prevention tool during suturing such as incision surgery.
- it is necessary to detach the brace when disinfecting the brace or dry the affected part, and techniques for these must be acquired in advance.
- the patient is forced to live a life in which attention is not paid to the external force applied to the wound-opening prevention device attached to the suture part, particularly the external force caused by turning over during sleep.
- the present invention has a high effect of preventing the release of a wound from a wound having a releasable defect caused by a part of the body being scratched, and is an easy to use / wearing wound It is an object to provide an auxiliary tool.
- the present inventor has intensively studied and, as a result, has completed the present invention. That is, the auxiliary device for preventing dehiscence of the present invention prevents the dehiscence of the wound by covering the wound and the surrounding tissue with the releasable flaw generated by scratching a part of the body.
- a wound-opening direction that accompanies the installation of the wound-breaking prevention portion comprising a shrinkage-preventing portion that maintains a state in which the wound-breaking prevention portion is appropriately stretched in the wound-breaking opening direction and has a function of preventing shrinkage of the wound-breaking prevention portion
- the wound separation / opening prevention part In a state where the contraction distance in the vertical direction with respect to the wound separation / opening direction is equal to or greater than the contraction distance, the wound separation / opening prevention part is brought into close contact with the wound and the surrounding tissue, and is fixed and attached by the holding part, and then the shrinkage prevention part is removed. Yes. Note that the wound separation / opening prevention auxiliary tool of the present invention can be effectively mounted regardless of whether the wound is sutured or not stitched.
- the means for continuously reducing the physiological and static tension (hereinafter referred to as physiological tension) received by the tissue around the wound is prevented.
- physiological tension physiological and static tension
- the wound floor When the wound floor is shallow, it can be used as a function in the surgical aid to loosen the tissue around the wound, lightly wrinkle it, and release the wound received by the wound's surrounding tissue (hereinafter referred to as the wound separation direction).
- the wound separation direction When the wound floor is shallow, it can be used as a function in the surgical aid to loosen the tissue around the wound, lightly wrinkle it, and release the wound received by the wound's surrounding tissue (hereinafter referred to as the wound separation direction).
- the wound separation direction hereinafter referred to as the wound separation direction.
- the wound separation / opening prevention part is appropriately stretched in the direction of wound opening / closing, and by providing a shrinkage prevention part having a function of preventing contraction, the wound separation / opening prevention part is appropriately stretched in the wound opening / closing direction. Since it can be maintained, the mounting becomes remarkably easy. And after fixing and mounting
- FIG. 1 is a schematic plan view showing a state when the auxiliary tool for preventing wound separation showing the first embodiment of the present invention is not worn.
- FIG. 2 is a schematic plan view showing a state when the auxiliary tool for preventing wound separation shown in FIG. 1 is attached.
- FIG. 3 is a schematic plan view showing a shrinkage prevention unit provided in the second embodiment of the present invention.
- FIG. 4 is a schematic plan view showing a state when the auxiliary tool for preventing wound separation provided with the shrinkage prevention unit shown in FIG. 3 is not attached.
- FIG. 5 is a schematic plan view showing a state when the auxiliary tool for preventing wound separation shown in FIG. 4 is mounted.
- the present inventor has found that in the process of earnest research, the cause of wound separation is closely related to the physical force accompanying the physiological action of the living body. For example, muscles are always subjected to physiological tensions due to the elasticity of the fascia, muscle fibers in the lower layer, and the like, and the skin has elasticity and muscle tissue in the lower layer. When sewing muscles and skin, it is necessary to pull the muscles and skin to be sutured with sutures, the operator's fingers or instruments, etc. This is because the muscles and skin that have been subjected to continuous physiological tension in the direction of wound opening and closing.
- the tissue surrounding the sutured wound is loosened from the direction against the wound opening and closing direction, lightly wrinkled, and the physiological tension in the wound opening and closing direction received by the tissue surrounding the sutured wound
- the continuous reduction of the tension acting on the suture due to the physiological tension prevents the wound opening and tearing by suture cutting after suture and the necrosis of surrounding tissue of the wound sutured by the suture. It becomes an effective means for. Incorporating this effective means as a function in the auxiliary device for preventing dehiscence keeps the physiological tension in the direction of dehiscence and the tension acting on the suture associated with the physiological tension received by the tissue surrounding the sutured wound.
- the present inventor has introduced a function of continuously reducing the physiological tension in the wound opening / closing direction received by the tissue surrounding the sutured wound and the function of continuously reducing the tension acting on the suture accompanying the physiological tension.
- a stretchable material that can be used for medical purposes as a material for the wound opening prevention assistive device, and further select a material that has a stretchability superior to physiological tension.
- the idea was to construct an auxiliary device for preventing wound separation. A test piece is cut out from the material that forms the material of the auxiliary tool for preventing wound separation, and the stretched length is measured by applying a predetermined force.
- a length (hereinafter referred to as a contraction distance) obtained by subtracting a numerical value in a contracted state by reducing the load to zero is obtained from the measured numerical value in a stretched state by adding a load, and the contraction distance is different.
- Action caused by the difference in contraction distance in each part of the auxiliary device for preventing wound separation caused by using the material when stretched with a constant force when wearing, the part with a long contraction distance is more than the part with a short contraction distance If the friction between the material and the wound's surrounding tissue is taken into account, the physiological tension received by the sutured wound's surrounding tissue and suture is reduced.
- Means for continuous reduction can be incorporated as a function in the auxiliary device for preventing wound separation, and the tissue surrounding the sutured wound is loosened, lightly wrinkled, and the sutured wound is removed.
- the present invention by appropriately selecting and combining the materials constituting the auxiliary device for preventing wound separation, the shrinkage distance in the wound opening direction accompanying the attachment of the wound separation preventing portion is reduced by the shrinking distance in the wound opening direction accompanying the mounting of the holding portion.
- the wound separation / expansion prevention part is stretched in the direction of wound separation / opening, and the contraction distance in the wound separation / opening direction associated with the installation of the wound separation / expansion prevention part is contracted in the direction perpendicular to the wound separation / opening direction accompanying the attachment of the wound separation / opening prevention part Basically, it is in close contact with the wound and its surrounding tissue in a state where the distance is greater than or equal to the distance, and is fixed and attached with a holding part.
- the contraction distance associated with wearing here refers to the stretched state caused by physiological movements of the body (changes in chest circumference and abdominal circumference due to breathing, etc.) that occur after wearing each part of the auxiliary device for preventing wound separation that can occur even at rest.
- the present invention it is provided with a wound separation preventing portion that covers the wound and the surrounding tissue, and a holding portion that has a function of holding the wound separation preventing portion in close contact with the wound and the surrounding tissue, and accompanying the attachment of the wound separation preventing portion It is essential that the shrinkage distance in the direction of separation and separation is equal to or greater than the distance of shrinkage in the direction of separation and separation associated with the mounting of the holding part. It is desirable to provide a non-stretching function in order to increase the difference from the distance.
- the holding portion may be provided with a function of expanding and contracting in the direction of opening and closing as long as it has a function of preventing the opening and closing of the wound.
- the present invention extends the wound opening / closing prevention portion in the wound opening / closing direction, and the contraction distance in the wound opening / closing direction accompanying the installation of the wound opening / closing preventing portion is relative to the wound opening / closing direction accompanying the mounting of the wound opening / closing preventing portion.
- the contraction distance in the wound separation / opening direction refers to a state at least equal to or longer than the contraction distance in the direction perpendicular to the wound separation / opening direction when the wound separation / opening prevention unit is attached.
- the wound separating and preventing portion 1 covering the suture portion and the skin around the suture portion, and the wound separating and preventing portion 1 are sutured.
- Holding part 2a, 2b, 2c, 2d, 2e, 2f, 2g, 2h, 2i, 2j, 2k, 2l, and the wound separation preventing part 1 and holding part having a function of holding in close contact with the skin around the skin part and the suture part It comprises connecting parts 3a and 3b for connecting the parts 2a to 2l. As shown in FIG.
- the holding portions 2a to 2l are connected and extended from connection portions 3a and 3b provided at both ends of the wound separation / opening prevention portion 1 in a non-mounted state.
- the holding units 2a, 2b, 2c, 2d, 2e, and 2f are connected to the connection unit 3a, and the holding units 2g, 2h, 2i, 2j, 2k, and 2l are connected to the connection unit 3b.
- the forearm is held by appropriate holding portions 2c, 2d, 2i, and 2j in order to hold the wound separation prevention portion 1 in close contact with the suture portion and the skin around the suture portion.
- the holding part 2a, 2b, 2e, 2f, 2g, and unnecessary holding part 2a, 2b, 2e, 2g, 2h, 2k, 2l are excised.
- the holding portions are arranged in the direction of the wound separation and are disposed at both ends of the wound separation prevention portion because they can be held in close contact with the suture portion and the skin around the suture portion.
- the position of the holding portion is preferably 2c, 2d, 2i, 2j.
- 1a shows the centerline of a wound separation prevention part.
- FIG. 2 a state in which an auxiliary tool for preventing wound opening is attached to the suture part 5 on the outer side of the forearm with the center line 1 a of the wound opening and closing preventing part being aligned is shown.
- the “human body” portion is indicated by a broken line.
- the shrinkage distance in the wound opening direction accompanying the attachment of the wound separation preventing portion has a function of being equal to or greater than the shrinkage distance in the wound opening direction accompanying the mounting of the holding portion
- the suture part is stretched in the direction of the wound opening and closing, and the contraction distance in the wound opening and closing direction due to the mounting of the wound splitting prevention part is equal to or larger than the contraction distance in the direction perpendicular to the wound opening and closing direction due to the mounting of the wound splitting prevention part.
- the holding part is fixed to the holding part so as to function by contracting in the direction against the wound opening and closing direction by the shrinkage force of the wound opening and closing prevention part, and the holding part is attached to the skin around the suture part. It connects with the both ends of a wound separation prevention part by a connection part.
- a wound-break prevention aid that has a wound-break prevention portion that sufficiently covers the suture part and the skin around the suture part, and align the center line of the wound-break prevention portion with the suture part.
- the wound opening / closing prevention part is appropriately stretched in the direction of wound opening / closing, and is closely attached to the skin around the suture part and the suture part, and the wound release prevention part is closely attached to the skin around the suture part and the suture part from the 12 holding parts.
- An appropriate holding portion is selected to hold the pin, and the holding portion is fixed and attached so as to function by being contracted in a direction against the direction of opening and closing by the contraction force of the wound opening and closing prevention portion. Thereafter, unnecessary holding parts are excised.
- the contraction distance associated with the sutured part and the wound separation preventing part that is in close contact with the skin around the stitched part is equal to or greater than the contracted distance associated with the holding part attached, and the contraction distance in the wound opening direction associated with the attachment of the wound separation preventing part.
- the holding part is connected to both ends of the wound opening / closing part via the connecting part with a difference that is more than the contraction distance in the vertical direction with respect to the wound opening / closing direction when the wound opening / closing part is attached,
- the degree of contraction distance associated with the attachment of the prevention aid is maximized in the direction of wound opening and closing of the wound opening and closing portion that is in close contact with the skin around the sutured portion and the sutured portion, and the skin around the sutured portion from the direction against the wound opening and closing direction.
- the skin around the sutured part is loosened from the direction against the wound-opening direction with the attachment of the auxiliary tool for preventing wound separation, and the physiological tension on the suture thread, the sutured part, and the skin around the sutured part.
- the auxiliary device for preventing dehiscence of the present invention means for continuously reducing the physiological tension received by the tissue surrounding the wound can be incorporated into the auxiliary device for preventing dehiscence as a function and stitched.
- the tissue around the wound is loosened, lightly wrinkled, and the physiological tension in the wound opening direction received by the tissue surrounding the sutured wound and the tension acting on the suture accompanying the physiological tension are continuously reduced.
- the wound can be opened and closed by cutting the suture after the suture, and the blood circulation in the surrounding tissue of the wound sutured by the suture can be improved, and the wound can be prevented from being opened by necrosis of the surrounding tissue of the sutured wound. It becomes.
- the wound separation / opening prevention unit 1 is made of a stretchable bare sheet fabric (89% cotton, 11% polyurethane), and the shrinkage distance in the wound opening / closing direction associated with wearing. Is used in a direction that is longer than the contraction distance in the vertical direction with respect to the wound opening / closing direction associated with the mounting, and both ends of the wound separating / opening preventing portion 1 are folded back to be double to form the connecting portions 3a and 3b.
- the holding parts 2a, 2b, 2c, 2d, 2e, 2f, 2g, 2h, 2i, 2j, 2k, 2l are made of a twill fabric made of cotton yarn that does not have an expansion / contraction function to form a string.
- the holding portions 2a, 2b, 2c, 2d, 2e, and 2f are attached to the connecting portion 3a, and the holding portions 2g, 2h, 2i, 2j, 2k, and 2l are attached to the connecting portion 3b.
- the shape of the wound separation / prevention portion 1 is square and the holding portions 2a to 2l are strings.
- the shape of the retraction and prevention portion 1 may be a rectangle, a circle, a rhombus, or the like depending on the application.
- the holding portions 2a to 2l may have any number or length of cords depending on the application, may have elasticity, and may not have a string shape.
- buttons, fasteners and magic tapes. Etc. may be used, and a medical pressure-sensitive adhesive may be applied to the surface in close contact with the skin.
- the wound separation / prevention portion 1, the holding portions 2a to 2l, and the connection portions 3a and 3b are sewn together, but a manufacturing method having no seams or seams in all or a part may be used.
- the present invention is used as an auxiliary device for preventing wound separation
- the above-mentioned materials are used.
- the constituting materials include chemical fibers such as nylon and natural materials such as silk and hemp. Examples thereof include fibers and the like, and those having air permeability, flexibility, heat retention, durability and the like suitable for each of the wound separation / opening prevention unit 1, the holding units 2a to 2l, and the connection units 3a and 3b are preferable. These are examples and not limiting.
- the holding portion has a function of holding the wound separation and prevention portion in close contact with the wound and its surrounding tissue, and the contraction distance in the wound opening direction accompanying the attachment of the wound separation and prevention portion is accompanied by the attachment of the holding portion.
- the material, shape, part, and the like are not limited depending on the application.
- only the pressure-sensitive adhesive suitable for medical use may be used as a holding part, and it may be provided in a part or all of the lower layer of the wound separation prevention part.
- FIG. 3 is a schematic plan view showing the shrinkage prevention unit 4
- FIG. 4 is a schematic plan view showing the front side when the auxiliary tool for preventing wound separation provided with the shrinkage prevention unit 4 shown in FIG. 3 is not attached. It is.
- Reference numeral 1 is a separation / opening prevention section
- reference numeral 1a is a center line of the separation / opening prevention section
- reference numerals 2a, 2b, 2c, 2d, 2e, 2f, 2g, 2h, 2i, 2j, 2k, 2l are holding sections
- reference numerals 3a and 3b denote connection portions
- reference numeral 4 denotes a shrinkage prevention portion.
- the auxiliary tool for preventing wound separation in the second embodiment has a cylindrical shape as the connection portions 3a and 3b of the first embodiment of the present invention, and is a contraction prevention portion 4 shown in FIG. By using two letter-shaped metals and inserting them from the upper and lower sides of FIG.
- the wound-opening prevention part 1 is maintained in a state of being appropriately extended in the wound-opening direction, and the wound-opening prevention part 1 is prevented from contracting.
- the wound prevention part 1 is brought into close contact with the stitched part and the skin around the stitched part, fixed with the holding parts 2 (2a to 2l), and then attached, and then the shrinkage preventing part 4 is removed. Thereby, the wound separation preventing part 1 can be easily mounted while maintaining the stretched state in the wound separation opening direction.
- FIG. 5 is a schematic plan view showing a state when the auxiliary tool for preventing wound separation shown in FIG. 4 is mounted.
- a state in which an auxiliary tool for preventing and separating the wound is attached to the suture part 5 on the outer side of the forearm with the center line 1a of the wound and preventing part being aligned is shown.
- the “human body” portion is indicated by a broken line.
- the wound separation / opening prevention unit 1 is made of a stretchable bare sheet fabric (89% cotton, 11% polyurethane), and the shrinkage distance in the wound opening / closing direction associated with the mounting is the mounting. It was used in a direction longer than the contraction distance in the vertical direction with respect to the wound opening / closing direction, and both ends of the wound separating / opening prevention portion 1 were folded back into a cylindrical shape to form connection portions 3a and 3b.
- the holding parts 2a, 2b, 2c, 2d, 2e, 2f, 2g, 2h, 2i, 2j, 2k, 2l are made of a twill fabric made of cotton yarn that does not have an expansion / contraction function to form a string.
- the holding portions 2a, 2b, 2c, 2d, 2e, and 2f are attached to the connecting portion 3a, and the holding portions 2g, 2h, 2i, 2j, 2k, and 2l are attached to the connecting portion 3b.
- two anti-shrinkage portions 4 made of a U-shaped metal shown in FIG. 3 are used in the cylindrical connection portions 3a and 3b and are inserted from both sides. Then, in the mounted state, as shown in FIG. 5, the forearm inner side is secured by the appropriate holding portions 2c, 2d, 2i, and 2j for holding the wound separation prevention portion 1 in close contact with the suture portion and the skin around the suture portion.
- the holding part 2a, 2b, 2e, 2f, 2g, 2h is attached to the holding part 2a, 2b, 2e, 2g, 2h. 2k, 2l are excised.
- the shrinkage prevention part 4 is pulled out from the cylindrical connection parts 3a and 3b after mounting.
- the holding portions are arranged in the direction of the wound separation and are disposed at both ends of the wound separation prevention portion because they can be held in close contact with the suture portion and the skin around the suture portion.
- the position of the holding portion is preferably 2c, 2d, 2i, 2j.
- connection portions 3a and 3b are formed in a cylindrical shape and a U-shaped metal is inserted, and the anti-shrinkage portion is provided. As long as it has a function of maintaining a state of being properly stretched in the direction of wound opening and closing, there is no restriction on the material, shape, part, etc. according to the application.
- Each of the auxiliary tools for preventing wound separation of the present invention shown in FIG. 1 and FIG. 4 has the basic structure of the present invention, and with such a configuration, the surrounding tissue of the wound is received.
- Means for continuously reducing physiological tension can be incorporated into the device for preventing dehiscence as a function, loosening the tissue surrounding the sutured wound, lightly wrinkling it, and receiving the tissue surrounding the suture wound. Continuously reduces the tension in the direction of wound separation and the tension acting on the suture accompanying the physiological tension, and the wound is opened by cutting the suture after the suture and necrosis of the tissue around the wound sutured by the suture. It becomes possible to prevent the wound separation and opening due to the like.
- the wound is attached regardless of whether the wound is sutured or not stitched. be able to.
- it can be attached to each part of the body regardless of the outer part of the forearm, and can have a shape suitable for each part.
- the term “closely attached to the tissue” as used in the present invention is not limited to the case where the tissue is in direct contact with the surface of the tissue and covers the tissue around the sutured part such as a treatment for preparing a moist environment or gauze. The case where it adheres via is included.
- the present invention provides an auxiliary tool for preventing wound separation that is highly effective in preventing the wound from being opened and easily used and worn with respect to a wound having a releasable wound caused by a part of the body being scratched.
- the debridement caused by necrosis of the surrounding tissue of the wound due to poor circulation of blood and the like cannot be expected even if it is sutured again, and all the sutures are removed. Necrotic tissue must be excised and covered with a wound dressing and switched to a conservative treatment that expects natural healing.
- the auxiliary tool for preventing wound separation of the present invention works effectively. Furthermore, the effect of preventing the dehiscence of other epithelial tissues such as lips and nails other than the skin can be expected. Therefore, the use of the auxiliary device for preventing wound separation of the present invention is not limited to the skin, and may be used for other epithelial tissues as long as it is medically effective. It can be used regardless of whether the wound is sutured or not.
- the auxiliary device for preventing dehiscence of the present invention has an extremely high effect of preventing dehiscence due to physiological tension, and can be used regardless of whether the wound is sutured or not sutured, contributing to the medical industry. But it ’s big.
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Abstract
Description
従来、開放性のきずである「創(そう)」に対しては、創底が浅い場合は、絆創膏や包帯等で創を閉じて固定する手段で創離開を防止し、創底が深い場合は、縫合糸等による縫合の手段により創を閉じて創離開を防止している。さらに、縫合糸等による縫合の手段では、外力等によって縫合糸が切断されることによる創離開を防止するために、適度な太さの複数の縫合糸の中から、より太い縫合糸を選択し使用する手段が汎用されている。
さらに、切開手術等による縫合は、創の周辺組織を引き寄せて行われる。そのため、縫合糸と縫合した創の周辺組織は引き合っている。この状態で外力が加われば、縫合糸が細ければ縫合糸が切れ、縫合糸が太ければ縫合した創の周辺組織が裂ける。即ち、適度な太さの縫合糸を選択し使用しても、創離開の予防は困難であった。
特許文献1には、細い縫合糸によって、患部組織に応力が集中的に働かないようにするため、患部への接触面積の大きな当て具を用意し、糸に張力を掛けるための弾性付与形状とし、糸の巻きつけを容易化するためのガイドスリット及び糸固定スリットを設けた創離開防止用当て具が提案されている。
特に、血液等の循環不良による縫合した創の周辺組織等の壊死を原因とする創離開に対しては、再度縫合しても効果は期待できず、縫合糸をすべて除去し、壊死組織を切除し、創傷被覆材で覆い自然治癒に期待するという保存的治療に切り替えなければならない場合も稀ではなく、そのため、患者は長期間の入院や通院を余儀なくされることも少なくはない。ゆえに、創離開の防止そのものや創離開を防止するための従来の創離開防止用補助具を使用・装着することは容易ではなく、このような不利を適切に解決できる手段がなかったのが現状である。
なお、前記創が、縫合された状態あるいは未縫合の状態に関わらず、本発明の創離開防止用補助具を効果的に装着することができる。
また、適度な太さの複数の縫合糸の中から、より細い縫合糸を選択し使用することが可能となり、縫合の跡を目立ちにくくすることができる。さらに、創の状態によっては縫合を不要とすることも可能となる。また、挫創や咬創等のような一般的に縫合が困難な創の創離開を防止することも期待することができる。さらに、創の状態が縫合、未縫合に関わらず、創およびその周辺組織を安静に保つことができ、自然治癒を早めることもできる。
さらに、創離開防止部を創離開方向に適度に引き伸ばした状態を維持し、収縮を防止する機能を有する収縮防止部を備えることで、創離開防止部を創離開方向に適度に引き伸ばした状態に維持できるため、装着が著しく容易となる。そして、保持部で固定して装着した後に収縮防止部を取り外すことで、創離開防止部を創離開方向に抗する方向に効率よく収縮させ、創離開防止用補助具として機能させることができる。また、創の状態が縫合、未縫合に関わらず、該創離開防止用補助具を効果的に使用することができる。
例えば、筋肉は、筋膜が備える弾性や下層にある筋線維等により、皮膚では、皮膚が備える弾性や下層にある筋組織等により常に生理的張力を受けている。筋肉や皮膚の縫合時に、縫合糸や施術者の手指または器具等で、縫合する筋肉や皮膚を引き寄せる必要性が生じることや、縫合後に、外力によらずとも創離開が生じやすいのは、縫合した筋肉や皮膚が創離開方向の生理的張力を持続的に受けているためである。
この有効な手段を創離開防止用補助具に機能として取り入れることで、縫合した創の周辺組織が受けている創離開方向の生理的張力ならびにその生理的張力に伴う縫合糸に作用する張力を持続的に減少させることが可能となり、縫合後の縫合糸切断による創離開ならびに縫合糸等による縫合した創の周辺組織の壊死等による創離開を防止することができる。
さらに、創離開方向の生理的張力を持続的に減少させることができるため、創の状態によっては縫合を不要とすることも可能となり、挫創や咬創等のような一般的に縫合が困難な創の創離開を防止することも期待することができる。加えて、創の状態が縫合、未縫合に関わらず、創の周辺組織を安静に保つことができ、自然治癒を早めることもできる。
これらの観点から見ると、従来の創離開防止用補助具においては、縫合した創の周辺組織や縫合糸が受けている創離開方向の生理的張力に対する考慮がなされていないことがわかる。
創離開防止用補助具の材料をなす素材から試験片を切り出し、所定の力を加えてその伸びた長さを測定する。そして、この測定した、負荷を加えて引き伸ばした状態の数値から、負荷をゼロにすることによって収縮した状態の数値を差し引いた長さ(以下、収縮距離と称する)を求め、この収縮距離が異なる素材を用いることによって生じる、創離開防止用補助具の各部における収縮距離の差異によって生じる作用(装着する際に一定の力で引き伸ばした場合、収縮距離の長い部位は、収縮距離の短い部位よりさらに伸びる。すなわち、装着時において収縮距離の最も長い部位が最も縮む)と、素材と創の周辺組織との摩擦を考慮すれば、縫合した創の周辺組織や縫合糸が受けている生理的張力を持続的に減少させるための手段を創離開防止用補助具に機能として取り入れることができ、縫合した創の周辺組織を弛ませ、軽くしわをよせ、縫合した創の周辺組織が受けている創離開方向の生理的張力ならびにその生理的張力に伴う縫合糸に作用する張力を持続的に減少させ、創離開を防止することができるとの知見を得て、本発明を完成するに至った。
本発明は、創離開防止用補助具を構成する素材の適切な選択・組み合わせによって、創離開防止部の装着に伴う創離開方向の収縮距離が、保持部の装着に伴う創離開方向の収縮距離以上となる機能を備え、創離開防止部を創離開方向に引き伸ばし、創離開防止部の装着に伴う創離開方向の収縮距離が、創離開防止部の装着に伴う創離開方向に対する垂直方向の収縮距離以上となる状態で、創およびその周辺組織に密着させ、保持部で固定し装着することを基本とする。ここで云う装着に伴う収縮距離とは、安静時にも起こりうる創離開防止用補助具の各部の装着後に生じる身体の生理的な動き(呼吸による胸囲や腹囲の変化等)によって引き伸ばされた状態の数値から、これらの負荷をゼロにすることによって収縮した状態の数値を差し引いた長さである。
本発明において、創およびその周辺組織を覆う創離開防止部と、創離開防止部を創およびその周辺組織に密着させて保持する機能を有する保持部とを備え、創離開防止部の装着に伴う創離開方向の収縮距離が、保持部の装着に伴う創離開方向の収縮距離以上となることが必須であり、保持部の装着に伴う創離開方向には、創離開防止部の装着に伴う収縮距離との差異を大きくするために非伸縮機能を備えることが望ましい。
しかし、縫合した創の周辺組織を弛ませ、軽くしわをよせ、縫合した創の周辺組織が受けている創離開方向の生理的張力ならびにその生理的張力に伴う縫合糸に作用する張力を持続的に減少させ、創離開を防止する機能を備えてさえいれば、保持部にも創離開方向への伸縮機能を備えさせてもよい。また、前述したように、本発明は、創離開防止部を創離開方向に引き伸ばし、創離開防止部の装着に伴う創離開方向の収縮距離が、創離開防止部の装着に伴う創離開方向に対する垂直方向の収縮距離以上となる状態で、創およびその周辺組織に密着させ、創離開防止部の収縮力により、創離開方向に抗する方向に収縮させて機能させるように、保持部で固定し装着するものである。なお、創離開防止部の装着に伴う創離開方向の収縮距離が、創離開防止部の装着に伴う創離開方向に対する垂直方向の収縮距離以上となる状態とは、創離開防止部の装着に伴う創離開方向の収縮距離が、創離開防止部の装着に伴う創離開方向に対する垂直方向の収縮距離と少なくとも同等か長い状態をいう。
そして、装着状態においては、図2に示すように、創離開防止部1を縫合部および縫合部周辺の皮膚に密着させて保持するために、適切な保持部2c、2d、2i、2jによって前腕内側部で、創離開防止部の収縮力により、創離開方向に抗する方向に収縮させて機能させるように保持部で固定し装着され、不要な保持部2a、2b、2e、2f、2g、2h、2k、2lは切除されている。また、保持部は、創離開方向に配置され、かつ創離開防止部の両端に配置されることが縫合部および縫合部周辺の皮膚に密着させて保持できるため好ましく、例えば、縫合部5が創離開防止部の中央線1aの方向にある場合には、保持部の位置は、2c、2d、2i、2jが好ましい。
該創離開防止用補助具において、創離開防止部の装着に伴う創離開方向の収縮距離が、前記保持部の装着に伴う創離開方向の収縮距離以上となる機能を備え、前記創離開防止部を創離開方向に引き伸ばし、前記創離開防止部の装着に伴う創離開方向の収縮距離が、前記創離開防止部の装着に伴う創離開方向に対する垂直方向の収縮距離以上となる状態で、縫合部および縫合部周辺の皮膚に密着させ、前記創離開防止部の収縮力により、創離開方向に抗する方向に収縮させて機能させるように前記保持部で固定し装着する構成からなり、保持部は創離開防止部の両端に接続部によって接続される。
さらに、保持部は、創離開防止部を創およびその周辺組織に密着させて保持する機能を備え、前記創離開防止部の装着に伴う創離開方向の収縮距離が、前記保持部の装着に伴う創離開方向の収縮距離以上となる機能を備えさせていれば、用途に応じ、その素材や形状および部位等に制限を受けない。
例えば、医療用として適した粘着剤のみを保持部とし、創離開防止部の下層の一部もしくは全部に備えても良く、この時、保持部の装着に伴う創離開方向の収縮距離は、創離開防止部の装着に伴う創離開方向の収縮距離と同等となることが望ましく、創離開防止部または保持部の形状により、保持部の装着に伴う創離開方向の収縮距離と、創離開防止部の装着に伴う創離開方向の収縮距離との差異が少なくても良い。
図3は、収縮防止部4を示す概略平面図であり、図4は、図3に示した収縮防止部4を備えた創離開防止用補助具の非装着時の前面側を示す概略平面図である。なお、符号1は創離開防止部、符号1aは創離開防止部の中央線、符号2a、2b、2c、2d、2e、2f、2g、2h、2i、2j、2k、2lは保持部、符号3a、3bは接続部、符号4は収縮防止部である。
この第2の実施の形態での創離開防止用補助具は、本発明の第1の実施の形態の接続部3a、3bを筒状とし、図3に示した収縮防止部4であるコの字型の金属を2個使用し、これを図4の上下両側から差し込むことによって、創離開防止部1を創離開方向に適度に引き伸ばした状態に維持し、創離開防止部1の収縮を防止し、創離開防止部1を縫合部および縫合部周辺の皮膚に密着させ、保持部2(2a~2l)で固定して装着した後に、収縮防止部4を取り外すようになっている。これにより、創離開防止部1を創離開方向に引き伸ばした状態を維持して容易に装着することができる。
そして、装着状態においては、図5に示すように、創離開防止部1を縫合部および縫合部周辺の皮膚に密着させて保持するために適切な保持部2c、2d、2i、2jによって前腕内側部で、創離開防止部の収縮力により、創離開方向に抗する方向に収縮させて機能させるように保持部で固定し装着され、不要な保持部2a、2b、2e、2f、2g、2h、2k、2lは切除されている。収縮防止部4は、装着後、筒状の接続部3a、3bから引き抜かれている。また、保持部は、創離開方向に配置され、かつ創離開防止部の両端に配置されることが縫合部および縫合部周辺の皮膚に密着させて保持できるため好ましく、例えば、縫合部5が創離開防止部の中央線1aの方向にある場合、保持部の位置は、2c、2d、2i、2jが好ましい。
なお、本発明でいう組織に密着して装着するとは、組織の表面に直接に接して密着する場合に限らず、湿潤環境を整えるための処置やガーゼ類等の縫合部周辺の組織を覆うものを介して密着する場合も含んでいる。また、縫合糸を用いず、医療用接着剤やステープラー(ホッチキス)等を用いた場合でも同様の効果が得られる。
また、本発明は、身体の一部がきずつけられて生じた解放性のきずである創に対し、創の離開を防止する効果が高く、使用・装着が容易な創離開防止用補助具を提供するが、前述したように、血液等の循環不良による創の周辺組織等の壊死を原因とする創離開に対しては、再度縫合しても効果は期待できず、縫合糸をすべて除去し,壊死組織を切除し,創傷被覆材で覆い自然治癒に期待するという保存的治療に切り替えなければならない。このような場合にも本発明の創離開防止用補助具は有効に作用する。さらに、皮膚以外の唇や爪等の他の上皮組織の創離開を防止する効果も期待できる。そのため、本発明の創離開防止用補助具の使用は、皮膚に限定するものではなく、医学的に有効であれば他の上皮組織に使用してもよい。また、創の状態が縫合、未縫合に関わらず、使用することができる。
1a:創離開防止部の中央線
2:保持部
2a:保持部
2b:保持部
2c:保持部
2d:保持部
2e:保持部
2f:保持部
2g:保持部
2h:保持部
2i:保持部
2j:保持部
2k:保持部
2l:保持部
3a:接続部
3b:接続部
4:収縮防止部
5:縫合部
Claims (3)
- 身体の一部がきずつけられて生じた解放性のきずである創に対し、創およびその周辺組織を覆って装着し、創の離開を防止するための創離開防止用補助具であって、創およびその周辺組織を覆う創離開防止部と、該創離開防止部を創およびその周辺組織に密着させて保持する機能を有する保持部と、前記創離開防止部を創離開方向に適度に引き伸ばした状態を維持し、該創離開防止部の収縮を防止する機能を有する収縮防止部とを備え、前記創離開防止部の装着に伴う創離開方向の収縮距離が、前記保持部の装着に伴う創離開方向の収縮距離以上となる機能を備え、前記創離開防止部を創離開方向に引き伸ばし、前記創離開防止部の装着に伴う創離開方向の収縮距離が、前記創離開防止部の装着に伴う創離開方向に対する垂直方向の収縮距離以上となる状態で、前記創離開防止部を創およびその周辺組織に密着させ、前記保持部で固定し装着した後に前記収縮防止部を取り外すことを特徴とする創離開防止用補助具。
- 前記創が、縫合された状態にある請求項1に記載の創離開防止用補助具。
- 前記創が、未縫合の状態にある請求項1に記載の創離開防止用補助具。
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CN103932752A (zh) * | 2014-03-10 | 2014-07-23 | 株洲市芦淞区姚家坝乡卫生院 | 一种用于勃朗氏牵引架包扎的包扎带及包扎方法 |
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US10596041B2 (en) | 2014-08-28 | 2020-03-24 | Ascension Texas | Apparatuses and methods for minimizing wound dehiscence, scar spread, and/or the like |
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- 2011-06-03 EP EP11812160.7A patent/EP2599446A4/en not_active Withdrawn
- 2011-06-03 WO PCT/JP2011/062767 patent/WO2012014567A1/ja active Application Filing
- 2011-06-03 KR KR1020117027422A patent/KR101146548B1/ko active IP Right Grant
- 2011-06-03 US US13/258,779 patent/US8541641B2/en active Active
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JP2013017509A (ja) * | 2011-07-07 | 2013-01-31 | Chouryuu:Kk | 処置対応型創離開防止用補助具 |
CN103932752A (zh) * | 2014-03-10 | 2014-07-23 | 株洲市芦淞区姚家坝乡卫生院 | 一种用于勃朗氏牵引架包扎的包扎带及包扎方法 |
CN103932752B (zh) * | 2014-03-10 | 2016-04-20 | 株洲市芦淞区姚家坝乡卫生院 | 一种用于勃朗氏牵引架包扎的包扎带及包扎方法 |
Also Published As
Publication number | Publication date |
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JP2012135601A (ja) | 2012-07-19 |
US20120310132A1 (en) | 2012-12-06 |
KR101146548B1 (ko) | 2012-05-25 |
KR20120029391A (ko) | 2012-03-26 |
CN102548487B (zh) | 2014-12-17 |
US8541641B2 (en) | 2013-09-24 |
EP2599446A4 (en) | 2015-07-22 |
EP2599446A1 (en) | 2013-06-05 |
CN102548487A (zh) | 2012-07-04 |
JP4790091B1 (ja) | 2011-10-12 |
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