WO2017213534A1

WO2017213534A1 - Graft preparation method, perforator (variants) for the implementation thereof and method for treating burn wounds

Info

Publication number: WO2017213534A1
Application number: PCT/RU2016/000337
Authority: WO
Inventors: Василий Александрович МЕНЗУЛ
Original assignee: Василий Александрович МЕНЗУЛ
Priority date: 2016-06-06
Filing date: 2016-06-06
Publication date: 2017-12-14

Abstract

The invention relates to medicine, and more particularly to burn care and skin grafts. A system of through slits is made to a skin flap such that when the flap is subsequently stretched, polygonal openings form which have at least one strip connecting opposite angles of the polygons. The present method is implemented using a perforator, comprising a housing and two shafts, in which, according to the invention, retaining disks are configured in the form of small disks, which are rigidly fastened to a shaft, and floating rings, which are fastened to the shaft such as to be capable of radial movement, wherein the diameter of the small disks is 2-8% smaller than the inside diameter of the floating rings, and the thickness of the floating rings is in a range of 0.2-2.0 mm and is proportional to the thickness of a blade, wherein the thickness of the blades is in a range of 0.2-2.0 mm, and the diameter of the shafts is in a range of 15-80 mm. In the lower part of the housing there is a comb with teeth which have a thickness proportional to that of corresponding spaces, the tips of said teeth being situated between the disk blades. As a wound covering, sterile MD dressings are used, which are made of a polyethylene film, the surfaces of which have a non-medicinal ingredient of mineral and/or organic origin applied thereto, such as, for example, talc or pollen. The film is made in the form of a tape with tear-away perforations in the form of openings arranged along tear lines. The method makes it possible to carry out gentle treatment of deep 3B-4 degree burn wounds, accelerate the healing of burn and donor area wounds, and reduce the likelihood of scar formation by using a device which enables high-quality preparation of a graft.

Description

Transplant preparation method, perforator

(options) for its implementation and a method for treating burn wounds

The invention relates to medicine, specifically to methods for treating deep burn wounds ST-4 degree.

A common problem in the treatment of deep burn wounds is the creation of a gentle method that accelerates the healing of burn and donor wounds, reduces the time of treatment, reduces the pain of the patient and the possibility of scarring.

A known method for the treatment of burns ST-4 degree, which consists in the fact that after removing patients from shock, a toilet is used for burned surfaces. It is performed in the operating room after preliminary administration of pain medications to the patient. The skin around the burn is wiped with napkins moistened with 0.5% ammonia solution or soapy water, dried and treated with alcohol. Then foreign bodies, scraps of the epidermis are removed from the burnt surface. After the toilet, burns are treated with wet-drying and ointment dressings. After the appearance of granulations, autodermoplasty is carried out, followed by treatment of burn and donor wounds using wet-drying and ointment dressings (see Big Medical Encyclopedia M .: Soviet Encyclopedia 1981, v. 17, p. 231).

The traditional method of treating deep burn wounds requires the preparation of burned surfaces before dressing, the use of anesthesia for toilet wounds, since these dressings are very painful, dressings they dry to the surface of wounds, injure granulation and young epithelium, wound infection is often observed. The engraftment of skin flaps is accompanied by skin scars and the formation of keloid scars and contractures.

A known method for the treatment of burns ST-4 degree, based on the fact that they apply the dressing to granulation, followed by gentle dermatome ectomy of granulations and autodermoplasty, and, as a dressing, use a perforated film material containing rows of holes that form a rectangle of a solid surface with side sizes of 100 and 200 mm, while the holes are made rectangular with side sizes of 1 and 3 - 5 mm at a distance of 1 mm, and the treatment with film transfer dressings carried out until complete wound cleansing (see. Russian patent

IPC A62F13 \ 02 A61L15 \ 00, publ. from 04/10/1998)

This method also does not fully meet the requirements, both in terms of graft survival and in the number of scars formed.

A known method of preparing a skin graft for transplantation to a patient, based on its perforation by applying a system of through cuts and forming a system of polygonal holes in a flap, (see RF patent> 239275, IPC АВВ 17V322, dated December 27, 2007)

Known perforator containing a housing, two shafts, one of which contains a set of circular knives with spacers, and the other, a set of thrust disks with spacers, (see RF patent 2000087, class A61B 17X322, publ. 09/07/93 - prototype).

A disadvantage of the known method and device for its implementation is the lack of completeness and saturation of the skin flap, which leads to an increase in the healing time of wounds and the formation of excessive scars on damaged areas of the skin (wafer-like skin defects).

There is a method of treating burn wounds by applying dressings to the formation of granulation, followed by gentle dermatome ectomy of granulations and autodermoplasty, and, as a dressing, use perforated film material, (see RF patent 2108078, class A61F 13/02, publ. 10.04 .98 - a prototype).

This method also does not fully meet the requirements, both in terms of transplant survival and cosmetic effect.

The invention solves the problem of creating a more gentle way of treating deep burns, accelerating the healing of burns and donor wounds, reducing the time of their treatment, reducing the possibility of scarring using devices that provide better preparation of the graft.

The problem is solved due to the fact that in the known method of preparing a skin graft for transplantation to a patient, based on its perforation by applying a system of through-cuts and forming a system of polygonal holes in the flap, according to the invention, the system of through-cuts is applied so that upon subsequent stretching, the flap , in it, in a system of polygonal holes, form at least one jumper connecting the opposite corners of the polygons, for example, on a large diagonal.

In addition, through the slots are applied so that by stretching the flap, rectangular holes are formed in it with an aspect ratio of 1: 2, or 1: 3, or 1: 4, or 1: 6.

Or through the slots are applied so that by stretching the flap in it form rhombic holes. Or, through the slots are applied so that by stretching the flap, hexagonal holes are formed in it.

Or, through the slots are applied so that by stretching the flap, holes are formed in it in the form of a parallelogram with an aspect ratio of 1: 2, or 1: 3, or 1: 4, or 1: 6.

The specified method is implemented using a perforator containing a housing, two shafts, one of which contains a set of circular knives with spacers, and the other a set of persistent disks with spacers, in which, according to the invention, the persistent disks are made in the form of small disks rigidly fixed to the shaft , and floating rings mounted on the shaft with the possibility of movement in the radial direction, and the diameter of small disks is 2-8% less than the inner diameter of the floating rings, and the thickness of the floating rings is in the range of 0.2-2.0 mm and is commensurate with the thickness knife, and the thickness of the knives is in the range of 0.2-2.0 mm, and the diameter of the shafts is in the range of 15-80 mm, and in the lower part of the body there is a comb with teeth, the width of which is proportional to the thickness of the spacers, and their vertices are located between the circular knives .

The second variant of the punch can be a punch containing a housing, two shafts, one of which contains a set of circular knives with spacers, and the other a set of thrust discs with spacers, characterized in that the thrust discs are made in the form of small discs rigidly mounted on the shaft, and floating rings mounted on the shaft with the possibility of movement in the radial direction, and the diameter of small discs is 2-8% less than the inner diameter of the floating rings, and the thickness of the floating rings is in the range of 0.2-0.2 mm and is commensurate with the thickness of the knife., except t The second knife is made in the form of two cutting disks with a thickness of 0.05-1.15 mm rigidly connected to an intermediate washer 0.2-1.5 mm thick, and the diameter of the knife is 0.1-1.5 mm greater than the diameter of the intermediate washer, moreover, in the lower part of the body a comb with teeth is located, width which is proportional to the thickness of the spacers, and their vertices are located between the circular knives.

Thus prepared graft is the basis of the proposed method of treating burns based on the use of a perforated skin flap, in which, according to the invention, flaps perforated in the form of polygonal holes having diagonal jumpers are used as a graft skin graft.

In addition, sterile MD dressings made of a polyethylene film are used as a wound dressing, and on the surface of the film only one ingredient of mineral and / or organic origin is applied, which is not a medicine, for example, talc or flower pollen, and the film is made in the form of a tape, with detachable notches made in the form of holes located along the separation lines.

The combination of the proposed features of each object of the invention affects the final technical result, namely, the creation of a more gentle method of treating deep burns, accelerating the healing of burn and donor wounds, reducing the time of treatment, reducing the possibility of scar formation. Thus, this combination form a single inventive concept.

A schematic diagram of the proposed punch is shown in FIG. 1-3, where:

Fig 1 is a General view of the punch;

Fig 2 is a General view of the perforator (side view);

FIG. 3 - drive shaft

FIG. 4 - Driven shaft;

FIG. 5 - Comb;

FIG. 6 - Knife (option 2), where:

1. housing 2. drive shaft

3. driven shaft

4. knife

5. spacer

6. thrust disc

7. small disk

8. floating rings

9. comb

Y. teeth

1 1. cutting disc

12. intermediate washer

The hammer drill contains a housing 1, two shafts - a leading 2 and a driven 3, moreover, the driven shaft 3 contains a set of disk knives 4 with spacers 5, and the drive shaft 2 - a set of thrust disks 6 with knives 5. The thrust disks 6 are made in the form of small disks 7, rigidly mounted on the shaft 2, and floating rings 8, mounted on the shaft 2 with the possibility of movement in the radial direction, the diameter of small disks 7 being 2-8% less than the inner diameter of the floating rings 8, and the thickness of the floating rings 8 is in the range 0 , 2-2.0 mm and is proportional to the thickness of the knife 4.

The thickness of the knives 4 are in the range of 0.2-2.0 mm, and the diameter of the shafts in the range of 15-80 mm. In the lower part of the body there is a comb 9 with teeth 10, the width of which is proportional to the thickness of the spacers 5, and their vertices are located between the circular knives 4.

The second option of the puncher is characterized in that the knife is made in the form of two cutting discs 1 1 with a thickness of 0.05-0, 15 mm rigidly connected to an intermediate washer 12 with a thickness of 0.2-1.5 mm, and the diameter of the knife (discs 11) is larger than the diameter of the intermediate washer 12 to 0, 1-1.5mm.

The preparation of the perforator for work is the same for both of their variants and consists in its sterilization and final assembly in the required configuration. The choice of the thickness of the knives 4 and its ratio with the thickness spacers 5 determine the required thickness of the diagonal jumper obtained on the skin flap. So with a knife thickness of 4 in 0.3 mm, and the corresponding thickness of the spacer 5, the thickness of the diagonal bridge will be about 0.8 mm. The form of perforation of the skin flap (the shape of the cells) depends, as in the prototype, on the number of recesses on the knife blade.

The work of the puncher is similar to the work of the prototype with the only difference that the result is a perforated flap with diagonal jumper cells, which increases the filling of the skin flap and contributes to its accelerated survival.

The proposed solution to the technical problem involves the following process chain during the operation.

1) Necessary tools and dressings (in addition to the standard set): a) Menzul dermatome (Menzul Dermatome) with disposable ultra-thin interchangeable disc knives for cutting skin grafts and granular wounds, for example Menzul Dermatome-60-Ol b) PM leather perforators for producing perforated skin flaps with a skin bridge in a rhombus (made in accordance with paragraph 6 or 9 of the formula)

c) “Dressings - MD” - Menzul Dressinq disposable plastic dressings with minerals for the closure and treatment of transplanted autodermografts and donor wounds.

The technology of the operation is as follows.

Used tools the dermatome nozzle Menzul-61-01 a perforator PM-1: 3, a gear motor and a disposable ultrathin circular knife to the dermatome are laid out from sterile bags and placed on the operating table. The circular knife on the dermatome is attached manually by the surgeon or operating nurse. The Menzul-61-01 dermatome nozzle is connected and fastened to the motor with a gear with a special union nut. The height of the thickness gap, cut off the skin flap, is set on the vernier, by rotation of the dermatome nozzle. The assembled dermatome is connected to the power supply from the gear motor by a cord. Before starting the operation, the operability of the tool is checked. The rotation of the disk knife of the dermatome is carried out by the gear motor when you press the pedal outgoing from the power supply. Cutting a split skin flap for transplantation:

Before cutting the skin flap, the surgical field of the donor wound is treated with a sterile disinfectant solution. A sterile liquid paraffin is applied on a sterile skin surface with a thin layer to smoothly slide the dermatome across the skin. If the skin is flabby, then saline is injected into the subcutaneous tissue with a syringe. The dermatome in the surgeon’s hand is applied by the cutting part of the knife to the cut-off area of the skin and at that moment the surgeon presses the pedal with his foot. With the beginning of the rotation of the circular knife in the dermatome, the advancement of the instrument along the donor skin and cutting off gradually begins. Between the gap of the rotating knife and the bed of the dermatome nozzle, a split skin flap appears, which must be grabbed with tweezers and gradually removed during cutting. The cut and taken skin flap is placed on a wet towel on the operating table. A bleeding donor wound “donars” is formed in place of the taken skin. A wound is applied with a sterile cloth moistened with a hemostatic solution.

Disposable sterile polyethylene dressings are removed from the packaging - MD is expanded and the wound is covered with the inside in excess. In the combination treatment of a donor wound with an MD dressing and ointments or with powdered powder. First, the wound surface is treated, for example, balsamic laziment according to A.V. Vishnevsky, levomikol is applied with a sterile spatula or sprinkled with baniocin powder. The MD dressing on the wound is strengthened between itself to healthy areas of the skin by leukoplasty strips. Sterile dry dressings are applied over a disposable plastic dressing covering the wound and bandaged. Bandages are changed after 24-72 hours. After removing the dressings, the wound toilet is made with wet sterile napkins with an atiseptic solution. By quenching, the wound surface is dried and healthy skin around the wound is treated. The fibrin-leukocyte membrane enveloping the membrane is not forcibly removed. A new MD dressing is applied to the wound and fixed as described above. Wound healing occurs on the 6-8th day. Obtaining a perforated skin flap with a skin bridge in a rhombus:

Perforation of the skin flap is performed using a perforator PM with a skin bridge in the rhombus, for example, with a coefficient of 1: 3. The taken autoderm graft with tweezers is placed on the platform between the knives of the punch. The graft is passed between the rotating knives and on the opposite side with tweezers, the perforated skin is held and removed.

Before skin transplantation, a special wound preparation is performed - removal of the wound of the posterior layers. To do this, Dermatom Menzul-61-01 perform an operation - surgical dermatome pre-transplant resection of granulation tissue (PTRG) wounds. By gentle, tangential movements of the dermatome, the surface and middle layers of granulations are cut in layers. The thickness of the cutting tissue 0.1-0.2 mm The wound surface is leveled, making the receiving bed more optimal. The wound is transferred from chronic to acute. Bleeding is stopped with sterile wipes moistened with a solution of adrenaline or an electrocoagulator. A perforated autoderm graft with a jumper in the rhombus is taken with tweezers and transplanted onto an optimally prepared wound. The skin flap transferred to the wound surface is fixed to the healthy edges of the skin and between each other using ligatures or a stapler.

A wound with a transplanted atoderma transplant is treated with disposable polyethylene MD dressings (made of a polyethylene film, and on the surface of the film only one ingredient of mineral and / or organic origin is applied, which is not a medicine, for example, talcum powder or pollen, and the film is made in the form of a tape, with tear-free cuts made in the form of holes located along the tear lines) in the conditions of its own liquid medium and in combination with ointments or powder powders . An MD single-use dressing is removed from the sterile bag and the wound with excess skin is closed, the dressing is fixed with adhesive tape to healthy areas of the skin and in places on the whip. Also for these purposes, you can use ligature seams or a stapler. In the combination treatment of wounds with transplanted skin with an MD dressing and ointments or with powdered powders, the wound surface is first treated, a levomycol is applied to the auto-transplant with a sterile spatula or sprinkled with baniocin powder. On top of the disposable MD plastic dressing covering the wound, apply sterile dry dressings and bandage. Bandages are changed after 24-48 hours. When the healing of perforated skin cells appears, closing is done with mesh wound coverings, for example fragments of parapran. Dressings are carried out until complete transplantation of the transplanted skin.

Thus, the use of the present invention will allow the creation of a more gentle method of treating deep burns, accelerating the healing of burns and donor wounds, reducing the time of their treatment, reducing the possibility of scarring using devices that provide better preparation of the graft.

Claims

Claim

1. A method for preparing a skin graft for transplantation to a patient, based on its perforation by applying a system of through cuts and forming a system of polygonal holes in the flap, characterized in that a system of through cuts is applied to the skin flap so that with subsequent stretching of the flap, polygonal holes are formed with , at least one jumper connecting the opposite corners of the polygons.

2. The method according to claim 1, characterized in that the through slots are applied in such a way that by stretching the flap, rectangular holes are formed in it with an aspect ratio of 1:2, or 1:3, or 1:4, or 1:6.

3. The method according to claim 1, characterized in that through slots are applied in such a way that by stretching the flap, rhombic holes are formed in it.

4. The method according to claim 1, characterized in that through slots are applied so that by stretching the flap, hexagonal holes are formed in it.

5. The method according to claim 1, characterized in that the through slots are applied in such a way that by stretching the flap, holes are formed in it in the form of a parallelogram with an aspect ratio of 1:2, or 1:3, or 1:4, or 1:6.

6. A hammer drill containing a housing, two shafts, one of which contains a set of circular knives with spacers, and the other, a set of thrust disks with spacers, characterized in that the thrust disks are made in the form of small disks rigidly fixed to the shaft and floating rings, fixed on the shaft with the possibility of movement in the radial direction, and the diameter of the small disks is 2-8% less than the internal diameter of the floating rings, and the thickness of the floating rings is in the range of 0.2-2.0 mm and is commensurate with the thickness of the knife.

7. A hammer drill according to claim 1, characterized in that the thickness of the knives is in the range of 0.2-2.0 mm, and the diameter of the shafts is in the range of 15-80 mm.

SUBSTITUTE SHEET (RULE 26)

8. A hammer drill according to claim 1, characterized in that in the lower part of the body there is a comb with teeth, the width of which is commensurate with the thickness of the spacers, and their tops are located between the disk knives.

9. A hammer drill containing a housing, two shafts, one of which contains a set of circular knives with spacers, and the other, a set of thrust disks with spacers, characterized in that the thrust disks are made in the form of small disks rigidly mounted on the shaft and floating rings, fixed on the shaft with the possibility of movement in the radial direction, and the diameter of the small disks is 2-8% less than the internal diameter of the floating rings, and the thickness of the floating rings is in the range of 0.2-0.2 mm and is commensurate with the thickness of the knife. In addition, the knife is made in the form of two cutting disks with a thickness of 0.05-0.15 mm rigidly connected to an intermediate washer with a thickness of 0.2-1.5 mm, and the diameter of the knife is 0.1-1.5 mm larger than the diameter of the intermediate washer.

Yu. Perforator according to claim 9, characterized in that in the lower part of the body there is a comb with teeth, the width of which is commensurate with the thickness of the spacers, and their tops are located between the disk knives.

1 1. Method of treating burns based on the use

perforated skin flap, characterized in that flaps perforated in the form of polygonal holes with diagonal jumpers are used as a skin graft graft.

12 Method of treating burns according to claim 1 1, characterized in that sterile disposable polyethylene dressings are used as a wound covering, and only one ingredient of mineral and/or organic origin, which is not a drug, is applied to the surface of the film, for example, talc or pollen , and the film is made in the form of a tape, with tear-off notches made in the form of holes located along the tear lines.

SUBSTITUTE SHEET (RULE 26)