WO2019211173A1

WO2019211173A1 - Device for reducing the retraction of the edges and/or for stretching the edges of an opened fascia of a patient

Info

Publication number: WO2019211173A1
Application number: PCT/EP2019/060660
Authority: WO
Inventors: Frank Beyer
Original assignee: Fasciotens Gmbh
Priority date: 2018-05-04
Filing date: 2019-04-25
Publication date: 2019-11-07
Also published as: DE102018219149A1

Abstract

The present invention relates to a device for reducing the retraction of the edges and/or for stretching the edges of an opened fascia of a patient having an open soft tissue defect, wherein the device (10) has a holding element (11) which can be fixed at a first distance from the patient (1), and an attachment element (12) with a plurality of attachment points (13) which are designed for the attachment of tensioning means (14) which can be connected to an edge of the fascia (4), wherein the attachment element (12) is connected to the holding element (11) in such a way that it is positioned at a second distance from the patient (1) which is shorter than the first distance, wherein the attachment element (12) is connected to the holding element (11) via precisely one tensile force transmission element (15), wherein the holding element (11) is fixed relative to a patient receiving device (20, 30, 40) which has a lying surface (21, 31, 41) for the patient (1).

Description

Device for reducing the retraction of the edges and / or

Stretching the edges of an open fascia of a patient

Field of the invention

The present invention relates to a device for reducing the retraction of the edges and / or stretching of the edges of an open fascia of a patient with an open soft tissue defect, the device comprising a holding element which is fixable by the patient at a first distance , and a connection element comprising a plurality of attachment points, which are adapted to connect traction means, which are connectable to an edge of the fascia, wherein the attachment member is connected to the holding member such that it at a second distance to the patient - Is ordered, which is smaller than the first distance, wherein the connection element is connected to the holding element via exactly one tensile force transmission element.

The invention can be applied to open soft tissue defects and / or open wounds. Such soft tissue defects or wounds can be present, for example, as an abdominal wall defect, back wall defect, soft tissue defect in the area of the hip or soft tissue defect on the limb dimensions.

State of the art

A device for reducing the retraction of the edges of an open fascia of a patient of the type mentioned is known from WO 2017/216 224 A1. By means of this device, a tensile force can be applied to the edges of the opened fascia. The edges of the open fascia are kept at a distance, so that the access to the lying under the soft tissue defect body interior, z. As the abdominal cavity is possible, for example, to perform a negative pressure wound therapy. The tensile force maintains the tension of the fascia and thus reduces the retraction of the edges of the fascia. The edges of the fascia can be attached to each other after completion of the therapy and closed directly.

To perform a negative pressure wound therapy, it is necessary to seal the open soft tissue defect or the open wound, so that a negative pressure can be generated.

To seal, for example, gas-tight films can be used, which define a sealed against the environment vacuum range. The well-known The device has a holding element which can be fixed at a first distance from the patient. The holding element is connected via a rigid tensile force transmission element with a connection element, which has a plurality of connection points, which are set up for the connection of traction means. The traction means are connected to an edge of the fascia, so that a tensile force acts on the fascia. The attachment element is arranged at a second distance from the patient, which is smaller than the first distance. When negative pressure wound therapy is carried out, the retaining element can be arranged outside the negative pressure region and hold the attachment element arranged within the negative pressure region. Since there is only a connection between the holding element and the connecting element, the sealing of the vacuum area is facilitated.

In this device, the holding element is held over a plurality of supports, which rest on the skin of the patient. This makes it possible to relocate the patient during therapy with open soft tissue defect. However, this support on the skin has proved to be disadvantageous with respect to the use in children, in particular newborns with gastroschisis or omphalocele, since these patients have hardly suitable bearing surfaces for the supports because of their small size. In addition, the bones of infants are often too soft to absorb the pressure of a support of the device can.

Disclosure of the invention

The object of the present invention is to provide a device of the type mentioned, which is suitable for use in children, especially newborns.

To achieve the object, a device for reducing the retraction of the edges and / or stretching of the edges of an open fascia of a patient with an open soft tissue defect is proposed, wherein the device comprises a holding element, which is fixable at a first distance from the patient, and a connection element comprising a plurality of connection points, which are arranged for the connection of traction means, which are connectable to an edge of the fascia, wherein the connection element is connected to the holding element such that it is at a second distance to the Patients is arranged, which is smaller than the first distance, wherein the Anbindungs- element is connected to the holding element via exactly one tensile force transmitting element, wherein the holding element is fixed relative to a patient receiving device having a bed for the patient. The device according to the invention comprises a patient receiving device which has a lying surface for the patient. The holding element is fixed relative to the patient receiving device. It is therefore not necessary to support the retaining element on the body of the patient. On supports or similar devices that rest on the skin of the patient, can be dispensed with. The device according to the invention is suitable for the treatment of infants, in particular newborns, since these patients hardly move and therefore the position of the body is hardly changed relative to the retaining element fixed to the patient.

The holding element may be designed rod-shaped or rod-shaped. Preferably, the tensile force transmission element is guided in a recess in the holding element, so that the tensile force transmission element for adjusting the distance between the holding element and the connection element is movable. In this respect, the tensile force transmission element can be moved in a direction which is transverse, in particular perpendicular, to the body surface.

According to an advantageous embodiment of the invention, it is provided that the lying surface of the patient receiving device extends in a longitudinal direction and the holding element is arranged on the patient receiving device such that it is oriented in a direction transverse to the longitudinal direction, in particular perpendicular to the longitudinal direction Transverse direction extends. The longitudinal direction is the direction in which the patient rests on the lying surface. In this respect, the holding element can extend across the patient. Alternatively, the holding element may be arranged on the patient receiving device such that it extends along the longitudinal direction of the lying surface or diagonally to the longitudinal direction of the lying surface.

The lying surface can be designed as a heated lying surface. For this purpose, heating elements can be provided within the lying surface and / or on the lying surface.

According to an advantageous embodiment, it is provided that the Zugkraftübertragungsele- element is connected to the holding element at a connection point, wherein a position of the connection point on the holding element is variable. By changing the position of the connection point on the holding element, the position of the connection element can be adjusted with respect to the patient. This makes it possible to adjust the direction of the tensile force transmitted via the traction element connected to the holding element. loading Preferably, the position of the connection point on the holding element along the Halteele- element is displaceable, so that the connection point, in particular a connecting element of the connection point, is guided by the holding element.

An advantageous embodiment provides that the holding element is clamped between two walls of the patient receiving device. The patient receiving device preferably has two walls which run parallel to one another laterally of the lying surface, so that the patient can be positioned on the lying surface between the walls. Particularly preferably, the holding element on spring elements, which clamp the holding element between the walls. For example, the holding element may be rod-shaped, have a main part and two opposite the main part movable ends, which are each stored via a spring element with respect to the main part of the holding member. Alternatively or additionally, the holding element may be rod-shaped, having a main part with a main part thread and two ends movable relative to the main part, each having an end thread which engages with the main part thread.

Alternatively or additionally, it is advantageous if the holding element is connected via a plurality of hooks with two walls of the patient receiving device. The hooks can be hooked to the walls, for example at the top of the wall or in a recess in the wall, in order to fix the holding element with respect to the wall of the patient receiving device.

It is advantageous if the retaining element defines at least one, preferably several, more preferably two, three or four, supports in the first distance from the patient to the patient receiving device, for example connected thereto. The at least one support can be variable in length, in particular telescoping, so that the distance of the retaining element from the lying surface of the patient receiving device or the patient can be adjusted by changing the length of the support.

According to an advantageous embodiment, the holding element can be fixed by a plurality, preferably two, three or four, supports in the first distance from the patient, wherein the supports are supported on the lying surface of the patient receiving device.

A preferred embodiment of the invention provides that the patient receiving device is an incubator. Incubators are also referred to as an incubator or cuvée and generally have a lying surface for a premature baby or newborn, a plurality of laterally arranged side walls of the lying surface and a ceiling wall which closes an interior of the incubator upwards. The ceiling wall can be removable. The incubator is sealed to the environment and can provide a microclimate with tightly controlled air humidity and air temperature. By means of the retaining element fixed relative to the incubator, a therapy of an open soft tissue defect can take place in the incubator, the retraction of the fascia being reduced, so that the edges of the fascia can be placed on each other and closed directly after completion of the therapy.

In this context, it is preferred that the holding element is designed as, in particular substantially horizontally arranged, ceiling wall of the incubator. Preferably, the top wall has an opening for passing through the tension transmission element, so that the connection element can be moved relative to the top wall. Particularly preferably, a sealing element, for example a sealing sleeve, is arranged in the opening of the ceiling wall, which seals the interior of the incubator against the environment, so that the microclimate in the incubator is not impaired.

An alternative preferred embodiment provides that the holding element is arranged below a ceiling wall of the incubator. Such a configuration has the advantage that the holding element can be fixed to the incubator when the top wall is open. The pulling means of the device can be connected to the fascia of the patient when the ceiling wall is removed and the ceiling wall can then be attached to the incubator.

According to an advantageous embodiment, it is provided that the patient receiving device is a bed or a couch.

In a trained as a bed or couch patient receiving device, it is preferred if the holding element is connected to a bed rod, which extends above the lying surface.

An advantageous embodiment provides that the patient receiving device is a weighing device, wherein the lying surface is formed as an inner surface of a pivotable shell of the weighing device. The shell may have a curved or polygonal outer contour. Preferably, the orientation of the pivotable shell relative to a substrate on which the shell rests, changeable. In this respect, an outer contour of the Roll the tray on the ground to swing the tray from a first position to a second position.

Preferably, the patient receiving device is a weighing device and the lying surface is pivotable, in particular schwaukelbar, stored. The lying surface can be pivoted to relocate the patient about a pivot axis. Preferably, the lying surface of the weighing device is curved, for example, as the inner surface of a shell, which preferably has the shape of a half-cylinder. If the lying surface is formed as an inner surface of a pivotable shell, it is advantageous if the shell is pivotally supported, in particular pivotable with respect to a background or with respect to a base of the patient receiving device. Alternatively preferably, the lying surface of the weighing device is planar. The flat lying surface may be pivotally mounted, in particular pivotable with respect to a background or with respect to a base of the patient receiving device. On the sides of the lying surface, in particular the flat lying surface, side walls are preferably provided which make it difficult for the patient to fall out or slip out of the patient receiving device. Preferably, the side walls are pivotable so that the side walls can be pivoted from a limiting position, in which they limit the lying surface and make it difficult for the patient to fall out or slip out of the patient receiving device, into an extension position in which it has a lateral extension form the lying surface, so that particularly large patients can be accommodated.

Preferably, the weighing device can be arranged to an incubator. For this purpose, the weighing device may have dimensions that are adapted to the size of an interior of an incubator. For example, the weighing device may have a width of less than 60 cm, preferably less than 55 cm, particularly preferably less than 50 cm. The weighing device may have a length of less than 70 cm, preferably less than 65 cm, particularly preferably less than 60 cm. The height of the weighing device is preferably less than 60 cm, more preferably less than 50 cm, for example less than 40 cm.

It is preferred if the lying surface extends in a longitudinal direction and the lying surface is pivotable about a pivot axis which is oriented parallel to the longitudinal axis. In such an embodiment, the patient can be transferred by pivoting the lying surface of the weighing device, for example, from a supine position in the direction of a lateral position. Alternatively or additionally, it is preferred if the lying surface extends in a longitudinal direction and the lying surface is pivotable about a pivot axis, which is oriented transversely, in particular perpendicular, to the longitudinal axis. In such an embodiment, by pivoting the lying surface of the weighing device, for example, the patient can be pivoted from a straight supine position into a position in which the patient's head is raised in comparison to the feet or vice versa.

It is advantageous if the weighing device has a display device for displaying a pivoting angle of the lying surface. The display device may be configured to display a first pivot angle about a pivot axis oriented parallel to the longitudinal axis and / or a second pivot angle about a pivot axis oriented transversely, in particular perpendicularly, to the longitudinal axis. The display device can be designed as a spirit level. Alternatively or additionally, the display device may have a scale, in particular a graduated scale.

It is preferably provided that the lying surface can be fixed in a pivoting position, which is pivoted relative to a horizontal position, in particular in a plurality of pivoting positions. For fixing the lying surface in the pivot position or positions, the weighing device preferably has one or more, in particular length-variable and / or telescopic, supporting devices. The support devices can support the lying surface with respect to a base, for example a base of an incubator or bed. Alternatively, the patient receiving device can have a fixable joint, for example a fixable ball joint or a fixable hinge joint, for pivoting the lying surface, which can be fixed in several pivoting positions of the lying surface. Particularly preferably, the fixable joint comprises a hinge-Arre animalvorrichtung, which allows a locking by engagement of a locking element. The articulated locking device can have a plurality of latching recesses in which the latching element can optionally be accommodated. The latching recesses are preferably arranged along an arcuate, in particular circular arc, extending virtual Kurvenlinie.

It has proven to be particularly advantageous if the holding element is rigidly connected to the lying surface of the weighing device, so that the holding element is pivoted along with the lying surface when the lying surface is pivoted. Such a configuration has the advantage that the orientation of the traction means during a rearrangement of the patient remains unaffected by pivoting the lying surface by the pivoting of the holding element. An advantageous embodiment provides that the device has a Zugkraftmesser for measuring the tensile force transmitted via the tensile force transmitting element. About such Zugkraftmesser all forces acting on the edges of the fascia forces can be detected. The Zugkraftmesser is preferably designed as a spring balance. With the spring balance, the tensile force on the basis of the elongation of a compression spring or a Zugfe-, in particular a helical compression spring or coil spring can be determined. Alternatively, the traction force meter can be configured as an inductive dynamometer, capacitive dynamometer, optical dynamometer, strain gauge, magnetic dynamometer, electromagnetic dynamometer or piezoelectric dynamometer. The tensile force meter, in particular an indicator of the tensile force meter, is preferably arranged between the retaining element and the tensile force transmission element, so that the display of the tensile force meter can also be read when the connection element is arranged in the sealed negative pressure region.

Preferably, the tensile force meter on a compression spring which comprises a first end of the spring, which is fixedly mounted relative to the holding element, and a second spring end, the ment against a driver of the tensile force transmitting element or against a seated on an external thread of the tensile force transmitting element Befestigungsele-, in particular one Mother, is mounted fixed. The compression spring can cause a tensile force on the edge of the fascia, which is transmitted via the tensile force transmission element, the connecting element and the traction means. At the same time, the tensile force transmitted via the tensile force transmission element can be determined over the length of the compressed compression spring. For example, the first spring end abut against the holding element and / or be connected to the holding element. The second spring end may abut against the driver of the traction transmission element or on the fastening element seated on the external thread of the traction transmission element or be connected to the driver or the fastening element. It has proved to be advantageous if the pressure spring of the tensile force meter is arranged concentrically to the tensile force transmission element. In this respect, the tensile force transmission element can move within the compression spring with respect to the first spring end, which is fixedly mounted in relation to the retaining element.

Alternatively preferably, the tensile force meter has a tension spring which can bring about a tensile force on the edge of the fascia. Preferably, an adjusting and locking device is additionally provided, via which a tension of the traction-transmitting element is set can be and which allows a determination of the set voltage. The adjusting and locking device may be formed, for example, as a clamping device.

According to an advantageous embodiment, the traction force meter has a graduated sleeve and / or a pointer sleeve, which are arranged so as to be movable concentrically with respect to the traction force transmission element. The scale sleeve can have several, in particular three, areas that are provided with different colors and / or hatchings and / or symbols. Alternatively or additionally, the scale sleeve can have a scale display. Preferably, the pointer sleeve has a larger diameter than the scale sleeve, so that the pointer sleeve can grip around the scale sleeve from the outside. The scraper sleeve is preferably fastened to the holding element and the pointer sleeve to the tensile force-transmitting element, in particular to a driver or to a fastening element seated on an external thread of the traction transmission element. Alternatively, the pointer sleeve can be fastened to the retaining element and the scale sleeve to the tensile force transmission element, in particular to a driver or to a fastening element seated on an external thread of the traction transmission element.

It is particularly preferred if the tensile force meter has three or more sleeves, which are arranged to be movable relative to one another concentrically with respect to the tensile force transmission element.

The traction force meter preferably has a monitoring device which is set up to compare the measured tensile force transmitted via the traction force transmission element with a predetermined threshold value. Preferably, the monitoring device is additionally set up to generate an alarm when the predetermined threshold value is exceeded, for example an optical and / or acoustic alarm. By such a monitoring device too strong tensile stress of the patient's fascia can be detected.

According to an advantageous embodiment, the device has a weight detection device for detecting a weight force of the patient. The weight detection device is preferably designed as part of the lying surface of the patient receiving device and / or arranged below the patient. The weight detection device may be provided as an alternative or in addition to the tensile force meter. About the weight detecting device, a weight force difference between a first weight in a first state in which on the tensile force transmitting element no tensile force on the Patients is transmitted and a second state in which a tensile force is transmitted to the patient via the traction transfer element, are determined. The transmitted weight difference then essentially corresponds to the tensile force transmitted via the traction transfer element. The determination of the tensile force can thus be done either only via the weight detection device or both by the Zugkraftmesser and the weight detection device.

Preferably, the weight detection device has a monitoring device which is set up to compare the detected weight force of the patient with a predetermined threshold value. Preferably, the monitoring device is additionally set up to generate an alarm if the threshold falls below the predetermined threshold, for example an optical and / or audible alarm. By means of such a monitoring device, an excessive tensile stress on the patient's fascia can be detected.

An embodiment in which the tensile force transmission element is rigid is advantageous. A rigid tensile force transmission element is understood in particular to mean a traction force transmission element, via which a compressive force opposite to the traction force can be transmitted. The rigid tensile force transmission element may be formed, for example, as a rod, a screw or a pipe. Alternatively, the Zugkraftübertragungsele- ment be elastic, for example as a hose.

An advantageous embodiment provides that the tensile force transmission element is variable in length, in particular telescopic, is formed. Preferably, the traction transfer element can be fixed in several length settings so that the traction transfer element behaves as a rigid traction transfer element with the respective adjusted length setting.

According to an advantageous embodiment, the tensile force transmission element has a flexi bel trained portion and the holding element has a deflecting element, via which the flexibly formed portion of the traction transfer element is arranged deflected verlaufend. By a deflected arrangement of the flexibly formed section, the overall height of the device can be reduced. This facilitates the use of the device in applications in which a greatly reduced structural space is available, for example the arrangement of the device within an incubator. The flexible portion may be formed as a thread, wire, flat band, chain, belt or rope. The tensile force transmission element can be designed completely flexible be. Alternatively, the tensile force transmission element can have a rigidly formed section in addition to the flexibly formed section. Preferably, a plurality of deflecting elements are arranged on the holding element and the flexibly formed section is arranged such that it is deflected over these several deflecting elements.

Preferably, the flexibly formed portion is arranged running within a cavity of the Halteele- element, so that it is protected against undesired contact. For example, the holding element may have a tubular area, wherein the flexibly formed section of the pulling force element is arranged within the tubular area. Alternatively, it is possible for the one deflecting element or the several deflecting elements to be arranged on an outer side of the holding element, so that the flexibly formed section of the traction-transmitting element is easily accessible.

In this context, it is advantageous if the flexibly formed portion of the traction transmission element is connected to a tensile force meter which is arranged laterally of the lying surface. An arrangement on the side of the lying surface is to be understood as meaning an arrangement in which the tension measuring blade is not arranged above the lying surface in particular. The arrangement of the Zugkraftmessers side of the lying surface, the height of the device can be further reduced. As traction force meter all variants of traction knives described above can be used.

An embodiment has proven to be advantageous in which the connection element is detachably connected to the holding element, so that the holding element can be removed from the patient without it being necessary to release the traction means from the edge of the fascia. Such a release may be necessary in particular when the area around the soft tissue defect has to be released, for example in order to be able to perform resuscitation measures on the patient.

The device preferably has an unlocking device, via which the connection between the retaining element and the connecting element and / or the connection between the tension-transmitting element and the retaining element and / or the connection between the connecting element and the tension-transmitting element can be released. The unlocking device is preferably designed as a quick-release device, which can be unlocked with a handle. For example, the tensile force transmission element can be connected to the attachment element in such a way that it can be detached from the retention element together with the attachment element. It is particularly preferred if the tensile force transmission element has a first part and a second part, which are selectively connectable to each other or separable from each other. Such a configuration has the advantage that the first part can be arranged in a sterile region and the second part in a non-sterile region, or vice versa.

Preferably, a releasable coupling is arranged between the first part and the second part, which connects the first part to the second part. The coupling is particularly preferably releasable by hand, i. without a tool, so that the area of the soft tissue defect can be quickly released, for example, when resuscitation measures are to be performed on the patient. For example, the coupling may be a plug-in coupling or a rotary coupling.

Preferably, the tensile force transmission element is connected to the holding element and / or to the connecting element via a hinge. Through the joint, it is possible to adjust the position of the connection element relative to the holding element. The joint can be designed as a ball joint. Alternatively, the joint may be designed as a hinge joint. In one embodiment, in which the tensile force transmission element has a first part and a second part, between which a coupling is arranged, the joint, in particular the ball joint, may be provided in the region of the coupling. The joint can be arranged either on the first part or on the second part of the traction transmission element.

An advantageous embodiment provides that the attachment element has two attachment regions, the attachment regions each having a plurality of attachment points and a distance of the first attachment region from the second attachment region being adjustable. Preferably, the two connection areas are detachable from each other. Particularly preferably, the two attachment regions are detachable from one another and from the tensile force transmission element.

It is advantageous if the device has at least one traction means connectable to the fascia. About the traction means, the tensile force can be introduced into the fascia. Preferably, a plurality of traction means are provided, via which tensile forces can be applied to the edges of the opened fascia at several different locations. The various traction devices may each have different strengths and different orientations. initiate forces into the fascia. Alternatively, the traction means may be connected to the body surface, in particular to the abdominal wall or back wall, including the fascia, so that not only the fascia but also the skin overlying the fascia is kept tensioned. Preferably, the traction means is designed as a thread and / or as a wire and / or as a network. Conventional surgical threads, wires, bags, foils or nets used in surgery may be used. The traction means can be connected directly or indirectly by means of a connecting means to the fascia. Preferably, the traction means is formed as a combination of a thread and / or a wire and / or a network. It is also preferred if the traction means is connectable to the fascia via a surface-formed connecting means. An improved connection of the traction means to the fascia can be achieved via the flat connecting means. The risk of tearing of the fascia can be reduced and the fascia can be spared with repeated changes of the tension agent. Particularly preferred is an embodiment in which the flat connecting means can be sewn to the fascia. The tension means connectable to the fascia can be formed as a bag, bag or foil. From this bag, this bag or foil can, for example, in the presence of Gastroschisis or omphalocele, organs of the patient be enclosed, for example, to protect against dehydration. The bag, the bag or foil may be attached to the connecting element, in particular by means of a hook, a clamping device or a wire.

To achieve the object mentioned at the outset, a kit for treating an open soft tissue defect with at least one sealing means for sealing the soft tissue defect, the kit having a device as described above, further contributes.

As a result, the same advantages can be achieved as have already been described in connection with the device according to the invention for reducing the retraction of the edges of an opened fascia of a patient.

The sealing means may be formed as a film, which on the side facing away from the body of the sponge on the open soft tissue defect, in particular the open abdominal wall or the open back wall, applied, in particular glued, can be. By means of the sealing means, the body interior, in particular the abdominal cavity or the space lying within the back wall, can be closed in a liquid-tight and gas-tight manner. The sealing means may be arranged such that the device for reducing the retraction of the edges of an opened fascia lies wholly or partly within the area sealed by the sealing means. The sealing means is preferably designed as a non-adhesive, air-impermeable film. The non-adhesive, air-impermeable Film may be directly adjacent to the device for reducing the retraction of the fascia ligaments. The non-adhesive, air-impermeable film can be fixed to the patient's body via adhesive, for example an adhesive film.

The sealing means advantageously has an opening for passing through the traction transfer element. In the region of the opening of the sealing means, the sealing means can be connectable to the sealing element of the tensile force transmission element. The sealing element may be formed as, in particular elastic, sealing ring. Preferably, the sealing means, in particular the film, in the region of the opening on an adhesive, via which the sealing means can be sealingly connected to the sealing element of the traction transfer element. The adhesive may be formed, for example, as a self-adhesive area of the sealing means or as an adhesive element arranged on the sealing means.

The kit preferably has a vacuum pump for generating a negative pressure in the interior of the body, in particular in the abdominal cavity or in the space lying within the back wall, of the patient. Excess liquids and / or gases can be sucked out of the body interior, in particular the abdominal cavity or the space lying within the back wall, via the vacuum pump.

Preferably, the kit additionally comprises a sponge for covering the soft tissue defect.

Brief description of the figures

Further details, features and advantages of the invention will become apparent from the drawings, as well as from the following description of exemplary embodiments with reference to the drawings. The drawings illustrate only exemplary embodiments of the invention, which do not limit the inventive concept. It shows:

1 shows a first embodiment of a device according to the invention with a patient receiving device designed as an incubator in a sectional view along a transverse direction of the lying surface;

FIG. 2 shows the device of FIG. 1 in a sectional view along the section line II-IG; FIG.

FIG. 3 shows the device from FIG. 1 in a side view; FIG. 4 shows a second exemplary embodiment of a device according to the invention with a patient receiving device designed as an incubator in a sectional view along a transverse direction of the lying surface;

Fig. 5-7 representations of the apparatus of Fig. 4 for illustrating various

Possibilities of therapy of an open soft tissue defect;

8 shows the device from FIG. 4 in a sectional view along the section line VIII - VI I G; FIG.

FIG. 9 shows the device from FIG. 4 in a side view; FIG.

10 shows a third exemplary embodiment of a device according to the invention with a patient receiving device designed as an incubator in a sectional view along a transverse direction of the lying surface;

FIG. 11 shows the device from FIG. 10 in a sectional view along the section line XI-XL; FIG.

FIG. 12 shows the device from FIG. 10 in a side view; FIG.

13 shows a fourth exemplary embodiment of a device according to the invention with a patient receiving device designed as an incubator in a sectional view along a transverse direction of the lying surface;

FIG. 14 shows the device from FIG. 13 in a sectional view along the section line

XIV-XIV ';

FIG. 15 shows the device from FIG. 13 in a side view; FIG.

16 shows a fifth exemplary embodiment of a device according to the invention with a patient receiving device designed as an incubator in a sectional view along a transverse direction of the lying surface;

17 shows the device from FIG. 16 in a sectional view along the section line

XVI l-XVI G; FIG. 18 shows the device from FIG. 16 in a side view; FIG.

19 shows a sixth exemplary embodiment of a device according to the invention with a patient receiving device designed as a weighing device in a sectional representation along a transverse direction of the lying surface;

FIG. 20 shows the device from FIG. 19 in a sectional view along a transverse direction of the lying surface, wherein the lying surface is pivoted to the left; FIG.

21 shows the device from FIG. 19 in a sectional view along a transverse direction of the lying surface, the lying surface being pivoted to the right; FIG.

FIG. 22 shows the device of FIG. 19 in a sectional view along a longitudinal direction of the lying surface, wherein the lying surface is arranged horizontally; FIG.

FIG. 23 shows the device from FIG. 19 in a sectional view along a longitudinal direction of the lying surface, the foot region of the lying surface being pivoted downwards; FIG.

24 shows a seventh exemplary embodiment of a device according to the invention with a patient receiving device designed as a bed in a sectional representation along a transverse direction of the lying surface;

FIG. 25 shows the device from FIG. 24 in a side view; FIG.

26 shows an eighth exemplary embodiment of a device according to the invention with a patient receiving device designed as a bed in a sectional representation along a transverse direction of the lying surface;

FIG. 27 shows the device from FIG. 26 in a side view; FIG.

28 shows a ninth embodiment of a device according to the invention with a patient receiving device designed as a bed in a sectional view along a transverse direction of the lying surface;

FIG. 29 shows the device from FIG. 28 in a side view; FIG. 30 shows a tenth embodiment of a device according to the invention with a patient receiving device designed as an incubator in a sectional view along a transverse direction of the lying surface;

31 shows an eleventh embodiment of a device according to the invention with a

Weighing device trained patient receiving device in a sectional view along a transverse direction of the bed surface;

32 shows a twelfth exemplary embodiment of a device according to the invention with a patient receiving device embodied as a weighing device in a sectional representation along a transverse direction of the lying surface;

33 shows a thirteenth exemplary embodiment of a device according to the invention with a patient receiving device embodied as a weighing device in a sectional representation along a transverse direction of the lying surface; and

34 is a fourteenth embodiment of a device according to the invention with a patient receiving device designed as a weighing device in a sectional view along a transverse direction of the lying surface. and

35 is a fifteenth embodiment of a device according to the invention with a trained as a weighing device patient receiving device in a sectional view taken along a transverse direction of the lying surface.

Embodiments of the invention

In the various figures, the same parts are always provided with the same reference numerals and are therefore usually named or mentioned only once in each case.

FIG. 1 shows a schematic sectional view of a patient 1 along a transversal plane. The patient 1 may be an early or newborn who has a congenital soft tissue defect in the form of an open abdomen (eg, gastrochisis or omphalocele). In some clinical pictures, which are accompanied by an intra-abdominal pressure increase, an abdominal compartment syndrome, it is necessary to open the abdominal wall of the patient 1 by surgical means. Such an open abdominal therapy allows the pressure within the abdominal cavity to be reduced and excess gases and / or fluids to be removed from the abdomen. Here can it comes to a emergence of internal organs, such as the intestine, through the abdominal wall opening. In order to counteract the development of infections in the abdomen and to facilitate the care of the open abdomen, the abdominal wall opening is usually provisionally sealed and at the same time a negative pressure therapy is performed, which will be discussed in more detail below. Such negative pressure therapy is usually carried out over a period of a few days to several weeks. So that the edges of the fascia 4 do not retract excessively during this period and the closing of the fascia 4, ie the connection of the fascia margins, after the period of the open abdomen with unproblematic wound healing, is possible after opening the abdominal wall Device 10 used to reduce the retraction and elongation of the fascia 4. In premature or newborn infants, the treatment of the (innate) open abdomen can be done without an oppression is generated. In this case, the soft tissue defect can be covered with a sterile bag, a sterile bag or foil. The bag or bag or foil then absorbs the organs which do not find any space in the abdomen.

1, 2 and 3 show a device according to a first embodiment of the invention. As can be seen from these illustrations, the device 10 for expanding and reducing the retraction of the fascia 4 has a holding element 11 in the form of a rod. The retaining element 11 is fastened to a patient receiving device of the device 10 via a plurality of fasteners, in particular two fasteners designed as hooks 16. The patient receiving device is an incubator 20. The patient 1 lies on a lying surface 21 of the incubator 20. On the side of the lying surface 21, walls 22 are provided, with which the holding element 11 is connected. For this purpose, the hooks 16 are guided over an upper edge of the walls 22 and / or through recesses in the walls 22 such that the hooks 16 engage behind the walls 22. In this case, the holding element 11 is fixed at a first distance from the patient 1. In this case, the holding element 1 1 is below a ceiling wall 23 of the incubator 20. In addition, the holding element 1 1 is clamped between the two two walls 22 of the incubator 20. For this purpose, the holding element 11 has a main part 11.1 and two ends 11.2 which are movable relative to the main part 11.1 and which are each mounted via a spring element 11.3 in relation to the main part 11.1 of the holding element 11. The ends are biased via the spring elements 1 1.3 in a direction away from the main part 1 1.1 direction, here outward, biased. Alternatively, the holding member 11 may be rigid and connected only by means of the hook 16 with the walls 22. The lying surface 21 of the incubator 20 extends in a longitudinal direction L. The holding element 11 is arranged on the incubator 20 such that it extends in a transverse direction Q oriented perpendicular to the longitudinal direction L.

The device 10 further has a connection element 12 connected to the retaining element 11. The attachment element 12 is arranged at a second distance to the patient 1, which is smaller than the distance of the holding element 11 from the patient 1. This means that the attachment element 12 is arranged closer to the patient 1 than the holding element 11. At the attachment element 12, a plurality of attachment points 13 are provided, which are designed such that pulling means 14, which are connected to the edge of the opened fascia 4, can be attached to them. Tensile forces are transmitted to the edges of the fascia 4 via the traction means 14. The traction means 14 are preferably designed as threads. Alternatively, wires, ropes, bags, bags, hooks, clamps or nets can be used. The traction means 14 may be elastic or non-elastic. In principle, it is possible to connect the traction means 14 directly to the fascia 4. In order to prevent the pulling means 14 from tearing out and damaging the fascia 4, the traction means 14 are preferably connected to the fascia 4 via a flat connecting means designed as a net. The planar connecting means can distribute the considerable tensile forces over a larger area and thus improve the introduction of the tensile force into the fascia 4. The sheet connecting means may remain connected to the fascia 4 throughout the duration of treatment of the open abdomen. The traction means 14, however, can be replaced if necessary. Alternatively it can be provided that the traction means 14 are connected not only to the fascia 4 but to other parts of the opened abdominal wall. For example, the traction means 14 may be connected via a puncture in the abdominal wall.

The device 10 applies tensile forces with a force component directed away from the body of the patient 1 onto the edges of the opened fascia 4 in such a way that the device 10 keeps the edges tensioned and at the same time spaced from each other. Due to the tensile force, the tension of the fascia 4 is maintained during the open-mouth therapy and thus the stretching of the edges of the fascia 4 is made possible. The soft tissue defect and thus also the fascia 4, is kept open. The soft tissue defect has an extension of more than 1 cm, preferably more than 5 cm, so that unhindered access to the inside of the body is possible. The edges of the fascia 4 can be applied to each other after completion of the therapy and sealed directly. In the case of the device 10, it is provided that the attachment element 12 is connected to the retaining element 11 via exactly one tensile force transmission element 15, so that the sealing of the negative pressure region during the negative pressure therapy is facilitated. The tensile force transmission element 15 is designed as a rigid tensile force transmission element 15, for example as a solid rod or hollow tube. Alternatively, the Zugkraftübertragungsele- element 15 may be flexible. The traction-transmitting element 15 may be connected to the connecting element 12 via a joint, in particular a ball joint, so that the orientation of the connecting element 12 relative to the traction-transmitting element 15 can be changed.

The traction-transmitting element 15 is movable relative to the holding element 11 in such a way that the distance between the connecting element 12 and the holding element 11 can be adjusted via the movement of the traction-transmitting element 15. The tensile force-transmitting element 15 is mounted in a recess formed as a passage opening in the holding element 11. The tensile force transmission element 15 has an external thread in an upper region, which lies opposite the connection element 11. On the external thread sits a fastener 19. The fastening element 19 has an internal thread. For example, the fastening element 19 can be designed as a nut. Between the fastening element 19 and the retaining element 11, a pressure spring is arranged, which is compressed in dependence on the tensile force transmitted via the tension-transmitting element 15. The compression spring may be part of a tensile force meter 18, in particular a spring balance, which indicates the tensile force transmitted via the tensile force transmission element 15.

The fastening element 19 forms an actuating element, by means of which the entire tensile force acting on the edges of the fascia 4 can be set. The fastening element 19 is arranged in the upper region of the tensile force transmission element 15, which is opposite to the connection element 12, so that the fastening element 19 can also be actuated when a negative-pressure therapy is carried out. Preferably, the fastening element 19 is designed such that it can be brought into an open position from an engagement position in which the internal thread of the fastening element 19 is in engagement with the external thread of the traction force transmission element 15, in which the internal thread of the fastening element 19 is not in Engagement with the external thread of the traction transmission element 15 is. For example, the fastener 19 may be formed as a split nut, in particular swing-nut. On the fastening element 19 an unlocking device is provided, via which the fastening element 19 can be moved with a handle in the open position. In the open position, the fastening element 19 can be removed from the tensile force transmission element 15. In a further step, the holding element 1 1 can be removed from the Pati ducks 1, without it being necessary to release the traction means 14 from the edge of the fascia 4. The connection element 12 connected to the patient 1 via the traction means 14 and the traction transfer element 15 connected to the attachment element remain on the patient 1. Such release may be necessary in particular when the area of the soft tissue defect has to be released, for example around the To resuscitate patients.

Furthermore, the tensile force transmission element 15 is designed as a preferably rigid tensile force transmission element 15 with two rigid parts 15.1, 15.2. The first part 15.1 and the second part 15.2 are selectively connectable or separable from each other. For this purpose, a releasable coupling 60 is arranged between the first part 15.1 and the second part 15.2, which connects the first part 15.1 to the second part 15.2. The clutch 60 is designed as a manually releasable quick release coupling, for example as a plug-in coupling. In the normal case, the two parts 15.1, 15. 2 of the traction transfer element 15 are connected to each other via the coupling 60. If, however, resuscitation measures have to be performed on the patient 1, the coupling 60 can be released with only one handle, so that access to the patient 1 is not impaired by the traction-transmitting element 15.

As can be seen from the illustration in FIG. 1, the connecting element 12 has a base part 12. 1, which is connected to the traction-transmitting element 15. Two connection regions 12.2 are connected to the base part 12.1 in such a way that they are movable relative to the base part 12.1 and against each other. The connection areas 12.2 can be locked relative to the base part 12.1. At the connection regions 12.2, a plurality of connection points 13 for traction means 14 are provided in each case. The connection of the traction means 14 to the attachment points 13 can take place in that the traction means 14 are guided through a passage opening, not shown in the figures, in the connection region and then knotted, for example. An alternative connection of the traction means 14 can take place via connection points 13 formed as grooves. The traction means 14 can advantageously be guided through the grooves and in particular fastened by crimping. The base part 12.1 and the connection regions 12.2 are formed as rods, which are arranged in particular parallel to one another or form an oval.

FIGS. 4 to 9 show a device 10 according to a second exemplary embodiment of the invention. The device 10 corresponds to the device according to the first embodiment, for which reason reference is made to the description of the first embodiment. The first embodiment has the difference that the holding element 11 is not fixed by hooks on the walls 22 of the incubator 20. The holding element 1 1 is thus clamped only between the two walls 22.

In addition, FIG. 4 schematically shows the performance of a negative pressure wound therapy. The open soft tissue defect is sealed by means of a foil 51 in order to prevent the intestine 5 from drying out. The film 51 has an opening, to which a suction hose 50 of a vacuum pump is connected. A vacuum is applied via the vacuum pump, so that unwanted fluids and / or gases can be removed from the abdominal cavity through the suction hose 50. This negative pressure therapy is usually carried out over a period of several days to several weeks. Alternatively, in negative pressure wound therapy, instead of the film, a bag may be used which does not seal the soft tissue defect, but is merely placed between the abdominal wall and the intestine.

FIG. 5 also shows the device 10 according to the second exemplary embodiment when negative pressure wound therapy is performed. The open soft tissue defect is covered by a sponge 52. Furthermore, a film 53 is guided in the region between the connecting element 12 and the holding element 11. This film 53, which delimits the negative pressure region, only has to be sealed at one point in relation to the tensile force transmission element 15. To the tensile force transmission element 15, a sealing element 17 is arranged, to which the film 53 can be attached. The film 53 preferably has an opening through which the tensile force transmission element 15 can be guided. The edge of the opening is preferably formed as an adhesive edge. The film 53 can be sealingly connected to the sealing element 17 via the adhesive edge. The sealing element 17 may be configured, for example, as a sealing ring. The sealing element 17 is rotatable relative to the traction force transmission element 15 and / or displaceable along the traction force transmission element 15. In this respect, it is possible to change the position of the traction transfer element 15 without affecting the film 53. The film 53 is further adhered to the skin of the patient 1. This makes it possible to make changes to the orientation of the connection element 12 and / or of the traction-force-transmitting element 15 during the low-pressure therapy without great effort. Optionally, in the area between the Soft tissue defect or the sponge and the connecting element 12 another

Sponge are arranged.

FIG. 6 shows the application of the device 10 according to the second embodiment without negative pressure wound therapy. Here, the open soft tissue defect is sealed by a foil or net 51.

FIG. 7 shows a further application of the device 10 according to the second exemplary embodiment. A negative pressure wound therapy is not performed in this application. In this application, a network 61 is used, which covers the open soft tissue defect, sewn at the edges of the open fascia 4 and connected to the connection points 13 of the connection element 12 via traction means 14. In this respect, is pulled by the traction means 14 at the edges of the network 61, thereby exerting a train on the edges of the fascia 4.

10, 11 and 12 show a device 10 according to a third embodiment of the invention. The device 10 corresponds to the device according to the first exemplary embodiment, for which reason reference is made to the description of the first exemplary embodiment. In contrast to the first embodiment, the holding element 1 1 of the third embodiment is designed as a top wall 23 of the incubator 20. In the substantially horizontally extending ceiling wall 23, a recess formed as a passage opening is provided, in which the traction-transmitting element 15 is movably mounted.

FIGS. 13, 14 and 15 show a device 10 according to a fourth embodiment of the invention. The device 10 corresponds to the device according to the first exemplary embodiment, for which reason reference is made to the description of the first exemplary embodiment. In contrast to the first exemplary embodiment, the holding element 11 is fixed by four supports 9 at the first distance from the patient, the supports 9 resting on the lying surface 21 of the incubator 20. The supports 9 are formed variable in length, so that the distance of the holding element 1 1 can be adjusted by the patient 1 by changing the length of the supports 9. On the supports 9 each have a locking device 9.2 is provided, via which the set length of the respective support 9 can be determined. The supports 9 have a head end 9.1, which is mounted displaceably in the transverse direction Q of the lying surface 21 in a receptacle in the holding element 1 1. Another difference from the first exemplary embodiment is that the holding element 1 1 extends in the longitudinal direction L of the lying surface 21.

16, 17 and 18 show a device 10 according to a fifth embodiment of the invention. The device 10 corresponds to the device according to the fourth embodiment, for which reason reference is made to the description of the fourth exemplary embodiment. In contrast to the fourth embodiment, the holding element 11 is fixed via two supports 9 at the first distance from the patient. Further, the holding member 1 1 extends in a direction perpendicular to the longitudinal direction L oriented transverse direction Q.

The illustrations in FIGS. 19 to 23 show a device 10 according to a sixth exemplary embodiment of the invention. The device 10 corresponds to the device according to the first embodiment, for which reason reference is made to the description of the first embodiment. In contrast to the first exemplary embodiment, the patient receiving device is designed as a weighing device 30, which has a lying surface 31 which is pivotally mounted. On the lying surface 31 of the weighing device 30, a blanket or a pillow or a similar soft element is arranged below the patient 1, which is not shown for reasons of clarity in Fig. 19 to 21. The blanket or pad may optionally be pulled out of the weighing device 30 in the longitudinal direction L together with the patient. This may be necessary, for example, during resuscitation measures. In order to enable the pulling out, the tensile force transmission element 15 can be divided by releasing the coupling 60 and thus the connection element 12 can be separated from the holding element 11. The weighing device 30 is arranged inside an incubator 25, which is not part of the device according to the invention.

The lying surface 31 is curved, here as the inner surface of a shell 32, which has the shape of a half-cylinder. The holding element 1 1 is rigidly connected to the shell 32, in particular to the lying surface 31, by means of at least one, in this case two, supports 35, so that the holding element 11 is pivoted together with the lying surface 31 when the lying surface 31 is pivoted. This makes it possible to relocate the patient even when pulling means 14 are sewn between the device 10 and the fascia 4. The at least one, preferably two, supports 35 are designed variable in length so that the distance of the holding element 1 1 from the patient 1 can be adjusted by changing the length of the supports 35. The weighing device has a joint embodied as a ball joint 33, via which the shell 32 or the lying surface 31 can be pivoted relative to the incubator 25. About the ball joint 33, the lying surface 31, which extends in the longitudinal direction L, about a pivot axis S1 verschwen kt, parallel to the longitudinal axis L is oriented. In addition, the ball joint 33 makes it possible to pivot the lying surface 31 about a pivot axis S2, which is arranged parallel to the transverse direction Q. Alternatively, the joint can only pivot about exactly one

Enable swivel axis. As an alternative, a joint can be completely dispensed with, with the shell 32, when pivoting with its curved outer contour, rolling on a substrate, in this case a base of the incubator 25.

The lying surface 31 may be formed as a heated lying surface. For this purpose, heating elements can be provided inside the lying surface 31 and / or on the lying surface 31

On the weighing device 30, in particular on the shell 32, a plurality of support means 34 are arranged, by means of which the lying surface 31 can be fixed in any desired pivot position opposite the horizontal position shown in FIG. On the shell 32 for this purpose a plurality of locking devices 36 are arranged, via which the position of the support means 34 relative to the shell 32 can be determined. For example, the locking device 36 may have an opening through which the support device 34 extends and in which it can be fixed, in particular by a force fit, by a screw element of the locking device 36. According to the exemplary embodiment, four support devices 34 are arranged on the shell 32, with two support devices in the foot region and two support devices in the top region of the shell 32. The support devices are variable in length and / or telescopically formed.

In a modification of the embodiment shown in FIGS. 19 to 23, the joint 33, in particular the ball joint or hinge joint, is designed as a lockable joint. In such a modification, the support devices 34 can be omitted partially or completely.

The illustrations in FIGS. 24 and 25 show a device 10 according to a seventh embodiment of the invention. The device 10 corresponds to the device according to the fourth embodiment, for which reason reference is made to the description of the fourth embodiment. In contrast to the fourth exemplary embodiment, the patient receiving device is designed as a bed 40. The supports 9 rest on a lying surface 41 of the bed 40 and are additionally held by hooks 42, which engage behind the lying surface 41 of the bed 40. The illustrations in FIGS. 26 and 27 show a device 10 according to an eighth embodiment of the invention. The device 10 corresponds to the device according to the seventh embodiment, for which reason reference is made to the description of the seventh exemplary embodiment. In contrast to the seventh embodiment, the holding element 11 is fixed to the bed 40 via exactly one support 9. The support 9 rests on the lying surface 41 of the bed 40 and is held by a hook 42 which engages behind the lying surface 41 of the bed 40.

The illustrations in FIGS. 28 and 29 show a device 10 according to a ninth embodiment of the invention. The device 10 corresponds to the device according to the first embodiment, for which reason reference is made to the description of the first embodiment. In contrast to the first exemplary embodiment, the patient receiving device is designed as a bed 40 with a bed rod 43 that extends above the lying surface 41 of the bed 40. The holding element 11 is connected to the bed rod 43, for example via an elastic or rigid suspension 44.

FIG. 30 shows a device 10 according to a tenth exemplary embodiment of the invention. The device 10 corresponds to the device according to the second exemplary embodiment, for which reason reference is made to the description of the second exemplary embodiment. For the second exemplary embodiment, the difference is that the traction transfer element 15 is connected to the holding element 11 at a connection point 1.4, a position of the connection point 1.4 on the holding element 11 being variable. The position of the connection point 11.4 on the holding element 1 1 is optionally lockable and detachable. The connection point 1 1.4 is guided by the holding element 1 1 and can be moved along the support member 1 1. The illustration in FIG. 30 shows a displacement of the connection point 1.4 from a position in the middle between the walls 22 in the direction A of a wall 22. The connection element 12 moves with the connection point 11.4 in this direction A. This causes a change the orientation of the traction means 14, so that a tensile force in increasingly lateral direction on the fascia 4 of Pati ducks 1 is applied.

FIG. 31 shows a device 10 according to an eleventh exemplary embodiment of the invention. The device 10 corresponds to the device according to the sixth exemplary embodiment, for which reason reference is made to the description of the sixth exemplary embodiment. For the sixth embodiment, there is the difference that the tensile force transmission element 15 comprises a flexibly formed section 15.3. Furthermore, the shark te 1 1 1 a first deflecting element 70, via which the flexibly formed portion 15.3 of the tensile force transmitting element 15 is arranged to extend in a deflected manner. Further deflecting elements 71 are also provided on the holding element 11, which likewise deflect the flexible section 15.3 of the tensile force-transmitting element 15. The flexible trained section 15.3 may be formed as a flat band, for example of a metal or a metal or plastic. The deflecting elements 70, 71 are arranged in the interior of the retaining element 11, so that the flexible section 15.3 extends within a hollow space of the retaining element 11. The flexible section extends from the first deflecting element 70 to the side of the lying surface 31. A tensile force meter, not shown in FIG. 31, can be arranged laterally of the lying surface 31, which is connected to the flexible section 15.3 and over which the tensile force transmitted via the tensile force transmission element 15 can be measured. Since the flexible section extends only on one side of the retaining element 11 formed here as a bow, instead of the semicircular arch shown in FIG. 31, a retaining element 11 can be used that extends from one side of the lying surface 31 only to approximately the middle the lying surface 31 extends, for example, a viertkreiskreisiger arc.

FIG. 32 shows a device 10 according to a twelfth exemplary embodiment of the invention. The device 10 corresponds to the device according to the eleventh exemplary embodiment, for which reason reference is made to the description of the eleventh exemplary embodiment. The eleventh embodiment has the difference that the deflecting elements 70, 71 are not arranged in an inner space of the holding element 11, but on an outer side of the holding element 11. The flexible portion 15.3 of the tensile force transmitting element 15 may be formed as a band, rope or thread. In Fig. 32, a tension gauge 18 is further shown, which is connected to a first end of the flexible portion 15.3. A second end of the flexible portion 15.3 is connected to the coupling 60, which is designed as a releasable quick disconnect coupling.

FIG. 33 shows a device 10 according to a thirteenth embodiment of the invention. The device 10 corresponds to the device according to the sixth exemplary embodiment, for which reason reference is made to the description of the sixth exemplary embodiment. For the sixth embodiment, there is the difference that the holding element 1 1 is fixed to the weighing device 30 via exactly one support 35.

FIG. 34 shows a device 10 according to a fourteenth embodiment of the invention. The device 10 corresponds to the device according to the thirteenth embodiment. For this reason, reference is made to the description of the thirteenth exemplary embodiment. The sixth embodiment has the difference that the device 10 has a weight detection device 72 for detecting a weight force of the patient 1. The weight detection device 72 is designed in the manner of a scale and represents a part of the lying surface 31 of the patient receiving device 30. The weight detection device 72 is therefore located below the patient 1. In the present exemplary embodiment, no tensile force meter is provided on the device 10. According to a modification of the embodiment, however, it is possible that in addition to the weight detecting device 72, a tensile force meter is present, for example a Zugkraftmesser 18, as shown in Fig. 32 or 33.

FIG. 35 shows a device 10 according to a fifteenth embodiment of the invention. The device 10 corresponds to the device according to the eleventh exemplary embodiment, for which reason reference is made to the description of the eleventh exemplary embodiment. The eleventh exemplary embodiment has the difference that the retaining element 1 1 extends from one side of the lying surface 31 only to approximately the middle of the lying surface 31. In this respect, the holding element 1 1 has the shape of a quarter-circular arc. In addition, a tensile force meter 18, which is connected to a first end of the flexible section 15.3, is arranged on the retaining element 11. A second end of the flexible portion 15.3 is connected to the coupling 60, which is designed as a detachable quick release coupling. Starting from a deflecting element 71 arranged in the interior of the holding element 11, the flexible section 15.3 of the traction-transmitting element 15 extends through a recess of the holding element as far as the tensile force meter 18. The flexible section 15.3 is preferably in the form of a cable, in particular a metal cable. Furthermore, the joint 33 is designed as a lockable joint, so that any support devices can be dispensed with.

The exemplary embodiments explained above show devices 10 for reducing the retraction of the margins and / or stretching of the edges of an open fascia of a patient with an open soft tissue defect, wherein the device 10 is a holding element 1 1, which is at a first distance from the patient 1 can be fixed, and a Anbindungsele- element 12 includes, which has a plurality of attachment points 13, which are adapted for connection of traction means 14 which are connectable to an edge of the fascia 4, wherein the connection element 12 with the holding element 1 1 so is connected, that it is arranged at a second distance to the patient 1, which is smaller than the first distance, wherein the connection element 12 with the holding element 1 1 over exactly one Zug- is connected to the force transmission element 15 and the holding member 11 with respect to a patient receiving device 20, 30, 40 is set, which has a lying surface 21 for the patient. By means of the device 10 according to the invention shown in the figures according to the exemplary embodiments, the fascia 4 can be kept open so far that the body interior, in particular the abdominal cavity or the space lying on the inside of the soft tissue defect, is accessible and / or the internal organs pass through the open soft tissue defect, in particular the abdominal wall opening or an open soft tissue defect on the back, can escape at least substantially unhindered. Further, the device 10 can be used to stretch a fascia 4 whose edges have already retracted. The device according to the invention can optionally be used without a negative pressure wound therapy being carried out. The therapeutic applications of the device 10 according to the second embodiment shown in FIGS. 4, 5, 6 and 7 may also be used in the devices according to the other embodiments.

LIST OF REFERENCE NUMBERS

1 patient

4 fascia

5 intestine

9 support

9.1 head end

9.2 Locking device

10 Device for reducing the retraction of the fascia 1 1 holding element

1 1.1 main part

1 1.2 end

1 1.3 spring element

1 1.4 connection point

12 connection element

12.1 base part

12.2 Connection area

13 connection points

14 traction means

15 tensile force transmission element

15.1, 15.2 part of the tensile force transmission element

15.3 flexible portion of the traction transfer element

16 hooks

17 sealing element

18 tensile force meter

19 fastening element

20 incubator

21 lying area

22 wall

23 cover wall

25 incubator

30 weighing device

31 lying area

32 shell

33 ball joint

34 Supporting device

35 support 36 locking device

40 bed

41 lying area

42 hooks

43 bed rod

44 suspension

50 suction hose

51 foil

52 sponge

53 foil

60 clutch

61 network

70 deflecting element

71 deflecting element A direction

L longitudinal direction Q transverse direction

S1, S2 pivot axis

Claims

claims:

1. Device for reducing the retraction of the margins and / or stretching of the edges of an open fascia of a patient with an open soft tissue defect, wherein the device (10) has a holding element (11) which is at a first distance from the patient (1). can be fixed, and a connection element (12) comprises, which has a plurality of attachment points (13) which are adapted for connection of Zugmit- (14), which are connectable to an edge of the fascia (4), wherein the connection element ( 12) is connected to the holding element (11) such that it is arranged at a second distance from the patient (1), which is smaller than the first distance, wherein the attachment element (12) with the holding element (11) via exactly one Traction transmission element (15) is connected,

characterized in that

the holding element (11) is fixed relative to a patient receiving device (20, 30, 40), which has a lying surface (21, 31, 41) for the patient (1).

2. Device according to claim 1, characterized in that the lying surface of the patient receiving device extends in a longitudinal direction and the holding element (1 1) on the patient receiving device (20, 30, 40) is arranged such that it is in a direction transverse to the longitudinal direction (L), in particular perpendicular to the longitudinal direction (L), oriented transverse direction (Q) extends.

3. Device according to one of the preceding claims, characterized in that the tensile force transmission element (15) with the holding element (11) at a connection point (1 1.4) is connected, wherein a position of the connection point (1 1.4) on the holding element (1 1) changeable, in particular along the retaining element

(1 1) is displaceable.

4. Device according to one of the preceding claims, characterized in that the holding element (11) between two walls (22) of the patient receiving device (20) is clamped.

5. Device according to one of the preceding claims, characterized in that the holding element (11) via a plurality of hooks (16) with two walls (22) of the patient receiving device is connected.

6. Device according to one of the preceding claims, characterized in that the holding element (11) via at least one, preferably a plurality, more preferably two, three or four, supports (9) is set at the first distance from the patient to the patient receiving device.

7. Device according to one of the preceding claims, characterized in that the patient receiving device is an incubator (20).

8. The device according to claim 7, characterized in that the holding element (1 1) as, in particular substantially horizontally arranged, ceiling wall (23) of the incubator (20) is formed.

9. Apparatus according to claim 7, characterized in that the holding element (1 1) below a ceiling wall (23) of the incubator (20) is arranged.

10. Device according to one of claims claim 1 to 6, characterized in that the patient receiving device is a bed (40) or a couch.

1 1. A device according to claim 10, characterized in that the holding element (1 1) is connected to a bed rod (43) which extends above the lying surface (41).

12. Device according to one of claims 1 to 6, characterized in that the patient receiving device is a weighing device, wherein the lying surface is formed as an inner surface of a pivotable shell of the weighing device.

13. The device according to one of claims 1 to 6, characterized in that the patient receiving device is a weighing device (30) and the lying surface (31) is pivotally, in particular schwaukelbar, stored.

14. The apparatus of claim 12 or 13, characterized in that the Lie- gefläche (31) in a longitudinal direction (L) and the lying surface (31) about a pivot axis (S1) is pivotable, which is oriented parallel to the longitudinal axis ,

15. Device according to one of claims 12 to 14, characterized in that the lying surface (31) in a longitudinal direction (L) and the lying surface (31) about a pivot axis (S2) is pivotally, the transverse, in particular perpendicular to of the Longitudinal axis (L) is oriented.

16. Device according to one of claims 12 to 15, characterized in that the lying surface (31) in a pivoted relative to a horizontal position pivot position, in particular in a plurality of pivot positions, can be fixed, preferably via a fixable joint, such as a fixable ball joint or a fixable hinge joint, for pivoting the lying surface, which can be fixed in several pivoting positions of the lying surface.

17. Device according to one of claims 12 to 16, characterized in that the holding element (1 1) is rigidly connected to the lying surface (31) of the weighing device (30), so that the holding element (1 1) during pivoting of the lying surface (31 ) is moved along with the lying surface (31).

18. Device according to one of the preceding claims, characterized in that the device has a tensile force meter (18), in particular a spring balance, for measuring the tensile force transmission element (15) transmitted tensile force has.

19. The device according to claim 18, characterized in that the Zugkraftmes- ser (18) comprises a first monitoring device which is adapted to compare the measured, transmitted via the tensile force transmitting element tensile force with a predetermined threshold.

20. Device according to one of the preceding claims, characterized in that the device comprises a weight detecting device (72) for detecting a weight of the patient (1).

21. Device according to claim 20, characterized in that the weight detection device (72) has a second monitoring device which is set up to compare the detected weight force of the patient with a predetermined threshold value.

22. Device according to one of the preceding claims, characterized in that the tensile force transmitting element (15) is rigid.

23. Device according to one of claims 1 to 21, characterized in that the tensile force transmission element (15) has a flexibly formed portion (15.3) up and the holding element (1 1) has a deflecting element (71, 72), via which the flexible formed section (15.3) of the traction transfer element (15) is arranged deflected extending.

24. The device as claimed in claim 23, characterized in that the flexibly formed section (15.3) is arranged running within a hollow space of the retaining element (11).

25. Device according to one of claims 23 or 24, characterized in that the flexibly formed portion (15.3) of the traction transfer element (15) is connected to a Zugkraftmesser (18) arranged laterally of the lying surface (21, 31, 41) is.

26. Device according to one of the preceding claims, characterized in that the tensile force transmission element (15) has a first part (15.1) and a second part (15.2), which are selectively connectable to each other or separable, preferably between the first part (15. 1) and the second part (15.2) a releasable coupling (60) is arranged, which connects the first part (15.1) with the second part (15.2).

27. Device according to one of the preceding claims, characterized in that the connection element (12) has two attachment regions (12.2), wherein the attachment regions (12.2) each have a plurality of attachment points (13) and the attachment regions (12.2) are mutually movable.

28. Kit for treating an open soft tissue defect with at least one sealing means (51, 53) for sealing the soft tissue defect, characterized by a device (10) according to one of the preceding claims.