Autobraking composite graft for hernioplasty

 

(57) Abstract:

The invention relates to medicine, namely to surgery hernias. The inventive graft formed from duplicatory decapitalizing flaps hernial SAC, connecting polymeric compositions medical glue Sulfacrylate, reinforcing sutures with antimicrobial action, is applied through separate incisions, which increases the mechanical strength of the graft and prevents scernario. 4 Il.

The invention relates to medicine, namely to abdominal surgery, and is intended for plastic surgery complicated hernia of abdominal wall defects.

Know the application of the elements of the hernial SAC to strengthen areas hernioplasty, in particular in the form of cutting out counter "languages" on both edges of the hernial defect with subsequent cross-strengthening (B. A. Brovkin//Surgery, 1985. -N 9. - S. 111-113), or plastics hernia repair by stitching tucked residues hernial SAC (A. C. USSR N 1598977).

The analogue of the present invention is the use of duplicatory hernial bag to prevent recurrence of the hernia, described by J. P. Palestinskim et al. (A. C. USSR N 1558394).

Disadvantages like is for the plastic autobraking tissues, the danger of long-term sacerdotii while maintaining mesothelial cover, dense convergence of the edges of the hernia gate on the principle of comparing homogeneous tissue due to the fact that in the above methods, the hernia SAC is not completely cut off.

The aim of the invention is the prevention of the recurrence of postoperative ventral hernias.

The prototype of the present invention is a method of manufacturing a graft for hernioplasty own local tissue after excision and decapitalization (Aminov MT, Nikolenko K. K. the Choice of method plastic with postoperative ventral hernias.// Surgery. - 1988. - N 12. - S. 79-80), which was used for the correction of the complex hernia defects as transplant material used scraps of autogerma additionally strengthen sutured to the edges of the hernial defect.

The disadvantages of this method is due to the use as a transplant autogerma, there are complications which are the formation of cysts sebaceous glands, inflammation of the hair follicles and purulent wound complications, which are described in the medical literature (Shevchenko P. C. Treatment of incisional hernias wall with the plastic aponeurosis split autograft. // Clinical surgery. - 1985. - N 2. - S. 37-38), as also noted by the authors of the journal articles listed as a prototype (level wound complications according to them amounted to 7.9%). This is due to high level of bacterial contamination of the skin, the inability to completely remove the appendages of the skin even when it decapitalization and lack of antibacterial action of the graft. The development of these complications dramatically reduces the efficiency of the operation and leads to high levels of recurrent hernias.

In Fig. 1 shows a General view autobraking composite graft and his scheme of cross section along section AA'. In the diagram are marked by numbers: 1 - autobusni flaps, 2 - biopolymer glue Sulfacrylate, 3 - reinforcing surgical sutures, 4 - punching notches.

In Fig. 2 depicts the overlay on autobraking flap reinforcing sutures (1) or grid of the same threads (2).

In Fig. 3 shows the application of the surface autobraking flap with reinforcing filaments medical glue Sulfacrylate from a syringe-tube and overlay on top of the second autobraking flap.

In Fig. 4 shows the alignment of the edges and causing perforation cuts obtained on the market decapitalizing flaps hernial SAC (1), linking polymer compositions medical glue Sulfacrylate (2) and reinforcing sutures with antimicrobial action (3), with a separate end-to-end notches (4).

Autobraking composite graft is prepared as follows. After extraction and processing of the hernial SAC in the usual way it remains cut off from the edges of the hernial defect. From the resulting material to form two close-largest flap. With their surfaces to remove any traces of fat and metallically cover. The strips are laid on a sterile gauze napkins in the stretched condition of the former mesothelial cover up. One of them impose surgical sutures with antimicrobial action (as USSR N 1473147) in the form of intersecting lines with an interval of 3-5 mm (Fig. 2-1) or thin knitted mesh of the same material, overlying the flap (Fig. 2-2). On the surface of the flap causing frequent small drops medical adhesive Sulfacrylate, so as to evenly distribute it over the entire area, and then impose the second flap, press and kept in this state for several seconds (Fig. 3). Scissors align the edges and the tip of the scalpel made the erasers in different housing options: on top of the aponeurosis, under the aponeurosis, in the form of an insert into the hernia defect.

This objective is achieved in that, with sufficient mechanical strength, the graft holding the edge of the hernial defect, thereby contributes to the formation of full postoperative scar. Fragments of adhesive compositions that undergo biodegradation in a fabric environment, have anti-inflammatory effect that reduces the risk of rejection of the composite graft. Antimicrobial effect of reinforcing filaments provides for prevention of purulent wound complications. The last two factors contribute to the more rapid germination of the surrounding tissues in the cells of the prosthesis and make the transplant in monolithic soedinitelnotkannoy plate, optionally a stabilizing zone hernioplasty, able to withstand the increased intra-abdominal pressure, thereby to prevent the recurrence of the hernia.

Example 1. Patient K., 56 years old, operated on for recurrent median postoperative ventral hernia. Under General anesthesia, after excision of the old postoperative scar from subcutaneous fat allocated thick hernial SAC size HH see the Bag opened at the bottom, prepay scar on the edge of the defect. The resulting cloth is divided into two approximately equal to the fragment after purification from residues of fatty tissue, scraping mesothelial cover and remove the spongy edges obtained flaps sizes I see They stretched out on the gauze napkins former converted into the abdominal cavity surface facing up. One of them imposed nylon surgical sutures N 4 with antimicrobial action in the form of intersecting lines with an interval of 3 mm (Fig. 2) on the surface of the flap caused frequent drops uniformly distributed medical adhesive Sulfacrylate polyethylene ampoule packing (Fig. 3), after which the second flap superimposed over the first, held tightly to him for 30 seconds. Scissors made alignment of the edges and the formation of a graft in the form convenient for the oval the size of 12x8 see In the intervals of the crosshairs of reinforcing filaments with the tip of a scalpel applied through a notch (Fig. 4). After completion of plastics hernial defect with local tissues on top of the aponeurosis laid and fixed in a moderately taut made autobraking composite graft. Installed vacuum drainage tube and the wound is sutured in layers tightly. Postoperative course the next year. Unpleasant sensations in the rumen does not feel, hernia recurrence was not found.

Using autorouting composite graft made 12 operations ventral hernioplasty. In any case, not marked purulent wound complications. When studying the long-term results of recurrent hernias is not revealed.

A method of manufacturing a graft for hernioplasty, consisting in the use of local tissue after excision and decapitalization, characterized in that from the remnants of the hernial SAC to form two flaps, one of them laid devitalizirovannah surface up, put on his surgical sutures with antimicrobial action in the form of intersecting rows or knitted mesh from these threads, cause medical adhesive Sulfacrylate, placed second flap devitalizirovannah surface down and put punching notches in the gaps of the reinforcing filaments.

 

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SUBSTANCE: device has head, neck, trochanteric part, pedicle, axle, elastic members and casings having internal conic surfaces. The axle has variable cross-section with grooves on its surface arranged at an angle. The casings are mounted in tubular part of the pedicle uniformly along its length. The axle is mounted in the casings and longitudinally movable as a result of action of cylindrical portion of the trochanteric part. The elastic members are manufactured as hollow body of arc revolution having longitudinal slits. They have end flanges one of which is rigidly fixed on the axle and the other one is movable and has fingers movable along the grooves. The elastic members embrace the axle on the segments of greater diameter and are engageable with internal conic surfaces.

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2 dwg

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