Method for treating soft tissue abscesses

FIELD: medicine.

SUBSTANCE: method involves puncturing pyogenic cavity with trocar having blunt obturator via skin incision made outside of abscess boundary having length equal to arthroscope diameter. Then, arthroscope is introduced and the cavity is filled with physiologic saline. Pyogenic cavity revision is carried out under arthroscope control, irrigation cannula is set, constant water medium is created. Arthroscopic mill on shaver handle is introduced via another skin incision. Non-viable tissues are removed with stage-by-stage hemostasis using endocoagulator. The cavity is healed. Perforated draining tube is set under arthroscope control. Tube ends are brought out through pierces outside of the cavity and sutured to skin. Active suction of wound exudates is carried out using closed vacuum drain system in postoperative period. The drainage is removed when cleaning the wound from wound microflora and single sutures are placed.

EFFECT: enhanced effectiveness of treatment.

3 cl

 

The invention relates to medicine, namely to purulent surgery, and can be used in the treatment of soft tissue abscesses of different localization.

There is a method of treating inflammation in soft tissues, including the opening of a purulent cavity puncture remote from the epicenter of inflammation points, evacuation of the purulent cavity exudate, drainage of the cavity, wash it with medicinal solutions that pass through the perforated tube is held tightly blunt through inflammation (ed. mon. The USSR №662074, And 61 In 17/00, publ. 1979).

The disadvantage of this method is the lack of a visual audit of purulent cavities and extracting only the purulent exudate, which reduces the effectiveness of treatment of purulent processes of soft tissues.

Closest to the proposed method to the technical essence and the achieved result is a method of treatment of abscess of the soft tissues, including access to home purulent inflammation by type cut-puncture, evacuation of pus, "blind" revision cavity and wash it with an antiseptic solution (kurlayev P.P. and other prognosis of post-infectious abscesses using a mathematical model. // J. Surgery for them. N.I.Pirogov. - M - Media Sphere.-1999, No. 7. - P.46.) - adopted for the prototype.

The disadvantage of the method adopted is a prototype, is the lack of a visual audit of a purulent cavity, its Sadekov and pockets full of hemostasis and how agressively to debride and, as a consequence, the low efficiency of treatment.

The present invention solves the problem of increasing the effectiveness of treatment of purulent processes soft tissues and reliability control how agressively to debride with thorough hemostasis, speedy cure the patient through visual audit purulent cavity and adequate debridement with a maximum reduction of the level of microbial contamination, reduction of the time of lysis of non-viable tissue.

To achieve the mentioned technical result in the proposed method, including access to home purulent inflammation by type cut-puncture, evacuation of pus, a revision of the cavity, removal of tissue sequestra, cavity lavage solutions and its drainage, under the control of the arthroscope carry out an audit of a purulent cavity, install irrigation cannula create permanent aquatic environment, evaluate the prevalence of purulent process. For this purpose through a skin incision is made outside the boundaries of the abscess, the length equal to the diameter of the arthroscope, the dotted line a trocar with a blunt obturator purulent cavity and enter the arthroscope. Through another skin incision enter arthroscopic cutter on the handle of the shaver, max is maximum remove nonviable tissue with a phased hemostasis by anticoagulation, carry out reorganization of the cavity to clean the wash water. Also under control of the arthroscope set in the cavity perforated drain tube, remove the ends of the tube through the puncture outside of the cavity and sew it to the skin, are actively aspiration of wound exudate using a closed system vacuum drainage in the postoperative period. Remove the drain when cleaning the wound microflora and impose a single seams.

In addition, a skin incision is made with a length of 5 mm to 9 or 3 hours on the dial.

The method is as follows.

When establishing indications for closed treatment of purulent lesion through the skin incision the dotted line trocars with a blunt obturator purulent cavity. The blunt obturator is removed, evacuate purulent contents. Through the trocar enter the arthroscope, to which is attached the camera and the fiber light guide from the light source, and a container of saline solution. The cavity is filled with a saline solution. Under the control of the arthroscope set irrigation cannula. Do a visual audit of purulent: determine the nature and extent of affected tissues, the possibility of their removal taking into account anatomical and topographical features of the intervention zone, the degree of spread of the inflammatory process. Through another skin incision enter arthrosc the practical cutter on the handle of the shaver and maximally remove nonviable tissue. Carry out thorough phased hemostasis by anticoagulation, cavity sanation to clean wash water. Remove arthroscopic cutter. Under the control of the arthroscope is installed in the cavity of the drain tube with the removal of the ends of the tube and fixing it to the skin of the individual seams. The arthroscope remove the skin and put the hub seam.

A specific example of the method

Order full disclosure of the nature and advantages of the present invention shows an example of a closed treatment of suppurative process of soft tissues.

Through the incision 5 mm to 9 or 3 hours on the dial, retreating 15-20 mm from the border of the abscess, the dotted line a trocar with a blunt obturator purulent cavity. The blunt obturator is removed. Evacuate purulent contents. Through the trocar enter the arthroscope. To attach the last video camera and the fiber light guide from the light source. The arthroscope through a tube attached to the container of saline solution to a height of not less than 1 m from the level of the wound. The cavity is filled with a saline solution. Under the control of the arthroscope set irrigation cannula. The entry point of the cannula is placed on 6-hour dial in the projection of the lowermost point, retreating 15-20 mm from the border of the cavity. Creates a constant water pressure of at least 100 cm water. senior Cavity was washed with 1 l of f zoologicheskogo solution, that allows you to remove the maximum amount of free purulent particles and to explore the abscess cavity. Perform an audit of purulent: determine the nature and extent of affected tissues, the possibility of their removal taking into account anatomical and topographical features of the intervention zone, the degree of spread of the inflammatory process. Through additional puncture the skin on the opposite side of the cannula is injected arthroscopic cutter on the handle of the shaver and maximally remove nonviable tissue in the direction from its surface layers to deeper until capillary bleeding. Carry out thorough phased hemostasis by anticoagulation. After radical excision of all necrotic, viable and soaked with pus tissue exercise cavity lavage 1-2 l of saline solution to clean the wash water. Remove arthroscopic. the cutter. Under the control of the arthroscope set in the cavity perforated PVC drainage pipe with a diameter of 4.5 mm with removing the ends of the tube through an irrigation cannula and the wound channel cutter. The ends of the tube is fixed to the skin of the individual seams. The arthroscope remove the skin and put the hub seam. In the postoperative period actively aspiration of wound exudate using a closed system VA is wannago drainage laboratory control over the course of the wound process. The indication for removal of drainage are sterile inoculation wound and clinical criteria that indicate favorable during the inflammatory process. Skin wounds heal by first intention.

The claimed invention is aimed at reducing the traumatic impact when conducting primary surgical treatment, microbial contamination of the wound, with the exception of stage necrectomy and dressings, bacterial contamination of the environment and secondary infection of the wounds; to obtain a good cosmetic and functional results; increased reliability of operation and cure the patient.

1. A method of treating soft tissue abscesses, including access to home purulent inflammation by type cut-puncture, evacuation of pus, a revision of the cavity, removal of tissue sequestration, cavity lavage fluids and drainage of the cavity, characterized in that the purulent cavity by the dotted line with a blunt trocar obturator through the skin incision is made outside the boundaries of the abscess, the length equal to the diameter of the arthroscope, enter the arthroscope, fill the cavity with saline, under the control of the arthroscope carry out an audit of a purulent cavity, install irrigation cannula create permanent aquatic environment, evaluate the prevalence of purulent process, through another dermal tissue is the first incision arthroscopic enter the cutter on the handle of the shaver most remove the cutter nonviable tissue with a phased hemostasis by anticoagulation, carry out reorganization of the cavity to clean wash water, under the control of the arthroscope set in the cavity perforated drainage tube, while the output ends of the tube through the puncture outside of the cavity and sew it to the skin, are actively aspiration of wound exudate using a closed system vacuum drainage in the postoperative period, remove the drain when cleaning from the microflora of the wound and put a single seams.

2. The method according to claim 1, characterized in that the skin incision is made with a length of 5 mm.

3. The method according to claim 1 or 2, characterized in that the skin incision is made at the 9 or 3 hours on the dial.



 

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