Method for suturing in laparotomic wound

FIELD: medicine.

SUBSTANCE: the present innovation deals with ways to suture post-operational wounds of anterior abdominal wall: one should suture in aponeurosis with uninterrupted suture by capturing patient's peritoneum, then one should suture in subcutaneous-fatty fiber and skin with separate sutures, perform the first puncture in - puncture out from the top downwards through aponeurosis, a muscle and peritoneum leaving 5 mm against the first edge of the wound, then comes the second puncture in puncture out from the bottom upwards through peritoneum, a muscle and aponeurosis by capturing both anterior and posterior leaves of sheath of rectus muscle of abdomen followed by the third puncture in - puncture out at the side of the second puncture in - puncture out in direction being similar to the first one, at the distance of 15 mm against wound's edge. Such manipulations as punctures in - punctures out should be carried out till complete wound closing. Moreover, by making uninterrupted suture with inclined ligature at anterior surface of muscular-aponeurotic layer of the wound it is possible to achieve better adaptation of wound edges, steady tension of tissue that enables to obtain hermetic and strong suture for more anatomical tissue adjustment of anterior abdominal wall.

EFFECT: higher efficiency in preventing wound complications.

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The invention relates to medicine, in particular to surgery, to a method of suturing postoperative wounds of the anterior abdominal wall.

Currently, the main methods of treatment of postoperative wounds of the anterior abdominal wall are methods of wound closure after recovery by imposing different types of nodal and continuous seams.

There are different methods of suturing aponeurosis: a hub, mattress, U -, U-bolts, front and rear U-shaped, one - and two-row, depreciation, seams of Girard-sica with the creation of duplicatory aponeurosis, continuous - furrier, mattress (Kochnev O.S, Izmailov YEAR, the Monograph "Methods of suturing wounds." Publishing house of Kazan state University, 1992) [1].

For prevention of postoperative eventrate and hernias white line of the abdomen, many surgeons prefer a simple hub seam, which is simple in technique, better maps edge of the aponeurosis and allows to measure the degree of force tightening the knot. At high risk of developing eventrate used method of suturing the median laparotomic wound on Smead - Jones, consisting in wound closure single deep seam to grip the edges of the fascia (abstract CMN Peter Mathebula Iberian Oreiro Prediction and prevention of eventrate after abdominal operations, Moscow, 1990) [2].

Order p is opractice of eventrate after laparotomy for wound closure is applied through a deep seam through all layers with the mandatory seizure of the front and rear sheets of the vagina of the rectus abdominis muscle for a strong consolidation edges stitched aponeurosis with a wide area of tissue contact (Valenko AV, Titova, G.P., White SR Materials 11 international conference. Moscow, 1995, str-312) [3].

Known layer-by-layer suturing laparotomic wound, through which the peritoneum is sutured separately (catgut), aponeurosis and skin separately (Professor Telkom N.A., Telkov E.N. On the prevention of postoperative eventrate // journal of surgery. 1985, No. 11, p.46-49) [4].

Bodrov A.A. has developed a method of suturing median laparotomic wound overlay intermittent blanket stitch. This method, as well as certain types of continuous (uninterrupted) seam to reduce the trauma for stapling tissue, increase the reliability of their connection and thereby reduce the risk of wound complications (abstract CMN Bodrov A.A. improvement of the technologies of postoperative wounds suturing of the anterior abdominal wall. Nizhny Novgorod, 2001) [5].

For the suturing of the aponeurosis of the presently preferred continuous seam (non-pulling hernioplasty/Under the General editorship Egawa NR. The honey. practice. Moscow, 2002) [6].

For comparative analysis with the claimed invention, the used method of suturing wounds continuous removable monofilament (BSM) seam [1, p.85].

The seam is performed as follows. To perform this method is used monofilament the nylon thread with a diameter of 0.4 mm. To achieve the tightness of the wound on the peritoneum and muscle impose BSM-seam, starting from the inner corner of the wound. Ukoli-vicoli needle with a ligature doing against each other in relation to the edges of the wound in the form of a U-shaped continuous seam. The edges of the aponeurosis of the external oblique muscles by using a double strand link BSM-seam imposed in such a way that the tensioning of the strands of one edge of the aponeurosis lies on the other in the form of duplicatory.

On the subcutaneous fat impose BSM-seams, making symmetric ukoli-vicoli needle with a ligature. The point of nearest needle on one side must be positioned accurately against the points of withdrawal of the needle on the opposite side. The skin connect intradermal BSM-seam.

Known seam has drawbacks: this seam should not be applied on the median laparotomic wound, increased operative time, there is no accurate anatomical mapping of the tissues of the anterior abdominal wall.

Adverse these factors are the cause of purulent complications and eventrate, and subsequently incisional hernias.

The technical result of the claimed method is a good adaptation of the wound edges, uniform tension of the fabrics, the opportunity to achieve a more anatomical mapping of the tissues of the anterior abdominal wall, getting more tight and durable joint, which then prevents wound complications (eventualy, festering wounds).

The technical result is achieved in that in a method of suturing laparotomic wound, in which the wound edges of the aponeurosis is sutured with a continuous suture with the capture of the peritoneum and the subsequent closure of the subcutaneous fat and skin separate seams, it is new that the first WCOL-Vical spend down through the aponeurosis, muscle and peritoneum, some distance from the first edge of the wound for 5 mm, then spend the second WCOL-Vical from the bottom up through the peritoneum, muscle and aponeurosis capture front and rear sheets of the vagina of the rectus abdominis muscle, produce the third WCOL-Vical on the side of the second skola-Mykola in the direction like the first at a distance of 15 mm from the second edge of the wound, such manipulations as Ukolov-indentation depth, as per to perform final closure of the wound, forming a continuous seam with a sloped holding ligatures on the front surface of musculoaponeurotic layer wound.

The invention is illustrated in figure 1 - 3.

Here: 1 - ligature (thread); 2 - the first side of the wound (the first region); 3 - the second side of the wound (the second region); 4 - skin; 5 - subcutaneous fat first side of the wound; 6 - aponeurosis; 7 - muscle; 8 - peritoneum; 9 - abdominal wall; 10 - place first skola-Mykola needle with a ligature; 11 - place the second skola-Mykola needle with a ligature; 12 - place third skola-Mykola needle with a ligature; 13 - place of the fourth vcol-Mykola needle with a ligature; 14 - the fifth skola-Mykola needle with a ligature; 15 - the first node.

The proposed method is carried out as follows. While holding the needle with the ligature 1 through 8 and peritoneum muscle-aponeurotic layers of the anterior abdominal wall 9 use continuous seam. First WCOL-Vical 10 needles with ligature 1 hold down through the aponeurosis 6, muscles 7 and peritoneum 8 of the anterior abdominal wall 9, some distance from the first edge 2 wounds for 5 mm, then the needle with the ligature 1 lead to the second edge 3 wounds, where the second WCOL-Vical 11 from the bottom up through the peritoneum 8, muscles 7 and the aponeurosis of the 6 anterior abdominal wall 9 with capture front and rear leaf sheaths straight abdominal muscles, then form the first node 15. The third WCOL-Vical 12 needles with ligature spend 1 side 3 of the second skola-Mykola 11 in the direction like the first skolu-Vicolo 10, but at a distance of 15 mm from the second edge 3 of the wound and the last skola-wikala. The fourth WCOL-Vical 13 is performed on the first side 2 wound up at a distance of 5 mm, the fifth WCOL-Vical 14 needles continuous ligature 1 on the side of the first region 2 wounds from the top down through the aponeurosis 6, muscles 7 and peritoneum 8, periodically pulling the thread 1. Such manipulations as Ukolov-indentation depth, as per and pull the thread to perform final closure of the wound. The final step is to tie the remaining end of the thread 1 in the bonds of the L. The subcutaneous fat 5 and the skin 4 is sutured anchor or cosmetic sutures.

The proposed method of suturing laparotomic wound showed the following significant advantages over the known prototype:

- achieved a good adaptation of the wound edges of the peritoneum and muscle-aponeurotic layers and fairly reliable fixing them by reducing the tension of the tissues between the stitches, which provides a favorable wound healing;

- the continuity of the seam provides a uniform tension of the tissues, without violating local blood flow;

- the continuity of the seam reduces the time of surgery, and reduces the voltage tissues;

this method makes it possible to achieve more accurate anatomical mapping of the tissues of the anterior abdominal wall;

- getting more tight and durable joint allows you to completely isolate from each other the abdominal cavity and subcutaneous adipose tissue, which is one of the important factors in the prevention of postoperative complications.

Thus, the claimed invention differs significantly from the prototype, it's just in technical execution, safe, a little traumatic, provides mapping of stitched fabrics and earlier formation gentle postoperative scar, reduces the time of surgery, eliminates the potential for relapse, which gives the right to take it in wide x the surgical practice along with traditional methods of treatment of surgical wounds.

A method of suturing laparotomic wound, in which the wound edges of the aponeurosis is sutured with a continuous suture with the capture of the peritoneum and the subsequent closure of the subcutaneous fat and skin separate seams, otlichayushiesya seeing the first WCOL-Vical down through the aponeurosis, muscle and peritoneum, some distance from the first edge of the wound for 5 mm, then spend the second WCOL-Vical from the bottom up through the peritoneum, muscle and aponeurosis capture front and rear sheets of the vagina of the rectus abdominis muscle, produce the third WCOL-Vical on the side of the second skola-Mykola in the direction like the first, at a distance of 15 mm from the second edge of the wound, such manipulations, as Ukolov-indentation depth, as per, to perform final closure of the wound, forming a continuous seam with a sloped holding ligatures on the front surface of musculoaponeurotic layer wound.



 

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