Method for suturing in post-operational wound after laparotomy

FIELD: medicine, surgery.

SUBSTANCE: one should apply a single-row uninterrupted suture upon skin and subcutaneous fiber, fix ligature in subcutaneous fiber in one of the wound's corners, apply a subcutaneous-intracutaneous suture up to the wound's opposite corner, form a knot in subcutaneous fiber with the help of terminal ligature of aponeurosis suture. The method enables to prevent purulent complications and provide the development of valuable cicatrix.

EFFECT: higher efficiency of suturing in post-operational wound.

1 dwg, 2 ex

 

The invention relates to medicine, operative obstetrics and gynecology, and can be used for the suturing of skin and subcutaneous tissue of the anterior abdominal wall, especially when repeated median-lower laparotomy for the elimination of diastasis between the edges of the wound.

The known method is the prototype of the suturing of skin and subcutaneous tissue, which allows you to compare the wound edges even when a large diastasis: vertical mattress suture on Donatti (VNIIEF, Vmenu, Oiaduul. "Surgical incision". M., 2001, p.51-52). Thus vcol doing at a distance of 2 cm from the edge of the wound, the needle promote as far as possible to capture the bottom of the wound. Vicol produce on the opposite side is also at a distance of 2 cm parallel to ucolo. When holding the needle in the opposite direction vCal and Vicol are at a distance of 0.2-0.3 cm from the edges of the wound so that the thread passed in the layer of the leather itself. The imposition of this seam avoids the formation of residual cavity in the depth of the wound.

However, the presence of discrete seams on the skin promotes the formation of shear bands, which are located along the entire length of the scar, and scars in places Ukolov; at a distance of 2-3 mm from the edges of the wound. In addition, the node is the weakest area of the surgical suture, and reliability of the highest requirements. When you remove the hub seam along which onetti need to pull the end of the thread before until you find the area of the white color (2-3 mm long), located in the thickness of the dermis and subcutaneous tissue, after which the thread intersects with a scalpel. Pull the thread you up and in the direction of the scar, because the other direction may result in divergence of the associated edges of the wound that is traumatic.

The invention is aimed at solving problems: increasing the efficiency of the method, the prevention of suppurative complications, improved cosmetic effect.

Implementation of the tasks is achieved by applying to the skin and subcutaneous tissue of the new continuous single subcutaneous intradermal suture. This type of single-row suture used for the suturing of surgical wounds after laparotomy for the first time.

The method shown in the drawing, which shows a single continuous subcutaneous intradermal suture: 1 - sutured wound, 2 - edge nausithoe wounds, 3 - dermis, 4 - subcutaneous fatty tissue, 5 - bottom of the wound (the aponeurosis), 6 - string, 7 - left thread with aponeurosis.

The method is as follows. After the suturing of the aponeurosis and the formation of the node of the last individual weld one end of the threads cut off, another leave for the subsequent fixing subcutaneous intradermal suture. Synthetic absorbable thread (for example, Polisorb) with atraumatic needle is fixed in the subcutaneous tissue in one of the corners of the wound (n is an example, the top). Then the needle capture the subcutaneous tissue and the skin on the one (right or left) hand and the needle thread take intradermally. Next, the needle is injected directly opposite and consistently carried through the intradermal and subcutaneous layers Mykola over the aponeurosis. Then the procedure is repeated: WCOL and capture an entire layer of subcutaneous tissue on the right with Vicolo intracutaneous, intradermal vcol left with capture entire layer of subcutaneous fat and out over the aponeurosis. Suturing produce to the opposite corner of the wound using to build a node in the subcutaneous tissue left filum terminale last seam of the aponeurosis. When suturing aponeurosis continuous suture after the suturing and the formation of the site for fixing subcutaneous intradermal suture also use one of the left end of the threads.

Examples of specific performance.

Example 1

Patient X., 36 years old, hospitalized in the Perm design Bureau, Department of pathology of pregnant women with the diagnosis of Pregnancy 37 weeks. The TAA. The uterine scar after cesarean section. Chronic pyelonephritis (active phase). Vesical-vaginal fistula. Hydronephrosis II Art. both kidneys", two years before this pregnancy was operated on for a ruptured bowel after road trauma. On the anterior abdominal wall has a scar after a median-min is th laparotomy 2 cm wide, with transverse stripes, based on the length of the seam. After treatment in the period of 39 weeks completed mid-lower laparotomy with excision of the old skin scars, cesarean section at the lower end with sterilization. Anterior abdominal wall is sutured in layers, with the imposition of a single continuous subcutaneous intradermal suture the Polisorb. The postoperative period was without complications. Healing of the suture by first intention. Discharged in a satisfactory condition for 8 days.

Example 2.

Patient A., aged 32, arrived in Perm design Bureau in the Department of pathology of pregnant women with the diagnosis of Pregnancy 36 weeks. Insolvent uterine scar after 2 cesareans. NEF. Chronic intrauterine hypoxia. Disorder of fat metabolism II. If previous caesarean section was performed Nizhneserginsky laparotomy. On the skin of the anterior abdominal wall scar on the middle line width 1.8 cm, with transverse stripes along the hem in place Ukolov - white scar tissue in diameter 2-3 mm At 38 weeks performed a caesarean section with excision of the old skin of the scar and sterilization about pain syndrome due to the inadequacy of the seam on the uterus. Anterior abdominal wall is sutured in layers, with the imposition of a single continuous subcutaneous intradermal suture the Polisorb. The postoperative period was without complications. Healing of the suture by first intention. Was discharged in good condition on the 9th day.

Thus, the method of suturing surgical wound using subcutaneous intradermal suture, especially when repeated median-lower laparotomy allows for physiological mapping of stitched fabrics with the formation of a full rumen, contributes to the prevention of suppurative complications, provides economic savings suture material) and good cosmetic effects.

A method of suturing surgical wound after laparotomy which includes applying to the skin and subcutaneous tissue single continuous suture, wherein the fixed thread in the subcutaneous tissue in one of the corners of the wound, impose subcutaneous intradermal suture to the opposite corner of the wound, forming a node in the subcutaneous tissue with the end of the thread of the seam aponeurosis.



 

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