Detachable lamellar sutures

FIELD: medicine, surgery.

SUBSTANCE: one should apply a suture onto a wound after surgical treatment, then one should lift cutaneous part of both loops to apply a loop-containing clip into it. Another clip should be put in from another side of the loop due to introducing it into the loop of the first clip, as well. One should, moreover, put in clip's stems into the loops of each other. Then it is necessary to separate clip's stems by increasing the degree of adaptation in wound's edges. The innovation enables to improve the results of therapy in patients after surgical treatment of wounds.

EFFECT: higher efficiency.

5 dwg, 1 ex

 

When surgical treatment (especially secondary) wounds after imposing seams often in subsequent stitches sink into the skin, plunging below the surface and continued to keep in contact with the wound edges. This is because tension when tightening the divergent edges of the wound, and the development of inflammation, often associated with healing. So, in almost all cases, the stitches on the festering wound is made in conditions of inflammatory changes its edges, walls and perifocal tissue, expressed in varying degrees depending on the lifetime of the wound. Therefore, to prevent the eruption and dehiscence are commonly used plate seams (figure 1). However, during the operation is not always possible to accurately predict the course of the wound process in the future, and thus to establish a clear testimony to the overlay plate seams. The latter impose in the process of suturing wounds and relieve too, along with the removal of stitches. The overlay is associated with increased operative time and some discomfort in the postoperative period to which it relates accumulation under them wound, the emergence of MAZERATI on the skin, etc. It usually stops surgeon from the use of plate welds without serious grounds, and when these appear on the first - the inflammation around the existing joints limit the possibility of their replacement plate seams.

As a prototype we have taken the plate seams in the form of a rubber tube of the shock absorbers described in the monograph "Wounds and wound infection" edited Migasena (1981), the essence of which consists in the following. After debridement impose normal joints (nodal or mattress), before tying them between the skin and the loop (loops) seam as shock absorbers set of rubber tubing (figure 2). Thus the value and square last inversely correlated with the magnitude of the pressure of the seam on the skin, preventing the possibility of its eruption. Thus, the use of the prototype serves as a prevention of the eruption and dehiscence. However, along with this, the prototype has several drawbacks, which include the following:

1) the Ability to overlay only in the process of suturing wounds, i.e. most often with the preventive purpose.

2) No possibility of removing or replaced without removal of the stitches on the wound.

3) No possibility of regulating the degree of tension of the weld and mutual adaptation of the wound edges.

4) the Possibility of accumulation under them wound that leads to the development of MAZERATI on the skin or secondary infection of the wound.

For exception verojatno the above complications and ensure a favorable course of wound healing in the postoperative period, available plate seams, the essence and the mapping method which consist in the following. After excision of the wound edges impose vertical mattress sutures (stitches on the Donati). The preference for vertical mattress suture in front of the hub due to the possibility of closing wounds without leaving kathodavid joints, the presence of which in the tissues tighten healing, and often is a cause of aseptic or septic inflammation. Vertical mattress suture brings not only a skin wound edges, but globeasia tissue (figure 3). Then impose a removable plate seams. The latter consists of two detachable brackets (figure 4,a), made of wire osteosynthesis or improvised material (for example stainless paperclips). Nackoney part of both loops of the seam by Donati raise needle or tweezers and put the bracket (figure 4,b). On the other hand hinge seam, put the other bracket, the insertion in the loop of the first brackets (figure 4)than the plate and create a seam. The larger the area, the correspondingly less pressure on the skin. This is regulated by the length of the brackets and the diameter of its hinges. The proposed plate joints also allow you to adjust the tension of the suture by Donati, if necessary, increasing the degree of adaptation of the wound edges breeding both legs of brackets. This increase in the skin portion of the hinge seam along Donati and accordingly, reduce body part with the attraction to each other and mutual adaptation of the wound edges (figure 5). Due to its lattice structure of the proposed plate seams do not prevent the outflow of wound and are not accompanied by maceration of the skin under them.

Thus, the proposed plate joints have the following advantages over traditional:

1) the Possibility of applying and removing them as needed, and not only as a form of prevention.

2) Noninvasive overlay (if available double-row suture).

3) the Release and replacement, if necessary, to a more suitable size and shape.

4) the Ability to control the degree of mutual adaptation edges of the wound, the tension of the vertical mattress suture by breeding the legs of the brackets.

5) Lack of probability of accumulation of wound under the apron seams due to their lattice structure.

As an example of clinical application of the invention here is the following observation.

Patient H., 26, enrolled in a planned manner in the trauma Department of ROTC (Republican of orthopedic and trauma center) 18.04.00, with a diagnosis of non-Union fire comminuted fracture of the seventh and eighth ribs on the left with the soft tissue defect of the left half of the thorax.

From ANAMA is: 23.03.00, in ggutierrez received tangent shrapnel and bullet wound in the left half of the chest with a comminuted fracture of the seventh and eighth ribs and soft tissue defect. Was treated in CRH glucerna (bandages, antibiotic therapy, means the total stimulation, symptomatic treatment, which is translated in ROTC (Makhachkala).

Local status: in the left half of the chest has a cross-wound size of 7.0 2.5 1.5 cm, the bottom of which are the muscles with the outcrop areas, growing together comminuted fracture of the eighth rib. The wound is covered with bright red granulation, moderate bleeding at dressing. There are signs of incipient epithelialization of the wound.

19.04.00 were operation: secondary debridement, mobilization of its edges and the imposition of a double row of vertical seams (seams on Donati) on the wound. Last managed to close mobilization and moderate tension of its edges. However, after 2-3 days due to the effects of reactive inflammation around the wounds had a tendency to dive under the skin and dehiscence. So while bandaging 21.04.00, produced overlay removable plate joints, consisting of a detachable wire brackets, as follows. Injection needle alternately raised seam loops Donati, in which both sides were putting brackets split seam, devenyi in which etli each other. This technique has been restored tension double row of vertical joints, and to improve mutual adaptation wound edges of the leg wire brackets were dosed divorced.

The wound healed primarily. Sutures were removed on the 9th day. The patient was discharged with recovery. The result of treatment is regarded as good.

Thus, the proposed plate seams are better in comparison with the prototype, which allows to improve the results of treatment of patients after surgical treatment of wounds.

Way to suture the wound after surgical treatment, including the imposition of vertical mattress sutures, wherein the cutaneous part of both loops superimposed seam raise and put her in a brace containing a loop on the other side of the loop, put the other bracket by typing it in the loop of the first brackets, with feet brackets devuda in loops each other, the legs of the brackets are bred, increasing the degree of adaptation of the wound edges.



 

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FIELD: medicine, surgery.

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2 dwg, 2 ex

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FIELD: medicine, surgery.

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1 cl, 1 dwg

FIELD: medicine.

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1 cl, 3 dwg, 2 ex, 1 tbl

FIELD: medicine, surgery.

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2 dwg, 1 ex

FIELD: medicine, surgery.

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FIELD: medicine; medical engineering.

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23 cl, 8 dwg

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4 dwg

FIELD: medicine, surgery.

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7 dwg

FIELD: medicine, abdominal surgery.

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FIELD: medical engineering.

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