Method for suturing surgical wound at plastic operations upon female external genital organs

FIELD: medicine, plastic surgery.

SUBSTANCE: it is necessary to apply a blanket suture onto female genital organs at up to 4-5 mm distance between the stitches at capturing the tissue along the surface for the depth of about 1-2 mm and inside by applying any absorbable material. The innovation enables to avoid inflammatory and cicatricial tissue deformations and, also, increase cosmetic effect.

EFFECT: higher efficiency.

4 dwg, 2 ex

 

The invention relates to medicine and relates to methods of suturing the wound with plastic surgery on the vulva in women.

Known methods of suturing the wound with plastic surgery on the vulva in women, including separate knotted stitches, seam Donati, intradermal cosmetic seam, the seam on the Jester (1, 2, 3). The disadvantages of these methods are lengthening the time interval suture, a large amount of suture material, a significant trauma to the tissue area of surgical intervention.

The closest clinical effect (prototype) is a method of suturing the wound with plastic operations on external genitalia, including the use of intradermal cosmetic seam (4).

However, application of this method is associated with the occurrence of complications: the lengthening of the time interval suture, which, in turn, leads to a lengthening of the time of surgical intervention, a rather complicated method of suturing wounds, the impossibility of imposing such a seam all patients (e.g. patients with severe subcutaneous fat layer under the scar tissue deformation). Moreover it requires an expensive suture material, taking into account the requirements of this type of seam (thin atraumatic needle, with nationsa monofilament thread with a low degree allergies).

The problem solved by the invention, is to eliminate the disadvantages of the prototype, the reduction of side effects, which leads to more effective treatment and reduction of terms of stay of the patient on the bed.

The set task is solved by a new method of suturing the wound with plastic surgery on the vulva in women by suture, and impose a continuous blanket stitch with the distance between stitches to 4-5 mm, depth of capture tissue on the surface of the 1-2 and 1-2 mm inside using any absorbable suture material.

Continuous blanket stitch according to the literature is only used when suturing the internal organs and the aponeurosis. However, the possibility of applying blanket continuous suture for surgical interventions on the external genitals are not obvious to the expert.

These distinctive features is unknown in scientific medical and patent literature. Thus, the proposed method meets the criteria of the invention of "novelty."

Thus, the set of distinctive features is not obvious to a person skilled in the art. The proposed method meets the criterion of "inventive step".

The method is as follows. After appropriate preparation of the patient the treatment of the surgical field delineate the boundary of the proposed resection of tissue. Then have infiltration anesthesia solution "Septanest". After plastic surgery of the external genitalia in the area of surgery is superimposed continuous blanket stitch using any absorbable suture material. The distance between stitches to 4-5 mm, depth of capture of tissue on the surface 1-2 mm, inside 1-2 mm Suture crosses the border of the incision, embraced tissue (Fig.1-4).

Clinical trials of the method of suturing with plastic surgery on the vulva in women prove that a continuous blanket stitch can be successfully used in clinical gynecology, as a way adequate mapping of the edges of the wound surface, which allows the surgeon to operate without additional extension of time of the operation, and the patient not to experience painful sensations in the field of surgical intervention. Continuous blanket stitch is more versatile than the considered prototype, as it can be used with a larger number of cases. Contraindications to the use of this suture is not found, unlike cosmetic seam. Thus, the proposed method meets the criteria of the invention "industrially applicable".

Specific examples confirming the efficiency of the use of continuous blanket stitch.

1) Clinical example 1

Patient L., aged 26, was hospitalized in the Clinic of Plastic and Reconstructive Surgery" in Tomsk with 19.04.02, to 27.04.02, with a diagnosis of Trauma labia minora. Case history No. 63. 19.04.02, under local infiltration anesthesia solution "Septanest" transaction "Resection of small sexual lips on the right. Local tissue rearrangement". Progress: the skin of the perineum, double-processed alcoholic solution, the vaginal mucosa treated with an antiseptic solution with an exposure of 1 minute. Produced markup intended resection tissue right small sexual lips and lower third of the small sexual lips on the left. Produced infiltration anesthesia solution "Septanest". Then under visual control produced the actual resection of the upper part of the small sexual lips on the right, with simultaneous grafting of local tissues. Resection of the lower third of the small sexual lips on the left. Hemostasis by electrocautery. The imposition of blanket continuous suture on the skin of the labia minora thread "Vicryl" 5/0. Processing seam with an antiseptic solution. Cold in the crotch for 20 minutes.

During the inspection the next day: satisfactory condition; no complaints. The organs and systems without features. The temperature of 36.7°; BP - 110/70 mm Hg; pulse 72 beats per minute. Status genitalis: there is moderate on the EC of the labia minora. Seams wealthy processed.

Sutures were removed on day 7. Healing by primary intention. 10.06.02 the patient was discharged from hospital in satisfactory condition with recommendations (hygiene, sexual rest for 1 week).

2) Clinical example 2.

Patient S., 31, was hospitalized in the Clinic of Plastic and Reconstructive Surgery" in Tomsk with 05.02.01 B.C. 12.02.01, with a diagnosis of Inferiority of the pelvic floor muscles. The asymmetry of the labia minora. Systemic vasculitis. Case history No. 16. 06.02.01, under epidural anesthesia produced by operation of the Rear colpoperineorrhaphy. Resection of small sexual lips left. Progress: in aseptic conditions produced outlining the flap tissue. Blunt and partly sharp produced by separation of the flap. Suturing the vaginal mucosa continuous suture "PGA" 3/0 to mircovich papilla. The muscles of levatores imposed 2 submersible kathodavid seam. A continuous suture is continued until the rear spikes. The muscles of the urogenital diaphragm, overlay 2 submersible kathodavid seam. On the skin of the perineum imposed 3 the U-shaped kathodavid seam. Produced markup intended resection tissue small sexual lips on the left. Under visual control actually produced resection, starting with the upper inner edge of a small genital lips, gradually moving in the direction down. Hemostasis by electrocautery. Blanket continuous seam on the skin of the labia minora "PGA" 5/0. The seams are treated with a solution "Octenisept". Loose tampon in the vagina for 24 hours. Cold in the crotch.

Sutures were removed on day 7. Healing by primary intention. 12.02.01, the patient was discharged from hospital in satisfactory condition with recommendations.

It was first shown that the use of continuous blanket seam in plastic operations on external genitalia largely contributes to the effectiveness of surgical intervention, can achieve careful hemostasis, good matching of the edges of the wound. The use of a continuous blanket of weld plastic operations on external genitalia in women is characterized by a good cosmetic effect: not leads to anatomical changes of the tissues subjected to surgical intervention. Also proven no side effects when suturing the wound as described above.

The use of continuous blanket seam in plastic operations on external genitalia became possible only thanks received during the clinical trial results. To prove the effectiveness of our proposed method of suturing surgical wounds Prov is Deno examination and surgical treatment of 3 groups of women. The total number of surveyed amounted to 23 people.

The first group: it included 17 women with a diagnosis of Hypertrophy of the labia minora, which was conducted "operation Resection of the labia minora, with subsequent grafting".

The second group: it includes 3 women with a diagnosis of Asymmetry of the labia minora, which was conducted "operation Resection of the labia minora, with subsequent grafting".

The third group: it includes 3 women with a diagnosis of Trauma to the genital lips, which were conducted operation on Excision of the labia minora, with subsequent grafting".

Plastic labia minora was carried out under local anaesthetic solution "Septanest". When the preoperative preparation of patients of all groups were conducted preventive hygiene of the vagina for 3 days before surgery. Special preparation before surgery was not required. Early surgical intervention was carried out appropriate treatment of the surgical field. Operation on Excision of the labia minora, with subsequent grafting" starts at the intended resection of tissue. Then infiltration anesthesia solution "Septanest" starting from the bottom inner edge of the small sexual lips. After 1 minute after the start of anesthesia you can start the actual operation Resection of the labia minora, with subsequent grafting" under VI the property control. After surgery, the wound was usuals continuous blanket stitch according to the proposed method.

The study made it possible to identify sufficient efficiency blanket continuous suture with plastic operations on external genitalia. The absence of inflammation and scarring in the weld area, the ease and simplicity of its imposition, the minimum quantity of suture material and the reduction of hospital stay can be associated with improved operating technique due to the introduction of continuous blanket stitch.

Justification mode. Mode use continuous blanket seam based on clinical observations for the period from 2000 to 2004 in the gynecological clinic of the Siberian medical University and the Clinic of Plastic and Reconstructive Surgery" in Tomsk. After the main stage of plastic surgery on the genitals of the wound edges are processed by the standard method and is performed mapping and continuous suturing of blanket stitch. First vcol needle is at the upper pole of the wound. After fixing thread node is superimposed continuous blanket stitch all over the wound. The distance between stitches to 4-5 mm, depth of capture of tissue on the surface 1-2 mm, inside 1-2 mm. these parameters allow EF the objective to approximate the wound edges, reaching good hemostasis and subsequent healing.

Thus, the obtained results allow to conclude about the effectiveness of continuous blanket seam when performing plastic surgery on the vulva.

Thus, the use of the proposed method in clinical practice for the suturing of the wound surface when performing plastic surgery on the vulva has allowed to achieve through the use of continuous blanket seam according to the proposed method, namely reducing the side effects (inflammatory and scar tissue deformation and increase the effectiveness of treatment.

References

1. Davydov, S., Khromov B.N., Sheiko old Testament Atlas of gynecological surgery. - L.: Medicine, 1982. - 296 S.

2. Rambus I.N. Operative gynecology. - Kiev.: Zdorovi I, 1966. - 288 S.

3. Semenov G.M., Petryshyn V.L., Kovshova was M.V. Surgical suture. - St. Petersburg: Piter, 2001. - 256 S.

4. Serebrov A.I. Operational oncogynecology. - L.: Medicine, 1965. - 224 S.

5. Hirsch HA, Kezer, O., Icle FA Operative gynecology: Atlas: TRANS. from English./ Ed. by V.I. Kulakov, Yevpatoria. - M.: GEOTAR MEDICINE, 1999. - 656 C.

Method of suturing the wound with plastic surgery on the vulva in women by suture, characterized in that impose blanket shows distance between stitches to 4-5 mm with grip fabric on the surface to a depth of 1-2 and inward using any absorbable suture material.



 

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