Device for inguinal hernia repair

FIELD: medicine.

SUBSTANCE: device for inguinal hernia repair in the form of synthetic mesh prosthesis with formed branches has a removable frame attached thereto to make it flat. The frame shape and size after having been attached to the synthetic mesh prosthesis enable leaving edges of the latter free to keep a width required to fix the synthetic mesh prosthesis to the body organs, including along the section line forming the branches. The removable frame of the synthetic mesh prosthesis pores of which are elastically extensible and contractible; it is trident-shaped and made of a metal wire of specific thickness depending on pore size of the synthetic mesh prosthesis; the removable frame is fixed to the synthetic mesh prosthesis with delivering the dent ends more than once through the synthetic mesh prosthesis in parallel with long edges of the latter toward its branches. Each frame dent has a rounded thickening at the end.

EFFECT: device simplifies the fixation procedure in tissues of the synthetic mesh prosthesis when repairing the inguinal hernia.

2 cl, 2 dwg

 

The invention relates to the field of medicine (medical equipment, namely to surgical devices, and is designed to enhance the convenience and reliability of plastics for inguinal hernias.

In recent years, the most common surgical treatment of inguinal and other hernias of the anterior abdominal wall got ways of using alloplastic synthetic mesh prosthesis. The main advantage of the above methods is to reduce the number of relapses. The most commonly used polypropylene mesh. This group of retrieved from polypropylene monofilament sutures. The mesh is held in a fixed position strengthens the surface and serve as a scaffold for ingrowth of connective tissue. They do not undergo hydrolysis and biodegradation, do not lose durability. Calling weakly pronounced inflammatory response, the material promotes the formation of connective tissue, which germinate in the grid cells almost engage in thickness formed of a scar. Solidity and hydrophobic monofilament grids provide resistance to infection (Povarikhina O. A. Synthetic explants in abdominal surgery // Pharmindex-Practices - 2005. - No. 8. - P. 32-35).

The most common inguinal hernia repair received method I. L. Lichtenstein, who belongs to the group h�stretch endoskopicheskih plastic. The method involves performing the traditional front of the inguinal access to the inguinal canal and the plasticity of its rear wall polypropylene mesh. After opening the inguinal canal secrete the inguinal ligament, spermatic cord, allocate and process the hernial SAC. Polypropylene mesh model in the form of the inguinal canal and fixed with a continuous suture to inguinal ligament to the internal inguinal ring. Individual sutures non-absorbable mesh material is fixed to the internal oblique muscle. The lateral edge of the mesh is dissected into 2 parts: 1/3 below and 2/3 above the spermatic cord. Upper jaws is captured, extends over the spermatic cord and separate sutures fixed to the inguinal ligament (Chizhov D. V., Shurygin S. N., Resurrection P. K., Philodina N. In. Plasty of the inguinal canal for Liechtenstein and its modifications. - Herniology, 2004, No. 1, pp. 43-51). The aponeurosis of the external oblique muscle in the surgery of Liechtenstein sew edge to edge with no tension.

The use of polypropylene mesh for inguinal hernioplasty allows you to securely strengthen the posterior wall of the inguinal canal. The author of the method on a large material shows excellent results - 0.2% recurrence with minimal wound complications. The technical simplicity of the method makes it accessible to a wide range of surgeons. The Lichtenstein technique is currently BP�me, probably one of the most common ways plasty of the inguinal canal.

However, the prosthesis in the form of a polypropylene mesh has a number of drawbacks. It should be noted that when using this prosthesis I play it with his fixation to tissues. The mesh prosthesis, being soft, in the wound takes shapeless nature and constantly have to stretch in order to prifessional in position. To mesh properly to sew to anatomic structures, additional efforts are needed. This is most apparent in patients with large body mass. The ideal option would be to save the flat form of a mesh prosthesis.

One of the solutions to the problem - increase the stiffness of the prosthesis. Such prostheses are used in the plastic on the Trabucco. The method involves performing anterior to the inguinal canal and the plasticity of its rear wall without rigid fixation of the polypropylene mesh with shape memory to flat position (Ermanno Trabucco. Atlas of herniology. Turin, 2006, p.44; satin. "Hernia repair without tension on the methodology Trabucco hernia inguinal and ventral". Ermanno Trabucco, Peter Witkowski. Published in Russia. "Endscan". Exclusive representative in Russia of the Italian company "Herniamesh S. R. L.").

The method of hernioplasty allows you to securely reinforce the backside�Yuyu wall of the inguinal canal tissues without tension. The rate of relapse by this method is less than 0.2%. A significant positive factor of plasticity is that it does not require fixation of the mesh to the tissues, which reduces the interference and eliminate the capture in the joints of the nerves of the groin area. Hard mesh prostheses are not subject to the wrinkling effect in the postoperative period, and thus the offset for the area of the hernial defect.

However, the use of a rigid grid set forth in the method has its drawbacks. Rigid polypropylene mesh prostheses cause considerable discomfort and foreign body sensation in the area of operation in the late period after surgery due to the rigid structure.

The closest analogue to the claimed invention is the device described in the application U.S. No. 2006064175. This device for plastic surgery for inguinal hernia is made in the form of synthetic mesh prosthesis formed with jaws and attached to the frame. The frame has a shape and dimensions, which, after its attachment to the synthetic mesh prosthesis allows you to leave the edges of the latter, including along the cut line to form the jaws, needed, free, to for fixing synthetic mesh prosthesis to the tissues of the body width. This known device allows to provide a flat shape of the prosthesis in the wound that �blogchat the procedure of fixation to tissues.

In addition to the advantages specified device has a negative side. First of all, it's non-removable nature of the frame, which increases the consumption of materials of construction.

Other the closest analogue to the claimed invention is known to the device (application USA US2009270999 A1 (29.10.2009, [0027], Fig. 1-7), which includes a removable frame element for attachment to the prosthesis. It is implied by the completion of the fixation of the synthetic mesh prosthesis in the tissue to detach the frame and remove from the area of operation in order not to increase the consumption of the device in the postoperative period.

In addition to the advantages specified device has a negative side. First of all it is understood that the frame is made of metal with shape memory. This complicates the design. More complex is the removal of the carcass from the area of surgical operation. In addition, the attachment element of the frame-frame to a mesh prosthesis is the thread, and method of attachment - the formation of stitches. To unpin a frame, that is, removal of yarn from the wound, with a complex configuration, it takes time.

The objective of the claimed technical solution is the development of effective devices for plastic surgery for inguinal hernias, including synthetic mesh prosthesis, which gives the latter a flat shape � the wound, and it is not necessary to increase the intensity and rigidity of the synthetic mesh prosthesis in the postoperative period.

The technical result of the proposed device is to increase the effectiveness of surgical treatment for inguinal hernias by:

- perform device in the form of synthetic mesh prosthesis formed with jaws and attached to it to give it a flat shape in the wound with a removable frame having a shape and dimensions, which, after its attachment to the synthetic mesh prosthesis allows you to leave the edges of the latter, including along the cut line to form the jaws, needed, free, to for fixing synthetic mesh prosthesis to the tissues of the body width;

- perform device so that the removable frame of the synthetic mesh prosthesis, the pores of which have properties of elastic stretch and contraction in the shape of a Trident from a metal wire of a certain thickness depending on the pore size of the synthetic mesh prosthesis;

- perform device so that the removable frame is fixed to the synthetic mesh prosthesis repeatedly swiping the ends of the teeth through synthetic mesh prosthesis parallel to the long edges of the latter in the direction of his jaws;

- perform device so that the removable to�RCAS synthetic mesh prosthesis, pores which have properties of elastic stretch and contraction in the shape of a Trident from a metal wire of a certain thickness depending on the pore size of the synthetic mesh prosthesis, wherein each tooth has at one end a rounded thickening, the removable frame is fixed to the synthetic mesh prosthesis repeatedly swiping the ends of the teeth through synthetic mesh prosthesis parallel to the long edges of the latter in the direction of his jaws.

The technical result is achieved in that the device for plastic surgery for inguinal hernias in the form of synthetic mesh prosthesis formed with jaws and attached to it to give it a flat shape in the wound with a removable frame having a shape and dimensions, which, after its attachment to the synthetic mesh prosthesis allows you to leave the edges of the latter, including along the cut line to form the jaws, needed, free, to for fixing synthetic mesh prosthesis to the tissues of the body width.

The difference lies in that the removable frame of the synthetic mesh prosthesis, the pores of which have properties of elastic stretch and contraction in the shape of a Trident from a metal wire of a certain thickness depending on the pore size of the synthetic mesh prosthesis.

Honors� device is the removable frame is fixed to the synthetic mesh prosthesis repeatedly swiping the ends of his teeth through synthetic mesh prosthesis parallel to the long edges of the latter in the direction of his jaws.

The device should include the fact that the removable frame of the synthetic mesh prosthesis, the pores of which have properties of elastic stretch and contraction in the shape of a Trident from a metal wire of a certain thickness depending on the pore size of the synthetic mesh prosthesis, wherein each tooth has at one end a rounded thickening, the removable frame is fixed to the synthetic mesh prosthesis repeatedly swiping the ends of the teeth through synthetic mesh prosthesis parallel to the long edges of the latter in the direction of his jaws.

Comparative analysis of the claimed device and the prototype shows that the claimed device differs from the known above-mentioned features. These differences allow to draw a conclusion about conformity of the proposed technical solution the criteria of the invention of "novelty."

From the analysis of patent and literature the authors found that the proposed technical solution has features that distinguish it not only from the prototype, but also on other technical solutions in this field of medical technology. Us not �adeno devices for plastic surgery for inguinal hernias, contains distinctive features of the proposed device.

The proposed device for plastic surgery for inguinal hernias includes synthetic mesh prosthesis formed with jaws and attached to it to give it a flat shape in the wound removable frame having a shape and dimensions, which, after its attachment to the synthetic mesh prosthesis allows you to leave the edges of the latter, including along the cut line to form the jaws, needed, free, to for fixing synthetic mesh prosthesis to the tissues of the body width. With the removable frame of the synthetic mesh prosthesis, the pores of which have properties of elastic stretch and contraction in the shape of a Trident from a metal wire of a certain thickness depending on the pore size of the synthetic mesh prosthesis. Said form frame for the synthetic mesh prosthesis allows you to give the most stable form in the wound. Material in the form of a metal wire is in this situation optimal. Wire thickness is determined by the pore size of nets, and netting. The removable frame is fixed to the synthetic mesh prosthesis repeatedly swiping the ends of the teeth through synthetic mesh prosthesis parallel to the long edges of the latter in the direction of his jaws. In the d�nom case, the attachment frame is carried out by means of the teeth of the frame without the need for separate devices. Frame this construction is well fulfills its function and is easily removed from the mesh of the prosthesis.

Removable frame synthetic mesh, the pores of which have properties of elastic stretch and contraction in the shape of a Trident from a metal wire of a certain thickness depending on the pore size of the synthetic mesh prosthesis, wherein each tooth has at one end a rounded thickening, the removable frame is fixed to the synthetic mesh prosthesis repeatedly swiping the ends of the teeth through synthetic mesh prosthesis parallel to the long edges of the latter in the direction of his jaws. Said form frame for the synthetic mesh prosthesis allows you to give the device the most compact form. In this case, the attachment frame is carried out by means of teeth of the armature. Rounded thickenings at the ends of the teeth of the armature in the form of a Trident contribute additional fixing of the frame in the fabric mesh of the prosthesis.

All the features of the independent claim of the claimed device are essential, as they are necessary to achieve the specified technical result.

Symptom: - "Device for plastic surgery for inguinal hernias in the form of synthetic mesh prosthesis formed with jaws" is known and determines the material for protasio�ing for inguinal hernias and shape of the cutting of the mesh prosthesis.

Symptom: - "the Device includes a synthetic mesh attached to the prosthesis to give it a flat shape in the wound removable frame is known and determines the structure, which gives a flat shape synthetic mesh prosthesis during fixation in the wound, wherein the frame is removable in nature and after performing its function is removed.

Symptom: - "the Removable frame has a shape and dimensions, which, after its attachment to the synthetic mesh prosthesis allows you to leave the edges of the latter, including along the cut line to form the jaws, needed, free, to for fixing synthetic mesh prosthesis to the tissues of the body width is known and determines the shape and size of the removable frame of the synthetic mesh prosthesis.

Symptom: - "the Removable frame of the synthetic mesh prosthesis, the pores of which have properties of elastic stretch and contraction in the shape of a Trident from a metal wire of a certain thickness depending on the pore size of the synthetic mesh prosthesis" - is new and defines the shape of the frame for the synthetic mesh prosthesis in the form of a Trident, as well as the material from which it is made.

Symptom: - "the Removable frame is fixed to the synthetic mesh prosthesis repeatedly swiping the ends of teeth Squaw�ü synthetic mesh prosthesis parallel to the long edges of the latter in the direction of his jaws - is new and defines the nature of the removable fixing of the frame to the synthetic mesh prosthesis.

Symptom: - "the Removable frame of the synthetic mesh prosthesis, the pores of which have properties of elastic stretch and contraction in the shape of a Trident from a metal wire of a certain thickness depending on the pore size of the synthetic mesh prosthesis, wherein each tooth has at one end a rounded thickening, the removable frame is fixed to the synthetic mesh prosthesis repeatedly swiping the ends of the teeth through synthetic mesh prosthesis parallel to the long edges of the latter in the direction of his jaws - is new and defines the shape of the frame for the synthetic mesh prosthesis in the form of a Trident, the material from which it is made, as well as additional fixing elements at the ends of teeth.

Three of the six distinctive features of the claimed device from the prior art is not known. Therefore, the claimed technical solution meets the criterion of "inventive step".

In the interaction of all of these characteristics result in a new technical result, namely improving the effectiveness of surgical treatment for inguinal hernias.

The essence of the claimed device is illustrated by two figures, reflecting its main features, where: 1 - synthetic�ski mesh prosthesis; 2 - cut synthetic mesh prosthesis to accommodate the spermatic cord; 3 - narrow jaws synthetic mesh prosthesis; 4 - wide jaws-synthetic mesh prosthesis; 5 - free edge of the synthetic mesh prosthesis; 6 - removable frame synthetic mesh prosthesis in the shape of a Trident; 7 - the teeth of the removable frame in the shape of a Trident; 8 - removable frame synthetic mesh prosthesis in the shape of a Trident, with rounded bulges at the ends of teeth; 9 - rounded thickenings at the ends of teeth removable frame in the shape of a Trident.

Fig. 1A - removable frame synthetic mesh prosthesis in the shape of a Trident. Fig. 1B - removable frame synthetic mesh prosthesis in the shape of a Trident attached to a synthetic mesh prosthesis. Fig. 2A - removable frame synthetic mesh prosthesis in the shape of a Trident, with rounded bulges at the ends of teeth. Fig. 2B - removable frame synthetic mesh prosthesis in the shape of a Trident, with rounded bulges at the ends of teeth attached to a synthetic mesh prosthesis.

The operation of the device is as follows. Perform incision of skin and subcutaneous tissue with a length of 6-8 cm in the projection of the inguinal canal above the inguinal crease. The aponeurosis of the outer�th oblique muscle cut longitudinally from the external inguinal ring lateral. At the opening of the aponeurosis allocate the inguinal ligament, the edge of the internal oblique muscle up, the edge of the vagina straight muscle and the pubic tubercle. Stupid finger allocate the space under the aponeurosis upward and laterally along the slit for subsequent placement of the prosthesis. Allocate spermatic cord and taped. Make the selection and processing of the hernial SAC on accepted techniques. Synthetic mesh prosthesis model 1 with the formation of a narrow 3 and 4 wide the jaws. Removable frame in the shape of a Trident 6 without swelling 9 at the ends of the teeth or with knobbed 8 9 at the ends of teeth is fixed to the synthetic mesh prosthesis 1. The ends of the teeth 7 are repeatedly carried out through synthetic mesh prosthesis 1 in parallel to the long edges of the latter in the direction of the jaws 3 and 4. In this case the edges 5 of the synthetic mesh prosthesis 1 must be left free on the need for fixation of the prosthesis to the tissues of the body width. Simulated synthetic mesh prosthesis with one removable 6 or 8 frames of Fig. 1 and 2, are placed in a prepared bed under the spermatic cord so that the last one was created for him through slit 2. In the medial part of the wound mesh should overlap the pubic bone at 1-2 cm Further perform inguinal hernia repair by Lichtenstein. Fix synthetic mesh prosthesis continuous u�DIPROPYLENE seam to inguinal ligament to the internal inguinal ring. Individual sutures non-absorbable mesh material is fixed to the internal oblique muscle and the medial to the vagina straight muscle. Upper jaws 4 of the prosthesis separate sutures fixed to the inguinal ligament (Chizhov D. V., Shurygin S. N., Resurrection P. K., Philodina N. In. Plasty of the inguinal canal for Liechtenstein and its modifications. - Herniology, 2004, No. 1, pp. 43-51). Spermatic cord is withdrawn downward, grasp the clip oriented medial portion of the removable frame and remove the last of the synthetic mesh prosthesis, removing from the wound. The aponeurosis of the external oblique muscle in the surgery of Liechtenstein sew edge to edge with no tension.

We have completed 14 of hernia repair in men from 32 to 62 years, with unilateral oblique, direct and recurrent inguinal hernias with the use of the proposed device. Used light grid companies "LINTEX", "B. Braun", "JOHNSON & JOHNSON". In all cases, the removable frame was made of Chromium metal wire Draht (diameter 0.6 mm, Schen-Dental GmbH). In three cases the teeth of the frame in the form of a Trident had rounded thickenings at the ends.

Patient M., 46 years old was in the surgical Department with the diagnosis: vpravimaya direct inguinal hernia on the right. Patient's height 172 cm, weight 88 kg. During the operation revealed a significant defect of the posterior wall of the inguinal canal. Hernia is straightforward. Allocated g�Zhevago bag with its reduction and suturing the transverse fascia over it. Used lightweight synthetic mesh prosthesis of the company B. Braun Optilene Mesh LP with a removable frame, made in the form of a Trident with thickenings at the ends. The use of this construction it was possible, without the complexity and complete to strengthen the posterior wall of the inguinal canal and finish the operation. The duration of surgery was 35 minutes. Early postoperative period was uneventful. The patient is examined in 1.5 years. No complaints, labor restrictions, no recurrence noted.

1. Device for plastic surgery for inguinal hernias in the form of synthetic mesh prosthesis formed with jaws and attached to it to give it a flat shape in the wound with a removable frame having a shape and dimensions, which, after its attachment to the synthetic mesh prosthesis allows you to leave the edges of the latter, including along the cut line to form the jaws, needed, free, to for fixing synthetic mesh prosthesis to the tissues of the body width, characterized in that the removable frame of the synthetic mesh prosthesis, the pores of which have properties of elastic stretch and contraction, made in the shape of a Trident from a metal wire of a certain thickness depending on the pore size of the synthetic mesh prosthesis, with removable'm reading frame� to synthetic mesh prosthesis repeatedly swiping the ends of the teeth through synthetic mesh prosthesis parallel to the long edges of the latter in the direction of his jaws.

2. The device according to claim 1, characterized in that the removable frame of the synthetic mesh prosthesis, the pores of which have properties of elastic stretch and contraction in the shape of a Trident from a metal wire of a certain thickness depending on the pore size of the synthetic mesh prosthesis, wherein each tooth has at one end a rounded thickening, the removable frame is fixed to the synthetic mesh prosthesis repeatedly swiping the ends of the teeth through synthetic mesh prosthesis parallel to the long edges of the latter in the direction of his jaws.



 

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EFFECT: reducing rate of recurrences and postoperative complications ensured by improving the endoprosthesis fixation by forming a high-density connective tissue scar immediately in the hernia defect and in the areas of the vertically and horizontally directed strips which transform into a less dense scar within surrounding tissues in a combination with adjusting expansibility along the whole surface of the primary area and increasing elasticity, preserving the endoprosthesis strength within the hernia defect and reducing an amount of a foreign material implanted into the body.

4 cl, 1 tbl, 4 dwg

FIELD: medicine.

SUBSTANCE: skin of the butt end of the stump of the first finger main phalange is moved into the palm part. A slot for the introduction into it of a bone part of a transplanted transplant is sawed in the stump. The radial digital vascular-nervous fascicle of the third finger is exposed. A cutaneous-fascial-bone transplant, including into its composition the vascular-nervous fascicle from the radial surface of the third finger, is formed. In the area of the thumb eminence a subcutaneous tunnel, in which the transplant is passed to the stump of the first finger, is formed. The bone part of the formed transplant is introduced into the slot of the first finger stump and fixed in the stump slot. The skin of the transplanted transplant is sutured with the finger stump skin and immobilised with a plaster bandage for 4 weeks.

EFFECT: method provides finger sensitivity and its resistance to mechanical trauma due to the transplantation of the transplant on the vascular-nervous fascicle form the radial surface of the third finger.

1 ex, 12 dwg

FIELD: medicine.

SUBSTANCE: method involves approaching out of a projection of the parathyroid gland on the pathologically involved side. Two trochars are inserted at an intersection of the parasternal and anterior axillary lines with the second intercostal space. One more trochar is introduced along an inferior edge of the mastoid bone. A layer between the superficial leaf of the pectoral fascia and the greater pectoral muscle is dissected. A window is created between the m. stemocleidomastoideus legs. Lateral edges of the prethyroid muscles are transected. Anterior and lateral surfaces of the thyroid lobes are separated on the operated side. Typical parathyroid regions are inspected. The parathyroid containing a new growth is visualised.

EFFECT: reducing surgical injuries, postoperative pain syndrome, probability of postoperative complications by decreasing an area of separated tissues when forming a subfascial tunnel, enabling the inspection of the surgical area at different angles of vision, preventing an instrumental conflict and achieving a high degree of aesthetic outcome by the technique of trocar insertion and minimum length of incisions.

10 dwg

FIELD: medicine.

SUBSTANCE: vascular pedicle of an internal haemorrhoid is ligatured; edges of the perianal skin wound and rectal mucosa wound are closed with a continuous blanket suture up to the base of the vascular pedicle, which is immersed under the mucosal layer by means of the above suture. The haemorrhoidectomy is followed by underrunning and ligaturing the vascular pedicle of the internal haemorrhoid with the use of one poly-filament biodegradable non-traumatic suture of 4/0 in relative size. Suture ends must not be cut off. A vascular pedicle stump is pulled up by a needle-free suture in the distal direction laid in the wound bottom and held therein. The wound starts to be closed precisely above the vascular pedicle stump with the use of a needle suture inside out on the rectal mucosa by means of a continuous blanket suture. Two stitches are made to immerse the vascular pedicle stump completely under the rectal mucosa, and the ends of the needle-free suture are cut off at the level of the ligature. The wound edges are kept on to be closed up to the distal edge on the perianal skin, wherein the suture is tied up.

EFFECT: invention enables reducing a risk of the wound infection, reducing pain syndrome accompanying clysterising and faecal matter passage, also reducing dressing injuries, prevents the anal canal strictures and the anal sphincter failure, and does not prolong the length of the surgical intervention.

4 dwg, 1 ex

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to plastic surgery, and can be used in surgical hair restoration. TrichoSciencePro v 1.1 software is used to calculate a recipient area. A phototrichogram is performed to evaluate hair follicle viability. The derived data are used to determine a required amount of hair follicles for grafting. A fragment of a skin implant is sampled from the hair area. A cosmetic stitch is applied on the formed defect. The cut-out fragment is divided on follicular grafts. A template is applied on the recipient area. Microincisions 1.0 mm in diameter are formed on 30% of the recipient area for engrafting 2 and 3 viable follicular grafts and single hair follicles. The follicular grafts are grafted therein by means of disposable needles 0.8-1.0 mm in diameter.

EFFECT: method enables taking out and engrafting the exact amount of the viable hair follicles and distributing them uniformly in the recipient areas, reducing the grafting time and increasing the graft survival, as well as provides reducing side effects by applying software, performing phototrichogram and observing the engraftment regimen.

6 dwg, 3 ex

FIELD: medicine.

SUBSTANCE: method is implemented by reducing the intraductal pressure over the use of a dual-lumen catheter: a base catheter is used to outflow the bile duct content, while an additional low catheter is applicable to administer an antiseptic solution. Using the presented modified catheter enables performing the effective sanitation of the bile ducts without increasing the intraductal pressure. The technical simplicity and availability of the method enables using them in surgical hospitals.

EFFECT: more effective percutaneous transhepatic biliary drainage and improving the outcome in the patients suffering from acute cholangitis accompanying obstructive jaundice.

1 dwg

FIELD: medicine.

SUBSTANCE: at the first stage, the method involves forming dorsal and carpal vascular pedicles of the displaceable metacarpal and finger stump, performing a metacarpal osteotomy followed by the apparatus distraction of a distal fragment of the metacarpal. At the second stage, the formed segment with elongated vascular pedicles is displaced into the position of the missing finger with fixing the bone fragments. On completion of the distraction, the bone fragments of the metacarpal and finger stump are fixed with a brace in the position of maximum spreading with preserving the formed bone graft by the intramedullary insertion of the distal and proximal ends of the brace into the respective fragments of the metacarpal and the homonymous finger stump with the maximum traction of the distal fragment. Six month later, the brace is removed, and the bone graft is transected. The vascular pedicle segment is re-mobilised and dislocated together with the distal part of the formed vascular pedicle bone graft onto the recipient stump. That is followed by performing an osteosynthesis of the bone graft with the distal part of the bony frame of the stump.

EFFECT: method enables forming the finger of an adequate length with the minimum donor defect and prevents contractures by forming the adequate length of the distraction vascular pedicle bone graft.

1 ex, 4 dwg

FIELD: medicine.

SUBSTANCE: preoperative patient preparation involves urinary catheterisation and rectal drainage. That is followed by radical surgical d-bridement of a purulonecrotic centre and wide opening of the involved site. The pus pockets are drained, and the necrotic tissues are excised to form a vast wound surface. The radical surgical d-bridement of the purulonecrotic centre leaves a sphincter muscle of anus and a serous-muscular layer of the rectal walls preserved. On the 3rd-4th postoperative day, after multiple necrectomies of the wound surface and intensive infusion, detoxification and antibacterial therapy, the vast wound surface is covered with a porous sponge and/or a gauze bandage as a wound filler. The sponge is made of a hydrophilic polyurethane base impregnated with activated carbon. The gauze bandage is impregnated with a colloidal solution of zerovalent metal silver Ag0 particles having a silver nanoparticle size from 2 to 25 nm. The patient is anaesthetised adequately and placed in a plastic air-tight transparent isolator chamber configured as cut down trousers with the vast wound surface covered with the wound filler. The 3-5 postoperative days involve 3-4 continuous vacuum drainage of inflammation products of the involved soft tissues through the porous sponge and/or gauze bandage coverage. The vacuum drainage does not require the dressings to be changed and uses a negative pressure of 85-130 mmHg. After each procedure of the vacuum drainage of the wound surface and every time the isolator chamber is opened, the wound is visually inspected, examined for bacterial contamination and explored. Necrectomy is performed if needed. After the inflammation is arrested completely and the wound surface is clean, whereas the wound surface is decreased considerably, a bacterial swab test is conducted. That is followed by the stages of skin repair of the wound defect with the use of local tissues. The vacuum drainage of the necrotic putrid inflammation products contaminating the soft tissues uses the porous sponge having 30 to 45 pores 700 to 1,500 mcm in size per 1 cm2 of the surface area. In case the combined use of the porous sponge and gauze bandage covering the vast wound surface during the vacuum drainage of the inflammation products contaminating the soft tissues, the gauze bandage is first to cover the wound, and then it is the porous sponge that is placed. The vacuum drainage of the inflammation products contaminating the soft tissues is combined with rectal drainage implying the controlled faecal diversion and urine diversion through a urinary catheter into an external urine bag.

EFFECT: reduced hyperemia and wound edge oedema, providing accurate visualisation of tissue necrosis, reducing the time of formation of the clean wound with adequate granulation tissue, preventing anaerobic flora growth, reducing the time of pus pockets cleansing and healing in a combination with higher quality of patient's life.

4 cl, 6 ex

FIELD: medicine.

SUBSTANCE: pancreatic leaks following pancreatic transplantation is eliminated. That is followed by X-ray and ultrasound guided drainage of the leak regions. A gastroscope with end-face optics is used to localise a greater duodenal papilla of the transplant. A pancreatic duct of the transplant is selectively catheterised on the side of a duodenal lumen. That is followed by X-ray controlled localisation of the pancreatic leak. The pancreatic duct of the pancreatic transplant is stented. A proximal end of the stent is arranged in a major pancreatic duct and blocks the stenosis from an oedema, while its distal end is found in the intestinal lumen.

EFFECT: method provides a lower risk of interduodenal anastomosis complications following the pancreatic-duodenal and donor duodenum transplantation by improving the visualisation of the donor duodenum and the arrangement of the stent in the major pancreatic duct with blocking the stenosis from the oedema.

5 dwg, 1 ex

FIELD: medicine.

SUBSTANCE: method requires colonic decompression in obturation obstruction. A minilaparotomy is performed at the level of a projection of blind intestine; an ileal loop is brought into the wound at 15-20 cm from ileocecal valve. A purse-string suture is applied on an antimesenteric edge of the brought ileum. An intestinal wall is incised in the centre of the suture. A metal or plastic sleeve is inserted into the incision. The purse suture is hermetically tightened up. A probe is inserted into a lumen of ascending intestine through a valve in the sleeve, and the content is removed gradually. After the intestine is emptied, the probe is left in the lumen, and an ileostomy is formed.

EFFECT: method provides the intestinal decompression from the short-scar incision in acute obturation colonic obstruction, reduces the number of postoperative complications and fatal outcomes, improves the results of the following surgical intervention by a low number of injuries.

1 ex, 2 dwg

FIELD: medicine.

SUBSTANCE: method is carried out by means of an optic navigation system with an intra-tumour introduction of a labelled colloidal radiopharmaceutical (RP), for which purpose dynamic scintigraphy of axillary, parasternal, supra and sub-clavian lymph nodes is carried out from the side of the mammary gland tumour localisation 3-5 min after RP introduction. It is repeated within 20-30 min with a 5-10 min interval. The moment of appearance of the first RP-accumulating node is identified and regarded as SLN. At the moment of appearance of the scintigraphic SLN image 4-5 markers of labels, used in the registration of the navigation system are applied on the patient's skin with positioning: the first marker - in the zone of the humeral head, the second - on lin. ax. anterior in such a way that it does not prevent in performing the biopsy but remains accessible for registration before the operation beginning, the third - at the presternum base, the fourth - 3-5 cm below the third one. In case of the fifth marker fixation its position is not rigidly regulated. Simultaneously SLN topography is determined by means of SPECT-CT - emission computed tomography with the following X-ray computed tomography. In case of impossibility to export volume zones of interest on the SPECT-CT images SLN topography is determined relative to adjoining anatomical structures and obtained information is transferred into the optic navigation system for identification and exact SLN detection in the process of performing the biopsy.

EFFECT: method makes it possible to identify true SLN, determine its exact topography and carry out its ablation by means of the optic navigation system, avoiding unjustified ablation of lymph nodes of the second and third order.

1 dwg, 1 ex

FIELD: medicine.

SUBSTANCE: method involves applying one or two parallel through draining tubes having lateral perforations. Flow lavage of the retroperitoneal space with antiseptic solutions is carried out via the perforations at room temperature and cooled solutions are administered concurrently with vacuum suction. Omental bursa is concurrently drained using the two parallel through draining tubes. Flow lavage of the omental bursa is carried out using these tubes.

EFFECT: enhanced effectiveness of treatment in healing pyo-inflammation foci.

5 cl, 1 dwg

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