DE102008044855A1 - Surgical needle, for suturing wounds, is spiral and hollow to take the thread secured at the needle tip - Google Patents

Abstract

A hollow spiral needle contains a wound closure thread that remains in the tissue that is sewn to it after it has been broken off and held tight and the spiral is removed.

Description

Sewing called in medicine the form of wound closure, in which a thread stung through the fabric on both sides of a gaping wound and subsequently is knotted. It is a fundamental and indispensable to this day Sub-discipline surgical treatment.

wounded Tissue heals best and fastest when associated wound layers lie stress-free together. A suture can be due to injury or surgery separate wound surfaces merge again and hold. The seam is so far only necessary temporarily. she should bridge the period until Wound healing has created a resilient biological scar.

The Sew is a historically very old form of treatment. The most important progress were and are made of materials, that is needles and threads. Different tasks require different sutures. Had earlier For example, natural silk and sheep's gut are used as sutures. Today almost exclusively state-of-the-art plastics used.

First of all, different Resorbable non-absorbable sutures. The seam has, as above described, only a temporary task and unnecessarily left in the body Suture poses a risk of inflammation Therefore, accessible, non-absorbable threads removed after sufficient time. This is called "pulling strings".

For areas, where you put the threads can not reach for pulling, for example, seams on inner Organs or subcutaneous fatty tissue, therefore one uses threads that from the body be mined yourself.

The Absorption is not just a material-specific property, but also a function of time. The modern threads are characterized by the presence of body water split hydrolytically. The size of the surface (and thus the diameter) of the thread therefore play just as important Roll like the kind of sewn Tissue whose moisture content is different.

thickness Have threads the advantage, big Withstand forces to be able to because the tensile strength u. a. depends on the cross section. So when sewing under Tensile stress like thick threads used. Thick threads but leave after pulling also thick stitch channels, the For example, in the case of a skin suture on the face, unsightly scars can cause. Therefore, today the industry provides a very wide range of different threads, from which the operating physician to task and experience selects the appropriate thread.

monofilament (Monofilament) Plastic threads are little pliable like fishing line. Although they slide well when sewing through the tissue, but are stubborn in handling and prevent by her smooth surface a secure node stop.

By Lichen a thread of several thin, comparable to knotting one Rope, creates a so-called braided or polyfiler thread, the much smoother, easier to knot and its knot seat that's for sure. Such threads saw at Tissue passage and its unclosed surface acts like a wick. So can germs in the body invade and promote infections.

When Hybrid offers the industry so-called pseudomonofilaments. These are braided threads with the advantages mentioned in handling, their surface but smoothed by sheathing is and so the sawing and wicking avoids.

today Only once usable needle-thread combinations are common. there forming needle and thread form a single unit, the thread is unalterable connected to the needle. Furthermore suitable thread material, the doctor but also a suitable Select a needle, because there is for every situation suitable: big or small, straight, slightly or strongly curved, round in cross-section or triangular with sharp edges and more.

Of the typical standard is the Einzelknopfnaht, in which by a circular guided through the tissue Thread with a multiple knot a punctiform wound adaptation is produced. Need long wounds therefore several. But the sewing long wounds can also be done with a continuous thread with different thread guides possible are: overflowing or just in one plane back and forth. To avoid skin leakage channels, you developed the completely submerged Intracutaneous.

Specific Shapes of the thread guide allow seams under fabric tension, so the vertical backstitch, the Donati seam. By alternating only one-sided Hautausstich can be hereby halve the number of skin exits, the Allgöwer seam. The paired other Side is taken only intra- and subcutaneously.

A tensioned seam is included closed to the surgeon's knot.

The To lead the needle by hand is no longer common today. Nowadays she becomes with a special metal clamp, the needle holder, of which it is two principally different species with many modifications are, stung through the tissue and thus pulled out again. This has several advantages: The risk of infection for the surgeon by accidental puncture injuries is lower and it can be smaller Needles are taken. Also, one can penetrate into deeper wound caves. With surgical gloves, the handling of the needle holder is easier as the guiding the needle by hand.

For sewing, there are a number of alternatives. However, none of these methods achieve the universal applicability and variety of stitching. Sorted by the effort you can call the following:
adhesive taping
are used only externally.

stick

in the body inside you can sew Seal with fibrin sealant, large wound surfaces to the same Seal or seal defects. The tear strength is limited. Therefore, such glued defects never become instant burdened, for example Achilles tendon gluing after rupture. It is advantageous that fibrin is converted or broken down as protein, that is no foreign matter in the body remains. Synthetic polyacrylic adhesives are currently becoming unavoidable toxic monomers exclusively externally applied.

clinch

At the Parentheses, "stapling" or "stacking" to the closure of Skin wounds set metal clamps that hold the skin from the outside, without piercing them. Internally you can use parentheses only these are usually not set individually, but it become staplers used.

Clamping devices (stackers) hollow organs such as Esophagus, Stomach, thin, Dick or rectum can be combined with such special equipment connect or cut through in a single operation and clump together again. Also were forklifts for vascular surgery but found no significant acceptance [1].

literature

• R. M. Kirk: Surgical Techniques. 3. erw. Ed. Thieme Verlag, Stuttgart 1997, ISBN 3-13-619403-9

Some problems remain unresolved during surgical suturing:
Sutures in the wound cavities are difficult for the surgeon to perform, and intracutaneous sutures, which would be particularly suitable for plastic surgery without skin puncture or stinging, are only possible with very accessible sutures.

moreover is the execution of single-stitched seams, as well as Allgöwer and Donati seams, very time consuming, because the surgeon after each one Execute node got to.

It is therefore an object of the present invention, suitable device and method for fast, secure and possibly invisible execution of seams to find.

This is inventively solved the application of two elements: namely a novel spiral needle in conjunction with a reciprocal thermal process.

The Spiral needle according to the invention consists of a corkscrew-like twisted needle that turning is guided between the tissue parts to be connected, that these, so far possible subcutaneously, or by contracting regular intersections get connected. These needles can in different lengths and sizes. be executed.

there the spiral needle is preferably designed as a hollow needle, in the one preferably monofilament yarn to the break-off tip is guided, with which he is firmly connected.

The Spiral needle is guided so far that their tip clearly emerges from the tissue, where it breaks off at a predetermined breaking point and held with the surgical forceps.

Now can the spiral needle by reverse rotation pulled out of the fabric and the thread held and possibly knotted be while remove the tip after cutting the thread. will, so that only the thread remains in the tissue.

Around while no gap between stitch channel and remaining thread to leave blood and prevent blood from the inside of the vessel emerges at the branch channel - but especially to the cohesion of the sewn To improve tissue parts, the seam area is first iced, which is an expansion of the tissue due to the expansion of the tissue water causes.

This can be done with one in eye surgery for the treatment of vein membrane melanoma and retinal detachment already common "cold stick" done with the sharply limited cooling to -70 ° C are possible.

To Constriction of capillaries and connective tissue in the incision area and their immediate reheating at 50 to 60 ° C Tightens the fabric and the seam is better hold. These Temperature change treatment can be repeated if necessary.

The Method is, for. B. in ophthalmology alone - d. H. without suturing - can be used if the tissues have a high water content and not under tension stand.

With But this method is also a second application of the spiral needle for fabric closure possible: Is the spiral needle made of biocompatible memory metal, z. B. one Titanium-tantalum alloy made, so it can be done be that they are very stiff when cold and therefore easy to handle "sewing" is. After heating lifts with increasing blood flow or heat conduction from the environment But this rigidity opens up and the spiral becomes as flexible as usual used monofilament suture. For some materials the softening becomes irreversible after a few cycles.

The Needle can if the surface is appropriately doped, then either remain in the body and becomes increasingly enclosed by collagen material. But it is also possible that surface equip hydrophobic by doping, which in turn makes it possible After the wound has healed, it works like a normal thread out of the tissue to draw.

The invention will be described below with reference to the drawings 1 and 2 explained in more detail:

1 shows a spiral needle according to the invention 1 with the approach for the guide tweezers 2 and the thread integrated into the needle 3 ,

2 shows the same needle 1 as 1 , with the at the breaking point 4 broken tip 5 and the pulled-out piece of thread 6

Claims (12)

Apparatus and method for surgical wound closure, characterized in that a helical needle is guided by rotational movement between the insides of two separated tissue parts to connect them. device and methods for Surgical wound closure according to claim 1, characterized in that that the spiral Needle is hollow except for its tip. device and methods for Surgical wound closure according to claims 1 and 2, characterized in that that the spiral Needle in her cavity contains a surgical thread. device and methods for Surgical wound closure according to Claims 1 to 3, characterized that this thread is firmly connected to the tip. device and methods for Surgical wound closure according to claims 1 to 4, characterized in that that the tip is breakable at a predetermined breaking point. device and methods for Surgical wound closure according to claim 1, characterized in that that the spiral needle is coated hydrophobic. device and methods for Surgical wound closure according to claim 1, characterized in that that to be closed Seam after sewing is frozen. device and methods for Surgical wound closure according to claim 7, characterized in that that icing with a cold stick he follows. device and methods for Surgical wound closure according to claim 7, characterized in that that the icing shortly thereafter by a warming of the same tissue is reversed around the seam. device and methods for Surgical wound closure according to claim 1, characterized in that that icing and warming be repeated periodically. device and methods for Surgical wound closure according to claim 1, characterized in that that the spiral needle is made of a material with memory effect. device and methods for Surgical wound closure according to claim 1, characterized in that that the spiral needle consists of bio-compatible material and in the flexible state is absorbed by the tissue.