RU2006210C1 - Wound retractor - Google Patents

Abstract

FIELD: abdominal surgery. SUBSTANCE: wound retractor is made in the form of a toroidal zigzag-shaped member fabricated of memory material and has auxiliary removable cylindrical drainage elastic envelope. EFFECT: enhanced reliability and convenience. 3 dwg

Description

 The invention relates to medicine, specifically to conservatives used in abdominal surgery.

 There is a Goss retractor used during surgical interventions. However, the rigidity of the structure, as well as the fact that the expanding mirrors push only the abdominal wall along the edges of the wound, does not allow its use in the postoperative period for drainage of the abdominal cavity.

 The closest in technical essence to the proposed one is a cavity expander. But this design has a limited scope - only to improve access to the cavity of small diameter - and cannot be used in abdominal surgery for drainage of the abdominal cavity.

 The aim of the invention is to reduce the morbidity by reducing the number of complications, reducing the duration of treatment and providing drainage.

The goal is achieved in that a retractor containing a wire spring made of material with a shape memory effect in the form of arcs with ends bent outward at one of the ends, and to reduce trauma by reducing the number of complications, shortening treatment time and providing drainage, a removable cylindrical drainage is introduced into it elastic shell mounted on the outer surface of the spring, made in the form of a toroidal zigzag element, consisting of 5 or 6 oriented along the surface ti shell arcs, the outwardly bent ends are oriented at an angle to the arcs ^70-80.

 In FIG. 1 shows a retractor without an elastic shell, consisting of a toroidal zigzag element 1 with 6 arcs 2, from the upper end of the arc, the springs are bent outward 3; in FIG. 2 - the same, in a compressed state, prepared for introduction into the wound channel; in FIG. 3 - retractor assembly, in working condition, covered with a removable elastic shell 4.

Apply a retractor as follows. After completing the main stage of operation retractor assembly is cooled for 30-40 seconds in a bath cooled to ^about 0-10. With a sterile saline solution, the arches of the spring are brought together and the expander is introduced into the wound channel. Warming up with body heat, the expander restores its shape within 25-30 s, gradually expanding the lumen of the wound canal. To remove the retractor, a napkin moistened with cooled physiological saline is introduced into the wound canal, after which the spring is compressed and the device is removed. For a more rapid manifestation of the memory effect of the shape of the material from which the device is made, the cooled physiological saline can be injected under the elastic membrane by piercing it with a needle connected to a regular syringe.

 PRI me R 1. Patient G., 45 years old, was admitted to the clinic 12.02.90, with complaints of dull pain in the right hypochondrium, weakness, fatigue. Sick for a year, was treated in a clinic with a diagnosis of chronic cholecystitis, no improvement in condition.

 Upon receipt, the condition is satisfactory. The skin is of normal color. From the side of the chest without pathology. The abdomen is of the usual form, with palpation soft, moderately painful in the right hypochondrium. The size of the liver according to Kurlov is 13x9x7 cm. The spleen is not palpable, no ascites.

 Ultrasound examination shows that the liver is enlarged, and in the central parts of the right lobe an inhomogeneous structure is determined by formation in the form of a node 9x7 cm in size with clear boundaries.

 Clinical analysis of blood, urine, biochemical analysis of blood without deviations from the norm.

 Diagnosis: liver tumor.

 Operation 02.28.90. Under general anesthesia with a staple incision according to B. I. Alperovich, the abdominal cavity was opened. A tumor was found in the thickness of the right lobe of the liver measuring 12 x 10 cm, emerging on its surface. Crossed the elements of the neck of the gallbladder. Blocked sutures were applied along the resection line. Resection of the right half of the liver with a tumor and gall bladder was performed. Hepatitis of the stump of the liver with an omentum on the leg. A glove-gauze swab and a drainage tube were placed in the right hypochondrium to the liver stump; the wound was sutured in layers.

 The postoperative period was difficult. The patient had suppuration of the residual cavity under the diaphragm on the right. Conservative therapy did not produce a positive effect. On the fistulogram from 04/06/90, under the diaphragm on the right there is a cavity measuring 6x5 cm communicating with the anterior abdominal wall through a narrow (0.6 cm in diameter) wound channel up to 6.0 cm long.

Given the failure of conservative therapy, 10.04.90, the patient was operated on. Under general anesthesia, a skin incision was made with partial excision of the old postoperative scar, muscles and underlying tissues along the wound canal are bluntly apart. A purulent cavity was opened under a 6x5 cm diaphragm, up to 80.0 ml of thick pus was removed. The cavity is washed with a solution of furacilin. The wound retractor placed, consisting of five arcs, from the upper end of the arc spring bent outwardly at an angle of ^about 80, provided that reliable fixation device. The wound channel all the way to the purulent cavity is expanded to 5 cm in diameter. In the purulent cavity under the diaphragm through the wound put 3 glove-gauze swabs.

 The first three days after the surgery, the patient changed tampons, the cavity through the wide wound canal was freely washed with antiseptics, and necrotic tissues were removed. On the 4th day, the retractor was removed, the diameter of the wound to the purulent cavity was 4-5 cm, the cavity quickly cleared of pus, healed by secondary intention. The patient was discharged for outpatient treatment in satisfactory condition 04.24.90,

 PRI me R 2. Patient Z., 60 years old, was admitted to the hospital 12.04.90, with complaints of moderate pain in the right hypochondrium. In 1988, he was operated on for hemangiomas of the liver; a right-sided hemihepatectomy was performed. Over the past 5 months, the condition has worsened.

 Upon admission, the patient's condition is satisfactory. The skin is of normal color. Height 154 cm, weight 78 kg. From the side of the chest organs without pathological changes. The abdomen is of normal shape. On the front wall in the epigastrium and the right hypochondrium, stronger postoperative scars. On palpation, pain is noted in the right hypochondrium, pain when pressed in the 9th intercostal space on the right (a positive symptom of Kryukov). The liver is not enlarged, the spleen is not palpable. Clinical analysis of blood, urine and biochemical analysis of blood without abnormalities. Ultrasound examination showed that the right lobe of the liver was resected; no focal lesions were detected in the liver. Under the right dome of the diaphragm, a cavity formation of 7x5 cm with thick uneven walls, echo-negative content.

 Diagnosis: chronic abscess of the right subphrenic space.

Operation 04/19/2010. Under general anesthesia, a transverse incision was made from the scapular to the anterior axillary line on the right at the level of the 10-11th ribs. 10-11th ribs are resected. The underlying tissue is stupidly apart. At a depth of 11 cm, a cavity measuring 7x6 cm was opened under the diaphragm. Up to 50.0 ml of pus and necrotic tissue were removed. The cavity is washed with a solution of furacilin. The wound is put expander composed of the arcs 6, the upper end of the arc of the spring are bent outwardly at an angle ^of 70, whereby the device is securely fixed. The diameter of the wound channel to the opened purulent cavity over the entire length up to 6 cm. The cavity was loosely swabbed with three gauze tampons with iodinol.

 The postoperative period was uneventful. Tampons in the wound for the first 4 days changed daily. The cavity was washed with antiseptic solutions. On the 4th day, the expander is removed. On the 7th day the wound was clean, granulation tissue appeared. With a superficial granulating wound, the patient was discharged from the clinic on the 20th day after the operation. (56) Ivanov V.A., Lopukhin Yu.M. and Molodenkov M.N. Surgery. M.: Gosmedizdat, 1963, p. 45, fig. 13-1.

 USSR copyright certificate N 1405824, cl. A 61 B 17/02, 1986.

Claims (1)

RANOG EXPANDER containing a wire spring made of material with a shape memory effect in the form of arcs with ends bent outward at one of the ends, characterized in that, in order to reduce the morbidity by reducing the number of complications, shortening the treatment time and providing drainage, a removable cylindrical draining elastic shell mounted on the outer surface of the spring, made in the form of a toroidal zigzag element, consisting of 5 or 6 oriented along the surface of the shell chki arcs, with the ends bent outwards to the arcs are oriented at an angle of 70 - 80 ^o.

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