RU2483680C2 - Block surgical suture - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to surgery. After adaptation of wound edges double knot is applied. Then, mattress suture is applied with one end of thread. Glover's suture is applied with the second thread end in such a way that thread inside wound is laid at an angle to edges, and on skin surface perpendicular to them. Both ends of thread are fixed with terminal knot.

EFFECT: method increases suture consistency in case of difficult convergence of wound edges, reduces risk of development of postoperative hernias and myofasciodesis.

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Description

The invention relates to medicine, namely to surgical surgery.

Each surgical operation, as a rule, is accompanied and ends with a layered connection of tissues. The main principles of the latter are a careful attitude to stitched fabrics and the reliability of seams. An error in suturing can be the cause of postoperative complications - from the inefficiency of the operation (for example, with various types of lavsanoplasty, plastic of tendons, ligaments, patella suture, etc.) to the life threat of the patient (when the knot is untied and the ligature slides off the main blood vessel). Common complications after suturing of surgical wounds are also postoperative hernias and myofasciodesis (mutual adhesion of fascia and muscles, limiting movements in adjacent joints of the limb).

When connecting tissues, the convergence of which is difficult, usually use particularly strong seams of large diameter with a conventional nodal seam or block (polyspastny) seam, which is twice drawn through the thickness of both edges of the wound or other stubborn tissue, for example ribs (figure 1). The disadvantages of the block seam are: the need to impose additional nodes - 4-5 or more, and also - leaving the ends of the threads long (1.5 cm or more). These measures, in turn, are accompanied by an increase in the risk of ligature fistula formation, cohesion of different layers of soft tissues with limited movement and other functional disorders. Myofasciosis, in addition to increasing the duration of rehabilitation treatment, often requires repeated and not always effective surgical intervention: restoration of the layered position of tissues due to their separation and isolation from the scars. Mutual cicatricial adhesion of tissues occurs due to the fact that different layers of the healing wound along the cut line are glued together with fibrin, and this is facilitated by large nodules and long ends of the left threads.

Prototype:

As a prototype, we present a simple nodal surgical suture described in the manual of M.P.Burykh “General principles of the technology of surgical operations” (Rostov n / A: publishing house “Phoenix”, 1999. - 544 p., - P.408- 410), which is as follows. A needle with a thread is carried out from the outside to the inside of one edge of the wound and the inside of the outside is punctured at the other edge of the wound, and the ends of the threads are tied together (Fig. 2). The use of a conventional nodal suture when connecting tissues, the convergence of which is difficult, has the following disadvantages:

1) the danger of breakage of the thread when the wound is tightened;

2) the difficulty of achieving adequate mutual adaptation of the edges of the wound or even failure to achieve their contact (lack of access);

3) the need to hold the first stitch of the suture tightened by the assistant (“step on the knot”) in order to avoid its relaxation and loss of adaptation of the edges of the wound - when he holds the loop with Kocher clamp until the surgeon imposes a second, fixing suture loop. This, in turn, often leads to the breakage of the stretched thread captured by the grooved jaws of the clamp;

4) the unreliability of the seam with the danger of its insolvency due to subsequent breakage or unbinding of the thread;

5) the need to impose additional nodes (4-5 or more) and leave the long ends of the threads (1.5 cm or more);

6) the risk of subsequent formation of ligature fistula and myofasciosis.

To prevent these disadvantages, a device is presented, represented by a blocking surgical suture (Fig. 3, a, b, c, d, d, e), the method of application of which is as follows. After double holding the needle with the thread through both edges of the wound (Fig. 3, a) by pulling the ends of the thread, reduce the wound edges and tie the first loop of the suture (Fig. 3, b). In this case, the tension load of the thread is evenly distributed on both of its loops, preventing its breakage and untying. A double knot is applied at the site of the needle puncture, fixing the achieved mutual adaptation of the edges of the wound (Fig. 3, c), then one of the two free ends of the thread on the needle is used as a mattress suture (Fig. 3, g), and the other as a furrier (Fig. .3, d). When a mattress suture is applied, the needle is removed from the fabric on the same side of the wound edge where it was inserted, and the next stitch is made on the other edge, as a result of which the thread on the skin surface lies parallel to the wound edges, and inside the wound - perpendicular to them. When a furry suture is applied, the needle is passed through both edges of the wound so that the thread inside the wound lies at an angle to the edges, and on the skin surface - perpendicular to them. Then both ends of the thread are fixed with the final (triple or more) node, leaving the ends of the threads 0.5-1.5 cm long (Fig. 3, f).

As an example of the use of a suture proposed as an invention, represented by a surgical block suture, the following observation is proposed.

Patient I., born in 1958, was in the orthopedic department of the RTC from 02.16.11 to 03.03.11 with a diagnosis of Tight false joint of the upper third of the right femur after a pathological fracture (focus of osteoblastoclastoma (OBK) of the upper third of the right femur).

From the anamnesis: in 1981 there was a pathological fracture of the upper third of the right thigh at the site of the OBK, rounded in shape and about 6 × 3.5 cm in size. Later a stiff false joint developed. 10.11.10, when falling from the stairs there was a combined injury, which included a head injury and refracture of the femur. She was at the cure in Karabudakhkent, from where she was discharged in a hip plaster cast.

1.03.11, the operation was performed: Open reduction and bone osteosynthesis of the right femur with bone autoplasty.

Under endotracheal anesthesia in the patient’s position on the left side with a roller under the lumbar region, an external lateral skin incision was made 16-17 cm down from the top of the greater trochanter. The subcutaneous tissue and wide femoral fascia with a Z-shaped relaxing fascia incision were cut throughout the wound both corners of the wound. In a sharp and blunt way along the muscle fibers, the incision is deepened to the outer surface of the zone of consolidating transverse fracture with an offset along the width, length and axis. In this case, a thickening of the diameter of the femur was noted as a type of hypertrophic false joint. Using bone chisels, spoons and a spherical cutter, bone fragments are separated, sequentially put into the wound, cleaned from the regenerate and cartilaginous tissue of a dirty-gray color within a healthy bone with restoration of the patency of the bone marrow canal and modeling of the ends of the fragments with a decrease in their diameter to the diameter of the normal femur . The intraosseous cystic lesion is scooped up to a normal bone with the formation of a rounded defect, moderately bleeding like "blood dew".

In order to replace the resulting intraosseous defect at the ends of bone fragments, 5 × 3 cm in size, a cortical-spongy autograft from the wing of the right iliac bone was taken subperiostally and cleaned from cartilaginous tissue. To do this, a skin incision was made along the crest of the wing of the right ilium with a length of 7 cm. The wound was sutured in layers, leaving drainage from glove rubber.

To activate osteogenesis, the fracture surface of bone fragments was processed according to Jude (shallow nicks were made with a chisel to increase their surface and the area of mutual contact). Bone fragments are mutually adapted with tight implantation of a cortical-spongy autograft in the medullary canal and are fastened with a 165 mm plate on 8 screws (1 of which are spongy and 7 are cortical), modeled along the external contour of the proximal femur. Osteosynthesis is stable, wealthy. The wound is washed with antiseptic solutions. Sutures were laid on the wound in layers, leaving tubular perforated drainage. An aseptic sticker was placed on the wound and a derotational boot on the foot.

When suturing the difficult to tighten fascia of the thigh, a blocking suture was applied as follows. After double holding the needle with the thread through both edges of the wound, pulling the ends of the thread brought the edges of the wound and tied the first loop of the suture. At the same time, the tension load of the thread was evenly distributed on both of its loops, preventing its breakage and untying. A double knot was applied, fixing the achieved mutual adaptation of the edges of the wound, then one of the two free ends of the thread on the needle was used as a mattress suture, and the other as a furrier. When a mattress suture was applied, the needle was pulled out of the fabric on the same side of the wound edge, where it was inserted, and the next stitch was made on the other edge, as a result of which the thread on the skin surface lay parallel to the wound edges, and inside the wound - perpendicular to them. When a furry suture was applied, the needle was passed through both edges of the wound so that the thread inside the wound lay at an angle to the edges, and on the skin surface - perpendicular to them. Then both ends of the thread were fixed with a final, triple knot, leaving the ends of the threads 0.7 cm long. Throughout the wound (17-18 cm), 3 such sutures were applied, between which ordinary knotted sutures were placed. The edges of the wound were adequately and reliably adapted.

The postoperative wound healed initially, the sutures were removed on the 9th day. The result of treatment is regarded by us as good.

Therefore, the structural differences from the prototype and the advantages of the proposed block seam are the following:

1) reliability and elimination of the danger of insolvency of the surgical suture due to the uniform distribution of the load on both initial loops of the block suture with the prevention of their breakage and untying;

2) the absence of the need for the Kocher clamp to hold the tensioned first loop of the seam as an assistant (“step on the knot”);

3) the use of one of the two free ends of the thread after fixing the achieved mutual adaptation of the edges of the wound with a double knot - as a mattress suture, and the other - as furrier. Then both ends of the thread are fixed with a final (triple or more) knot;

4) a combination of the positive qualities of block nodal and continuous (mattress and furrier) seams;

5) the greatest compliance with the rule of structural mechanics: "At the lowest cost of material the greatest strength";

6) a decrease in the likelihood of ligature fistulas and myofasciodesis, due to the much smaller number of left ends of the threads at the nodes;

7) profitability and lack of need to find material for manufacturing.

Thus, the proposed block surgical suture can improve the reliability, efficiency and quality of surgical treatment of the operated patients.

Claims (1)

A block surgical suture, which is a nodal surgical suture, characterized in that after double holding the needle with the thread through both edges of the wound and mutual adaptation of the edges of the wound by pulling the ends of the thread at the needle puncture site, a double knot is fixed, fixing the mutual adaptation of the edges of the wound, then one of the two free ends of the thread on the needle is used as a mattress seam, when applied, the needle is removed from the fabric on the same side of the wound edge, where it was inserted, and the next stitch is made on the other edge, as a result of which the thread on the surface of the skin lies parallel to the edges of the wound, and inside the wound perpendicular to them, and the second free end of the thread on the needle is used as a furry suture - a continuous suture, when applied, the needle is drawn through both edges of the wound so that the thread inside the wound lies at an angle to the edges , and on the surface of the skin perpendicular to them; both ends of the thread are fixed with a final (triple or more) knot, leaving the ends of the threads 0.5-1.5 cm long.

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