RU2594446C2 - Method of preparing transplant, perforator (versions) for its implementation and method of treating burn wounds - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to combustiology. One prepares skin graft for transplantation. For this purpose on skin graft is applied system of through cuts so, that during subsequent tension flap formed polygonal hole having at least one bridge connecting opposite angles of polygons. Above method is realized using perforator including housing, two shafts, in which according to invention thrust discs are composed of small discs rigidly fixed on shaft, and floating rings fitted on shaft with possibility of movement in radial direction, wherein diameter of small discs on 2-8 % smaller than floating rings, and thickness of floating rings is in range 0.2-2.0 mm and is proportional to thickness of blade, wherein thickness of knives is in range 0.2-2.0 mm, and diameter of shafts in the range of 15-80 mm, and in lower part of housing there is comb with teeth width of which is proportional to thickness of spacers, and their tops are located between disc blades. As wound covering is sterile MD bandages are used made of polyethylene film, on surface of film is applied one ingredient mineral and/or organic origin, is not drug, for example TALC or pollen. Film is made in form of tape with pull out through cuts made in form of holes arranged along lines of separation.

EFFECT: method allows performing sparing treatment of deep burn wounds healing of 3B-4 degree, providing faster healing of burn and donor wounds, reduced probability of cicatrization using device, providing for quality preparation of graft.

12 cl, 6 dwg

Description

The invention relates to medicine, specifically to methods for treating deep burn wounds 3B-4 degree.

A common problem in the treatment of deep burn wounds is the creation of a gentle method that accelerates the healing of burn and donor wounds, reduces the time of treatment, reduces the patient's pain and the possibility of scar formation.

A known method of treating burns 3B-4 degrees, which consists in the fact that after removing patients from shock, a toilet is used for burned surfaces. It is performed in the operating room after preliminary administration of pain medications to the patient. The skin around the burn is wiped with napkins moistened with 0.5% ammonia solution or soapy water, dried and treated with alcohol. Then foreign bodies, scraps of the epidermis are removed from the burnt surface. After the toilet, burns are treated with wet-drying and ointment dressings. After the appearance of granulations, autodermoplasty is carried out, followed by treatment of burn and donor wounds using wet-drying and ointment dressings (see Big Medical Encyclopedia M .: Soviet Encyclopedia 1981, v. 17, p. 231).

The traditional method of treating deep burn wounds requires the preparation of burned surfaces before dressing, the use of anesthesia for toilet wounds, as these dressings are very painful, dressings dry to the surface of the wounds, injure granulation and young epithelium, wound infection is often observed. The engraftment of skin flaps is accompanied by skin scars and the formation of keloid scars and contractures.

A known method for the treatment of burns 3B-4 degrees, based on the fact that they apply the dressing to form granulation, followed by gentle dermatome ectomy of granulations and autodermoplasty, and as a dressing use perforated film material containing rows of holes that form a rectangle of a solid surface with the dimensions of the sides are 100 and 200 mm, while the holes are made rectangular with the sizes of the sides 1 and 3-5 mm at a distance of 1 mm, and the treatment with film bandaging chnym pictures is performed until complete wound cleansing (see. Russian patent №2108078, IPC A62F 13 \ 02 A61L 15/00, publ. 10.04.1998 by)

This method also does not fully meet the requirements for both the survival rate of the graft and the number of scars formed.

There is a method of preparing a skin graft for transplantation to a patient, based on its perforation by applying a system of through cuts and forming a system of polygonal holes in the flap (see RF patent No. 239275, IPC АВВ 17/322, dated December 27, 2007)

Known perforator containing a housing, two shafts, one of which contains a set of circular knives with spacers, and the other a set of thrust disks with spacers, (see RF patent 2000087, class A61B 17/322, publ. 09/07/93 - prototype).

A disadvantage of the known method and device for its implementation is the lack of completeness and saturation of the skin flap, which leads to an increase in the healing time of wounds and the formation of excessive scars on damaged areas of the skin (wafer-like skin defects).

A known method of treating burn wounds by applying dressings to the formation of granulation, followed by gentle dermatome ectomy of granulations and autodermoplasty, and perforated film material is used as a dressing (see RF patent 2108078, class A61F 13/02, publ. 10.04. 98 g. - prototype).

This method also does not fully meet the requirements for both transplant survival and cosmetic effect.

The invention solves the problem of creating a more gentle way of treating deep burns, accelerating the healing of burns and donor wounds, reducing the time of their treatment, reducing the possibility of scarring using devices that provide better preparation of the graft.

The problem is solved due to the fact that in the known method of preparing a skin graft for transplantation to a patient, based on its perforation by applying a system of through-cuts and forming a system of polygonal holes in the flap, according to the invention, the system of through-cuts is applied so that upon subsequent stretching, the flap is it, in a system of polygonal holes, form at least one jumper connecting the opposite corners of the polygons, for example, on a large diagonal.

In addition, through the slots are applied so that by stretching the flap, rectangular holes are formed in it with an aspect ratio of 1: 2, or 1: 3, or 1: 4, or 1: 6.

Or through the slots are applied so that by stretching the flap in it form rhombic holes.

Or, through the slots are applied so that by stretching the flap, hexagonal holes are formed in it.

Or, through the slots are applied so that by stretching the flap, holes are formed in it in the form of a parallelogram with an aspect ratio of 1: 2, or 1: 3, or 1: 4, or 1: 6.

The specified method is implemented using a hammer drill containing a housing, two shafts, one of which contains a set of circular knives with spacers, and the other a set of thrust discs with spacers, in which according to the invention the thrust discs are made in the form of small discs rigidly fixed to the shaft, and floating rings mounted on the shaft with the possibility of movement in the radial direction, and the diameter of small discs is 2-8% less than the inner diameter of the floating rings, and the thickness of the floating rings is in the range of 0.2-2.0 mm and is commensurate with the thickness but a, and the thickness of the knives is in the range of 0.2-2.0 mm, and the diameter of the shafts is in the range of 15-80 mm, and in the lower part of the body there is a comb with teeth, the width of which is proportional to the thickness of the spacers, and their tops are located between the circular knives .

The second variant of the punch can be a punch containing a housing, two shafts, one of which contains a set of circular knives with spacers, and the other a set of thrust discs with spacers, characterized in that the thrust discs are made in the form of small discs rigidly mounted on the shaft, and floating rings mounted on the shaft with the possibility of movement in the radial direction, and the diameter of small discs is 2-8% less than the inner diameter of the floating rings, and the thickness of the floating rings is in the range of 0.2-0.2 mm and is commensurate with the thickness of the knife, except oh, the knife is made in the form of two cutting disks with a thickness of 0.05-0.15 mm, rigidly connected to an intermediate washer with a thickness of 0.2-1.5 mm, and the diameter of the knife is larger than the diameter of the intermediate washer by 0.1-1.5 mm, moreover, in the lower part of the body there is a comb with teeth, the width of which is proportional to the thickness of the spacers, and their vertices are located between the circular knives.

Thus prepared graft is the basis of the proposed method of treating burns based on the use of a perforated skin flap, in which according to the invention flaps perforated in the form of polygonal holes having diagonal jumpers are used as a skin graft graft.

In addition, sterile MD dressings made of a polyethylene film are used as a wound dressing, and on the surface of the film only one ingredient of mineral and / or organic origin is applied, which is not a medicine, for example, talc or flower pollen, and the film is made in the form of a tear-off tape perforations made in the form of holes? located along the lines of separation.

The combination of the proposed features of each object of the invention affects the final technical result, namely, the creation of a more gentle method of treating deep burns, accelerating the healing of burn and donor wounds, reducing the time of treatment, reducing the possibility of scar formation. Thus, this combination forms a single inventive concept.

A schematic diagram of the proposed punch is shown in FIG. 1-6, where:

Fig 1 is a General view of the punch;

Fig 2 is a General view of the perforator (side view);

FIG. 3 - drive shaft;

FIG. 4 - driven shaft;

FIG. 5 - comb;

FIG. 6 - knife (option 2), where:

1 - housing

2 - drive shaft,

3 - driven shaft

4 - knife

5 - spacer,

6 - thrust disk,

7 - a small disk

8 - floating rings,

9 - comb

10 - teeth

11 - cutting disc,

12 - intermediate washer.

The hammer drill contains a housing 1, two shafts - a drive 2 and a driven 3, and the driven shaft 3 contains a set of circular knives 4 with spacers 5, and the drive shaft 2 - a set of thrust disks 6 with knives 5. The thrust disks 6 are made in the form of small disks 7 rigidly mounted on the shaft 2, and floating rings 8, mounted on the shaft 2 with the possibility of movement in the radial direction, and the diameter of small disks 7 is 2-8% less than the inner diameter of the floating rings 8, and the thickness of the floating rings 8 is in the range 0, 2-2.0 mm and proportional to the thickness of the knife 4.

The thickness of the knives 4 is in the range of 0.2-2.0 mm, and the diameter of the shafts is in the range of 15-80 mm. In the lower part of the body there is a comb 9 with teeth 10, the width of which is proportional to the thickness of the spacers 5, and their vertices are located between the circular knives 4.

The second option of the punch differs in that the knife is made in the form of two cutting disks 11 with a thickness of 0.05-0.15 mm, rigidly connected to an intermediate washer 12 with a thickness of 0.2-1.5 mm, and the diameter of the knife (disks 11) is larger than the diameter of the intermediate washers 12 by 0.1-1.5 mm.

The preparation of the perforator for work is the same for both of their variants and consists in its sterilization and final assembly in the required configuration. The choice of the thickness of the knives 4 and its ratio with the thickness of the spacers 5 determine the required thickness of the diagonal jumper obtained on the skin flap. So, with a knife thickness of 4 in 0.3 mm and the corresponding thickness of the spacer 5, the thickness of the diagonal bridge will be about 0.8 mm. The form of perforation of the skin flap (the shape of the cells) depends, as in the prototype, on the number of recesses on the knife blade.

The work of the puncher is similar to the work of the prototype with the only difference that the result is a perforated flap with diagonal jumper cells, which increases the filling of the skin flap and contributes to its accelerated survival.

The proposed solution to the technical problem involves the following process chain during the operation.

1) Necessary tools and dressings (in addition to the standard set):

a) Menzul Dermatome dermatome with disposable ultra-thin interchangeable circular knives for cutting skin grafts and granular wounds, for example Menzul Dermatome-60-01,

b) PM leather perforators to obtain perforated skin flaps with a skin bridge in a rhombus (made in accordance with paragraph 6 or 9 of the formula),

c) “Dressings - MD” - Menzul Dressinq disposable plastic dressings with minerals for the closure and treatment of transplanted autodermografts and donor wounds.

The technology of the operation is as follows.

Tools used: Menzul-61-01 dermatome nozzle, PM-1: 3 skin puncher, gear motor and disposable ultrathin circular knife to the dermatome, are laid out from sterile bags and placed on the operating table.

A circular knife on a dermatome is attached manually by a surgeon or operating nurse. The Menzul-61-01 dermatome nozzle is connected and fastened to the gear motor with a special union nut. The height of the thickness gap, cut off the skin flap, is set on the nonius by rotating the dermatome nozzle. The assembled dermatome is connected to the power supply from the gear motor by a cord. Before starting the operation, the operability of the tool is checked. The rotation of the disk knife of the dermatome is carried out by the gear motor when you press the pedal, departing from the power supply.

Cutting a split skin flap for transplantation.

Before cutting the skin flap, the surgical field of the donor wound is treated with a sterile disinfectant solution. A sterile liquid paraffin is applied on a sterile skin surface with a thin layer to smoothly slide the dermatome across the skin. If the skin is flabby, then saline is injected into the subcutaneous tissue with a syringe. The dermatome in the surgeon’s hand is applied by the cutting part of the knife to the cut-off area of the skin and at that moment the surgeon presses the pedal with his foot. With the beginning of the rotation of the circular knife in the dermatome, the advancement of the instrument along the donor skin and cutting off gradually begins. Between the gap of the rotating knife and the bed of the dermatome nozzle, a split skin flap appears, which must be grabbed with tweezers and gradually removed during cutting. The cut and taken skin flap is placed on a wet towel on the operating table. A bleeding donor wound “donars” forms in place of the skin taken. A sterile cloth moistened with a hemostatic solution is applied to the wound.

Disposable sterile polyethylene dressings - MD are removed from the packaging, unfold and the wound is covered with an excess side inside. In the combination treatment of a donor wound with an MD dressing and ointments or with powdered powder. First, the wound surface is treated, for example, balsamic laziment according to A.V. is applied with a sterile spatula. Vishnevsky, levomikol or sprinkled with baniocin powder. The MD dressing on the wound is re-attached to healthy areas of the skin with leucoplastic strips. Sterile dry dressings are applied over a disposable plastic dressing covering the wound and bandaged. Bandages are changed after 24-72 hours. After removing the dressings, a wound toilet is made with wet sterile napkins with an atiseptic solution. By quenching, the wound surface is dried and healthy skin around the wound is treated. The fibrin-leukocyte membrane enveloping the membrane is not forcibly removed. A new MD dressing is applied to the wound and fixed as described above. Wound healing occurs on the 6-8th day.

Obtaining a perforated skin flap with a skin bridge in a rhombus.

Perforation of the skin flap is performed using a perforator PM with a skin bridge in the rhombus, for example, with a coefficient of 1: 3. The taken autoderm graft with tweezers is placed on the platform between the knives of the punch. The graft is passed between the rotating knives and on the opposite side with tweezers, the perforated skin is held and removed.

Before skin transplantation, a special wound preparation is performed - removal of pathological layers from the wound. To do this, Dermatom Menzul-61-01 perform an operation - surgical dermatome pre-transplant resection of granulation tissue (PTRG) wounds. By gentle, tangential movements of the dermatome, the surface and middle layers of granulations are cut off layer by layer. Thickness of tissue cutting is 0.1-0.2 mm. The wound surface is leveled, making the receiving bed more optimal. The wound is transferred from chronic to acute. Bleeding is stopped with sterile wipes moistened with a solution of adrenaline or an electrocoagulator.

A perforated autoderm graft with a jumper in the rhombus is taken with tweezers and transplanted onto an optimally prepared wound. The skin flap transferred to the wound surface is fixed to the healthy edges of the skin and between each other using ligatures or a stapler.

A wound with a transplanted atoderma transplant is treated with disposable MD plastic dressings (made of a polyethylene film, and on the surface of the film only one ingredient of mineral and / or organic origin is applied, which is not a medicine, for example, talcum powder or pollen, and the film is made in the form of a tape with tear-off tape notches made in the form of holes located along the tear lines) in the conditions of their own liquid medium and in combination with ointments or powder powders. An MD single-use dressing is removed from the sterile bag and the wound with transplanted skin is closed in excess, the dressing is fixed with adhesive tape to healthy areas of the skin and in places of overlap. Also for these purposes, you can use ligature seams or a stapler. In the combination treatment of wounds with transplanted skin with an MD dressing and ointments or with powdered powders, the wound surface is first treated, a levomycol is sterilized with a sterile spatula or sprinkled with baniocin powder on an auto transplant. On top of the disposable MD plastic dressing covering the wound, apply sterile dry dressings and bandage. Bandages are changed after 24-48 hours. When the healing of the cells of the perforated skin appears, the closure is performed by mesh wound coverings, for example, parapran fragments. Dressings are carried out until complete transplantation of the transplanted skin.

Thus, the use of the present invention will allow us to create a more gentle method of treating deep burns, accelerating the healing of burn and donor wounds, reducing the time of treatment, reducing the possibility of scarring using devices that provide better preparation of the graft.

Claims (12)

1. A method of preparing a skin graft for transplantation to a patient, based on its perforation by applying a through-cut system and forming a system of polygonal holes in the flap, characterized in that a through-cut system is applied to the skin flap so that subsequent stretching of the flap results in polygonal holes having at least one jumper connecting the opposite corners of the polygons. 2. The method according to p. 1, characterized in that the through-slots are applied so that by stretching the flap, rectangular holes are formed in it with an aspect ratio of 1: 2, or 1: 3, or 1: 4, or 1: 6. 3. The method according to p. 1, characterized in that the through-slots are applied so that by stretching the flap, rhombic holes are formed in it. 4. The method according to p. 1, characterized in that the through-slots are applied so that by stretching the flap, hexagonal holes are formed in it. 5. The method according to p. 1, characterized in that the through slots are applied so that by stretching the flap, holes are formed in it in the form of a parallelogram with an aspect ratio of 1: 2, or 1: 3, or 1: 4, or 1: 6. 6. A rotary hammer containing a housing, two shafts, one of which contains a set of circular knives with spacers, and the other a set of persistent disks with spacers, characterized in that the persistent disks are made in the form of small disks rigidly mounted on the shaft and floating rings, mounted on the shaft with the possibility of movement in the radial direction, and the diameter of the small discs is 2-8% less than the inner diameter of the floating rings, and the thickness of the floating rings is in the range of 0.2-2.0 mm and is commensurate with the thickness of the knife. 7. The hammer drill according to claim 1, characterized in that the thickness of the knives is in the range of 0.2-2.0 mm, and the diameter of the shafts is in the range of 15-80 mm. 8. The hammer drill according to claim 1, characterized in that a comb with teeth is located in the lower part of the body, the width of which is proportional to the thickness of the spacers, and their vertices are located between the circular knives. 9. A rotary hammer containing a housing, two shafts, one of which contains a set of circular knives with spacers, and the other a set of persistent disks with spacers, characterized in that the persistent disks are made in the form of small disks rigidly mounted on the shaft and floating rings, mounted on the shaft with the ability to move in the radial direction, and the diameter of the small discs is 2-8% less than the inner diameter of the floating rings, and the thickness of the floating rings is in the range of 0.2-0.2 mm and is commensurate with the thickness of the knife, in addition, the knife is made two cutting disco 0.05-0.15 mm thick, is rigidly connected to the intermediate washer a thickness of 0.2-1.5 mm, the blade diameter greater than the diameter washers on the intermediate 0.1-1.5 mm. 10. A hammer drill according to claim 9, characterized in that a comb with teeth is located in the lower part of the body, the width of which is proportional to the thickness of the spacers, and their vertices are located between the circular knives. 11. A method of treating burns based on the use of a perforated skin flap, characterized in that flaps perforated in the form of polygonal holes having diagonal jumpers are used as a graft skin graft. 12. A method of treating burns according to claim 11, characterized in that sterile disposable polyethylene dressings are used as a wound dressing, and only one ingredient of mineral and / or organic origin is applied to the film surface, which is not a medicine, for example, talcum powder or pollen, and the film is made in the form of a tape with tear-off cutouts made in the form of holes located along the tear lines.

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