RU2648859C1 - Method of tying of the surgical knot by the length of the loop of the previous stitch - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to surgery. Perform a suturing of a continuous locking stitch with fixation of the ends of the thread before and after its application. Fixation of the second working end of the main thread after the application of the locking stitch is performed as follows: keeping the tension of the previous stitches of the suture, form the last stitch with the outer threading between stitch output and input without tension of the thread, through the relaxed loop of this stitch conduct an additional thread, then pull the main thread over the working end, ensuring the tension of the last stitch, then connect the working end of the main thread and the ends of the additional thread.

EFFECT: method makes it possible to create conditions for the convenient tying of the surgical knot, regardless of the situation developing during the operation, ensures the reliability of the suture.

4 cl, 2 ex, 8 dwg

Description

The invention relates to medicine, namely to surgery, and can be used in operations using atraumatic surgical suture material.

Each surgical operation, as a rule, is accompanied and ends with a layered connection of tissues. Suturing and tying of surgical knots is one of the main sections of a surgical operation. When performing a continuous twisting seam, problems often arise associated with knotting due to the short remainder of the surgical thread, the inconvenience of forming the surgical knot due to the loop of the previous stitch, loose tightening of the surgical knot, and others. This problem becomes even more urgent if it is necessary to tie the surgical site in conditions of deep surgical wounds (pleural cavity, abdominal cavity), as well as when using thin atraumatic suture material (6/0, 7/0).

A well-known technique is the traditional tying of a surgical site when applying a continuous twisting stitch (Kagan II, Chemezov S.V. Topographic anatomy and surgical surgery: textbook. M .; 2009. - 672 p. - prototype). In chapter 7.2.3 of the manual “Suturing Technique”, the following technique for applying continuous continuous suture is presented: a nodal suture is applied at the wound edge so that one end of the thread is much longer than the other (Fig. 1, a). Then, a needle tucked into the long end of the thread continuously sews fabric stitch to stitch throughout. The distance between the stitches should be equal to 0.5-0.7 cm. With the last stitching, the thread is not fully removed, but used to tie the last knot with the working end of the ligature (Fig. 1, b).

Using the usual method of tying the last knot of a continuous twisting seam has the following disadvantages.

1. An adequate length of thread is required after suturing is completed, as an additional 10-15 cm of thread is required to stretch the loop of the last seam to tie it to the working end of the ligature. With a short remainder of the thread after applying the last stitch, tying the surgical site becomes an intractable task.

2. Tying the knot requires additional efforts and manipulations to tighten the stitches of the loop of the last seam to prevent the relaxation of previous stitches and the surgical knot itself. These efforts and manipulations often lead to damage or rupture of the thread in its different areas, especially when using thin monophilic threads 6/0 or less.

3. When manipulating in a deep surgical field (abdominal cavity, chest cavity, bottom of deep wounds), the technique of tying such knots, especially when using thin threads, presents significant difficulties.

Disclosure of the developed method.

The technical problem solved in the developed method is the creation of a suturing technique devoid of the disadvantages of the prototype.

The technical result achieved in the developed method is the convenience of tying the surgical unit regardless of the situation during the operation (regardless of the residual length of the main ligature of the continuous twisting seam and the technique of tying the performed node, the ability to perform manipulations when tying the surgical seam in a deep surgical field) and reliability (eliminating the need for twitching at the ends of the loops of the previous seam due to the insufficient length of the ends of the knot my thread, minimizing the likelihood of damage and breaks the main thread for tying ligatures, especially when using fine threads (6/0 and thinner)).

In addition, the developed technique, due to the possibility of maintaining a large length of the residual main ligature, allows you to overlay additional stitches.

Perform the imposition of a continuous twisting seam with the fixation of the ends of the thread before and after its application. Moreover, the fixation of the second working end of the main thread after applying the twisting stitch is performed as follows: while maintaining the tension of the previous stitches of the stitched seam, the last stitch is formed with the outer thread being held between the puncture and injection without tensioning the thread, an additional thread is drawn through the relaxed loop of this stitch, then it is pulled by the working the end of the main thread, ensuring the tension of the last stitch, then the working end of the main thread and the ends of the additional thread are connected together. As an additional thread, kapron or silk thread is used. If necessary, after fixing the second end of the main thread, it is possible to make additional stitches of a twisting seam using an additional thread. To implement the developed technology, it is advisable to comply with the condition - the outer diameters of the cross section of the main and additional threads should be equal to each other.

The method is as follows.

A method of tying a surgical knot by lengthening the loop of the previous stitch involves the use of an additional silk or nylon thread that stretches through the loop of the previous stitch of the main thread before tying the surgical knot. After the completion of the overlaying of the stitches of the continuous twisting seam, the last thread is not fully removed with the last flashing (Fig. 2). A nylon or silk thread of approximately the same thickness as the main thread is passed through the loop of the last stitch (Fig. 3).

Further, the surgeon in one hand takes an additional kapron (silk) thread, and in the other - the working end of the main thread (Fig. 4). Pulling on the last one, the specified loop of the previous stitch is pulled out to a length sufficient for adequate knot formation (on average 2-3 cm). As a result, the ends of both threads in the hands of the surgeon are of sufficient length for tying (Fig. 4) without additional effort and special techniques.

After that, the surgeon has the opportunity to tie the threads together in any way convenient for himself (Fig. 5). Then the long ends of the knotted thread are cut off (Fig. 6).

Example 1

The application of the method of tying the surgical site by lengthening the loop of the previous stitch during the operation of the plasty of the descending thoracic aorta with a synthetic patch using a continuous twisted stitch with a 6/0 prolene thread (Fig. 7). In connection with the long line of the anastomosis and the short remainder of the ligature after its completion, when tying the surgical site, the above-described method of tying the surgical suture was used.

Example 2

The application of the method of tying a surgical node by lengthening the loop of the previous stitch during surgery of surgical fenestration of the abdominal aorta. After the reconstruction of the interisceral and interrenal sections of the aorta is completed, the aortotomy incision is sutured with a continuous twisted suture with 4/0 prolene thread and the suture line is reinforced with teflon gaskets (Fig. 8). Due to the considerable length of the aortotomy incision and the two-layer suture, the residual length of the suture does not allow an adequate surgical site to be applied. The application of the above method allowed to complete this stage of the operation without the use of additional threads and complex surgical procedures.

Using the developed method in all cases of practical use made it possible to obtain a reliable seam in conditions of convenient tying of a surgical unit.

Claims (4)

1. The method of tying the surgical site by lengthening the loop of the previous stitch, including applying a continuous twisting seam with fixing the ends of the thread before and after applying it, characterized in that the fixing of the second working end of the main thread after applying the twisted seam is performed as follows: maintaining the tension of the previous stitches of the applied the seam, form the last stitch with the outer thread passing between the puncture and the injection without tensioning the thread, through the relaxed loop of this stitch an additional thread is carried out, then pull the main thread by the working end, providing tension to the last stitch, then the working end of the main thread and the ends of the additional thread are tied together. 2. The method according to p. 1, characterized in that as an additional thread using kapron or silk thread. 3. The method according to p. 1, characterized in that after fixing the second end of the main thread impose additional stitches of a twisted seam using an additional thread. 4. The method according to p. 1, characterized in that the outer diameters of the cross section of the main and additional threads are equal to each other.

Images