RU2708201C1 - Fixator of sutures-holders for formation of vascular anastomosis without participation of assistant - Google Patents

Abstract

FIELD: medicine.SUBSTANCE: invention refers to medicine, namely to surgery, vascular surgery, microsurgery, traumatology, neurosurgery, and can be used for vascular anastomosis. Device for fixation of sutures-holders during formation of vascular anastomosis contains metal housing and mechanism of threads fixation. Housing is made in the form of rectangular base, curved C-shaped, having long and short sides. From the angle of each short face there are two lugs diverging from each other at angle of 60 degrees and mirror-converging working surfaces with two tabs of the opposite short edge. Ends of mirror-closing tabs are bent to insert sutures-holders.EFFECT: use of the invention provides reliability and safety when fixing sutures-holders.1 cl, 2 dwg

Description

The invention relates to medicine, namely to surgery, vascular surgery, microsurgery, traumatology, neurosurgery, and can be applied when performing a vascular anastomosis.

It is known that in the formation of a vascular anastomosis, the help of an assistant is necessary [Hai G.A. Assistance in surgical operations. Monograph, St. Petersburg: Hippocrates, 1998, 382 p.].

A known method of forming a vascular anastomosis according to A. Morozova, which consists in the use of two suture-holders, with which the ends of the anastomosed vessels are stretched to the sides, and the lower and upper edges of the anastomosed vessels are formed. During the operation, the surgeon-assistant holds these formed stitches-holders, constantly maintaining their optimal tension, while the surgeon-operator forms a continuous seam of the lower and then upper edges of the anastomosed vessels [Morozova A.I. On the vascular suture and vascular transplant. SPb. 1909]. This method prevents the collapse of the vascular walls between each other and provides a good visualization of the suture field. However, its drawback is that the continuous retention by the surgeon-assistant of the formed stitches-holders is one of the key points of surgical intervention. If it is not enough to stretch the stitches-holders to the sides and hold them at such non-optimal tension of the threads, the visibility of the ends of the stitched vessels is significantly impaired by the surgeon-operator. If the review is difficult, there is a significant risk of changing (increasing / decreasing) the distance between the places of injection and the bulging material, as a result of which there may be a violation of the optimal adaptation of the stitched edges of the vascular anastomosis, which may ultimately lead to thrombosis. Also, with a difficult review, the probability of the needle passing through not all the layers of the vascular wall increases, which can negatively affect the strength of the anastomosis and, ultimately, lead to bleeding. In addition to the foregoing, with a difficult review, the risk of a suture needle piercing the opposite wall of a collapsed vessel increases, which can also lead to thrombosis and / or bleeding from this vascular anastomosis. The listed risks and complications indicate the importance of the role of the assistant surgeon in ensuring an optimal overview to the operator surgeon.

Known latch seams-holders containing clamps with jaws and a mechanism for moving and fixing the clamps according to S.A. Popov [SU No. 1053817, 1983].

The closest analogue of the invention is the retainer of the suture-holders for applying a vascular suture according to A.I. Bliskunov [SU No. 349393, 1972], comprising a housing, a handle and a clip for a flat spring, the housing being made in the form of a U-shaped bracket with slots for threads, restrictive protrusions, a clip for a flat spring, and the handle is removable. The prototype has the following disadvantages. Firstly, the known tool has a complex structure, which reduces its wear resistance in each contacting node and increases the economic cost of its production. Secondly, the known tool is large due to the presence of the handle. Thirdly, due to the design features of the locking mechanism, when fixing the stitches-holders, the device captures the large length of the strings-holders, which reduces the mobility of the tool.

The objective of the invention is to develop a device for fixing suture material, ensuring the preservation, without the participation of an assistant, of the stability of the tension of the stitches-holders and adequate visibility of the stitched ends of the vessel, maintaining the stability of the tension of the threads of the holders.

The technical result when using the invention is to increase mobility, reliability and safety when fixing the seams-holders.

The specified technical result is achieved by the fact that the proposed tool is made in the form of an all-metal compact design, which increases its reliability, safety and ease of use, and also allows the application of vascular anastomoses in various anatomical areas, without compromising visibility.

The proposed device is made in the form of an all-metal primitive design, which reduces the cost of production and increases the wear resistance of the instrument, the versatility and ease of use of the clamp, as well as its mobility when applying a vascular anastomosis.

The invention is illustrated by the following figures: in FIG. 1 shows the proposed device, a General view; in FIG. 2 - the device is in working condition.

The proposed device contains an all-metal rectangular base 1, which is curved C-shaped, has long and short edges 2-3 and two legs 4, which originate from each short edge 3 near the corners and somewhat from the center. The tabs 4 diverge from each other at an angle of 60 degrees and mirror on the working surfaces with two tabs of the opposite short edge 3, the ends 5 of the mirror-closing tabs are unbent for the introduction of stitches-holders (Fig. 1). Thus, on the basis of the elastic properties of the metal, the mechanism of fixation of the seams-holders is formed.

The proposed device is used during the standard stages of applying a vascular anastomosis: after processing the surgical field and providing surgical access to the proposed site of intervention, blood vessels are isolated from the surrounding tissues. To stop bleeding from their lumen, clips are placed on the vessels and, in the case of primary trauma (traumatic rupture of the vessel), the edges of the vessels are excised with scissors to an intact structure. Then, at an equal distance from each other, on the lateral surfaces of the vessels, through all layers, by injection and puncture of atraumatic suture material, two suture-holders are applied U-shaped. The needles are cut off from the suture material, and the ends of the suture-holders are carefully inserted between the working surfaces of the legs 4 and fixed by them (Fig. 2). If necessary, the surgeon-operator can adjust the tension of the threads of the suture-holders, and provide for himself the conditions for optimal viewing, and, consequently, for technically competent operation. The device allows, without the assistance of an assistant, to keep an overview of the ends of stitched vessels, to ensure the constant tension of the vascular wall and the suture-holders, as a result of this, the help of an assistant to an operating surgeon disappears.

The proposed device was used in GBUZ RB GKB No. 21 of Ufa in medical work in 38 patients. There were no complications with the use of the device.

Clinical example. Patient X. 29 years old was admitted to the admission department of City Clinical Hospital No. 21 with traumatic amputation of the 2nd finger of the left hand. 2 hours before admission, he received a household injury with an electric saw. On clinical examination, the 2nd finger of the left hand was removed at the level of the main phalanx and delivered by the patient in an ice pack. Active bleeding continued from the digital arteries of a wounded limb wound. Under general anesthesia, osteosynthesis with spokes was performed on this phalanx. The superficial flexor is removed from the bone-fibrous canal. A comparison of the tendon of the deep flexor of the finger with a suture according to Kessler was performed. Next, the extensor extensor tendon is compared. After the two dorsal veins of the finger and the finger artery were isolated from the surrounding tissues, clips were applied to them for the purpose of temporary hemostasis. Next, the removal of non-viable tissue of the vessels and removal of their ends adventitia, to perform anastomosing suture. Then microvascular anastomoses were applied using the proposed device.

After removing the clips from the veins and then from the artery and checking the adequacy of blood flow in these vessels, the nerves were compared with polypropylene 9/0. Wound closure by layer-by-layer suturing of tissues and the application of an aseptic dressing. Plaster immobilization was performed for up to 4 weeks with subsequent development. In the postoperative period, no complications were detected. Examination of the patient after 6 months. The function of the 2 fingers of the left hand is good (according to V.I. Rozov). The patient works as a bricklayer.

Thus, the proposed device is a clamp suture-holders is safe, effective, easy to use and can be used when performing a vascular anastomosis, so it can be recommended for use in the departments of vascular surgery, microsurgery, traumatology, neurosurgery to provide medical care in planned and emergency order.

Claims (1)

A device for fixing the suture-holders during the formation of the vascular anastomosis, containing a metal body and a mechanism for fixing the threads, characterized in that the body is made in the form of a rectangular base, curved C-shaped, having long and short sides, two legs extend from the angle of each short face , diverging from each other at an angle of 60 degrees and mirror-like working surfaces with two legs of the opposite short face, and the ends of the mirror-closing legs are unbent for the introduction of stitches-holders.

Images