RU2721881C1 - Method for single-stage skin wound closure with cosmetic surgical suture - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to surgery. First nodal inverted suture in the caudal wound is applied to the subcutaneous fat with the absorbable atraumatic suture. 7–10 cm-long suture end is brought out of the wound and taken to a clamp. Further, a blanket suture is applied on the subcutaneous fat with needle pricks under the derma to the opposite angle of the wound at pitch of 1 cm with gradual tightening of the suture until tightness is created. Then, in the cranial angle of the wound, after the last thread in the subcutaneous fat, the needle is pricked out in derma at 1 mm from the skin surface. Suture is pulled, the prick in the opposite dermal edge of the wound is performed at depth of 1 mm from the surface and in parallel to the skin surface with the further implementation of the cosmetic intradermal suture up to the caudal angle of the wound. Last prick out is performed at depth of 3–5 mm from the skin surface. 3–5 nodules with a short end of the suture are knitted and immersed in the wound depth.

EFFECT: method enables reducing the operation time, accelerating the wound healing, levelling the subcutaneous cavity and improving the cosmetic effect.

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Description

FIELD OF THE INVENTION

The invention relates to medicine, in particular, to a method for performing simultaneous closure of a skin wound with a cosmetic surgical suture and can be used in surgery for simultaneous suturing of skin wounds, including purulent ones, with a cosmetic surgical suture.

State of the art

A known method of applying a surgical suture is to inject a surgical needle into the surface of the skin at the edge of the wound, remove the needle in the middle of the subcutaneous fat layer of the same side, pass the needle through the middle of the subcutaneous fat layer of the opposite edge under the bottom of the wound, followed by the passage of the thread through symmetrical points both edges of the wound with the formation of two vertical annular stitches located one above the other, knotting knots on the skin surface (see Ovchinnikov V.A., Abelevich A.I. Tissue connection in surgery. Manual for doctors. 2005, p. 34, fig. . 41).

The disadvantage of this method is a significant increase in the duration of suturing of the wound due to the need to repeatedly carry out the thread through the middle layer of subcutaneous fat of both edges of the wound during the formation of two vertical annular stitches of the suture.

A known method of performing a cosmetic surgical suture, including injecting a needle into the skin, through subcutaneous fat, with capture of the bottom of the wound, while the needle with suture material after injecting into the skin is carried out intradermally parallel to the skin at a distance of 2 to 5 cm from the edge of the wound, rotate , the needle is brought to the bottom of the wound, a puncture is carried out through all layers to the middle of the dermis from the opposite side 2-5 cm from the edge of the wound, then the needle is rotated and withdrawn intradermally to the injection site (see Pat. RU No. 2360624 IPC АВВ 17/04, published July 10, 2009, Bulletin No. 19).

The disadvantage of this method is the unsatisfactory cosmetic effect due to the possible inversion of the skin edges, especially in patients with severe subcutaneous fat, as well as the possibility of formation of pockets and cavities deep in the wound.

A known method of applying a surgical suture, including sequentially passing the thread through the skin, subcutaneous fatty tissue of both edges of the wound with the formation of a vertical single-ring stitch, tying the ends of the thread with a knot, while holding a needle over the free end of the thread with the formation of an inter-ring oblique stitch, pass a needle with thread under cross-ring oblique stitch in the opposite direction to the free end of the thread, tie the ends of the thread on the inter-ring oblique stitch in the center and in the depth of the wound (see Pat. RU No. 2436528 IPC А61В 17/04, published on December 20, 2011, bull. No. 35 )

The disadvantage of this method is the difficulty of close suturing due to the simultaneous contraction of the dermis and subcutaneous fat and narrowing of the wound, an increase in the distance between the seams, which can lead to the formation of pockets and infection, the difficulty of dosing tension when crossing the threads and the formation of nodes.

A known method of performing a vertical mattress nodal surgical suture Donati, which is used to suture extensive wounds as follows: injecting a needle into the skin, through subcutaneous fat with capture of the wound bottom, punctured through all these layers on the skin of the opposite side of the wound, the needle is again injected into the skin having deviated from the injection site by several mm, they are punctured from the side of the wound cavity, injected into the skin from the opposite side of the wound, also from the side of the wound cavity, and again punctured on the skin, departing a few mm from the site of the previous injection (see Topographic anatomy and operative surgery / Edited by Academician of the Russian Academy of Medical Sciences Yu.M. Lopukhin. 2 vol. M: GEOTAR-MED, 2002, T. 1, S. 64-67).

The disadvantage of this method is a cosmetic defect in the form of transverse traces on the skin remaining after removing the suture due to teething.

A known method of applying a surgical suture is to inject a surgical needle into the deep surface of the dermis from the side of an unhealed wound in the back, front and up with the needle passing through the middle of the dermis of both edges of the wound with a puncture in the deep layer of the dermis with the formation of the reverse single-ring stitch with the same the number of soft tissues in the seam and on the other hand and knotting deep in the skin surface (see Belousov AE Plastic reconstructive and aesthetic surgery, 1998, pp. 119-120, Fig. 12.6.13).

The disadvantage of this method is that the seam captures only the surface layers of the skin, which creates the conditions for the formation of a residual cavity and blood accumulation in the subcutaneous fat, which leads to infection of the hematoma, and inflammatory changes in the wound are the causes of the formation of a rough surgical scar, significantly reducing cosmetic result of the operation.

There is a method of performing a cosmetic surgical suture, including injecting a needle with suture material into the epidermis at the edge of the operating cavity, piercing the dermis with the bottom of the operating cavity grasping on its opposite side, then turning the needle to puncture through the dermis and epidermis, while after injecting the needle into the epidermis

 turn in the direction of the operating cavity and spend in the thickness of the dermis with the capture of the bottom of the operating cavity for its opposite side, behind which the needle is deployed in the opposite direction with the capture of the dermis is brought into the operating cavity at the level of a third of the wall from the epithelium, then at the same level the needle is injected into the opposite the wall of the operating cavity and through the dermis and epidermis carry out a puncture from the epithelium indented from the injection site in the direction of the edge of the operating cavity, after which the operating cavity is compressed and tightened with suture material, the latter is fixed over the epithelium with a surgical unit, then the upper third of the operating cavity is closed with the epidermis by applying a suture material by a continuous linear seam.

In the method, the injection of the needle in the epidermis is performed at a distance of 2-3 cm from the edge of the operating cavity (see US Pat. RU No. 2 408301 IPC A61B 17/04, publ. 10.01.2011, bull. No. 1).

However, this method has several disadvantages: multi-stage application of separate sutures on subcutaneous fat, the presence of additional skin punctures and cutaneous elements of the thread, which additionally lengthens the operation, additional scars appear, the wound needs attention after the surgical period, removal of sutures is required.

The closest in technical essence and the achieved positive effect and adopted by the authors for the prototype is a method of suturing a postoperative wound after a laparotomy, including applying a single-row continuous suture to the skin and subcutaneous tissue, while fixing the thread in the subcutaneous tissue in one of the corners of the wound, applying subcutaneous-intradermal a seam to the opposite corner of the wound, form a node in the subcutaneous tissue using the terminal thread of the suture of the aponeurosis (see US Pat. RU No. 2 268009 IPC АВВ 17/04, publ. 20.01.2006, bull. No. 2).

The disadvantage of this method is its low efficiency, since a cosmetic defect is manifested in the form of transverse traces on the skin remaining after the removal of the suture due to teething.

Disclosure of invention

The objective of the invention is to develop a method for performing simultaneous closure of a skin wound with a cosmetic surgical suture after surgical operations, which has, reducing the time of surgery and accelerating wound healing, as well as leveling the subcutaneous cavity and improving the cosmetic effect.

The technical result that can be achieved using the present invention is to reduce the time of the operation, accelerate wound healing, leveling the subcutaneous cavity and improve the cosmetic effect.

The technical result is achieved using the method of simultaneous closure of the skin wound with a cosmetic surgical suture, including fixing the thread in the subcutaneous fat in the corner of the wound, suturing with a continuous suture, with further immersion of the node into the depth of the wound, while the first nodal inverted suture is applied in the caudal corner of the wound on subcutaneous fat tissue with absorbable atraumatic suture, while the short end of the suture 7-10 cm long is removed from the wound and taken to the clamp, then an upholstered suture is placed on the subcutaneous fat tissue with needle punctures under the dermis to the opposite corner of the wound in 1 cm increments with the thread gradually tightened until tightness is created, then in the cranial corner of the wound after the last thread in the subcutaneous adipose tissue, the needles are punctured in the dermis 1 mm from the skin surface, followed by thread pulling, with an injection in the opposite skin edge of the wound at a depth of 1 mm from the surface and parallel to the skin surface with the farthest by conducting cosmetic intradermal suture to the caudal angle of the wound, the last puncture being performed at a depth of 3-5 mm from the skin surface and knit 3-5 knots with a short end of the thread and immersing it in the depth of the wound.

Thus, the technical result is achieved by the simultaneous application of a continuous upholstery suture on the subcutaneous fat (PUF), followed by cosmetic intradermal suture in the dermis and immersion of the node in the pancreas.

The essence of the method of performing simultaneous closure of the skin wound with a cosmetic surgical suture is as follows.

A needle is injected with suture material into the epidermis, the dermis is punctured, then a needle is punctured through the dermis and epidermis, and after the injection into the epidermis, the needle is turned in the direction of the operating cavity and is carried out in the thickness of the dermis with the bottom of the operating cavity being captured for its opposite side, behind which the needle is deployed in the opposite direction with the dermis being taken into the operating cavity, while the first nodal inverted suture is placed in one corner of the wound on the subcutaneous fat tissue with an absorbable atraumatic thread 3-0 or 4-0. The short end of the suture, approximately 7-10 cm, is removed from the wound and taken to the clamp. Next, a curvy suture is placed on the pancreas to the opposite angle of the wound in increments of no more than 1 cm with a gradual tightening of the thread until a reliable tightness is created, then in the cranial corner of the wound after the last thread in the subcutaneous fat, the needle is punctured in the dermis 1 mm from the skin surface . The thread is pulled. An injection is made in the opposite skin edge of the wound at a depth of 1 mm from the surface and parallel to the skin surface with the further classical technique of cosmetic intradermal suture to the caudal corner of the wound. The last puncture is performed at a depth of 3-5 mm from the surface and knit 3-5 knots with a short end of the thread. The node is immersed in the depths of the wound.

Brief description of drawings and other materials

In FIG. 1 shows a way to perform simultaneous closure of a skin wound with a cosmetic surgical suture, the short end of the suture is removed from the wound and taken to the clamp.

In FIG. 2, too, knit 3-5 knots with a short end of the thread, and the knot is immersed in the depth of the wound.

The implementation of the invention

Examples of specific performance of the method of performing simultaneous closure of the skin wound with a cosmetic surgical suture.

Example 1. A method of performing simultaneous closure of a skin wound with a cosmetic surgical suture, as follows.

For a better understanding of how to simultaneously close the skin wound with a cosmetic surgical suture, the suture is schematically shown in FIG. 1, 2, where:

- the first nodal inverted seam 1;

- wound (operating cavity) 2;

- subcutaneous fat (PUFA) 3;

- thread 4;

- clamp 5;

- upholstery seam 6 on PZhK 3;

- dermis 7;

- epidermis 8;

- node 9.

The first nodal inverted suture 1 is applied in the caudal corner of the wound 2 into the epidermis 8 on the subcutaneous fat (PUF) 3

 absorbable atraumatic thread 4 (3-0 or 4-0). The short end of the thread 4, approximately 7-10 cm, is removed from the wound 2 and taken to the clip 5. Next, a curving stitch 6 is placed on the pancreas 3 to the opposite corner of the wound 2 in increments of no more than 1 cm with a gradual tightening of the thread 4 to create reliable tightness. In this corner of the wound 2 after the last holding of the thread 4 in the subcutaneous fat 3, a needle is poked out (not shown in FIG.) In the dermis 7 1 mm from the skin surface. Thread 4 is pulled. An injection is carried out in the opposite skin edge of the wound 2 at a depth of 1 mm from the surface and parallel to the skin surface with the further classical technique of cosmetic intradermal suture to the left corner of the wound 2. The last puncture is performed at a depth of 3-5 mm from the surface and knit 3-5 knots 9 s the short end of the thread 4. The node 9 is immersed in the depth of the wound 2.

Examples of specific performance on patients of the method of performing simultaneous closure of the skin wound with a cosmetic surgical suture.

The proposed method for performing simultaneous closure of a skin wound with a cosmetic surgical suture was tested on 10 patients — an experimental group and 10 patients — a control group in which the method for closing a skin wound was performed using the classical technique of cosmetic intradermal suture (see Topographic Anatomy and Surgical Surgery / Ed. By Academician of the Russian Academy of Medical Sciences Yu .M. Lopukhina, V. 2, M .: GEOTAR-MED, 2002, T. 1, S. 64-67). Nosology: disc herniation L4-L5 with left-side lateralization, phlegmon, soft tissue abscesses of various locations, purulent peritonitis. In the control group: 7 patients aged 28 to 46 years have gross cosmetic defects in the form of traces on the skin from superimposed threads. In the experimental group: postoperative scars are even, without transverse traces from the applied threads. Example 2. Patient C, 48 years old. Diagnosis: lumbar osteochondrosis. L4-L5 disc herniation with left lateralization. Radiculopathy L5 on the left. Pronounced left-sided lumbar ischialgia. Under general anesthesia, pre-treatment of the surgical field with an antiseptic, a linear incision of the skin and subcutaneous fat 3 was made in the projection of the spinous processes L4-L5 3 cm long. Under the microscope, using the microsurgical technique, a typical L4-L5 microdisectomy was performed. Then, after applying the nodal 9 sutures 1 to the aponeurosis, simultaneous suturing of the wound 2 with absorbable atraumatic suture 4 - 3-0 was performed. In the caudal corner of the wound 2, the first inverted suture 1 is inserted over the subcutaneous fat 3. The short end of the suture 4 is removed from the wound 2 and taken to the clip 5. Next, a twisted suture 6 is applied to the subcutaneous fat 3 with needle punctures under the dermis 7 to the opposite corner of the wound 2 in increments of 1 cm, the thread 4 is gradually tightened until the edges of the wound 2 are tightly matched. In the cranial corner of the wound 2, the needle in the dermis 7 is punctured 1 mm from the skin surface. Thread 4 is tightened. Next, an injection is carried out in the opposite skin edge of the wound at a height of 1 mm from the surface and parallel to the skin surface with the further classical technique of cosmetic intradermal suture to the left corner of the wound. The last puncture is performed at a depth of 3 mm from the surface and 5 knots 9 are tied with the short end of the thread 4. The knot 9 is immersed in the depth of the wound 2. An aseptic dressing is applied. The postoperative period was uneventful. Wound 2 - the operating cavity healed by primary intention. The patient was discharged on the 4th day. The patient was examined after 1 and 3 months. Healing by primary intention is noted, the cosmetic effect is satisfactory, there is a thin skin scar. Recovery.

The present invention, in comparison with the prototype and other known technical solutions, has the following advantages: - allows to increase the tightness of the postoperative wound due to the dense suture of subcutaneous fat with a reliable upholstery;

- creates a good cosmetic effect due to the optimal adaptation of the edges of the wound and the absence of additional injection sites on the skin;

- reduces the patient’s hospital stay due to the absence of suture material from the outside and, starting from 4-5 days, does not require the supervision of a surgeon and dressings;

- leveling the subcutaneous cavity.

All this provides a high tightness of the wound, a satisfactory cosmetic effect, reduces the time of observation of the wound.

Claims (1)

A method of performing a simultaneous closure of a skin wound with a cosmetic surgical suture, including fixing the thread in the subcutaneous fat in the corner of the wound, suturing with a continuous suture, with further immersion of the node into the depth of the wound, characterized in that the first inverted suture is inserted in the caudal corner of the wound on the subcutaneous fatty tissue with absorbable atraumatic suture, while the short end of the suture 7-10 cm long is removed from the wound and taken to the clamp, then an oblique suture is placed on the subcutaneous fat with needle punctures under the dermis to the opposite corner of the wound in increments of 1 cm with gradual tightening the threads until the tightness is created, then in the cranial corner of the wound, after the last passage of the thread in the subcutaneous fat, the needles are punctured in the dermis 1 mm from the surface of the skin, followed by tensioning of the thread, injection in the opposite skin edge of the wound at a depth of 1 mm from the surface and parallel to the skin surface with further cosmetic intradermal suture to the caudal corner of the wound, the last puncture being performed at a depth of 3-5 mm from the skin surface and knit 3-5 knots with a short end of the thread and immersing it in the depth of the wound.

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