RU2241389C2 - Method and device for suturing cutaneous wounds - Google Patents

Abstract

FIELD: medicine; medical engineering.

SUBSTANCE: method involves conducting an intracutaneous atraumatic thread by piercing skin periphery on the same side with an incision in turn, fixing thread end portions brought outside and dosing thread tension during the whole wound-healing time period. The device has atraumatic thread, members for fixing thread end portions, and at least one tension member. The tension member is manufactured as spiral connected to thread end and fixing member. The thread and tension member are manufactured from titanium nickelide possessing superelasticity properties.

EFFECT: optimum and stable skin compression in wound.

2 cl, 3 dwg

Description

The invention relates to medical surgical equipment.

In the surgical technique, various technical means are known (paper clips, clips, adhesives, etc.) for joining disparate body tissues and methods corresponding to them. The most widely used suture material in the form of a thread and a method of connecting fabrics with its help, called suturing. Techniques for suturing wounds of various tissues are specific and causally justified.

For suturing skin wounds, when the cosmetic effect becomes important, in addition to the functional, filament suture material and the method are used, which means that an atraumatic thread with a knot tied at the end is carried out intradermally by alternately piercing the edges of the skin from the side of the incision, removing it from the end wounds and tying of a knot of thread, which is a retainer resting on the skin [1].

According to the greatest similarity of the technical essence, the specified method of suturing wounds is selected as a prototype of the invention - the method, and suture material, as a technical means of its implementation, as a prototype of the invention is a device.

These analogues have technical disadvantages that reduce the effectiveness of the operation.

1. The method and suture material do not provide the proper, optimal for healing, compression of the contracted edges of the wound. Surgeon errors are possible, leading to ischemic consequences (excessive tension) or suture failure (weak tension). Postoperative adjustment of the thread tension is difficult.

2. Fixation of the thread by knots does not create the necessary rigidity of the support; it is possible to weaken the tension of the thread after fixing. The small area of the supporting surface of the nodules leads to increased pressure on the tissue at the site of contact near the wound with the threat of necrotization.

3. The weakening of the thread tension as a result of the course of the wound process and reduce tissue edema. Compensation for such attenuation in the prototype method is not provided.

4. Traditional suture materials (silk, lavsan, etc.) have low surgical characteristics - soaking in a liquid medium, strength in knots and in linear sections, the complexity of disinfection, etc.

The technical result of the proposed invention is the optimization and stabilization of the degree of compression of the connected skin tissue in the wound.

The specified technical result is achieved by the fact that in the method of suturing skin wounds, including intradermal conduction of atraumatic suture by alternately punching into the edges of the skin from the side of the incision and fixing the terminal ends of the suture exposed to the outside, dosed tension is carried out throughout the healing time using a tensioner made of titanium nickelide with the effect of superelasticity.

The specified technical result is also achieved by the fact that the device for suturing skin wounds containing atraumatic thread and fixation elements of its end sections is additionally equipped with, but at least one tensioner in the form of a multi-link spiral connected to the end of the thread and the retainer, and as a material of the thread and tensioners selected titanium nickelide with the effect of superelasticity. The achievement of the technical result is due to ensuring optimal tension of the thread by selecting the strain value of the active element (spiral) and expanding the deformation range above sufficient to compensate for the elongation of the thread using the superelasticity of titanium nickelide and its accumulation in the multi-link structure of the spiral. The optimum tension is also achieved by selecting the operating point of the stress-strain diagram of titanium nickelide, which is carried out when the tensioner is installed.

The specified technical result is also accompanied by other positive consequences of the use of the proposed method and device.

1. Fixation of suture material away from the incision, which is prescribed by the need to place a tensioner, eliminates pressure on the skin in the access area.

2. High biocompatibility of suture material (titanium nickelide) reduces the healing of the body’s resources.

3. Due to the high mechanical strength of the suture material increases the reliability of the seam, the consistency of the entire operation.

The totality of the essential features indicated in the formulas in their causal connection with the technical result in the patent search undertaken by the authors was not found, which should indicate that the proposals meet the criterion of “inventive step”.

The illustrations show:

figure 1 - suturing of the skin wound of the proposed method using the proposed device; figure 2 - device for suturing a skin wound in the claims: 1 - thread, 2 - thread tensioner; figure 3 is a photo of a skin suture made by the proposed method by the proposed device.

Achievability of the technical result is confirmed by specific examples of clinical use in the regional clinical hospital in Novosibirsk.

Example 1

Patient B., 38 years old, medical history No. 599. The diagnosis of the disease: diffuse nodular non-toxic goiter stage 2. Operation - subtotal resection of the thyroid gland (neck, figure 3) in connection with increased cosmetic requirements performed by the proposed method using the proposed device.

The device (figure 2) contains an atraumatic thread 1 of titanium nickelide grade TN-1E with a diameter of 0.09 mm and a tensioner in the form of two serially connected flat zigzag spirals of nickel-titanium wire with a diameter of 0.5 mm.

The device and method are as follows: after removal of the thyroid gland through an incision in the neck, the resulting surgical wound 10 × 2 cm in size is sutured with this thread by alternately sticking into the edges of the skin from the side of the incision along a zigzag path (Fig. 1) and pulling the ends of the thread out. After reducing the edges of the wound and tightening them with a thread with a force of about 0.1 kgf, the edges of the thread are connected with tensioners 2, which are fixed to the skin of the patient with an adhesive plaster. Tensioners tension corresponds to the specified efforts.

The suture was removed on the 5th day after the operation and healing took place by primary intention. Inspection after 2 months established an excellent cosmetic effect. Postoperative skin scar is barely visible in the form of a reddish strip 0.3 mm wide.

Example 2

Patient K., 28 years old, medical history No. 547 went to the clinic with a diagnosis of hypertrophic postoperative scar of the area below the navel and cosmetic dissatisfaction with her appearance. 10.10.2001, the patient performed the operation of the proposed method using the proposed device. The device used nickel-titanium thread with a diameter of 0.09 mm and a tensioner in the form of a flat zigzag spiral of nickel-titanium wire with a diameter of 0.5 mm.

The device and method are as follows.

Under local novocaine anesthesia, a skin scar 110 mm long, 12 mm wide and up to 4 mm thick is excised with two bordering incisions to the abdominal wall aponeurosis with a 3-4 mm deviation from the edges of the scar.

The subcutaneous tissue is sutured with separate interrupted sutures using the “Vicryl” thread. The resulting skin defect (wound) with dimensions 120 × 35 × 25 mm is sutured intradermally by alternately injecting the thread along a zigzag path (Fig. 1.) The withdrawn ends of the thread after tightening the edges of the wound are tensioned with a force of 0.2 kgf and are fixed to tensioners fixed to skin with a band-aid. After 10 days, the tensioners are removed and the thread is removed by traction.

Cosmetic effect achieved after 1 month. The line of the skin scar of the transverse size of 0.2-0.5 mm is weakly visible upon examination. There is no pain, no seals on palpation.

The industrial applicability of the proposals is determined by their technological readiness and the availability of medical personnel with experience in conducting these operations.

Sources used in compiling the description:

1. Zoltan J. Cicatrix optima. Operating technique and conditions for optimal wound healing. Per. from Hungarian. - Budapest, 1977 (prototype).

Claims (2)

1. A method of suturing skin wounds, including intradermal atraumatic suture by alternately injecting into the edges of the skin from the side of the incision, fixing the outward end portions of the suture and dosed tension of the suture during the entire healing time, characterized in that they use a device for suturing skin wounds according to .2. 2. A device for suturing skin wounds containing atraumatic thread, elements for fixing the end sections of the thread and at least one tensioner, characterized in that the tensioner is made in the form of a spiral connected to the end of the thread and the retainer, while the thread and tensioner are made of titanium nickelide with the effect of superelasticity.

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