RU2636849C1 - Method for surgical nadelson's suture imposition - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: surgical suture is imposed. After needle injection into the hypodermis layer of one wound edge, the needle is co-vertically guided through the lower dermis of the same side near the hypodermic boundary. Transition to the other side of the wound is made. Here, through an injection at the same level, the needle is traversed co-vertically in the opposite direction from the bottom to the top with needle exit through the dermis of this side near the epidermis boundary. Further, a transition is made to the other side - an injection near the epidermis boundary. Then the needle is directed inside the dermis co-vertically from the top to the bottom with an exit at the place of the already present puncture. Transition to the other side is made, forming the second stitch. Through the injection in the place of the already existing puncture near the hypodermic boundary, the needle is held in a direction that is skewed to the first direction, from the top to the bottom. The needle is withdrawn through the deep layer of the hypodermis. Three consecutive knots are tied in series, adapting the wound edges.

EFFECT: method increases surgical suture reliability, reduces the risk of soft tissues necrosis, improves the aesthetic result.

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Description

The invention relates to medicine, namely to surgery, and can be used when performing manual cosmetic surgical suture for joining the edges of wounds using suture material.

Many varieties of surgical sutures have been proposed, depending on the physicomechanical properties of the tissues and the degree of violation of their integrity. The most general principle for the implementation of any suture is the respect for the edges of the stitched wound. As you know, primary wound healing is possible subject to the following principles:

- accurate and tight matching of the edges and walls of the wound without significant tension on the seam lines;

- retention of the edges and walls of the wound during the entire period of scar formation;

- atraumatic suturing and preservation of blood circulation in stitched tissues at a sufficient level;

- minimal effect of sutures on the surface of the skin and suture material on scar tissue.

As the analysis of the prior art, known inventions are aimed at solving these problems. So improving the accuracy of matching the edges of the wound and improving the aesthetic result of the operation is achieved in D1 by sequentially introducing the needle intradermally, parallel to the skin surface, at the same height, capturing the same amount of tissue with each stitch. At the same time, the needle injection site on one side is displaced posteriorly relative to the injection site on the opposite edge of the wound by 1/2 the length of the intradermal stitch, partially overlapping the previous intradermal stitch with the formation of an intradermal loop.

The seam execution method described in D2 ensures the reliability of tissue fixation due to the independent retention of the suture with burrs in the tissues and the techniques for passing it through the tissues. To do this, pushing the first end of the thread through the fabric is carried out until the first end protrudes at the exit point. The first end of the thread is pulled until the second position along the body of the thread is near the insertion point of the first end of the suture thread. Enter the second end of the thread at the point of introduction of the first end. Pull the second end of the thread until the second position is near the insertion point of the second end of the thread. After insertion and pushing of the ends of the thread, manual grouping and advancement of the tissue relative to the suture thread, it is tightened.

From D3 there is a known method for performing a cosmetic surgical suture, which provides significant tissue capture with a good cosmetic result. To do this, inject the needle into the skin, hold the needle intradermally parallel to the skin at a distance of 2 to 5 cm from the edge of the wound, then turn the needle and bring the needle 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. Turn the needle. The needle is withdrawn intradermally to the injection site. The method provides a significant capture of tissues with a good cosmetic result.

The essence of the method for performing the cosmetic surgical suture described in D4 is that when injecting into the epidermis, the needle is turned in the direction of the operating cavity and carried out in the thickness of the dermis with the bottom of the operating cavity being grasped on its opposite side, behind which the needle is turned in the opposite direction with the dermis grasping and withdraw 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 wall of the operating cavity and a puncture from the epithelium is carried out through the dermis and epidermis, indented from the injection site in the direction of the edge of the operating cavity. After that, the operating cavity is compressed and pulled together 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 with a continuous linear suture. It is possible to inject the needle into the epidermis at a distance of 2-3 cm from the edge of the operating cavity. Using this method allows to increase the cosmetic effect of suturing.

With all the advantages of the described sutures, they do not solve the problem of the formation of rough scars and do not provide the reliability of the fixing properties of the surgical suture.

This problem is partially solved by the method of applying a surgical suture (D5), aimed at increasing the reliability of the fixing properties of the surgical suture and improving the aesthetic result of the operation. For this, according to the invention, the needle is passed over the free end of the thread with the formation of an inter-ring oblique stitch, then a needle with a thread is passed under the inter-ring oblique stitch in the opposite direction to the free end of the thread. After that, the ends of the thread are tied on the inter-ring skew-cross stitch in the center and in the depth of the wound.

This method has several disadvantages. Soft tissues that find themselves inside the inter-ring oblique stitches, after tightening the seam undergo ischemia. As a result, necrosis is formed in the suture area with the development of suppuration of the wound. As a result, a rough, unaesthetic scar forms. In the case of ischemia and necrosis, the suture loses its mechanical strength, which leads to its insolvency and divergence of the edges of the wound. Another drawback is that when knotted, a significant deformation of the soft tissues in the suture zone occurs. Based on the set of essential features, this decision was taken as a prototype.

An object of the present invention is to provide the cosmetic effect of an atraumatic cutaneous-subcutaneous suture. The solution to this problem ensures the achievement of a technical result, which consists in increasing its reliability, reducing the risk of necrosis (necrosis) of soft tissues due to the open contour of the seam projection and the absence of soft tissue compression. Another result is to obtain an inconspicuous scar due to good adaptation and fixation of the edges of the wound. The proposed seam is simple in execution.

The achievement of the technical result and the solution of this problem is possible due to the combination of essential features characterizing the claimed method:

- injection into the deep layer of hypodermis on one side of the open wound,

- holding the needle inside the tissues of the hypodermis and dermis obliquely at an angle to the skin surface and shifting to the far edge of the wound in the direction from bottom to top with the exit of the needle through the bottom of the dermis of the same side of the open wound near the border of the hypodermis,

- transition to the other side of an open wound,

- injection opposite the place of exit of the needle of the opposite side of the open wound of the bottom of the dermis near the border of the hypodermis,

- holding the needle inside the tissue of the dermis coserevertically at an angle to the skin surface and shifting to the proximal edge of the wound in the direction from the bottom up with the exit of the needle through the top of the dermis of this side of the open wound near the border of the epidermis

- transition to the other side of an open wound,

- the injection in front of the exit point of the needle of the opposite side of the open wound of the top of the dermis near the border of the epidermis,

- holding the needle inside the tissue of the dermis coserevertically at an angle to the skin surface and shifting to the far edge of the wound in a top-down direction with the exit of the needle through the bottom of the dermis of this side of the open wound near the border of the hypodermis with the exit in place of an existing puncture, forming a second stitch,

- transition to the other side of an open wound,

- injection in the place of an existing puncture opposite the place of exit of the needle of the opposite side of the open wound of the bottom of the dermis near the border of the hypodermis,

- holding the needle inside the tissues of the dermis and hypodermis in an oblique direction at an angle to the skin surface and shifting to the proximal edge of the wound in a top-down direction with the exit of the needle through a deep layer of hypoderm opposite the site of the initial needle injection,

- loop formation.

The essence of the proposed method for applying a surgical suture is illustrated in FIG. 1 and FIG. 2., where: A - epidermis (surface layer of the skin); B - dermis (deep layer of the skin); C - hypodermis (subcutaneous fat);

1.1; 1.2; 1.3 - puncture points of the left surface of the wound;

2.1; 2.2; 2.3 - puncture points of the right surface of the wound;

1, 2, 3, 4, 5, 6, 7, 8, 9 — successive projections of the lines of the suture during surgical suture;

10 - monofilament.

The method of applying a surgical suture according to Nadelson D.A. carried out as follows. The wound is treated with antiseptics. An atraumatic needle with a rigidly fixed suture material makes an injection of the needle (1) in the subcutaneous fat on the left (pos. 1.1). The stitch goes cosvertically anteriorly (2). The puncture is carried out in the hypoderm close to the border with subcutaneous fat (1.3), and the thread passes (3) to the opposite right side with an injection in the hypoderm close to the border with subcutaneous fat (2.3.). Next, the stitch is carried out (4) in the hypoderm of the right side from front to back and slightly up (2.2). After the injection, the thread at one level passes (5) to the left side with an injection in the hypodermis (1.2.). The next stitch goes (6) in the hypoderm of the left side back to front and down with a puncture in the hypoderm (1.3) in the place of the stitch (3). After that, the thread goes back to the right side (7). The injection is carried out in the hypoderm close to the subcutaneous-living tissue (2.3) - the place where the stitch 3 starts. Next, the stitch goes in the hypodermic fatty tissue of the right half of the wound (8) in the oblique direction from front to back parallel to stitch No. 1 with the output of the thread at the same level (2.1) ) The seam with the formation of a vertical 7-shaped stitch ends with knotting the ends of the threads with a knot. To do this, cross the ends of the thread, form a loop, tie three double knots sequentially, adapting the edges of the wound. Cut off excess threads over the formed knot. 5-10 mm depart from the seam made and impose the next seam. Repeat the application of subsequent sutures until the wound closes, and suturing can be done in the direction from the near edge of the wound to the far edge of the wound or vice versa.

In contrast to the prototype, in the implementation of the present method, an open loop is formed of the projection of the suture on the wound wall with the formation of two ring stitches. This prevents squeezing of the soft tissue of the wound in the stitches of the seam, as a result, the risk of soft tissue necrosis is reduced and its reliability is increased. An exact comparison and close contact of tissues at different levels of the wound provides a subtle scar.

Polypropylene or polycaproamide monofilament is mainly used for surgical suture (10). Monofilament has thromboresistant properties. Perfectly smooth surface, extremely low friction effect and high biocompatibility provide high non-invasiveness and excellent cosmetic effect. Polypropylene monofilament is fibrillated and flattened when tied, which increases the reliability of the surgical unit. Suture material is made in the form of woven or twisted white or dyed blue threads.

The proposed method for performing a surgical suture according to D. Nadelson used in the clinic for patients with plastic and cosmetic surgery. As a result, good results were obtained without any complications. The proposed cosmetic surgical suture was used in particular in patient K., 24 years old, medical history N12, which was admitted to the clinic of Aesthetic Med Medical Center LLC with a diagnosis of hypomastia. Of the surgical incisions 4.5 cm long, breast implants were installed under chest access. Hemostasis was performed, nodal sutures were applied to the fascia of the gland. The skin wound was sutured according to the proposed method. In the postoperative period, dressings with antiseptic solutions were performed. On the 10th day of the wound edge without signs of inflammation, primary healing was noted. At the follow-up examination after 6 months, thin subtle linear scars 4.5 cm long are located in the area of submammary folds, there are no signs of proliferation of keloid tissue. The patient is satisfied with the cosmetic result of the operation.

Thus, this example confirms the possibility of obtaining in the implementation of the invention the claimed technical result. The technique of suturing is not difficult, because it is based on simple movements of the same type.

Sources

D1 - RU 2352271, А61В 17/04, publication date 04/20/2009;

D2 - RU 2355333, А61В 17/03, the date of publication of the application September 20, 2005;

D3 - RU 2360624, А61В 17/04, publication date July 10, 2009;

D4 - RU 2408301, А61В 17/04, publication date January 10, 2011

D5 - RU 2436528, А61В 17/04, publication date 12/20/2011

Claims (1)

A method of applying a surgical suture, including passing the thread through the skin and subcutaneous fatty tissue of both edges of the wound with the formation of a transverse stitch, tying the ends of the threads with a knot, characterized in that after injecting a needle (1) into the hypoderm layer of one edge of the wound, the needle is carried out cosvertically (2) with an exit through the bottom of the dermis of the same side near the border of the hypodermis, they pass (3) to the other side of the wound, here, through the injection at the same level, the needle is passed cosvertically (4) in the opposite direction from the bottom up with the exit of the needle through the dermis of this side They are near the border of the epidermis, then make the transition (5) to the other side, through the injection (6) near the border of the epidermis, then they pass the needle inside the dermis vertically downward with exit at the site of the existing puncture, switch to the other side, forming (7) the second the stitch, through the injection in the place of the existing puncture near the border of the hypodermis, the needle is passed in a slanting (8) direction to the first injection from top to bottom with the exit of the needle (9) through the deep layer of the hypodermis, after which three double knots are sequentially tied, adapting the edges of the wound.

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