RU2268009C1 - Method for suturing in post-operational wound after laparotomy - Google Patents

Abstract

FIELD: medicine, surgery.

SUBSTANCE: one should apply a single-row uninterrupted suture upon skin and subcutaneous fiber, fix ligature in subcutaneous fiber in one of the wound's corners, apply a subcutaneous-intracutaneous suture up to the wound's opposite corner, form a knot in subcutaneous fiber with the help of terminal ligature of aponeurosis suture. The method enables to prevent purulent complications and provide the development of valuable cicatrix.

EFFECT: higher efficiency of suturing in post-operational wound.

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Description

The invention relates to medicine, surgical obstetrics and gynecology, and can be used to suture the skin and subcutaneous tissue of the anterior abdominal wall, especially with repeated mid-lower laparotomy to eliminate diastasis between the edges of the wound.

A known prototype method of suturing the skin and subcutaneous tissue, which allows you to compare the edges of the wound even with a large diastasis: a vertical mattress stitch according to Donatti (V.N. Egiev, V.M. Buyanov, O.A. Udotov. "Surgical suture". M., 2001, p. 51-52). In this case, an injection is made at a distance of 2 cm from the edge of the wound, the needle is advanced as deep as possible to capture the bottom of the wound. The puncture is carried out on the opposite side also at a distance of 2 cm symmetrically injected. When holding the needle in the opposite direction, the injections and punctures are located at a distance of 0.2-0.3 cm from the edges of the wound so that the thread passes in the layer of the skin itself. The application of this suture avoids the formation of a residual cavity deep in the wound.

However, the presence of separate nodal sutures on the skin contributes to the formation of transverse strips located along the entire length of the postoperative scar, as well as scars at the injection sites; at a distance of 2-3 mm from the edges of the wound. In addition, the node is the weakest point of the surgical suture, and the highest demands are placed on its reliability. When removing the nodal suture along Donatti, it is necessary to pull the end of the thread until a section of white color (2-3 mm long) appears, located in the thickness of the dermis and subcutaneous tissue, after which the thread is crossed with a scalpel. You can pull the thread up and in the direction of the scar, since another direction can lead to a divergence of the matching edges of the wound, which is traumatic.

The invention is aimed at solving problems: increasing the efficiency of the method, prevention of purulent complications, improving the cosmetic effect.

The implementation of the tasks is achieved by applying to the skin and subcutaneous tissue a new continuous single-row subcutaneous-intradermal suture. This type of single-row suture was used for suturing the postoperative wound after laparotomy for the first time.

The method is depicted in the drawing, which shows a single-row continuous subcutaneous-intradermal suture: 1 - sutured wound, 2 - edges of an unhealed wound, 3 - dermis, 4 - subcutaneous fat, 5 - the bottom of the wound (aponeurosis), 6 - thread, 7 - left thread with aponeurosis.

The method is as follows. After suturing of the aponeurosis and the formation of the node of the last separate suture, one of the end threads is cut off, the other is left for subsequent fixation of the subcutaneous-intradermal suture. A synthetic absorbable suture (for example, polysorb) with an atraumatic needle is fixed in the subcutaneous tissue in one of the corners of the wound (for example, the upper one). Then, the subcutaneous tissue and skin are captured with a needle on one (right or left) side and the needle with thread is withdrawn intradermally. Next, the needle is injected strictly opposite and sequentially passed through the intradermal and subcutaneous layers with a puncture above the aponeurosis. Next, the sequence of actions is repeated: injection and capture of the entire layer of subcutaneous tissue on the right with an intradermal puncture, intradermal injection on the left with capture of the entire layer of subcutaneous tissue and exit over the aponeurosis. Suturing is carried out to the opposite corner of the wound using the left end thread of the last suture of the aponeurosis to form a node in the subcutaneous tissue. When suturing the aponeurosis with a continuous suture after suturing is completed and a node is formed to fix the subcutaneous-intradermal suture, one of the left end threads is also used.

Examples of specific performance.

Example 1

Patient X., 36 years old, was hospitalized in the OKB in Perm, the department of pathology of pregnant women with a diagnosis of Pregnancy 37 weeks. OAA. Scar on the uterus after cesarean section. Chronic pyelonephritis (active phase). Vesical-vaginal fistula. Hydronephrosis II Art. both kidneys, "two years before this pregnancy was operated on for a bowel rupture after a road injury. On the anterior abdominal wall there is a scar after a mid-lower laparotomy 2 cm wide with transverse stripes located along the seam. After treatment in a period of 39 weeks, a mid-lower laparotomy was performed with excision of the old skin scar, a cesarean section in the lower segment with sterilization. The anterior abdominal wall is sutured in layers, with the application of a single-row continuous subcutaneous-intradermal suture with a polysorb. The course of the postoperative period is without complications. Suture healing by primary intention. Discharged in satisfactory condition on the 8th day.

Example 2

Patient A., 32 years old, was admitted to the OKB in Perm, to the department of pathology of pregnant women with a diagnosis of “Pregnancy 36 weeks. Insufficient scar on the uterus after 2 caesarean sections. PSF. Chronic intrauterine hypoxia of the fetus. Impaired fatty metabolism II degree. In previous cesarean section surgeries, a lower middle laparotomy was performed: on the skin of the anterior abdominal wall, a scar along the midline 1.8 cm wide with transverse stripes along the scar, white scar tissue 2-3 mm in diameter at the site of the injections. section with excision of the old skin scar and sterilization due to pain due to failure of the suture on the uterus. The anterior abdominal wall is sutured in layers, with the application of a single-row continuous subcutaneous-intradermal suture with polysorb. The postoperative period is without complications. The suture is healed by primary intention. It is written in satisfactory condition. 9 day.

Thus, the method of suturing a postoperative wound using a subcutaneous-intradermal suture, especially with repeated mid-lower laparotomy, allows physiological comparison of stitched tissues with the formation of a full scar, helps to prevent purulent complications, provides economic (saving suture material) and good cosmetic effects.

Claims (1)

A method for suturing a postoperative wound after a laparotomy, comprising applying a single-row continuous suture to the skin and subcutaneous tissue, characterized in that the thread is fixed in the subcutaneous tissue in one of the corners of the wound, a subcutaneous-intradermal suture is applied to the opposite corner of the wound, a node is formed in the subcutaneous tissue with end thread of the suture of the aponeurosis.