RU2296516C2 - Method for applying vertical mattress suture - Google Patents

Abstract

FIELD: medicine, surgery.

SUBSTANCE: the needle should be punctured in at the distance of about 2-3 cm against the wound's edge to move it along the wound's bottom, as for the puncture out - it should be made symmetrically at the opposite side. One should apply the needle with a ligature in back direction by fulfilling the needle's puncture in at the distance of about 1.0-1.5 cm against the wound's edge and moving it at the level of the half of the wound's depth. One end of ligature should be kept free. Another end of the ligature upon a needle should be applied towards its initial position in the layer of cutis vera and cutaneously bound with the free end of the ligature with the help of double-triple final knot. The innovation enables to improve layer-by-layer adaptation of wound's edges, decrease the risk of tissue ischemia and increase reliability of the suture made.

EFFECT: higher efficiency of suturing.

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Description

The invention relates to medicine, namely to surgical surgery.

Each surgical operation, as a rule, ends with a layered connection of tissues. When surgical sutures are applied to the wound, it is necessary to carefully adjust the tissues at the site of their dissection so that there are no free cavities in the wound along its entire depth along the suture line. To adapt the edges of the wound without leaving "pockets" usually use its layer-by-layer suturing with interrupted sutures. However, leaving sutures in the tissues, due to the reactogenicity and sorption ability of the suture material, increases the healing time of wounds, the risk of inflammation and can even lead to the formation of ligature fistulas. The use of suture material capable of biodegradation (catgut, katselon, vikril, maksol, etc.) does not completely solve the problem, because for the most part, it has sensitizing properties and is also fraught with the development of inflammatory complications. Therefore, sutures that are removed after wound healing are preferred. These include the method of surgical suture, taken by us as a prototype.

As a prototype method, we selected a two-row vertical mattress seam according to Donati, described in the manual of M.P.Burykh "General principles of surgical operations technology" (Rostov n / A: Publishing House "Phoenix", 1999. - 544 pp. - S.423-432) and used if necessary, layered suturing of the wound. Its essence is as follows. The needle is injected at a distance of 2 cm from the edge of the wound, and the injection is on the opposite side symmetrically injected at the same distance from the edge of the wound. The needle is held as deep as possible, capturing the bottom of the wound. In the opposite direction, the needle is carried out vertically higher at a distance of 0.5 cm from the edges of the wound in the layer of the skin itself, it is withdrawn cutaneously (Fig. 1), and both ends of the thread are tied together. The Donati vertical mattress suture method, therefore, is distinguished by the absence of the need for subcutaneous leaving of sutures and the adaptation of the edges of the wound without the need for an assistant. However, along with these advantages, the Donati seam also has disadvantages:

1. With a wound depth of 3 cm or more, in the center of the loop of the suture may remain free space, a cavity (Fig.2), where blood and tissue are accumulated, causing a risk of suppuration and an increase in the healing time of the wound.

2. The need for a sufficiently large tension of the suture thread to adapt not only the edges of the wound, but also tissues throughout its depth. This leads to excessive pressure of the thread on the tissue with their ischemia and the leaving of rough suture marks on the skin. In addition, in the postoperative period, in the presence of excessive pressure on the thread of the tissue and the appearance of aseptic inflammation under the thread, the cutaneous part of the suture can sink below the level of the skin surface with the loss of mutual adaptation of the wound edges.

To prevent these shortcomings, a method of vertical mattress seam is proposed, which consists in the following. The needle is injected at a distance of 2-3 cm from the edge of the wound, carried out deep along its bottom, and the injection is symmetrical on the opposite side of the wound. Then the needle with the thread is carried out in the opposite direction at a distance of 1.0-1.5 cm from the edge of the wound and at about half its depth. After the first and second injections, the resulting loop of the suture is secured percutaneously (Fig. 3) with a double knot located above the site of the initial injection of the needle. In this case, the deep layers of the wound mutually adapt. One end of the thread is left free, and the other end of the thread on the needle is held over the first, fixed loop of the seam in the direction of the initial holding of the needle at a distance of 0.5 cm from the edges of the wound in the layer of the skin itself, output cutaneously (figure 4) and bind to the previously left the free end of the thread double-triple the final node located next to the previous node (figure 5). At the same time, the fabrics adapt in layers, and the tension of the thread and its pressure on the fabrics are moderate.

As an example of the application of the proposed method for a vertical mattress seam, we give the following observation.

Patient M., 44 years old, was admitted to the surgical department of the Republican Clinical Hospital in Makhachkala on March 24, 2003 with complaints of periodically worsening pains associated with movements in the right hypochondrium with radiation to the right scapula, nausea, belching, and abdominal bursting and frequent constipation. From the anamnesis: for more than five years he has been suffering from calculous cholecystitis with frequent exacerbations. On examination, the patient is noted for obesity (weighs 88 kg with a growth of 157 cm), friability of physique, yellowness of the skin. Body temperature increased - 37.3 ° C. On palpation of the abdomen and effleurage along the right costal arch - sharp pain. In the general analysis of blood - increased ESR (26 mm / h) and moderate leukocytosis (9 thousand). X-ray - a lot of calculi in the gallbladder. With a diagnosis of Acute calculous cholecystitis, they began to prepare the patient for a planned operation.

March 26, 2003 the operation was performed: cholecystectomy through an oblique incision along the right costal arch downward from the hypochondrium by 4 cm. The operation was performed without technical difficulties. When suturing the subcutaneous tissue and skin, the method of a three-row vertical mattress suture was applied as follows. The needle was injected at a distance of 3 cm from the edge of the wound, a needle was drawn along the bottom of the wound — approximately at a depth of 5-6 cm, and the needle was placed on the opposite side of the wound. Then the needle with the thread was held in the opposite direction at a distance of 1.5 cm from the edge of the wound and at the level of half its depth (2.5-3 cm). The resulting loop of the seam was secured percutaneously with a double knot located above the site of the initial needle injection. In this case, the wound tissue under the thread adapted to each other. One end of the thread was left free, and the other end of the thread on the needle held above a fixed loop of the seam in the direction of the initial holding of the needle at a distance of 0.5 cm from the edges of the wound in the layer of the skin itself. The cut-out thread was connected to the previously left free end of the thread by the triple terminating node located next to the previous node. The tension of the thread and its pressure on the tissue after matching the edges of the wound were moderate.

The postoperative period was uneventful. The wound healed first. Sutures were removed on the 11th day after surgery. When removing the sutures, both loops of each of them from the side of the wound opposite from the knot were successively raised and crossed with a scalpel, after which it was easily removed with a pair of tweezers or a clamp for the knot or for the ends of the thread.

Thus, the structural differences from the prototype and the advantages of the proposed method are the following:

1. Three-row seam and the possibility of mutual adaptation of the edges of the wounds, a depth of more than 3 cm

2. Layered adaptation of the edges of the wounds without leaving cavities and excessive thread tension.

3. Reducing the likelihood of tissue ischemia and suture marks on the skin.

4. Uniform load of the thread on the subcutaneous tissue and skin with a decrease in the likelihood of immersion of the cutaneous part of the suture above the skin surface and loss of adaptation of the edges of the wound.

5. Higher reliability of the seam and minimizing the risk of its failure due to the presence of two nodes, the simultaneous failure of which is unlikely.

Thus, the proposed method of a vertical mattress suture can increase the efficiency of surgical treatment of operated patients.

Claims (1)

A vertical mattress suture method, characterized in that the needle is injected at a distance of 2-3 cm from the edge of the wound, is carried out along its bottom, and the puncture is symmetrical on the opposite side, then the needle and thread are carried out in the opposite direction, performing a needle injection at a distance of 1 , 0-1.5 cm from the edge of the wound and passing it at the level of half the depth of the wound, after which the formed loop of the suture is fixed percutaneously with a double knot, leaving one end of the thread free, and the other end of the thread on the needle in the direction of the initial thread in the layer itself skin and subcutaneously connected to the free end of the thread with a double-triple terminating node.

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