RU2239371C1 - Method for wound suturing after radical mastectomy - Google Patents

Abstract

FIELD: medicine, surgery.

SUBSTANCE: one should successively apply P-shaped sutures in 2-3 cm beginning from the highest points along retro-axillary, median-clavicular lines and two points of external fragment along median-axillary line by tightening them at separate "rolls" at skin of mastectomic fragment. Additionally, one should fix mastectomic fragments with uninterrupted mattress suture out of synthetic material with two rows of sutures by muscular-fascial structures along the 4^th, the 5^th ribs beginning from posterior axillary line up to peristernal one to be withdrawn and tightened at separate "rolls" at skin of mastectomic fragment. One should drain axillary-subscapular-subclavicular spaces with the help of through perforated tube, its upper end should be withdrawn onto the skin of the upper fragment through great thoracic muscle, and lower end - along median-axillary line onto the skin of the lower fragment.

EFFECT: shortened terms for wound healing.

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Description

The invention relates to medicine, namely to oncology, and can be used to close the defect resulting from a radical mastectomy.

There is a method of suturing a wound after radical mastectomy, which consists in the simple application of nodal skin sutures and “blind” drainage of the axillary-subclavian-subclavian space with a vinyl tube through a separate puncture in the lower corner of the wound (1).

The disadvantage of this method is poor adaptation, the displacement of the skin-fascial flap, the formation of a cavity between it and the bottom of the wound, inadequate outflow of wound discharge due to the formation of clots in the lumen of the drainage tube, which can subsequently lead to the accumulation of wound exudate in the wound, flotation of the flap, suppuration of the wound and prolonged lymphorrhea.

There is a method of suturing a wound with radical mastectomy, which consists in suturing the subcutaneous tissue of the external flap to the muscular-fascial tissues of the chest wall along the posterior axillary, anterior axillary and middle clavicular projection lines, starting from the upper posterior point of the axillary fossa, with three rows of nodal sutures; the imposition of nodal sutures on the wound without removing drains (2).

The disadvantage of this method is the lack of outflow of wound, its accumulation under the flap; possible formation of hematoma, seroma and suppuration of the wound. Hemming of the subcutaneous tissue of the external flap to the muscular-fascial formations of the chest wall in the axillary region due to the lack of strong connective tissue structures and the resulting tension leads to eruption of sutures and the formation of “dead space”, which increases the likelihood of wound complications. In addition, the presence of internal sutures contributes to the occurrence and support of inflammation.

The aim of the invention is to reduce the healing time of the wound.

This goal is achieved by putting U-shaped sutures sequentially after 2-3 cm, starting from the highest points along the rear axillary, mid-clavicular lines and two points of the external flap along the mid-axillary line, tighten the seams on separate “rollers” on skin of a mastectomy flap; fix the mastectomy flaps with a continuous mattress suture from synthetic material in two rows for the muscular-fascial structures along the 4th, 5th ribs, starting from the rear axillary to the periosternal line, remove and tighten them on separate “ridges” on the skin of the mastectomy flap; axillary-subclavian-subclavian space is drained through a perforated tube, the upper end of which is brought through the pectoral muscle to the skin of the upper flap, and the lower - along the mid-axillary line to the skin of the lower flap.

The invention is illustrated by graphic material. Figure 1 shows a general view of the wound after performing a radical mastectomy and through drainage with a vinyl tube, figure 2 shows a view of the wound after sequentially applying U-shaped sutures, Fig. 3 shows a view of the wound after tightening the U-shaped sutures, in Fig. 4 shows a view of a wound after applying two rows of a continuous mattress suture; FIG. 5 shows a view of a wound after applying sutures.

The method is implemented as follows.

After removal of the mammary gland with the tumor in a single unit with axillary-subclavian-subclavian tissue and lymph nodes and hemostasis:

1. Drain through separate punctures axillary-subclavian-subclavian space through a perforated tube 1.

2. In succession, after 2-3 cm, U-shaped sutures 2 are applied, starting from the highest points along the posterior axillary 3, the mid-clavicular 4 lines and two points 5 of the external flap along the mid-axillary line, tighten the seams on separate “rollers” 6 on the skin of a mastectomy flap.

3. Fix the mastectomy flaps 7 with a continuous mattress suture from synthetic material in two rows 8 for the muscular-fascial structures along the 4th, 5th ribs 9, starting from the rear axillary to the periosternal line, remove and tighten the seams on separate “ridges” 10 on the skin of the mastectomy flap .

4. Apply skin sutures to the wound 11.

Example

Patient D.F. (IB No. 1527). Diagnosis: Cancer of the left breast T2H1M0 after DHT with normal fractions.

The cuts bordering the mammary gland in the horizontal direction cut the skin. Mobilized flaps. Breast tissue was removed with axillary-sub-scapular-subclavian tissue and subclavian vein treatment using a generally accepted technique. Hemostasis. The axillary-subscapular space is drained through the vinyl chloride tube through a puncture of the lower mastectomy flap along the mid-axillary line with the upper mastectomy flap being brought out onto the skin along the mid-clavicular line. A series of U-shaped seams were sequentially applied with their fixation on the “tubes”. Two continuous mattress sutures from synthetic material were laid on the lower and upper mastectomy flaps along the 4, 5 ribs. Skin sutures on the wound. The postoperative period without complications. Drainage removed on the 4th day. The term of lymphorrhea is 10 days. After surgery, 2 weeks after the removal of sutures, a course of PCT was started.

According to the proposed method in the Samara Regional Oncology Center performed 31 operations. In all patients, the postoperative period was uneventful. The wounds healed by primary intention. PCT according to indications within 2 weeks after the operation.

The proposed method has the following advantages over the known:

1. There is a reliable elimination of “dead space” due to the imposition of U-shaped sutures on the flap in the axillary region and fixation of the mastectomy flap to the chest with continuous sutures.

2. The probability of violation of the outflow of wound discharge due to the use of “through” drainage is reduced.

3. Persistent lack of cavity reduces the number and duration of lymphorrhea.

4. Removing continuous mattress and U-shaped seams relieves the wound from the presence of foreign material.

The method can and should be used in the surgical departments of oncology clinics / centers during wound closure after performing a mastectomy in patients with breast cancer.

Sources of information

1. Atlas of cancer operations. / Ed. Peterson B.E. - M .: Medicine, 1987, p. 167-173.

2. USSR author's certificate No. 1517163, M. cl. A 61 B 17/00, 1986.

Claims (1)

A method of suturing a wound after a mastectomy by fixing a mastectomy flap to the chest wall, applying nodal sutures to the wound and draining, characterized in that, in order to reduce the healing time of the wound, they are applied successively through 2-3 cm U-shaped sutures, starting from the highest points along of the posterior axillary, mid-clavicular lines and two points of the external flap along the mid-axillary line, tighten the seams on separate “rollers” on the skin of the mastectomy flap, fix the mastectomy flaps with a continuous mattress suture from of inthetic material in two rows behind the muscular-fascial structures along the 4th, 5th ribs, starting from the rear axillary to the periosternal line, bring them out and tighten them on separate “ridges” on the skin of the mastectomy flap, drain the axillary-subscapular-subclavian space with a through perforated tube, the upper the end of which through the pectoralis major muscle is withdrawn onto the skin of the upper flap, and the lower - along the mid-axillary line to the skin of the lower flap.

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