RU2614211C2 - Means for fixation of tissues connected during surgery - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: fixation means is made of a cord material based on knitted fabric of nickel alloy and titanium thread. The means has the form of a ribbon, formed by cord material laying by several layers flattened to contact and layer binding along edges with each other.

EFFECT: increased possibility of intraoperative monitoring of tightening effort adequacy and reduced local pressure and underlying tissues atrophy.

5 dwg

Description

The invention relates to surgical technique.

During the consolidation of disparate body tissues in plastic surgeries, various specialized fixation agents are used, most often biocompatible binders of the proper strength, structure and configuration. The simplest remedy is a medical bandage.

An important technical characteristic of fixation devices is the area of the forthcoming contact, which does not cause tissue eruption and trophic blocking. For optimal combined satisfaction of the requirements, they select the material, form the structure of the means in the form of a monofilament (fiber) arrangement in bundles, cords, ribbons.

Of the progressive analogues of modern technology, the closest in similarity of features to the proposed solution means for tissue fixation is used, which is used in the method of sternum consolidation in sternotomy [RF Patent No. 2489097, priority 04/06/2012]. It uses a superelastic titanium nickelide alloy. The threads of the material are woven in a knitted "stocking" method, which in the working half-stretched state is a cylindrical cord. The unselected remainder of the elastic deformation is selected by the surgeon during the operation subjectively, according to the sensation of sufficient compression of the bone fragments and the possibility of their normal postoperative excursion.

The elastic nature of the fixation, the high biocompatibility of the nickel-titanium material, coupled with a well-chosen fixation technique, ensure the consistency of the operation, reduce the surgeon’s labor and emotional stress.

According to expert estimates, the disadvantages of the prototype, calling for its improvement, are as follows:

1. The subjective assessment of the stretching of the formed cord from its original, tubular shape to the beginning of the working section of elasticity leaves the danger of inadequate tension of tissue tightening. Its lack leads to pathological mobility of fragments, which prevents fusion; excess of some optimal value leads to pain syndromes and a decrease in solvency.

2. The cylindrical working form of the fixation means and the possible formation of surface folds when stretched lead to an inhomogeneous local pressure on the tissue with an atrophic effect.

The technical result of the invention is to increase the possibility of intraoperative control of the adequacy of contracting efforts.

The specified technical result is achieved in that the means for fixing the body tissues that are connected during the surgical intervention are made of cord material based on knitted fabric of nickel-titanium filament, in the form of a tape, while the tape is formed by laying said cord material in the form of several, flattened to touch , layers and a bunch of them together on the edges of the tape.

The tape shape of the fixation tool allows you to develop a uniform contact surface (Fig. 1) compared with the almost linear contact of the cylindrical surface of the prototype. As a result, the pressure of the tensile forces is distributed over a large area, lowering the local (specific) pressure and atrophy of the underlying tissues.

The anisotropy of elasticity and aggregate stiffness, i.e. those properties that are important when fixing living tissue. The unidirectional nature of the transmission of the locking action facilitates the work of the surgeon, increases the correctness of the actions.

Multilayer styling, the number of layers allows you to vary the mechanical strength of the tool in accordance with the task of the action. A single-layer material is practically impractical and does not correspond to the technical result.

For the integrity of the entire installation, the layers along the edges of the tape are interconnected by any technological method, for example, stitching or knit strapping (Fig. 3).

The illustrations show:

FIG. 1. The structure of the proposed means for fixation (cross section): 1 - layers of knitted fabric; 2 - bundles of layers along the edges of the tape.

FIG. 2. A specific implementation example. Initial state (cross section): 3 - combination of sleeves from knitted fabric.

FIG. 3. The final (working) form of the fixative (transverse section).

FIG. 4 Pancreatic ligation scheme: 4 - fixative; 5 - line of resection; 6 spleen.

FIG. 5. Completion of the operation: 7 - stump of the resected pancreas.

Achievability of the technical result is confirmed by a specific example of the clinical use of the claimed means for fixing the connected tissues of the body in the hospital surgery clinic of the Siberian State Medical University (Tomsk).

Example.

Patient B., 39 years old, diagnosed with a pseudocyst of the tail and body of the pancreas (pancreas) is susceptible to surgery, during which a fixative with the following characteristics was used:

means for fixing in the form of a tape formed by the coaxial alignment of two sleeves of knitted knit nickel-titanium wire (filament) with a diameter of 50 μm (Fig. 2). A ribbon-like shape is given to the product by flattening the said composition until the layers touch each other (Fig. 3). The width of the molded tape is 10 μm.

During the operation, the fixation tool is used as follows:

after a laparotomy, the tail and body of the pancreas are mobilized to the site of healthy tissue, as well as the spleen. The pancreas in its middle third, outside the area of interest, is covered by two turns with a tension of the tape to the state of hemostasis and abturation of the excretory duct. The ends of the fixation device are tied in a knot, the turns are fixed to exclude their migration to the pancreatic capsule. Outside the compression zone, the pancreas body with the tail is cut off, the stump 7 (Fig. 5) of the remainder is sutured with silk suture material.

Along the way, spleen 6 was removed (Fig. 4) due to the intimate coalescence of its blood vessels with a pseudocyst and the lack of technical ability to isolate them.

The wound is sutured. The abdominal cavity is drained.

The efficiency of the proposed tool, the validity of the claimed technical result was monitored intraoperatively, by the effectiveness of the action, the reliability of hemostasis, the absence of factors of necrotization and inflammation of the squeezed tissues. The mentioned advantages of the product, professional accessibility, motivating the "industrial applicability" of the invention are stated.

The patient is activated and discharged from the clinic with normal test data, in a satisfactory physical and psycho-emotional state.

Claims (1)

The means for fixing the tissues of the body that are connected during the surgery, made of cord material based on knitted fabric of nickel-titanium thread, characterized in that it is made in the form of a tape, wherein the tape is formed by laying said cord material in the form of several layers flattened to touch and a bunch of layers among themselves along the edges.

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