RU2845456C1 - Method for applying an intradermal cosmetic suture on an l-shaped surgical wound - Google Patents

Abstract

FIELD: medical science.

SUBSTANCE: invention refers to medicine, particularly to surgery, and can be used for intradermal cosmetic suture on L-shaped surgical wound. Retreating from the external right angle by 7 mm in the direction to one end of the L-shaped surgical wound and intradermally pricking in with a non-traumatic needle with an absorbable suture material, the needle is pricked out intracutaneously at 7 mm from an external right angle towards the opposite end of the wound. Then the needle is pricked in intradermally along the far side of the internal right angle, retreating from it by 2 mm towards the end of the wound, the needle is pricked out intracutaneously at 2 mm from an internal right angle towards the opposite end of the wound. Then the needle is pricked in the skin along the far side of the external right angle, retreating from it by 2 mm towards the end of the wound, the needle is pricked out intracutaneously at 2 mm from an external right angle towards the opposite end of the wound. Then a needle is pricked in the skin along the near side of the internal right angle, retreating from it by 7 mm towards the end of the wound, the needle is pricked out intracutaneously at 7 mm from an internal right angle towards the opposite end of the wound. Needle is pricked in and out at 1 mm from the skin surface, and the free ends of the suture material are knotted.

EFFECT: method enables reducing a probability of wound dehiscence, improving a cosmetic effect in the remote postoperative period and minimizing a risk of cicatrisation by increasing the accuracy of matching the wound edges and a set of surgical techniques.

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Description

The invention relates to medicine, in particular to surgery, maxillofacial surgery, operative surgery, traumatology, gynecology, and can be used to apply an intradermal cosmetic suture to an L-shaped surgical wound.

Surgical sutures are used in surgical interventions to close surgical wounds, to close the skin after surgery and to fix damaged or torn tissues in order to promote healing and fusion. Currently, when suturing the skin, preference is increasingly given to intradermal sutures, especially in open areas of the body. The advantages of intradermal cosmetic sutures include such characteristics as minimization of scars, since the suture is applied inside the skin and allows to avoid noticeable scars; rapid healing due to minimal tissue trauma; aesthetic result, since the suture is practically invisible, which is especially important for open areas of the body. [Nikolaev A.V. Topographic anatomy and operative surgery. - M.: GEOTAR-Media, 2016. - 736 p.].

The scientific literature presents methods for applying intradermal sutures to linear wounds. However, there are no methods for applying intradermal sutures to star-shaped wounds, which include the L-shaped wound.

The difficulty in suturing a G-shaped wound lies in the configuration of the wound. Such a wound has 4 wound edges: A-G, A-B, B-C and C-G; 4 walls: A-B-D, B-C-D, C-G-D and A-G-D; 2 sharp ends A and C; as well as 2 angles: an internal right angle G and an external right angle B (Fig. 1). Whereas a linear wound has only 2 edges, 2 walls and 2 ends, which makes it easier to apply a surgical suture [Khokhlov V.V. Handbook of Forensic Medicine. General Provisions and Thanatology: a textbook for universities. - 5th ed., revised. and enlarged. - Moscow: Yurait Publishing House, 2024. - 479 p.; Bedrin L.M., Kryukov V.N., Litvak A.S. Forensic Medicine / Ed. V. M. Smolyaninov. - Moscow: Medicine, 1975. - 343 p.; Sidorov L. A. Angle. Mathematical Encyclopedia / Ed. -in-chief I. M. Vinogradov. - Moscow: Soviet Encyclopedia, 1985].

A "Method for applying an intradermal cosmetic suture to an L-shaped surgical wound" is known, which consists in the fact that the authors continuously apply a suture intradermally, prick out a needle with a thread every 3-9 cm and tie it to form a sliding loop on the skin, for which they wind the free end of the thread onto a needle holder. They make 2-3 turns around the needle holder, then grasp the thread at the exit from the skin with the jaws of the needle holder. Pull the captured thread through the loops on the needle holder. Then tighten the thread until a sliding loop is formed on the skin [Firsov A.A., Zhila N.G., Evseev A.N., Ladnyuk P.B. Intradermal suture // Patent for invention RU No. 2270620. - 2006].

Disadvantages of the method: this suture can only be applied to rectilinear wounds; the distance between the sutures is large, which can contribute to disruption of the alignment of the edges of the wound, which can lead to the development of keloid scars.

A "Method for Applying an Intradermal Cosmetic Suture to an L-Shaped Surgical Wound" is known, which consists in the fact that the authors apply sutures to small skin wounds, use needles with a tip and an opposite free end, attach the first end of the suture material to the opposite free end, insert the tip of the needle into the epidermis on one side of the wound, remove the needle from the opposite side of the wound, remove the second end of the suture material from one side of the wound, insert the tip of the needle around the second end of the suture material into one side of the wound. The tip of the needle is brought out from the opposite side of the wound to form a first loop, the first end of the thread is brought out from the second side of the wound to form a second loop, a knot is tied in the thread and it is tightened to close the wound [Hussam Saeed Salem Alghamdi. Method for suturing small skin wounds // Patent for invention US No. 9706983. - 2017].

Disadvantages of the method: this suture can only be applied to straight wounds.

The closest to the claimed invention is the "Method for applying an intradermal cosmetic suture to an L-shaped surgical wound", which consists in the fact that the authors insert a needle through the side wall of the wound. The thread is passed through the thickness of the skin. The puncture is made into the side wall of the wound on the same side, without affecting the upper layers of the epidermis, the thread is brought out to the opposite side of the wound. The needle is inserted into the dermis layer, and the puncture is made into the side wall of the wound. After tying a knot, the short end of the thread is cut off, and the long end with the needle at the end is punctured into the thickness of the skin on the opposite side of the wound, while the sutures are applied at a distance of 0.9-1.2 cm from each other, using absorbable suture material. The suture consists of individual interrupted sutures [Kazakov Yu.I., Lukin I.B., Ivanova O.V., Zhuk D.V. Method for applying an intradermal Q-shaped cosmetic suture // Patent for invention RU No. 2661800. - 2018].

Disadvantages of the method: this suture can only be applied to straight wounds.

In the studied scientific, medical and patent literature, no method of applying an intradermal cosmetic suture to an L-shaped surgical wound was found, therefore, the proposed method meets the criterion of novelty.

The technical result is the possibility of applying an intradermal cosmetic suture to an L-shaped surgical wound, which allows for better wound healing.

In the proposed method, they retreat from the external right angle B in the direction of the sharp end of the wound A by 7 mm and at point 1 intradermally, retreating 1 mm from the skin surface in depth, they make a puncture with an atraumatic needle with absorbable suture material. The puncture is made at point 2 intradermally, retreating 1 mm from the skin surface in depth, retreating from the external right angle B by 7 mm in the direction of the sharp end of the wound B.

Then they retreat from the internal right angle G in the direction of the sharp end of the wound A by 2 mm and at point 3 intradermally, retreating 1 mm from the surface of the skin in depth, make an injection. The injection is made at point 4 intradermally, retreating 1 mm from the surface of the skin in depth, retreating from the internal right angle G by 2 mm in the direction of the sharp end of the wound B.

Then they retreat from the external right angle B in the direction of the sharp end of the wound A by 2 mm and at point 5 intradermally, retreating 1 mm from the surface of the skin in depth, make an injection. The injection is made at point 6 intradermally, retreating 1 mm from the surface of the skin in depth, retreating from the external right angle B by 2 mm in the direction of the sharp end of the wound B.

Then they retreat from the internal right angle G in the direction of the sharp end of the wound B by 7 mm and at point 7, intradermally, retreating 1 mm from the surface of the skin in depth, make an injection. The injection is made at point 8 intradermally, retreating 1 mm from the surface of the skin in depth, retreating from the internal right angle G by 7 mm in the direction of the sharp end of the wound A (Fig. 2).

Then the free ends of the suture material at point 1 and point 8 are tied into a knot.

Results obtained

The study involved 150 people with L-shaped wounds. 50 of them were given an intradermal Q-shaped cosmetic suture (group 1), 40 patients were given a simple interrupted suture (group 2), and 60 were given our proposed intradermal cosmetic suture (group 3), with an assessment of the long-term results.

The evaluation of the results of suturing the L-shaped wound with different sutures is presented in Table 1.

Table 1

Evaluation of the results of suturing an L-shaped wound with different sutures

Results of suturing an L-shaped wound Patients with intradermal Q-shaped cosmetic suture (n=50) Patients with simple interrupted suture (n=40) Patients with our proposed intradermal cosmetic suture (n=60) n % n % n % Wound angle divergence 20 40.0 23 57.5 1 1.7 *# Accuracy of wound edge matching 25 50.0 21 52.5 60 100.0 *# Cosmetic defects in the late postoperative period (one month after suturing) 25 50.0 23 57.5 3 5.0 *#

Note : * - differences between groups 1 and 3 are statistically significant (p<0.05);# - differences between groups 2 and 3 are statistically significant (p<0.05).

When applying the intradermal cosmetic suture proposed by us, in one case an inflammatory process was observed in the postoperative period, assessed as hyperreactivity of the body to the suture material. In two cases, the development of a moderate keloid scar was observed in the late postoperative period, assessed as individual characteristics of the patient's body (p<0.05).

Examples of specific implementation of the method

Example 1. A 32-year-old patient had an L-shaped wound in the area of the shoulder skin treated with the intradermal cosmetic suture we proposed. The wound edges were precisely aligned. No wound angle divergence was observed in the postoperative period. No cosmetic defects were observed during a month of observation in the late postoperative period, which confirms the good aesthetic effect of the intradermal cosmetic suture we proposed.

Example 2. A 26-year-old female patient had an L-shaped wound in the area of the shin skin treated with the intradermal cosmetic suture we proposed. The wound edges were precisely aligned. No wound angle divergence was observed in the postoperative period. No cosmetic defects were observed during a month of observation in the late postoperative period, which confirms the good aesthetic effect of the intradermal cosmetic suture we proposed.

Example 3. The patient is 37 years old. The intradermal cosmetic suture we proposed was applied to the L-shaped wound on the skin in the subscapular region. The wound edges were precisely aligned. No wound angle divergence was observed in the postoperative period. No cosmetic defects were observed during the month-long observation in the late postoperative period, which confirms the good aesthetic effect of the intradermal cosmetic suture we proposed.

The advantages of the claimed method of applying an intradermal cosmetic suture to an L-shaped surgical wound are that the method is simple to perform, easily reproducible, does not require large material costs, allows achieving an aesthetic result due to the precise alignment of the edges of the wound, and minimization of scars, especially on open areas of the body.

Claims (1)

A method for applying an intradermal cosmetic suture to an L-shaped surgical wound, comprising applying an intradermal suture, characterized in that they retreat 7 mm from the outer right angle in the direction of one end of the L-shaped surgical wound and make an intradermal puncture with an atraumatic needle with absorbable suture material, the puncture is made intradermally, retreating 7 mm from the outer right angle in the direction of the opposite end of the wound, then they make an intradermal puncture along the far side of the inner right angle, retreating 2 mm from it in the direction of the end of the wound, the puncture is made intradermally, retreating 2 mm from the inner right angle in the direction of the opposite end of the wound, then they make an intradermal puncture along the far side of the outer right angle, retreating 2 mm from it in the direction of the end of the wound, the puncture is made intradermally, retreating 2 mm from the outer right angle in the direction of the opposite end of the wound, then they make an intradermal puncture along the near side of the inner right angle, stepping back from it by 7 mm in the direction towards the end of the wound, the puncture is made intradermally, stepping back from the internal right angle by 7 mm in the direction towards the opposite end of the wound, and the punctures and punctures are made at a distance of 1 mm from the surface of the skin, then the free ends of the suture material are tied into a knot.