RU79240U1 - PORTABLE DEVICE FOR DERMOTENSION OF EXTENSIVE WOUND SURFACES - Google Patents

Abstract

The proposed utility model relates to medicine, namely to surgery, in particular, to the treatment of extensive wound defects in purulent-septic surgery, traumatology and cambustiology. A device for dermotension of extensive wound surfaces containing Kirchner spokes is characterized in that it is made in the form of a rectangular parallelepiped of duralumin, with a side size of 1.0; 2.0; 3.0 cm through the body of which pass 2 parallel channels with fasteners with clamps (bolts) for knitting needles. At one end of the knitting needles there are hooks attached to the Kirchner knitting needles drawn through the skin flaps. Effect: providing a phased and adequate stretching of the skin with subcutaneous tissue to close granulating wounds, which can be carried out at any time of the day without dressings, excluding injury to the wounds by structural elements, due to its location above the bandage. The portability of the device allows for the implementation of a full range of conservative measures for wound care until complete healing.

Description

The proposed utility model relates to medicine, namely to surgery, in particular, to the treatment of extensive wound defects in purulent-septic surgery, traumatology and cambustiology.

According to the WHO, a large number of patients with extensive wound defects of large skin defects, resulting from anaerobic non-clostridial phlegmon or other extensive purulent processes and traumatic injuries, remain. Such wound surfaces require the development of effective methods for their closure. Most often, spoke dermatotomy is used to close such defects with local tissues.

However, most of the previously proposed devices have a number of significant drawbacks, their use and the complications arising in connection with this have shown the urgency of the problem of modernization of spoke dermatotension.

Known needle skin fixation apparatus (ASKF), containing metal parts of Ilizarov’s compression and distraction apparatus in the form of a frame around the affected limb, to which Kirchner spokes are inserted through the skin edges of the wound / E.A. Chertov, A.V. Zherebitsky, Yu. N. Yusupov. "Controlled wound opening with a spoke skin fixation apparatus as a method of treating anaerobic lower limb infection." General Surgery Clinic of the Military Medical Academy, St. Petersburg. The journal "Bulletin of Surgery", St. Petersburg, "Aesculapius, 1998, No. 2, pp.66-68 /.

The design of this apparatus provides for the closure of a wound in two stages:

first stretching these flaps, and then laying them on the wound and suturing it. Disadvantages: this unit is bulky, has considerable weight, puts pressure on the wound, makes it difficult to change dressings and treat wounds during dressings. In addition, the device causes significant inconvenience to the patient.

For the closest analogue, the device is a spoke adaptation-reposition apparatus (reconstructed retractor), which consists of a gear rack with fixed and movable plates (jaws), a ratchet mechanism with a handle. On the branches, depending on the variant, grooves are made for guide needles or spikes / S.G. Izmaylov, V.V. Beschastnov. "The use of adaptive reposition apparatus for closing granulating soft tissue wounds." Department of Surgical Diseases of the Military Medical Institute of the Federal Border Service of Russia at the Nizhny Novgorod State Medical Academy. The journal "Bulletin of Surgery named after I.I. Grekov", St. Petersburg, 2000, No. 2, pp. 66-70 /.

A device prepared for work, for example, with tires, with diluted branches, is placed on the wound so that the ends of the spikes are 4-6 cm from the edges of the wound. Then the jaws are slowly reduced by rotating the handle of the ratchet mechanism until the studs are pierced into the tissue. Then, suture threads are preliminarily drawn through the edges of the wound and the scar-like tissue of the edges of the wound is excised with an oblique incision at an angle of approximately 45 degrees to the skin surface. After the suture, the edges of the wound are continued to be reduced using the apparatus. First, at the first stage of the hardware connection of the edges of the wound, deep layers of granulation tissue are compared. Then, at the second stage, fresh sections are adapted and after that the knot is finally tied.

The design of this apparatus makes it difficult to care for the wound surface, and the spokes can injure the wound. The device is bulky and its branches

can cause circulatory disturbance and tissue ischemia, which inhibits regeneration and prolongs healing time, and changing the parameters of the degree of tension of skin flaps is possible only during wound dressing.

The objectives of this proposal are:

1) Elimination of the risk of ischemia and necrosis of the soft tissues of the edges of the wound due to the pressure of individual nodes of the device, as well as trauma to the muscles, fascia and other tissues of the bottom of the wound.

2) Ensuring a phased and adequate stretching of the skin with subcutaneous tissue at any time of the day without dressings, in place.

3) Portability, prostate design, low cost, ease of sterilization and the possibility of use in any medical institution.

The tasks are achieved in that the device for dermotension of extensive wound surfaces containing Kirchner spokes is characterized in that it is made in the form of a rectangular parallelepiped of duralumin, with a side size of 1.0; 2.0; 3.0 cm through the body of which pass 2 parallel channels with fasteners with clamps (bolts) for knitting needles. At one end of the knitting needles there are hooks attached to the Kirchner knitting needles drawn through the skin flaps.

Effect: providing a phased and adequate stretching of the skin with subcutaneous tissue to close granulating wounds, which can be carried out at any time of the day without dressings, excluding injury to the wounds by structural elements, due to its location above the bandage. The portability of the device allows for

a full range of conservative measures to care for the wound until complete healing. The device was tested on 14 patients with extensive wound defects, with a flat surface, who were treated in the purulent ward of the KRASNODAR REGIONAL CLINICAL HOSPITAL No. 1 named after Professor Ochapovsky S.V. (KKB) and showed good results. In 13 patients using this device, it was possible to completely close the wounds without complications and reduce the length of hospital stay by one third.

For a better understanding of the sketch of the device shown in figure 1, "a" is a general view of the device, where 1 is the box, 2 are the knitting needles, 3 are the hooks on the knitting needles, 4 are the locking bolts; "b" -p. 5 - grooves (channels) and figure 2 - General view of the device when used, where item 6 - Kirchner spokes, 7 - the edges of the wound, 8 - the wound.

The device is used as follows. Kirschner spokes (6) are passed through the edges (7) of the granulating wound (8), to it, perpendicularly with a hook (3), strengthen the other spoke (2) passing through one of the grooves of the channels (5) of the parallelepiped (1), and stabilize with using the clamp (4) after tensioning the skin flap. Similarly, the skin flap is tensioned on the opposite side of the wound. In this case, the knitting needle with hook (3) is fixed in the other channel (5) of the parallelepiped (1). The parallelepiped (1) is placed over the bandage, while the spokes with hooks (3) are pierced through the layers of the bandage and fixed in the parallelepiped (1), this allows you to change the degree of tension of the skin flap at any time of the day, without bandaging. After the wound is completely closed, the edges of the flaps are strengthened with point sutures for the underlying tissue, after which all the needles are removed. Point seams allow you to reliably fix the adjacent edges of the wound without the threat of circulatory disorders, remove the needles at an earlier date and

reduce wound healing time.

In 13 cases, it was possible to completely close the wound with local tissues, in one patient the remaining defect between the edges of the wound 4 cm wide was covered with free skin grafting (a skin graft was taken from the thigh of a healthy limb). Example.

Patient M., 58 years old, purulent department of KKB was transferred from Vyselkovskaya CRH with extensive anaerobic non-clostredeal phlegmon of the anterior abdominal wall formed after laparocentesis and removal of 5 liters of ascitic fluid. Twice he was operated on at the place of residence about phlegmon by producing linear sections. In KKB superradical surgical treatment of phlegmon was performed. As a result of two operations performed earlier and six linear incisions, skin necrosis developed and a defect measuring 20-25 cm formed. After the inflammatory process was stabilized, the proposed device was applied to a granulating wound, while a rectangular parallelepiped was placed over the dressing and dynamic dosed dermatotension was performed. The degree of stretching of the skin-subcutaneous flap changed every 4-6 hours during the first 4 days. When traction of the edges of the wound, having a large length, as a rule, arched bending of the Kirschner spokes occurs. To avoid this, two proposed devices were superimposed, and the hooks were fixed at a distance of 5 cm from the ends of the Kirchner spokes drawn along the edge of the wound. Three weeks later, the edges of the wound were brought together in such a way that a defect 4 cm wide remained. Further dermotension was considered inappropriate and the wound defect was closed with a free skin graft taken from the left thigh one week before the termination of the dermotension. During treatment, with dressings, sodium hypochlorite, water-soluble ointments, and a pulsating stream were used. Intensive therapy was carried out using antibiotics, immune

drugs, intra and extracorporeal detoxification. In addition, 6 hyperbaric oxygenation sessions were performed. It was possible to avoid repeated surgical treatments, and the wound healed by the type of primary tension. The patient was discharged four weeks after admission to the purulent department of the KKB. Thus, dynamic dermatotension, carried out at intervals of 4-6 hours in the first four days, with one or two dressings per day, as well as transplantation of the transplant on the center of the wound, in parallel with the ongoing dermatotensia one week before its completion, significantly accelerated plastic closure wounds and reduce the patient’s hospital stay.

Claims (1)

A portable device for dermotension of extensive wound surfaces, containing Kirchner spokes, characterized in that it is made in the form of a rectangular parallelepiped of duralumin with a side size of 1.0; 2.0; 3.0 cm, through the body of which the spokes in two parallel channels pass, from the opposite ends of the spokes there are hooks fixed on the Kirchner spokes, and in the mutually perpendicular direction relative to the spokes in the parallelepiped, fixing bolts are installed.