RU2006208C1 - Method for connecting edges of skin-aponeurotic cranial wound - Google Patents

Abstract

FIELD: medicine; neurosurgery. SUBSTANCE: button needles are introduced alternating puncture of skin and aponeurosis and introducing needle into periosteum at the opposite side of the wound; ligature is fixed at the first needle, wound edges are adjusted by tension and ligature of the second needle is fixed too. EFFECT: decreased trauma of tissues and postoperative complications. 1 dwg

Description

 The invention relates to medicine, namely to neurosurgery.

 Known methods of suturing a wound during interventions on the skull, when at the end of the intervention they apply a layer-by-layer connection of tissues and finish by applying a nodular, twisting, mattress, Mulchinovsky suture, etc., or using Michel metal brackets.

 The disadvantages include the mandatory phased stitching, the connection of layers alien to the body with a catgut (hetero-protein), the deterioration of blood supply to the edges of the wound with a classic skin suture. The prototype is a well-known way of suturing a wound by phasing stitches: 1st — row on the periosteum, 2nd — on the aponeurosis, 3rd — on the skin. The periosteum and aponeurosis are connected with catgut, the skin with silk or kapron sutures, while the layers of the same and right edges of the wound must be pierced.

 The disadvantage of this method is the use of catgut, which can lead to aseptic inflammation near the catgut suture; sagging or mild elastic skin makes it necessary to stitch with a shorter gap between them, which leads to poor blood supply with the occurrence of regional necrosis or pain in the wound intensifies, the time of the operation and the patient's stay under anesthesia are prolonged, the method is traumatic, since each puncture with a needle is accompanied by a proliferative reaction surrounding tissues both along the wound tunnel and around the foreign body (catgut or silk knot). The aim of the invention is to eliminate these disadvantages, reduce complications and injuries, reduce the time of the operation at the stage of connecting the edges of the wound and the duration of anesthesia, reduce pain.

 This goal is achieved by the fact that the layered connection of the edges of the wound is carried out by combining the layering of the tissue and puncture with a buttoned skin needle, aponeurosis of its side with subsequent injection into the periosteum of the opposite edge of the wound. The next needle is inserted from the opposite side, 2-2.5 cm away from the first needle, injected into the skin, aponeurosis of its side into the periosteum of the opposite edge of the wound and so on to the end of the wound, the distance between the needles of its side being 5-6 cm, then from the first needle to the next for the protruding edges of the needles conduct the thread according to the type of lacing with a slight pull-up, thereby achieving an adequate layer-by-layer connection of the edges of the wound.

 Based on data on patent research on the Union and the leading capitalist countries, the proposed method for wound closure meets the criterion of novelty. The method allows to achieve a qualitatively positive effect and has new properties: carry out a layered wound connection without traditional suture material (catgut, nylon or silk threads), which reduces postoperative complications, such as aseptic inflammation near the catgut suture, less traumatic; does not violate the blood supply to the edges of the wound, which improves the cosmetic effect; a reduction of 3-5 times of the time spent on suturing the wound is achieved in comparison with known methods, the specified meets the criterion of "significant differences".

 The method of suturing a wound with damage to the integument of the skull is as follows.

Upon receipt of the victim with an open craniocerebral injury, the wound is treated according to the classical canons (excision of the skin, 2-3 mm from the edge, removal of non-viable areas of the underlying tissues, etc., with hemostasis). Then, with tweezers, the opposite edges of the resulting wound are brought to each other to touch. Departing from any angle within wounds 1 cm 1st bellied needle pierce the skin and aponeurosis its part (A) at an angle ^of 40-45 to the axis of the wound and it is carried out through the wound cavity with push periosteum opposite wound edges (side B) ( see drawing).

 Having shifted 2-3 cm along the length of the wound from the projection of the 1st needle, the second is inserted into the skin and side aponeurosis (B), followed by an injection into the periosteum of the opposite edge of the wound (A). The third and subsequent needles are inserted alternately into edge A and then B. For such injections, the gap between adjacent needles of edge A or B is from 5 to 6 cm. Then, according to the "lacing" type, from the first needle of side A to the needle of edge B, etc. e. for the protruding ends of the needles, the thread is carried out, pulling it with such an effort to freely match the edges of the wound. According to generally accepted recommendations, the needles are removed for 7-8 days, i.e., in the period of formation of a loose connective tissue scar between the edges of the wound, in open areas (face), to achieve a cosmetic effect, the needles must be removed for 4-5 days.

 Example 1. B. Akkazhiev U. T. (source b-N 13251) was operated on 05.12.88. Operation No. 228: late cranioplasty with an allograft of the cranial vault defect due to the earlier removal of right-sided meningioma of the middle third of the sagittal sinus. A defect of the cranial vault 8 x 7 cm in size. A 25 cm wound was formed by excision of the postoperative scar. No commonly accepted material was used for suturing the wound (catgut, silk). The wound connection is completed by matching its edges. Then the skin is pierced with the 1st buttoned needle, the aponeurosis of its side, followed by the injection of the needle into the periosteum of the opposite side. Injection with the 2nd needle is carried out 2.5 cm from the first, but in the skin, the aponeurosis of its wound edge, the 3rd needle is pierced in the skin of its side so that the distance between the 1st and 3rd needles is 5-6 cm; at the same time, the gap between the 2nd and 3rd needles is 2.5-3 cm. The sequence of the 3rd and subsequent needles is identical. Then, having tied the knot on the 1st needle, the thread is carried out by the “lacing” method to the last needle, where it is fixed with the knot.

 13 buttoned needles were used to connect the edges of the wound, the connection time was about 6 minutes (control by anesthesia card of the operated patient). Control ligation by the end of the first or third day did not reveal inflammation. Needles removed on the 7th day, healing by first intention.

 PRI me R 2. B-Kashavtsev P. P. (source b-n N 5471) was operated on emergency indications 05/28/89, Operation N 105: osteoplastic trepanation on the right, removal of subacute subdural hematoma. A soft tissue incision 22 cm long, the wound was connected without using catgut and silk with the help of buttoned needles: by comparing the edges of the wound at the initial angle of the incision, the first buttoned skin needle was injected, the aponeurosis of its side was fixed into the periosteum of the opposite edge. Retreating 2.5-3 cm from the 1st, they pierce the skin with a second needle, aponeurosis of the opposite edge of the wound with its passage into the periosteum of its side; The skin is pierced with the 3rd needle, the aponeurosis of its wound edge 5-6 cm from the first, followed by fixation on the periosteum of the opposite side of the wound, etc. In total, 11 buttoned needles were used, they are somewhat brought together by “lacing” the thread from 1st needle to the next, to which this thread is fixed. The wound connection time is about 6 minutes (control by anesthesia map). The wound was monitored on the 1st and 3rd day: a wound without inflammation. Needles removed on the 8th day, wound healing by primary intention.

 PRI me R 3. The victim A. Zhulkaev (source no. N 7105) was operated on 06/14/89 (operation N 115 - primary surgical treatment of an open non-penetrating fracture of the right parietal bone). When processing, the edges of an existing wound 10 cm long were excised; in addition, a traumatic skin detachment was detected on an area of 10 x 4 cm. At the end of the surgical treatment, the edges of the resulting wound were approximately 12 cm long without using catgut and silk using the proposed method (the technique is identical to description 1 and 2 examples). 7 umbilical needles were applied to the wound for 4.5 minutes (control by anesthesia card of the operated patient). Sutures were removed on the 6th day. primary intention healing.

The number of patients in whom the connection of the edges of the wound was carried out by the proposed method is equal to 14:
1 - open craniocerebral injuries -4
2 - subacute subdural hematoma -1
3 - interventions for brain tumors -3
4 - replacement of a defect in the bones of the cranial vault (the intervention was accompanied by excision of the existing postoperative scar) -6.

 Based on available clinical observations, a more optimal course of the postoperative period can be traced: subfebrile temperature lasts for 2-3 days, followed by normalization, with ligation of the wound edge without inflammation, it is less swollen, the scar formed is tender and more mobile, which, in our opinion, has a cosmetic effect, especially with damage to open areas of the head. There were no complications in all 14 surgical patients. Timing (control by anesthesia card) indicates a reduction in the time to connect the edges of the wound by 4-5 times in comparison with the conventional method of suturing the wound. The comparison in the control and the groups given by the author is from 10 to 13-15 minutes, thereby reducing the patient’s time under anesthesia for this period.

 The complete exclusion of catgut and silk when connecting the edges of the wound gives an economic effect. For suturing the wounds of the skull integument with a length of 20 cm, 2 catgut ampoules and up to 4 m of silk are usually used. Treatment with wound closure by the proposed method was carried out in 14 patients.

 Thus, the analysis of the results shows that the method of suturing the edges of the skin-aponeurotic wound of the skull can completely eliminate the use of catgut or other suture material, reduce the trauma of the layers being compared, since such a wound connection occurs with less damage to the edges of the wound, which reduces the reaction of the body on the surgical wound, reduces the percentage of complications, such as infection of the ligature, fistula, etc., increases the cosmetic effect, reduces the time of the operation due to reduced the wound closure time (3-5 times compared with the prototype), the duration of anesthesia is reduced. (56) Shevkunenko V.N. Short course of operative surgery with topographic anatomy. M., 1947, p. 28-31.

Claims (1)

 METHOD FOR CONNECTING THE HEADS OF THE SKIN-APONEUROTIC HEAD OF THE HEAD by suturing the layers of the wound and tying the ends of the ligature, characterized in that, in order to reduce tissue trauma and reduce postoperative complications, needle-shaped needles are inserted, alternating skin puncture and aponeurosis with an injection into the periosteum, perpendicular to the periosteum. ligature on the first needle, pull together the edges of the wound by tension and fix the ligature on the last needle.

Images