No abstract
Frequent cases of man-made disasters, terrorist attacks and military conflicts lead to an increase in the number of victims. Significant soft tissue defects are known to result from gunshot wounds. So, as a result of mine-blasting injuries, defects in the skin and underlying tissues more than 10 cm in diameter are formed in 71.1% of cases. The prerequisite for the uncomplicated course of the wound process is to achieve an adequate comparison of the edges of the wound without excessive tension. To close such extensive wounds, various technical means are used: sutures on pads, various types of dermatotension. We have developed various models of wound contractors (RC) for treatment of wounds. With the help of the RC, a complete reposition and good adaptation of the edges of the wound is created. The wound closure method using these RC almost completely eliminates tissue cutting and limits the sawing effect to a minimum. This is explained by the effects of elastic forces reducing to zero when matching soft tissues and suturing. The use of hardware methods for suturing wounds requires the development of mathematical models of various types of wounds and surgical sutures. These models should provide a simulation of living tissues of the wound edges behavior to achieve the best results in the treatment of wounds by RC advanced technologies. The purpose of this study is to mathematically justify RC with the parallel holding of spokes. Another purpose is to develop a mathematical model of the wounds suturing by hardware technology.
Целью обзорной статьи стал поиск ответа на кли-нически важный вопрос о механизмах регуляции активности репаративной регенерации в гипок-сических условиях и возможности воздействия на этот процесс. В исследованиях последних лет компенсированная гипоксия характеризуется как триггер, запускающий процессы регенерации, при этом центральным регулирующим фактором выступает цитокин HIF-1 (англ. hypoxia-inducible factor-1). Изменение концентрации этого протеи-на модулирует клеточную миграцию, ангиогенез и эпителиально-мезенхимальную интеграцию, стимулирует пролиферацию клеток эндотелия и фибробластов, играя основную роль в стиму-ляции заживления ран, особенно при исходно скомпрометированной микроциркуляции, на-пример, на фоне сахарного диабета. Орлинская Наталья Юрьевна -д-р мед. наук, профессор кафедры патологической анатомии 2 В результате взаимодействия органа или ткани с внешней средой неизбежно воз-никают их повреждения, ответом на ко-торые становится регенерация -вос-становление анатомической целости органа или ткани после гибели структурных элементов. К частному случаю регенерации относится за-живление ран, представляющее собой слож-ный многоступенчатый процесс, требующий пространственно-структурной и временной ре-гуляции взаимодействия клеточных и внеклеточ-ных компонентов. При этом одним из ведущих факторов как в повреждении тканей, так и в про-цессе заживления ран выступает гипоксия.Целью настоящего обзора стал поиск ответа на клинически важный вопрос о механизмах регуля-ции активности репаративной регенерации в ги-поксических условиях и возможности воздействия Альманах клинической медицины. 2017 Декабрь; 45 (8): 674-680.
Nowadays, the problem of surgical treatment of incisional ventral hernia (IVH) still remains significant. According to the statistical data, the number of patients with postoperative ventral hernias has increased by more than 9 times over the past 25 years. Experts offer many solutions to this problem every year and the surgeon have to find the best method of postoperative rehabilitation in the flow of information. Academic research databases Google Scholar, CyberLeninka and others were used to search for the relevant literature. The following conclusions were drawn from this review. The etiology of IVH is multifactorial. There is no generally accepted evidence-based gradation of risk factors. There is no unified system for selecting the method of hernia repair of the anterior abdominal wall in patients with IVH. The choice of allotransplant material and the method of hernia repair are often individual. The value of the critical level of intraabdominal pressure have not been specified, however, all authors agree that its monitoring should become routine. The sublay technique remains the "gold standard" of plastic surgery by aponeurotic flap, inlay should be used when sublay is impossible to perform. Onlay should be used as a reserve method. In some situations, combinations of techniques are required. More and more laparoscopy is being introduced in the treatment of IVH as an assistance and in therapy. The introduction of new methods of hernia repair based on the uncontrolled separation of the anatomical structures of the abdominal wall imposes special requirements on surgical technology: plastic material, instrumental and technical support, wound closure and pharmacological support, especially in conditions of increased intra-abdominal pressure and tissue tension. We can use medication of pyrimidine’s row (xymedon) for a better implantation of the mesh implant and to increase the resistance of local tissues.
Existing techniques for suture of wounds are far from perfect. Less traumatic and more effective methods for suture using simple but efficient surgical devices, improved suture technique, and new types of appliances for wound adaptation should be developed and introduced into clinical practice. The new appliances should keep the edges of a wound together during suture, obviating the need for doing this them manually with forceps. The probability of rupture of sutured tissues would be minimized if the stretching forces occurring while bringing the wound edges together are applied to the entire circumference of the wound rather than at a single point. The study of the dependence of regeneration of a sutured wound on the coefficient of tension of tissues showed that the coefficient of tension in the region of suture has a considerable effect on regeneration. It is best for regeneration if the tension in the region of suture of skin and soft tissues does not exceed 40 g/ram 2. Such tension provides the required primary adhesion of the wound along the suture. The value of the coefficient of tension in the region of suture is of importance for the first 6-8 days. By this time the adhesion becomes firm enough that the coefficient of tension has virtually no further effect on reparative regeneration [23].There are various appliances for keeping the edges of a wound together. They are designed for use in various branches of surgery [1,8,17,32] into two groups. The first group includes appliances for temporarily bringing the wound edges together, decreasing the size of the wound, and keeping the edges of the wound in a fixed position: forceps, one-and two-toothed retractors, laminar clamps or clips with a rack. Wound adapters comprise the second group of appliances for bringing wound edges together. These devices keep the edges of the wound in a fixed position not only during but also after suture to provide adaptation of tissues. According to the design of the working part and apposition mechanism, wound adapters fall into the following subgroups: 1) spine (SWA); 2) laminar (LWA); 3) thread (TWA); 4) wire (WWA); and 5) rod wound adapters (RWA). They allow both intra-and extra-wound vutnosynthesis to be carried out.The working part of a SWA is a set of sharp needles or spines arranged over an elastic ribbon, a wire frame, or stiff branches. Tissues are seized by the needles (spines) and the edges of the wound are apposed by contraction of the elastic ribbon [30], with forceps [2], or with a screw [9,12]. For example, a SWA for closure of long (50-70 cm) shallow surgical incisions has been described [30]. The ribbon is elastic in the middle, whereas its edges are thick and rigid. There are 0.25-to 1.5-mmlong sharp retractors along the edges of the ribbon. The needles puncture only the epidermis; the derma remains intact. The surface of the ribbon applied to the skin is adhesive to provide its contact with the epidermis. This appliance provides good adaptation of easily movable segments of skin, but it cannot be used for tre...
The original composite thread including polyfilament central base with smooth polymer coating is proposed. The thread is of high strength and slip improving the approach of wound edges with minimum physical efforts of surgeon's hands, eliminating saw effect and excess traumatism of tissue.
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