Aim. To improve the results of surgical treatment in patients with large lipomas by using the device for closing the edges of wounds, allowing local preventive hemostasis in the surgical wound area, to create optimal conditions for atraumatic suturing and thereby reduce the amount of intraoperative bleeding and subsequently reduce the amount of postoperative wound complications. Methods. The results of treatment of 105 patients with different localization of large lipomas were analyzed. Lipomas ranged from 8.0 to 20 cm in diameter. All patients were divided into 2 groups: the control group consisted of 53 (50.5%) patients for which used the traditional technique of tumor excision with closing surgical wounds, and the study group with 52 (49.5%) patients, for which to reduce tissue damage during tumor removal and the edges of wound suturing, one of the device variants developed by us was used, approximation-distraction device. Fisher's exact test was used for the comparison of the outcomes rate, a p-value 0.05 was considered statistically significant. Results. Surgical wound complications occurred in 7 (6.7%) of 105 patients. In the study group, surgical wound complications occurred in 1.9% (1 observation), in the control group 11.3% (6 observations). Surgical wound complications were severity grade I and grade IIIa. Complications of the first grade did not require a debridement and will regress on its own; in grade IIIa complications, an opening, excision and drainage surgical wounds were performed without general anesthesia. Conclusion. Moderate local selective near-tumor tissue compression that occurs when the device branches come closer to each other accelerates spontaneous thrombus formation in damaged small vessels. This creates favorable conditions for the surgeon to work in a dry wound.
Aim. To improve the results of treatment of patients with breast cancer after radical mastectomy through the development and application of a device for wound closure after radical mastectomy, providing favorable conditions for wound healing. Methods. The proposed device for wound closure after radical mastectomy was used in 42 patients after the mandatory informed consent. A patent for the invention was obtained for the developed device. The study group included patients with indications for performing Madden mastectomy (Halsted, Patey) for breast cancer in the range of stages T1-4N0-1M0. The age of the patients was 57.5±10.4 (m±δ) years. In group 1 (n=21), wound closure after radical mastectomy was performed using the developed device, in group 2 (n=21) - without it. Results. In the process of working with the developed device, the following positive features were observed. The magnitude of the buckling in the plane of the jaws follows the contour of the thorax in the region of operation of the patient preventing the appearance of the plots of overpressure by the device to the adjacent tissue and ensuring uniformity of traction paravulnar tissues. The complete absence of tissue tension in the area of the suture is the result of the suturing of surgical wounds only after the complete wound edges attachment by means of the device. The above-mentioned factors lead to the formation of point scars in the joints, the absence of extended forms of postoperative scars. Conclusion. The developed device for wound closure after radical mastectomy performed for breast cancer allows shortening the hospital stay after surgery by 36% (p=0.01) and the deadline for removal of drainage by 31% (p=0.01), reducing the incidence of local necrosis of the flap (p=0.44) compared to traditional suturing of the wounds.
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