DE1810800A1 - Special wires and needles for the tendon sutures - Google Patents

Description

Special wires and needles for the tendon sutures .

The invention relates to steel wires reinforced with barbs. te and spiral needles for the tendon suture that, apart from the simplification of the suturing technique, compared to the previous methods, a multiple penetration of the tendon surface., as well as the remaining of suture sections, or. hooks, on the outside of the tendon, which are the cause adhesions of the tendon with the environment have so far impaired the functional result of the intervention,

Tendons are usually sewn with the finest steel wire, which either remains in the tissue or with the help of a separate one Pull-out wire after eau, three weeks, as with the Pull-out suture according to BUNNEII, which is particularly advantageous in the case of injuries to the flexor tendons in the palm of the hand Will get removed. Since the tendons consist of individual longitudinal fiber bundles that are only loosely connected to one another, a Tear out a simple suture while splitting the tendon, which is why In particular, thicker tendons that are under a correspondingly higher muscle tension must be sewn in this way, that the wire is not between the loosely milled fabric the longitudinal fibers, but by looping around the fiber bundles attacks himself, d. H. the wire has to weave at least the proximal tendon stump more or less spirally:

In the most widely used suturing technique according to BUNNELL, the tendon stump is first pierced transversely, and

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then both wire ends, each reinforced with a needle are laid diagonally through the string in opposite directions, that they cross twice in the tendon and emerge in the cut surface of the stump. Easier to do on the other hand is the tendon suture according to LENGEMNK, in which the tendon stump only has to be pierced longitudinally once and is held by a V-shaped double hook that rides on the string.

Apart from the far more favorable forecast for Streckseh ^nen compared with flexor tendons, the functional result of a tendon suture is not only dependent upon the seam holds in the tendon and the freshened cut surfaces well and without tension adapted but in same * ehern extent due to the fact that there are no adhesions with the environment that would prevent the restoration of the tendon gliding ability despite appropriate post-treatment. However, the less the smooth tendon surface is impaired by sutures or traumatizing holding instruments, the lower the risk of such adhesions.

However, the usual tendon sutures require a multiple: Pierce the surface of the tendon, with the outer one Steel wire as a result of the tissue reaction even with the best Material an at least punctiform, pitted connection between the tendon and surrounding tissue. The same, applies to the hook lying on the tendon when using the special wire according to LENGEMAM.

There are therefore special wires or a special needle proposed for use with conventional steel wire, with which the tendon suture is not only technically simple, but can also be performed without the previous trauma to the tendon surface.

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Fig. Λ A shows a wire reinforced on both sides with a needle with at least two small barbs, which are drawn into the proximal stump from the cut surface so that, in contrast to the suturing technique according to LSKGEMANN, they are not on the left but inside the tendon % en. A monofilament wire can be provided with such barbs by pins of various arrangements (Fig. 1 B and G), as well as by inclined incisions D or corresponding compression molds, with a non-round wire cross-section, e.g. B. triangular E or band-shaped, not only counteracts a twisting of the! Thread in the tendon better, but z. B. can also be better fitted to a correspondingly ribbon-shaped tendon. With polyfilament wires, on the other hand, barbs can be achieved by bending individual wires or wire loops accordingly. All barbs should also be slightly elastic so that they spread when pulled in one direction and narrow when pulled in the opposite direction, both to increase the hold in the tendon and to facilitate removal of the wire after three weeks.

Fig. 2 shows the use of two such barb wires in the form of a pull-out seam.

For the relatively rare cases where the distal If the tendon stump is to be fixed more strongly, wires with at least one barb are specified for both tendon stumps, (Fig. 3 A and B), the subsequent removal of such a wire is only possible when the connection the barb can be lifted from the outside over the seam, either by a predetermined breaking point a or a tiny thread b can be made, whereby a counter-twisting of the two wire ends the connection solves. So that the barbs sit when removing the

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However, if the wire cannot rotate, they have to, how shown in Fig. 3 A and B, as a ring rotatable on the wire sit.

The wire in Fig. 3 G, however, has non-rotating barbs, the connection of which goes over the seam caused by two nested, tiny loops c will the. are locked by the end of an additional, third wire, the withdrawal of which in turn disconnects.

In addition, there would also be the possibility of slowly absorbing barbs (Chromcatgut) on one after Consider three weeks of extendable steel wire Fig. 3 D. The central wire would have to be so stable be that the proximal tendon stump can be pushed over the barbs. A second needle was here however, in order to avoid the traumatizing puncture on the tendon surface of the proximal stump.

The V / iderhakenverbindungen in Fig. 3 E from appropriately stable Steel wire for attaching the tendon stumps, or possibly also made of slowly absorbable material, can IP can no longer be pulled out of the tendon however, any piercing of the tendon surface.

The spiral needles in Fig. 4-, on the other hand, not only allow a technically significantly simplified creation of crossed spiral seams like the BUNNELL seam, but avoid it also the previously necessary multiple piercing of the tendon surface and the trauma of external suture sections.

To place the suture (Fig. 5), a spiral needle is first inserted from the cut surface through the proximal stump

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end and then reinforced with a wire, whereby the atraumatic wire of the applicant is recommended, which by halving its diameter at the tip avoids doubling the wire thickness in the eye. When the needle is turned back, the wire is drawn into the spiral stitch channel in one operation. Corresponding the BUNNELL seam is then also the other end of the wire with the second spiral needle, the. has an opposite thread, in the same way, but in opposite directions drawn into the tendon stump.

As Fig. 6 shows, the course of the thread corresponds to the one created The pull-out suture is then based on the BUNNELL suture technique, with the exception of less trauma the surface of the tendons and the easier application of the suture, the precisely spiral course is the main advantage has that the wire is not on the loose intermediate fabric, but by evenly gripping the longitudinal fiber bundle supports.

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Claims (8)

Patent claims: Special wires and needles for the tendon sutures characterized by: 1.) That one in a conventional manner on both sides with a needle steel reinforced wire with a round, a dreiecki- Wk like or strip-like cross section in a short middle section or has a plurality of rectified barbs 2.) That the wire to the tendon suture on either side of the middle at least one rotatably attached to the wire, in the longitudinal direction, however, has barbs which are not displaceable in the opposite direction of attack, wherein the piece of wire between the two barbs has a twistable predetermined breaking point, z. B. by Narrowing or division of the wire. ^ 5.) According to cont. 2 characterized in that the twisting * Bare predetermined breaking point replaced by a small thread, will" 4-.) That a tendon wire in the middle at least two on top of each other has to directed barbs, the cohesion of the connecting piece by two tiny, nested loops is effected and is locked by the end of a separate wire. 009823/0097 5.) That a tendon wire reinforced with a needle on only one side is somewhat stronger on the opposite side Has longitudinal stability and on both sides with barbs of different sighting from one slowly absorbable material is occupied. 6.) That a both-sided pointed connecting piece of round or band-shaped cross-section bears barbs in opposite directions on both halves, and from stainless steel or a slowly absorbable material. 7 ·) That a needle for laying a tendon suture with conventional steel wire spirally to at least 1/2 turns is curved and at the tip a closed or open eye and at the end an angled or Has widened handle end. 8.) Make claim. 1-7 characterized in that wires and wheels are pre-sterilized and packaged sterile. 009823/0097 Blank page