Surgical surgery “3 major suture tools+7 suture methods”, super practical
The sutures we have learned together in those years ~
Basic principles of suture:
01. Ensure that the suture wounds or wounds are good: suture should be carried out in layers, suture according to the anatomical level of the tissue, so that the tissue levels should be strict. Blood and infection. The wound spacing and needle spacing of suture must be uniform.
02. Pay attention to the tension at the suture: The tightness of the suture stitching line should be tightly connected by the edge of the incision, and it should not be too tight.
03. The choice of suture and stitching needles should be appropriate.
1. Switching line
The surgical suture line refers to a special line used for wound ligation, suture hemostasis, and tissue sutures in surgery. According to its biodegradation performance, it can be divided into: irreplaceable lines and absorbable cables. In addition to the repair of tendon and ligament, the orthopedic incision should be selected from the inertia -inert material with inertia, and it is basically recommended to choose the absorbable sutures containing antibacterial agents to reduce the infection and foreign object caused by the implant (stitching) and the filament wire cable. reaction.
The specifications of the stitching are represented by numbers, and the specifications represent the diameter of the stitching. The larger the digital is above the 0, the larger the sewing line. For example, Line 4 is thicker than Line 1, and the greater the intensity of resistance. There are generally line 1 to 10. Below 0, the more 0, the smaller the diameter, the lower the strength of the Zhang.
The stitching resistance refers to the strength it can bear before the break (represented by pounds). The anti -tension intensity of the organization is a prerequisite for surgeons to choose stitching models and tension strength. It is generally recognized that the resistance of stitching does not require more than the tissue resistance of the tissue, but at least it should be strong with the normal tissue of the suture.
At present, the following materials are mainly used at home sutures:
(1) Silk wire: Wide application, cheap and strong price, convenient use, and occupying most surgical sewing markets, but the absorption cycle is more than 1 year, which is an irreplaceable range.
(2) Sheep intestine line: The sheep intestinal line is a traditional absorbable surgical stitching. Because the sheep intestine itself has an irreplaceable defect, it has gradually been replaced.
(3) Polyte avolybly (PGA) and polyethylene ester (PGLA) category can absorb sewing lines: Due to good biocompatibility and a reliable fixed effect, the use of clinical use is becoming more and more extensive Essence
(4) Single fiber and multi -fiber stitching: Single fiber sutures are less resistant to the resistance when passing through the tissue, and can avoid bacteria on top, suitable for sutures for vascular surgery or pollution wounds. Single fiber stitching is easy to knot, but the intensity is low. If the suture folding or curling occurs during the ligation process, the suture will be broken.
Orthopedic suture selection
The two most critical elements must be understood by selecting absorbable sutures: tension support time and absorption time.
The tension support time refers to the time when the absorption of the suture can maintain the tension that the incision is good; the absorption time refers to the time when the absorption of the suture can be completely degraded in the body’s tissue in the body.
The principle of selecting suture materials:
(1) Organizations with slow healing such as tendon and ligaments should choose small tissue reactions and non -absorbing lines with strong inertia, such as polypropylene and polyester.
(2) The incision tissue within 2 to 6 weeks of healing time should try to choose as much as possible to absorb the sutures to reduce the risk of infection caused by foreign body residues;
(3) Understand the healing time of the wound tissue in different parts, the tension support time of the absorption line must be greater than the time for the tissue complete healing. If the patient has high risk factors in the whole body and local area Absorbable line;
(4) In order to reduce the formation of skin scar, try to choose the way without penetrating the epidermis and the material suture incision.
(5) Most of the stitching materials now bring their own stitches. Without damage to the strength of the strength, the thin needle type is also in line with the concept of minimally invasive concepts. During the operation, rigidity is enough to resist bending, and the toughness is enough to resist the break. Essence Consider chord length and arc, choose different needle types according to the depth of the site and the thickness of the tissue.
Types of sewing needle:
1. According to the horizontal cross section of the needle tip: round needle; corner needle (sharp, mostly used for sewing skin); round body angle needle; shovel needle (mainly used for ophthalmology surgery); blunt needle.
2. Press the arc of the needle: 12 arcs; 318 arcs (mostly used for sewing skin); 5/8 arc; straight needles; 14 arcs (mostly used for ophthalmology surgery)
Classification and scope of the arc of sewing needles
3. The diameter of the stitching body part: The curvature of the body is generally 2/8, 3/8, 4/8 circles, 58 circles, or corresponding needle diameter: 0.25, 0.375, 0.5, 0.625 inches (Note: 1: 1 Inch = 2.54 cm) diameter. Among them, the needle curvature of the needle is 3/8 (0.375 inches). The needle is most commonly used for the suture of the skin. The needle curvature rate is 48 circles (0.5 inches) for sutures in a small space to adapt to the technical person. Big wrist operation action.
Choose the right needle holder
The maximum bending torque that the needle can withstand should be greater than the joint force that acts on the stitching when the needle holder clamping needle and the subsequent sewing and tissue, otherwise it will easily lead to bending and deformation during the stitching process.
Compared with the suture needle: Excessive needle holder, the deformation of the needle during surgery causes the curved needle to straighten the curvy needle from bending. The needle holder is too small, which will cause the suture needles to rotate along the long axis of the needle.
Master the correct way of holding acupuncture
(1) Use needle holder method
The needle bite should be matched with the size of the needle. The contact point of the needle and the needle should be located at the wide ovarian circle of the needle. In order to be the largest contact area of the needle and the needle, it is conducive to the stable control of the stitched needle with the needle holder, and avoid shaking and reversing when the sewing is sutured when the tissue sutures. The needle should be perpendicular to each other with the needle holder. When the stitching is sutured, the needle should not be clamped too much.
(2) Master the correct way to hold the needle
Put the thumb and ring finger into the rings of the needle holder, and place your fingers on the needle holder in order to steadily hold the hand holder, or hold the entire needle holder in the palm of the hand to increase the flexibility of the operation.
Figure: Correct needle holder holding method
Specify operation steps
Surgical operation details: The needle inlet angle of the needle should be perpendicular to the skin, which can reduce the size of the needle and avoid the inside of the skin. The position and depth of the inlet point depends on the thickness of the skin to be sutured. The inlet point is generally 1 to 3mm from the edge of the wound. The bilateral symmetry should be perpendicular to the surface of the skin.
The needle holder should always be clamped by clamping the needle until the needle leaves the wound before loosening. The details in this operation are very important, and the small sewing needle may fall in a deeper wound before loosening the needle.
Orthopedic suture choice
Orthopedic surgical incision sutures follow the principles of sterile, minimally invasive, and restoration of patients with patients and ensure good blood supply. The sewing of incision is mainly divided into two categories: continuous sutures and intermittent sutures. On the basis of this, it has evolved sutures such as embedded sutures, purse sutures, tension sutures, and exempting sutures.
Orthopedic surgery is most commonly used in simple sections, continuous sutures, continuous horizontal mattresses (suture in the skin), and exempting sutures; sometimes “8” stitching, vertical mattress sutures (exterior suture) and Reduce suture.
Simply intermittent sewing
The most applications are used for each seam. It is mostly used in the sutures of the skin, subcutaneous tissue, muscle, tendon membrane and peritoneum, and is especially suitable for sutures with infection.
Pay attention to the points:
(1) The needle should be vertical, that is, the needle and the wound incision are vertical, and the incision can be lift gently.
(2) The pitch of the needle is 0.5cm.
(3) When closing the line, the hands are evenly.
(4) Generally, the whole layer is required to penetrate. In special, you can choose the non -entire layer, such as. Switching of the slurry muscle layer.
Advantages: simple and fast operation; the tension of the suture can be adjusted according to the situation of different wounds during stitching, which has a small impact on the blood circulation of the fate; the sewing fracture of individual stitching after surgery does not affect other stitching; Line drainage.
Disadvantages: The suture time is long, and the suture consumption is more; the organization may be different and the aesthetics may be poor.
Simple continuous suture
Each needle is the same as the simply intermittent sewing, but only one line is completed from the start of the suture to the end. Mostly used for sutures of long wounds, such as the inner layer of the laculinity and the back wall of the gastrointestinal tract.
(1) Always enter the needle on the same side, and the needle is needed on the same side. When knotting, remember to leave the back line.
(2) Remember to let the assistant close.
(3) Other points are sutured with simplicity.
Advantages: Compared with simply sewing, this method has less knotting, short -term, faster, faster, and not easy to leave scars.
Disadvantages: If the suture is broken, it will cause the entire wound to crack, it is difficult to fine -tune along the suture line, and the suture is prone to wrinkle (especially when the suture is thinner).
Continuous horizontal mattress stitching (internal stitching)
For skin suture, it is generally used to absorb the sutures. The stitching is continuously sutured in the skin incision on both sides. It is widely used in surgical surgery, especially in plastic surgery, and sewing in the skin is commonly used to sewn the skin incision, such as the cervical thyroid surgical incision, the perineal cutting, etc.
Advantages: This method is small, healing scars, relatively beautiful, and the line removal time is early or no need to disassemble.
Disadvantages: The density and level of sutures are inseparable from the density and level of the subcutaneous tissue. If the tension of the incision is large and the subcutaneous suture is not good, this method should not be used.
Free knot suture
Removal suture is an emerging suture method. The tension support is large enough. The grip of the organization is strong and uniform. You can quickly complete the suture by single operation. You need to pay attention to the tightness when the suture is tight. ~ 3 stitches, close to the tissue scissors to prevent line tail damage from local tissue.
Also known as double -end stitching, consisting of two intermittent sutures, the suture line is crossing the deep surface of the tissue, the seam is firmly saved, and it is often used for tissue, tendon, ligament suture, and sutures of large blood vessels to stop bleeding.
Advantages: The sewing is firm and not easy to slip.
Disadvantages: The operation is cumbersome.
Vertical mattress stitching
This method is often used for wrinkled anatomical parts, such as the back of the neck, groin, armpit, skin relaxation parts (such as the elderly or the abdomen of the maternal, scrotum skin, etc.), and deep tear wounds.
(1) Pay attention to the distance between 1, 4 and 2, and 3, you can adjust the depth between 1 and 2 thicker than 3 and 4 according to the patient’s condition.
(2) Other points are sutured with simplicity.
Reducing sutures are often used to suture skin incisions with high tension. Generally, the border is above 1cm. It can be combined with vertical cooker suture to increase the stitching tension. When conditions permit, the new skin gum is used. It provides additional high -resistant tensile strength on the skin surface, while maintaining the skin’s aesthetic effect. For patients with higher requirements for surgical scars, patients can be adopted.
Source 丨 Bone today, Chinese and foreign
Pay attention to the points:
Pay attention to the points:
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