Surgical sutures

The surgical sutures are used for connection of the edges of the wounds with the help of the suture, absorbable (catgut) or nonabsorbable (silk, nylon, nylon and other synthetic filament). There are primary closure (see)imposed immediately after surgery or injury, and secondary seam (see)used for granulating wound. Surgical stitches for the wound, but not drawn, are named pharmaceutical. They tied on the 3-4th day after the imposition in the absence in the wound of the inflammatory process. Delayed primary closure imposed after 2-4 days after primary surgical treatment of wounds. Skin impose removable stitches are removed after healing wounds. Surgical sutures of non-absorbable material imposed on deep tissue, usually leave in the tissues forever.

types of surgical sutures
Fig. 1. Types of surgical sutures: 1 - node;
2 - continuous; 3 - purse-string; 4 - Z-shaped; 5 - direct site; 6 - double knot.
devanie thread a needle
Fig. 2. Devanie thread a needle.

By type of surgical sutures can be hub (Fig. 1,1), continuous (Fig. 1,2), purse string (Fig. 1,3), Z-shaped (Fig. 1,4) and blanket. After suturing them pull together so that the edges of the wound were in contact, and tied closed flower direct (sea) node (Fig. 1,5). Some suture materials (nylon, nylon) tied double (Fig. 1,6) or triple knot because otherwise they easily came undone.
For sutures used needle holder and curved or straight needles different curvature and section. The thread is put into the eye of a needle top (Fig. 2). More and more wide application receives mechanical suture using sewing machines (see), and suture material are metal brackets (mainly tantalum).


Figure 3 Removing weld.

To stitches accidental cut, not contaminated wounds of skin, face, lips, fingers can independently working paramedic. Stitches involving surgical treatment of wounds, produces only a doctor. Sutures are often charge nurse or the dressing room, the nurse. It is 7-10 day overlap (earlier - on the face, neck, in the absence of tension tissues and good wound healing, later - of the patients of elderly and senile age). After lubrication of the seam lines alcohol solution of iodine take anatomical tweezers one of the weld ends and pull it to the below site appeared not painted iodine tincture part of the thread (Fig. 3). It is crisscrossed with scissors and stretching retrieve the entire seam. After secondary lubrication seam lines alcohol solution of iodine impose Cleanaway bandage. Preparation of material for joints - see Sterilization surgery.
On some tissues and organs are special types of surgical sutures - intestinal suture (see), nervous seam (see), vascular suture (see), tendon suture (see). Surgical sutures that connects bones - see Osteosynthesis.

The surgical sutures - bloody and bloodless ways of connecting edges random and operating wounds. Bloody surgical sutures impose by conducting suture material through the tissues. If suture after healing wounds removed, such surgical sutures called removable, if he stays - submersible. Usually removable surgical sutures placed on the surface and submersible on the internal organs and tissues.
Surgical sutures, which must be bonded fabric only during any one stage of the operation, called temporary, or seams-taped. In terms of imposing W. H. on the wounds there are primary W. H. on a fresh wound, primary deferred, early and late secondary seams. Delayed primary called seam, which place the wound is not in conclusion, surgical treatment, and in the first 5-7 days (before the appearance of granulation). A variant of deferred surgical suture is makeshift, in which the threads are conducted through the wounds after surgery, but do not tighten until, until you find out that the infection is not present. Secondary seam is a surgical suture imposed on granulating wound without excision of granulation (early secondary seam) or after excision of granulating defect and its surrounding scars (late secondary seam).
Depending on the overlay techniques and materials distinguish the following surgical sutures: microwave, metal lamellar skin (Lister), metal wire bone, soft ligature threads (the most common), mechanical metal bracket.
Microwave surgical sutures - the contraction of the wound edges with adhesive tape, or thread through matter (flannel), embroidered along the edges of the wound, the recommended primarily to accelerate healing granulating wounds (Fig. 1). For wounds of the chest and abdomen recommend to impose across operating cuts plastic "bridges", which should contribute to more rapid healing. Investigate the possibility of applying methods edges of the wounds of soft tissues and bones using synthetic cyanoacrylate adhesive (Eastman-910, USA; Fix the USSR; Aron-alpha, Japan).

surgical sutures
Fig. 1. Adhesive bandage with a compression joints lace-up. Fig. 2. Wire laminar seams. Fig. 3. Nodular cutaneous seams on the cylinders. Fig. 4, a and b. Wire bone joints and two brackets and binding wire; b - tightening wire bead.


Metal wire surgical sutures were used already in the first half of the 19th century (lead-silk W. H. N. I. Pirogov; aluminum Neudorfer). Wire laminar W. H. provide an opportunity to bring together the region, even at relatively large tissue defects, and therefore shown under great tension edges of the RAS (Fig. 2). To reduce tension and to avoid the eruption of the skin sutures, you can do them hub, using a soft ligature threads that connect the nodes, and tied on each side on the rollers (Fig. 3).
Metal wire bone surgical sutures carried out through the hole, drill in the bone fragments (Fig. 4, a), or bone draw wire, or to carry through globularia notches (Fig. 4, 6). The ends of the wire spin.

the use of the needle holder
Fig. 5. Hand placement when using a needle holder: a brush in position pronation (vCal); b - brush in position supination (Vicol); - atraumatic needle.
types ligature nodes
Fig. 6. Types ligature sites: a - the double surgery; b - oblique; - the sea, or direct.

For surgical sutures soft ligature threads and flexible steel wire is used surgical straight or curved needles; the latter is manipulated using a needle holder. The most simple and convenient needle holder type Chegara with cremalleras. In needle holder insert the needle so that its hold on the border of the middle and posterior thirds (Fig. 5).
The needle is injected into the fabric perpendicular to the surface layers and promote, following its curvature.
For more dense tissues (skin) should be used triangular (cutting) curved needle less dense (colon) - round (pricking) straight or curved, which sew without needle holder. Conventional surgical needles with open ears hurt tissue as through the channel bead stretch yarn, folded in half. In this regard, the vascular, ocular, cosmetic surgery, urology use of atraumatic needles, wherein the end of a thread spresovuyetsya in the lumen of the rear end of the needle (Fig. 5). To eliminate unwanted rotation in needle holders round curved needles internal surface of the work of the jaws of steel needle holder to cover the diamond grit (diamond needle holder). At the proposal of E. N. Taube, part needles that pinch needle holder, you do not round but oval.
Surgical sutures impose consistently in the direction from left to right or from itself, but not from ourselves. The simplest type of surgical suture soft floss is a hub (old term "knotty") surgical suture, in which every stitch impose a separate thread and tied double surgical (Fig. 6, a) or sea (Fig. 6), but not skew ("Babi", Fig. 6, b) node. For tying the knot used different techniques (Fig. 7, a-e). At long or complex form wounds of the skin and subcutaneous tissue at first impose guides (situational) joints: one stitch in the middle of the wound, then one or two at the most dehiscence and hang them definitely double the surgical site. Usually skin impose seams with intervals of 1-2 cm and shoot them in an average of 7 days. Lifting tweezers site, several pull the thread from a channel in order to retrieve the thread is not to push through it, the part that was outside the channel, then cut off the thread below node (Fig. 8) and remove.

methods of tying knots
Fig. 7. Methods of tying knots: a and b - tying first loop double surgical site; the thread is a little finger of the right hand from left to right; in the first loop duplicate node tied; Mr. tying the second loop marine site; the thread is conducted III and IV fingers of the left hand from right to left; d and e - reception Claus: loop at the end of the thread attacking the tip pinned needles and locked automatically when the withdrawal of the latter.
removing skin hub seam
Fig. 8. Reception removing skin hub seam.

Aponeurotic and prevrashenie seams should be applied frequently - at the distance of 0.5-1 cm from each other. The ends of the silk threads are cut off, leaving antennae not more than 2 mm from the site. The ends Katsutoshi thread cut is usually a minimum distance of 1 cm from the node, given the possibility of sliding filament and blooming host (even triple!). When sewing muscle crossed transversely to the axis of the beam, in order to avoid the eruption of the use mattress, hub or U-shaped seams (Fig. 9). As a styptic, or okalahoma, you can do Z-shaped hub seams (Fig. 10) Sultan or purse string (Fig. 11).that is: Improved printing technique purse string sutures on the intestine is achieved by the use of the tools VNIIKI (Fig. 12).

U and Z-seams
Fig. 9. U-seams on the muscle is cut across a stroke beams. Fig. 10. Z-shaped hub seam at the gut to Sultanu. Fig. 11. Purse string suture to dive stump of the vermiform process.
Tools VNIIA
Fig. 12. Tools WEIHAI and needle (1) for the imposition purse string sutures: a - on the duodenum; b - in the small intestine; a - on a blind gut; Mr. scheme of the straight needles (1).
brackets Michel
Fig. 13. Brackets Michel for skin sutures (a) and store-tweezers (b) for the imposition of parentheses.

The advantage of nodular skin seams (Fig. 14, a) is that by removing one stitch, you can give the output separated wounds.
Continuous seam overlaps faster hub, but in case of breaking the threads in one place or the need to partially disclose the wound he disagrees on all length. Continuous surgical sutures are of various kinds: simple (Fig. 14 b), of blanket by P. Ya. Multanovsky (Fig. 14 in), mattress (Fig. 14, d), furrier on Smegenu (Fig. 14, d), intradermal cosmetics on Halstead (Fig. 14, e). If it is difficult to bring together the wound edges (for example, ribs), they pull together the block polyspastny seam (Fig. 15, a). To strengthen fasciale-aponeurotic dual layer (Fig. 15, b) or so-called greatcoat fold (Fig. 15). For strengthening the abdominal wall prefer to make two or even three floors seams, not counting the seam imposed on the parietal peritoneum, instead of the more complex the seam on Maseru (Fig. 16). To close the serous membrane (the peritoneum, pleura) line of stitches on the wall of a hollow organ, on this first row of stitches placed second - seasonality seam called Imaginarium, or immersing (to distinguish from submersible, see above).


Fig. 14. Different kinds of soft ligature joints: a - line correctly imposed nodular skin sutures; b - simple continuous seam and the way of tying; in - blanket continuous seam Multanovsky; g - mattress continuous seam; d - furrier seam on Smegenu; e - intradermal cosmetic scar to Halstead.
seams to strengthen fasciale-aponeurotic layers
Fig. 15. Seams to strengthen fasciale-aponeurotic layers: a - block polyspastny; b - double; in - seam in the form of "greatcoat folds".
the seam on Maseru
Fig. 16. Seam to strengthen the abdominal wall by Maseru: upper seam is on the skin, subcutaneous fatty tissue and muscles; lower on the peritoneum.

Thus, it is a two-storey seam. In some cases, you may need and three-seam.
Mechanical submersible impose seams with metal staples, internationally widespread after the implementation in practice of surgical stapling instruments developed in VNIIA. Michelle (P. Michel) suggested bracket for removable skin seams (Fig. 13).
For the formation of anastomoses hollow organs (intestines, blood vessels), in addition to manual and mechanical joints, use a variety of devices designed to facilitate the operation technique, ensure greater durability of seams and asepticheski. For operations on the intestine proposed pulp and needle I. G. Skvortsova; for operations on blood vessels - tools, M. Spoga and NICHOLAS Talankin, V. I. Bulynina, I. Pronin and N. C. Dobrovol, rings D. A. Donetsk.
Cm. also Intestinal suture, Nervous seam, Osteosynthesis, Vascular joint, Tendon stitch, Sewing devices, Surgical instruments, Suture material.