In their work, surgeons use surgical sutures, there are different types of them, this is one of the most common methods used to connect biological tissues: the walls of internal organs, wound edges, and others. They also help stop bleeding, the flow of bile, all thanks to the right suture material.
Recently, the main principle of creating any type of suture is considered to be careful attitude to each edge of the wound, regardless of its type. The suture should be applied so that the edges of the wound and each of the layers of the internal organ that requires suturing are exactly matched. Today, these principles are collectively referred to as precision.
Depending on which tool is used to create the seam, as well as the execution technique, two types can be distinguished: manual and mechanical seams. For manual suturing, ordinary and traumatic needles, needle holders, tweezers and other devices are used. Absorbable sutures of synthetic or biological origin, metal wire or other materials can be chosen for suturing.
A mechanical seam is applied with a special apparatus, whereuse metal staples.
During the stitching of wounds and the formation of anastomoses, the doctor can suture both in one row - single-row, and in layers - in two or even four rows. Along with the fact that the sutures connect the edges of the wound together, they are also excellent at stopping the bleeding. But what types of sutures exist today?
Classification of surgical sutures
As we have already said, the seams can be both manual and mechanical, but there are several more classes of their separation:
- according to the technique of their imposition, they are nodal, as well as continuous;
- if you divide them by shape - simple, nodal, in the shape of the letter P or Z, purse-string, 8-shaped;
- according to their functionality, they can be divided into hemostatic and screw-in;
- by the number of rows - from one to four;
- according to the period of stay inside the fabric - removable and immersed, in the first case, the seams are removed after a certain time, and in the second case they remain in the human body forever.
It is also worth mentioning that surgical sutures, their types are divided depending on the material used: they can be absorbable if catgut is used - this is a biological species and vicryl, dexon - these are synthetic. Erupting into the lumen of the organ - this type of suture is superimposed on hollow organs. Permanent - these are the types of sutures that are not removed, they remain in the body forever and are surrounded by a connective tissue capsule.
Types of raw materials for suturing
Suture material includes various materials used for ligationvessels with surgical sutures. The types of material for suturing tissues and skin have changed greatly every year, depending on how surgery has developed. What surgeons did not use in order to connect the tissues of internal organs and skin:
- mammalian tendons;
- fish skin;
- filaments obtained from rat tails;
- nerve endings of animals;
- hair taken from horses' manes;
- umbilical cord of a newly born person;
- strips from vessels;
- hemp or coconut fibers;
- rubber tree.
But, thanks to modern developments, synthetic threads have now become popular. There are also cases where metal can also be used.
Specific requirements apply to any suture material:
- high strength;
- flat surface;
- elasticity;
- moderate stretch;
- high slip on fabrics.
But one of the important criteria that apply to the suture material is compatibility with the tissues of the human body. The currently known materials used for seams have antigenic and reactogenic properties. There are no absolute species for these characteristics, but their degree of expression should be minimal.
It is also very important that the suture is sterilizable and retains it for as long as possible, while maintaining its essential characteristics.initial. A suture thread may consist of one or more fibers that are connected together by twisting, knitting or weaving, and to ensure a smooth surface, they are coated with wax, silicone or Teflon.
Resorbable and non-absorbable types of suture material are currently used in surgery. The classification of surgical sutures, most of it involves the use of absorbable sutures - catgut, which is made from the muscle membrane of the small intestine of a sheep, and the submucosal layer can also be used to create it. Today there are 13 sizes of catgut, which differ in diameter.
The strength of the seam material increases with size. So, for example, the strength of the three-zero type is about 1400 g, but the sixth size is 11500 g. This type of thread can dissolve from 7 to 30 days.
From non-absorbable suture material in surgery, threads of silk, cotton, linen and horsehair are used.
Types of seams
When suturing the skin, the doctor must take into account how deeply the wound is cut or torn, its length and how far its edges have diverged. The location of the wound is also taken into account. The most popular in surgery are such surgical sutures, the photos in the article will show how they look:
- subcutaneous continuous;
- subcutaneous nodules;
- cutaneous nodules;
- continuous multi-row applied inside the skin;
- continuous in one row, applied inside the skin.
This will help you understand which surgical sutures are most commonly used when suturing an external wound.
Continuous intradermal type
It has recently been used most often, providing the best cosmetic result. Its main advantage lies in the excellent adaptation of the wound edges, excellent cosmetic effect and minimal disruption of microcirculation when compared with other types of sutures. The thread for stitching is carried out in the layer of the actual plane of the skin parallel to it. However, for easier threading, it is better to use a monofilament material.
After the primary surgical treatment of wounds is carried out, different types of sutures can be selected, but often doctors prefer absorbable suture material: biosin, monocryl, polysorb, dexon and others. And from threads that do not dissolve, monofilament polyamide or polypropylene are perfect.
Knotted stitch
This is another of the most popular types of outside seam. When creating it, the skin is best pierced with a cutting needle. If you use it, then the puncture looks like a triangle, the base of which is directed towards the wound. This shape of the puncture allows you to securely hold the suture material. The needle is inserted into the epithelial layer as close as possible to the edge of the wound, retreating only 4 mm, after which it is carried out obliquely in the subcutaneous tissue, while slightly moving away from the edge, as far as possible.
After reachedone level with the edge of the wound, the needle is turned towards the midline and injected into the deepest point of the wound. The needle in this case passes strictly symmetrically into the tissue on the other side of the wound, only in this case the same amount of tissue will fall into the suture.
Horizontal and vertical mattress suture
Types of surgical sutures and knots are selected by the surgeon depending on the severity of the wound, if there is little difficulty in matching the edges of the wound, it is recommended to use a horizontal U-shaped mattress suture. If a nodal primary surgical suture is applied to a deep wound, then in this case a residual cavity can be left. It can accumulate something that is separated by a wound and leads to suppuration. This can be avoided by applying a seam in several floors. This method of suturing is possible with both nodal and continuous types.
In addition, a Donatti suture (vertical mattress suture) is often used. In its implementation, the first puncture is carried out 2 cm from the edge of the wound. The puncture is made on the opposite side and at the same distance. During the next injection and injection, the distance from the edge of the wound is already 0.5 cm. The threads are tied only after all the sutures have been applied, thus, manipulations in the very depth of the wound can be facilitated. The use of the Donatti suture makes it possible to suture wounds with large diastasis.
In order for the result to be cosmetic, in any operation, the primary surgical treatment of wounds must be carefully carried out, the types of sutures are chosen correctly. If carelessmatch the edges of the wound, then as a result this will lead to a rough scar. If you apply excessive force when tightening the first knot, then ugly transverse stripes will appear, located along the entire length of the scar.
As for tying knots, all silk threads are tied with two knots, and synthetic and catgut threads with three.
Types of surgical sutures and methods of their application
When applying any type of suture, and there are many of them in surgery, it is extremely important to strictly observe the execution technique. How to apply a knotted suture?
Using a needle on the needle holder, first pierce the edges at a distance of 1 centimeter, holding with tweezers. All injections are carried out one opposite the other. The needle is allowed to be passed immediately through both edges, but it can be passed alternately, then through one, then through the other. After completion, the end of the thread is held with tweezers and the needle is removed, and the thread is tied, while the edges of the wound should be brought one to the other as close as possible. So do the rest of the seams and until the wound is completely sewn up. Each seam should be 1-2 cm apart. In some cases, knots may be tied after all stitches have been completed.
How to tie a knot properly
Most often, surgeons use a simple knot to tie sutures. And they do it like this: after the suture material is threaded into the edges of the wound, the ends are brought together and a knot is tied, and another one above it.
The surgical knot can be performed in another way: they also thread the thread intowound, with one hand they take one end, and the other after the other, and, bringing the edges of the wound together, make a double knot, and already above it a simple one. The ends of the thread are cut at a distance of 1 cm from the knot.
How to properly stitch a wound using metal staples
Types of surgical sutures and methods of their application may be different, which is determined by the location of the wound. One option would be to staple it with metal staples.
Staples are metal plates, several mm wide and about a centimeter long, but maybe more. Both of their ends are presented in the form of rings, and on the inside they have a point that penetrates the tissues and prevents the staples from slipping off.
To apply staples to the wound, you should grab its edges with special tweezers, bring them together, attach well, holding it with one hand, with the other you need to take the staple with another tweezers. After that, put it on the seam line, squeezing the ends, applying force. As a result of such manipulation, the staple bends and wraps around the edges of the wound. Apply at a distance of 1 cm from each other.
Staples are removed, as well as stitches, after 7-8 days after their application. For this, a hook and special tweezers are used. Once removed, the staple can be straightened, sterilized, and reused for suturing wounds.
Types of seams in cosmetology
Cosmetic surgical suture can be made with any of the existing suture materials: silk, catgut, linen thread, fine wire, Michel's staples or horsehair. Among allof these materials, only the catgut is resorbed, and all the rest are not. Seams are either dipped or removable.
According to the overlay technique in cosmetology, continuous and knotted sutures are used, the latter can also be divided into several types: marine, ordinary female or surgical.
The nodular look has one major advantage over the continuous look: it securely holds the edges of the wound. But the continuous seam is in demand because it is applied faster and more economically as a material used. In cosmetology, the following types can be used:
- mattress;
- continuous Reverden stitch;
- continuous furrier;
- tailor (magic);
- subcutaneous (American Halsted suture).
In cases where the patient has strong tissue tension, the doctor can use plate or lead-plate sutures, as well as a suture with rollers, thanks to which it is possible to close large defects and securely hold the tissues in one place.
In plastic surgery also the doctor may sometimes use an apodactyl suture. Its essence lies in the fact that it is applied and tied only with the help of a special tool: a needle holder, tweezers and a torsion pean.
Horsehair is the best suture material. It is good to create types of surgical sutures and knots that exist in cosmetology with its help. It is often used in ENT operations, because it practically does not become infected, does not irritate the skin and tissues, and there are no suppurations and scars in the places of its application. horsehair elastic,therefore, unlike silk, it will not cut into the skin.
The use of sutures in dentistry
Dentists also use different types of sutures to stop bleeding or seal the edges of a large wound. All types of sutures in surgical dentistry are very similar to those that we have already described, the only thing is that there are slight differences in the types of instruments. For suturing in the oral cavity, the most commonly used:
- needle holder;
- eye surgical forceps;
- small two prong hook;
- eye scissors.
It can be difficult to carry out operations in the oral cavity, and only a professional in their field will be able to do this work with high quality, because not only high-quality primary wound treatment is important here. It is also important to choose the right types of sutures in dentistry, but most often it is a simple interrupted suture. And it is superimposed like this:
- Sequentially it is necessary to pierce both sides of the wound at a sufficient distance from one another, the thread must be stretched as much as possible, leaving only a small end - 1-2 cm.
- The long end of the thread and the needle are held in the left hand, after which they need to wrap the needle holder clockwise 2 times.
- Using a needle holder, grab the short tip and pull it through the formed loop - this is the first part of the knot, gently tighten it, slowly bringing the edges of the wound together.
- Also, while holding the loop, you need to do the same manipulations, only scroll counterclockwise once.
- Tighten an already fully formed knot, be sure to followeven thread tension.
- Move the knot off the cut line, cut off the end of the thread, that's all, the seam is ready.
It is also worth remembering that it is necessary to suture correctly from the middle of the wound and stitches should not be done too often so as not to disrupt blood circulation in the tissues. In order for healing to proceed steadily, especially for wounds resulting from trauma, it is necessary to install drainage between the sutures for several days.
Varieties of surgical sutures and methods of applying internal sutures
Not only do the outer seams need to be properly sewn, the inside fabrics must also be sewn securely. The internal surgical suture can also be of several types, and each of them is designed to stitch certain parts together. Let's look at each type to better understand everything.
Aponeurosis Suture
Aponeurosis is a place where tendon tissues fuse, which have high strength and elasticity. The classic place of aponeurosis is the middle line of the abdomen - where the right and left peritoneum are fused. Tendon tissues have a fiber structure, which is why their splicing along the fibers increases their divergence, among themselves surgeons call this effect the saw effect.
Due to the fact that these fabrics have an increased strength, it is necessary to use a certain type of seams to sew them. The most reliable is considered a continuous twisting seam, which is made using synthetic absorbable threads. These include "Polysorb", "Biosin", "Vikril". Through the useabsorbable threads can prevent the formation of ligature fistulas. Also, to create such a seam, you can use non-absorbable threads - "Lavsan". With their help, you can avoid the formation of hernias.
Suture on adipose tissue and peritoneum
Recently, these types of tissues are very rarely sewn together, because they themselves provide excellent adhesion and rapid healing. In addition, the absence of sutures does not interfere with blood circulation at the site of scar formation. In cases where a suture is indispensable, the doctor can apply it using absorbable threads - "Monocryl".
Intestinal sutures
Several sutures are used to stitch hollow organs:
- Single-row serous-muscular-submucosal suture of Pirogov, in which the knot is located on the outer shell of the organ.
- Mateshuk's suture, its feature is the fact that the knot, when it is created, remains inside the organ, on its mucous membrane.
- The single-row Gumby suture is used when the surgeon is working on the large intestine, which is very similar in technique to the Donatti suture.
Liver sutures
Due to the fact that this organ is quite "friable" and abundantly saturated with blood and bile, it can be very difficult to make a seam on its surface even for a professional surgeon. Most often in this case, the doctor applies a continuous suture without overlap or a continuous mattress suture.
U-shaped or 8-shaped surgical sutures are used on the gallbladder.
Sutures on vessels
Types of surgical sutures used in traumatology have their ownpeculiarities. If you need to sew the vessels, then in this case, a continuous seam without overlap, which ensures reliable tightness, will help as well as possible. Using it often leads to the formation of an "accordion", but this effect can be avoided if you use a single-row knotted stitch.
Surgical sutures, types used in traumatology and surgery are similar to each other. Each of the types has its drawbacks and advantages, but if you correctly approach their imposition and choose the best version of the thread, then any seam will be able to fulfill the tasks assigned to it and securely fix the wound or sew the organ. The timing of the removal of suture material in each individual case is determined individually, but basically they are removed already on the 8-10th day.
