Surgical sutures: types and methods of application

In their work surgeons use surgical sutures, their types are different, it is one of the most common methods used to connect biological tissues: the walls of internal organs, the edges of the wound, and others. They also help stop bleeding, the flow of bile, all thanks to the correctly selected suture material.

Recently, the main principle of creating any type of suture is a careful attitude to each edge of the wound, regardless of its type. The seam should be applied so that the edges of the wound and each of the layers of the internal organ that requires suturing are accurately compared. Today these principles are combined in the term "precision".

Depending on which tool is used to create the seam, as well as the technique of execution, two types can be distinguished: manual and mechanical seams. For suturing, manual and conventional traumatic needles, needle holders, tweezers and other devices are used manually . For crosslinking, absorbable fibers of synthetic or biological origin, metal wire or other materials can be chosen.

The mechanical seam is applied by a special device, where metal clips are used.

During the suturing of wounds and the formation of anastomoses, the doctor can apply seams in one row - single row, and layer by layer - in two or even four rows. Along with the fact that the seams connect the edges of the wound together, they also perfectly stop the blood. But what kinds of suture material are there 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 superposition, they are nodal, as well as continuous;
• If you divide them in form - simple, nodal, in the form of a letter P or Z, pouch, 8-shaped;
• By their functionality they can be divided into hemostatic and screwed;
• By the number of rows - from one to four;
• By the term of being inside the tissue - removable and immersed, in the first case the seams after a certain time are removed, and in the second case they remain in the human body forever.

It is also worth mentioning that surgical sutures, their types are subdivided depending on the material used: they can be absorbable if catgut is used - it is a biological species and vikril, dexon is synthetic. Erected into the lumen of the organ - this kind of suture is superimposed on the hollow organs. Constants are those kinds of stitches that are not removed, they remain in the body forever and are surrounded by a connective tissue capsule.

Types of raw material for suturing

Suture material includes various materials used for vascular dressing, applying surgical sutures. Types of material for sewing fabrics and skin changed year by year, depending on how the surgery developed. What only the surgeons did not use to connect the tissues of the internal organs and skin:

• Tendon of mammals;
• Fish skin;
• Obtained from tails of rat rats;
• Nerve endings of animals;
• Hair taken from the mane of horses;
• Umbilical cord of a newly born person;
• Strips of blood vessels;
• Hemp or coconut fibers;
• Rubber tree.

But, thanks to modern developments, nowadays synthetic threads have become popular. There are also cases where metal can also be used.

To any suture material certain requirements are applied:

• High strength;
• Smooth surface;
• elasticity;
• Moderate extensibility;
• High level of slipping through the tissues.

But one of the important criteria for suture material is compatibility with the tissues of the human body. The materials known to date used for joints have antigenic and reactogenic properties. Absolute species do not exist on these characteristics, but their severity should be minimal.

It is also very important that the suture material be sterilized, and also keep it as long as possible, while its basic characteristics must remain original. The suture thread can consist of one or more fibers that are interconnected by twisting, knitting or weaving, and that their surface is smooth, they are covered with wax, silicone or Teflon.

At present, resorbable and non-absorbable types of suture material are used in surgery. Classification of surgical sutures, most of it involves the use of absorbent filaments - catgut, which is made from the muscular shell of the small intestine of the sheep, and also a submucosal layer can be used to create it. Today there are 13 sizes of catgut that differ in diameter.

The strength of the seam material increases with the size. So, for example, the strength of the tri-zero species is about 1400 g, but the sixth one is 11500 g. The threads can be dampened from 7 to 30 days.

From non-absorbable suture material in surgery use threads from silk, cotton, flax and horsehair.

Types of seams

When a seam is applied to the skin, the doctor necessarily takes into account how deeply the wound is cut or torn, its extent and how far its edges have parted. The place of injury is also taken into account. The most popular in surgery are such surgical sutures, photos in the article will show how they look:

• Subcutaneous continuous;
• Subcutaneous nodular;
• Cutaneous nodular;
• Continuous multi-row, applied inside the skin;
• Continuous in one row, applied inside the skin.

This will help to understand which methods of superimposing surgical sutures are most often used when stitching an external wound.

Continuous intracutaneous type

Recently, it has been used most often, providing the best cosmetic result. Its main advantage is the excellent adaptation of the edges of the wound, excellent cosmetic effect and minimal disturbance of microcirculation, if compared with other types of sutures. The filament for sewing is carried out in a layer of the skin plane proper parallel to it. However, it is better to take a monofilament material for easier stretching of the filament.

After the initial surgical treatment of wounds, the types of sutures can be chosen different, but often the doctors prefer a resorbable suture material: biosin, monocrystal, polysorb, dexone and others. And from threads that do not dissolve, monofilament polyamide or polypropylene will perfectly suit.

Nodal seam

This is another popular type of outdoor seam. When you create it, the skin is best pierced with a cutting needle. If you use it, the puncture looks like a triangle, the base of which is directed to the wound. This kind of puncture allows you to securely hold the suture material. The needle is injected into the epithelial layer as close as possible to the edge of the wound, retreating just 4 mm, after which it is carried on the scythe in the subcutaneous tissue, while slightly away from the edge, as far as possible.

After reaching one level with the edge of the wound, the needle is turned towards the middle line and sticks into the deepest point of the wound. The needle in this case passes strictly symmetrically in the tissue on the other side of the wound, only in this case the same number of tissues will fall into the seam.

Horizontal and vertical mattress seam

Types of surgical sutures and knots are chosen by the surgeon depending on the severity of the wound, if there are slight difficulties in comparing the edges of the wound, it is recommended to use a matt suture in the form of a letter P that runs horizontally. If a nodal primary surgical suture is applied On a deep wound, then in this case you can leave a residual cavity. It can accumulate what 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 in both the nodal and continuous types.

In addition, often used a seam on Donatti (vertical mattress suture). When it is performed, the first puncture is carried out 2 cm from the edge of the wound. The puncture is done on the opposite side and at the same distance. At the next injection and forcing out the distance from the edge of the wound is already 0.5 cm. The filaments are connected only after all the seams have been applied, thus, it is possible to facilitate manipulations in the very depth of the wound. Using the Donatti seam makes it possible to sew the wounds for a large diastase.

In order for the result to be cosmetic, in any operation, the primary surgical treatment of wounds must be carefully performed, the types of seams selected correctly. If the edges of the wound are not accurately compared, then as a result it will lead to a rough scar. If you apply excessive force when tightening the first node, then there will be ugly transverse bands, located along the entire length of the scar.

As for tying knots, all silk threads are connected by two knots, and synthetic and catgut - by three.

Types of surgical sutures and methods of their application

When applying any type of seam, and they are used in surgery a lot, it is extremely important to strictly observe the technique of implementation. How correctly is the knotted seam applied?

Using a needle on the needle holder, first pierce the edges at a distance of 1 centimeter, holding it with tweezers. All injections are conducted one opposite the other. The needle is allowed to run immediately through both edges, but it can be carried out 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 to one another as close as possible. So do the rest of the stitches and until the wound is completely wiped. Each seam should be 1-2 cm apart. In some cases, the knots can be tied when all the stitches are already applied.

How to tie a knot correctly

Most surgeons use a simple knot to bind suture material. And do it this way: after the suture material is passed to the edges of the wound, the ends pull together and tie the knot, and above it one more.

The surgical junction can also be performed in a different way: they also thread the wound into the wound, take one hand with one hand and one after the other and, after bringing the edges of the wound together, make a double knot, and above it is simple. The ends of the thread are cut at a distance of 1 cm from the knot.

How to properly sew a wound using metal staples

Types of surgical sutures and methods of their application can be different, which is determined by the location of the wound. One option can be stapling with metal staples.

Staples are metal plates, the width of which is several mm, and the length is about a centimeter, but there may be more. Both their ends are presented in the form of rings, and from the inside they have a point that penetrates into the tissues and does not allow the clamps to slip.

To put the braces on the wound, you should grab its edges with a special tweezers, bring them together, put it well, holding it with one hand, the second one should take another clamp with another tweezers. After that, put it on the seam line, tightening the ends, applying effort. As a result of this manipulation, the staple bends and grabs the edges of the wound. Apply at a distance of 1 cm from each other.

Remove staples, as well as stitches, after 7-8 days after their application. For this, a hook and a special tweezers are used. After removing the staple, you can align, sterilize and re-use it to sew wounds.

Types of seams in cosmetology

The cosmetic surgical suture can be made by any of the existing sutures: silk, catgut, flax thread, thin wire, Michel staples or horsehair. Among all these materials, only the catgut dissolves, and all the others do not. The seams are immersed or removable.

According to the technique of application in cosmetology, continuous and nodular sutures are used, the latter can also be divided into several types: marine, ordinary female or surgical.

A knotty species has one major advantage over a continuous one: it securely holds the edges of the wound. But the continuous seam is in demand because it is superimposed faster and more economically as the material used. In cosmetology, the following types can be used:

• Mattress;
• Continuous seam of Reverden;
• Continuous furrier;
• Tailor (magical);
• The subcutaneous (American halsted suture).

In cases where the patient has a strong tissue tension, the doctor can use lamellar or lead-lamellar seams, as well as a seam with rollers, thanks to which it becomes possible to cover large defects and securely hold the tissues in one place.

In plastic surgery, a doctor can sometimes use an apodactyl suture. Its essence lies in the fact that it is imposed and tied only with the help of a special tool: needle holder, tweezers and torus pean.

Horse hair is the best suture material. Types of surgical sutures and nodes that exist in cosmetology, it is good to create with it. It is often used for ENT surgery, because it practically does not become infected, it does not irritate the skin and tissues, and there are no suppuration and scarring in places of its application. Horse hair is elastic, so unlike silk, it will not crash into the skin.

Use of stitches in dentistry

Dentists also use different types of stitches to stop bleeding or to fasten the edges of a large wound. All kinds of sutures in surgical dentistry are very similar to those that we have already described, the only thing that there are slight differences in the types of tools. For suturing the oral cavity is most often used:

• needle holder;
• Eye surgical tweezers;
• Small two-toothed hook;
• Eye scissors.

It is difficult to conduct operations in the oral cavity, and only a professional in his or her field will be able to perform this work in a qualitative way, since it is important not only to qualify the primary treatment of wounds. Types of stitches in dentistry is also important to choose correctly, but most often it is a simple nodal suture. And it is superimposed like this:

1. Sequentially it is necessary to pierce both sides of the wound at a sufficient distance from each other, the thread must be stretched as much as possible, leaving only a small end - 1-2 cm.
2. 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.
3. Using the needle holder to grasp the short tip and stretch it through the formed loop - this is the first part of the knot, gently tighten it, slowly bringing the edges of the wound closer.
4. Also, while holding the loop, you need to do the same manipulations, just scroll counter-clockwise once.
5. Tighten the already fully formed knot, be sure to follow the uniform tension of the thread.
6. Move the knot from the cut line, cut the end of the thread, that's all, the seam is ready.

Also it is worth remembering that it is necessary to apply seams correctly from the middle of the wound and do not make stitches too often, so as not to disturb blood circulation in the tissues. For the healing to proceed stably, especially for injuries resulting from trauma, it is necessary to install a drainage between the seams for several days.

Varieties of surgical sutures and methods of application of internal sutures

Not only external seams need to be applied correctly, inside the fabric should also be sewn securely. The internal surgical suture can also be of several kinds and each of them is intended for stitching certain parts. Let's look at each of the types to better understand everything.

Aponeurosis seam

Aponeurosis is the place where the tendinous tissues co-exist, which have high strength and elasticity. The classic place of aponeurosis is the middle line of the abdomen - where the right and left peritoneums splice. Tendon tissues have a fiber structure, which is why their splicing along the fibers enhances their discrepancy, between surgeons this effect is called the saw effect.

Due to the fact that these fabrics have an increased strength, it is necessary to use a certain type of stitches for their sewing. The most reliable is a continuous suture stitch, which is made with the help of synthetic absorbing threads. These include "Polysorb", "Biosin", "Vikril." Thanks to the use of resorbable threads, it is possible to prevent the formation of ligature fistulas. Also for the creation of such a seam you can use non-absorbing threads - "Lavsan". With their help, you can avoid the formation of hernias.

Seam on fatty tissue and peritoneum

Recently, these types of tissues are rarely sewn, because they themselves provide excellent adhesion and rapid healing. In addition, the absence of seams does not interfere with blood circulation at the site of scar formation. In those cases, if you can not do without a seam, the doctor can impose it, using absorbable threads - "Monocryl".

Stitches intestinal

For the stitching of hollow organs several stitches are used:

• Single-row serous-muscular-submucous suture Pirogov, whose node is located on the outer shell of the organ.
• The seam of Mateshuk, its feature is the fact that the knot when it is created remains inside the organ, on its mucous membrane.
• A single-row Gum suture is used when the surgeon works with the large intestine, which in its technique is very similar to Donatti's seam.

Stitches of the liver

In connection with the fact that this body is sufficiently "friable" and is abundantly impregnated with blood and bile, it is very difficult to perform a seam on its surface, even for a professional surgeon. Most often in this case, the doctor imposes a continuous seam without overlapping or a continuous mattress suture.

On the gallbladder, a U-shaped or 8-shaped surgical sutures are used.

Stitches on vessels

The types of surgical sutures used in traumatology have their own peculiarities. If you need to sew the vessels, then in this case the continuous seam without overlap, which ensures reliable tightness, will be the best possible. Using it often leads to the formation of "harmonica", but you can avoid this effect if you use a single-row nodal seam.

Surgical sutures, types used in traumatology and surgery are similar. Each of the species has its own shortcomings and advantages, but if it is right to approach their overlap and choose the optimal version of the thread, then any seam will be able to perform the tasks assigned to it and securely fix the wound or sew the organ. The timing of removal of suture material in each individual case is determined individually, but basically they are already removed on the 8-10th day.