The principle of the choice of suture

Required for different surgical suture of choice is one of the key issues in the many choices faced by the surgeon. Of course, the surgeon's personal preferences play a role, but affect the healing of patients with a variety of factors involved in the organization's characteristics and postoperative complications that may occur will affect the final selection of the suture.
The wide variety of suture material that may make people feel at a loss to choose. The following principles can be used as a guide:
Wound reaches maximum intensity when no longer needed stitches. : Have to use non-absorbable suture or timeliness longer absorbable suture to sew slow healing tissue (such as skin, fascia, tendons, etc.);
Selection of absorbable suture to sew the heal faster organization (such as the stomach, colon, bladder, etc.).
Memory organization allows foreign body contamination into infection. : In the sutured wound contamination, avoid the use of the multi-fiber suture;
Switch to monofilament suture or absorbable sutures.
Stressed the beautiful parts of it should be noted that accurate but a long time on the SCO, to avoid the application of a variety of stimuli. : Use the finest, the reaction single fiber suture material (such as nylon, polypropylene); subcutaneous tissue as much as possible at the same time; such as circumstances permit, the application of sterile skin involution tape.
Class crystal solution in high concentrations, any foreign matter may promote the formation of precipitation and stones. : In the urinary tract and biliary tract surgery, you should use absorbable sutures
5 About suture models:
Best match the natural strength and suture tissue slit line.

The basic principle of the suture

(1), to ensure good involution suture wounds or wounds. The suture should be layered, stitched at the anatomical level of the organization, strict organizational level, not to get involved or sewn into other organizations, do not leave residual cavity to prevent the effusion of blood clots and infection. Suture the wound edge distance and the pin spacing must be uniform, so it looks beautiful, but more importantly, consistent and tight suture tension force and Contributions to warrant the leak.
(2), pay attention to the tension of the suture. The ligation suture tightness should be closely connected to the edge of the incision subject of the not too tight, in other words, the wound healing sooner or later, good or bad is not the tightness of fully proportional too tight, too loose can lead to poor healing. Should suture the wound tension, wound such defect is too large, consider metastasis flap or skin graft.
(3), the choice of the suture and the suture needle to be appropriate. Sterile incision or less contaminated wound debridement and disinfection cleaning process can be used silk, wound infection or contamination serious choice of absorbable suture vascular anastomosis should choose the appropriate type of damage the needle.
The classification and commonly used suture suture suture many ways, there is no uniform classification. Press the the tissue involution relationship divided into simple suture, eversion suture, the varus suture three categories; each category by a continuous suture sutures were divided into intermittent and continuous suture two; suture and suture the positional relationship between the organization is divided into horizontal suture, the vertical suture; sometimes is above several cases named. Purse-string suture by suture form is divided into semi-purse the suture, U suture, 8 suture, T suture, Y-shaped suture. There are also special-purpose suture, suture, the intradermal suture and suture hemostasis.

Classification of surgical needle

General surgical needles of the needle tip, the needle body and pinhole (the eye of a needle). Both round and triangle shape of tip, curvature of the needle body is divided into a curved, semi-curved and straight. The various types of surgical needles are precision instruments. Surgical selection of surgical needles, according to the vulnerability of the body tissues, organs and blood vessels, the selection must pay attention to the sharpness of the tip and the size of the eye of a needle.
To avoid the trauma of the organization; pay attention to the bending angle of the needle according to the depth of tissue organ parts, and selection. Triangle needle through the tissue is easy to tear the tissue, it is used in the tough connective tissue and skin. Many types of stitches used, currently used several are described below:
1 circular needle: mainly used in soft and easily penetrate the organization, such as the peritoneum, gastrointestinal tract and heart tissue, through the damage.
Triangular needle: suitable for tough tissue, the tip of the triangle, the needle body part is circular.
3 triangle angle needle: the site of the tip to the strip line are triangular, used to penetrate the tough and hard to penetrate the organization, such as fascia and skin.
Metal wallet: this metal wallet loaded special nail-making tray, with a special holding clamp clamp metal wallet, used for skin closure and orthopedic surgery.
No damage to the needle: this type of needle attached to both ends of the suture used for vascular anastomosis and tubular or circular structure, but also for the continuous suture, intestinal anastomosis and heart surgery, curved and straight shaped two.
Lead pin: handle, front for oblate blunt curved tip and needle body, deep tissue vascular ligation, easy to cut, easy to operate, commonly used in liver surgery.

PDS is the compound

Johnson & Johnson surgical suture material PDS, its chemical name is poly dioxide cyclohexanone.
The advantages are:
Rely on in vivo hydrolysis degradation.
Various sizes can be made monofilament suture.
Tissue reaction.
Monofilament tensile strength than the polyamide and polypropylene.
Ene large.
In biological tissue strength retention rate, higher than woven PGLA, longer healing time for suturing wounds particularly useful.

The polymer material can absorb the performance requirements of the medical suture medical absorbable surgical sutures and biological

Product of a combination of materials, it is mainly used in general surgery and plastic surgery surgical suture need. It not only for the body a temporary stent or barriers, but also to avoid the body's rejection by the degradation and absorption of non-infectious inflammation and other adverse effects, while reducing secondary surgery may thus in medicine and animal medicine on
It has obvious advantages compared with other surgical sutures, a wide range of clinical applications, is a great potential for development of absorption-type implant material. Ideal absorbable surgical sutures should meet the following conditions:
(1) I can conduct a thorough disinfection process;
(2) certain mechanical properties (such as mechanical strength), about 20% elongation, certain soft Majesty, wet strength and friction factor;
(3) suture knot is easy to operate, concludes held knot performance;
(4) The suture within a certain period of time in the body to maintain a certain strength;
(5) adaptability of human tissue, not due to foreign body reaction and inflammation;
(6) after the self-decomposition of the body's internal absorbed or excreted, the absorbent predictable;
(7) The product quality is stable and reliable, making easy, cheap and easily obtained.
                   

Bandage

For fixing and protection of surgical or injured parts of the material necessary for the surgery. The most simple one is a single shed with gauze or cotton is made applicable to the limbs, tail, head, and chest and abdomen. Multiplexing bandage bandage is made according to the location and shape of various shapes, material Duplex cotton, different thickness therebetween can be clamped cotton the vicinity cloth, for knotting fixed, such as eye bandages, the back waist bandages, before chest bandages, abdominal bandages and the withers bandage. Special bandage in the limbs and joints fixed.
Types are:
Reel with:
Also known as a single band, cotton, gauze and elastic volume with three, depending on the volume with parts, following a variety of names:
(1) take the lead (Reel part) (4) (2) with tail (3) with a body inner surface (by volume side) (5) outside (the) ⑹ top of (7) below ⑻ rely on the other side of the volume Volume I
The double-headed with:
Double to take the lead, roughly the same width and the application method and reel with.
Third headband:
⑴ sling made of: natural color cotton, cotton four equal sides about 1 meter diagonal cut Serve two large bandage, such as ready-made bandage from the top to the bottom edge of the midline cut to crack into two small bandage, and their different parts of the following name: vertex, bottom and left and right two points, the majority of its use for the care of relying on suspending the hand and forearm. (2) Thong: used for the fixed perineal dressings and scrotum.
Bulls with:
The following: ⑴ four headband: of rectangular cotton or gauze cut from both ends and made of; ⑵ chest belt: for a fixed chest dressing or increase the pressure; (3) cummerbund: to fixed the abdomen dressing.
Self-adhesive elastic bandage:
Description: self-adhesive elastic bandage from pure cotton or elastic non-woven composite made of material by spraying natural rubber pivots, slitting made for clinical external fixation and dressing, can also be used in the movement to protect the wrist, ankle and other joints.
Type of sports protective bandage:
Focused on the protection of sports, medical dressing, medical fixed different scope of use, the use of imported medical glue, so fixed not easy to fall off, strong flexibility and scalability.

The introduction of several suture

1. Silk and cotton is a natural fiber spun into the surface often coated with wax or resin. Silk, are the most commonly used suture ligation material. The advantage of less tissue reaction and maintain the tensile strength is longer; The disadvantage of a longer-term memory in the organization can contribute to contamination development of infections, surgical site infection and significantly contaminated and therefore does not apply. Cotton organizational memory in time may be longer than silk. Cotton threads of the same thickness smaller than the thread tension strength, and relatively easy to loose.
Silk and cotton cut into the larger organization. Therefore, in the tension of the wound or more vulnerable organizations, as a last resort and with a coarse thread. However, residual lint also increases the formation of larger foreign bodies nodules; may start by postoperative shallow discharge from the wound scar, sometimes fistula formation.
2. The catgut composition of the collagen fibers, taken from the small intestine of sheep or cattle; there is a line of the same nature, made with bovine tendon processing. The catgut points two kinds of ordinary catgut and chromic catgut. Ordinary catgut about 72 hours within the organization that lost about a week to be absorbed. The chromic catgut collagen fiber bonding is more compact, and can keep for 5 days, 2 to 3 weeks to be absorbed within the organization. The duration of its existence and the environment related to contact with the digestive juices or bacterial infection can be faster useless.
The organization has a strong gut reaction; current suture similar reaction, but lighter. Initially the reaction, lymphocytes, exudation of neutrophils and fibroblasts proliferation of other organizations. Absorption dominated, monocytes, macrophages, fibroblasts gradient into fiber cells. Acute reaction to the strong neutrophil; slower absorption formation of granulation tissue around the suture.
Catgut (many with chromic catgut) applicable to expected rapid absorption and infection may occur suture ligation. For example: for ureter or bile duct suture (anastomosis), to avoid stone composition deposited on the suture; heavier purulent peritonitis, peritoneal catgut suture can also be used. Applied when soaked in warm water to make use of catgut flexibility is moderate, or ligation is often due to tight or easy to break.
3. Wire alloy, its tensile strength over other types of sutures, apply to the bone engaging and great tension wound closure. Tissue reaction is minor and does not procure the contaminated wound becomes infected wounds. Wire is not entirely within the organization can not afford to change, but the change is very slow, so long there. If it is near the surface and palpable, makes the patient feel unwell. In addition, the alloy wire also difficult to operate, cutting tissue may suture breakage or kinking operation may stabbed surgeon spread disease and other shortcomings.
4. Non-absorbent and absorbent two types of synthetic fibers.
(1) does not absorbent synthetic fibers: nylon 6.6, nylon (nylon 6), polyester the Pu Luolun (Prolene), have a greater tensile strength, slight tissue reaction, can maintain its performance within the organization for a long time. With silk, the advantages of the synthetic fibers: (1) can be made a considerable strength and small diameter thin line, it applies not only to general surgery, microsurgery; ② surface is very smooth, the tissue damage is very small (can be made without damage to the suture), tissue reaction than with the thread; ③ contaminated wound is very small, such as nylon, hydrolysis may also have an antibacterial effect. The disadvantage is slightly harder texture, knotted easier to release their own, the need to increase the number of knot (3 to 5 buckle) ligation.
(2) an absorbent synthetic fibers: Dexon (PGA, polyglycolic acid), protection Vicryl Vicryl (polyglactin 910, poly-lactic acid-glycolic acid), PDS (polydioxanone, poly-dioxo-heterocyclic cyclohexanone) and PVA (polyvinyl acetate Pooh Lun). Compared with chromic catgut, the advantage of this type of synthetic fiber: ① no natural suture antigenicity, less tissue reaction; (2) tensile strength and absorption time, such as Vicryl maintained within the organization for more than 35 days; (3) may have an antibacterial effect, such as glycolic acid hydrolysis of Dexon and Vicryl bacteriostatic effect, the suture for sterile environment. Synthetic suture through the tissue and smooth, accurate positioning knotted smooth ligation tensile strength, small tissue reaction, can be made of 10-0 Narrow sutures, good absorption performance, able to maintain the wound for up to 3 to 6 weeks, 56 to 70 days is substantially absorbed, there is a trend to replace the natural sutures and silk, the drawback is that the price is more expensive. Use of absorbable suture ligation, needed Triassic knot, thread left in the cut line should be longer, so that the knot loose. Avoid held with a needle or the vascular clamp extra virgin suture or line kink or even rupture. In pancreatic surgery, not catgut ligature and suture, catgut susceptible to trypsin digestion and absorption can occur secondary to bleeding and anastomotic leakage; synthetic absorbable suture is caused by the decomposition of the polymer chains by hydrolysis is absorbed, and therefore fewer limitations on their use.
The synthetic fiber is developed in order to achieve the aforementioned ideal suture material conditions. In addition, in view of the suture as a foreign body may be contaminated tissue infection rate increased, conducted a survey of the relationship between synthetic sutures and bacteria. Found that the physical configuration of the suture material chemical structure of bacterial adhesion, monofilament suture and coating (such as silicon package) with more silk suture and uncoated, less adhesion of bacteria; hydrophilic group (ester group) more easily adhere to bacteria. Types of bacteria on the distribution of the suture, such as Staphylococcus aureus easier than E. coli adhesion to the suture, the former often clustered adhesion, which scattered. The research in this area to contribute to the development of new suture, the suture is more suitable for the surgery of contamination and infection.