Skin sutures: application technique, suture materials used. Stitching

A) Single seam. For many patients, the skin suture is a trademark. The principle underlying all skin sutures is to achieve healing by primary intention and with minimal scarring. The prerequisite for this is the precise alignment of the edges of the skin and subcutaneous tissue without tension.

The edges of the skin should be well supplied with blood; Formation of cavities and pockets should be avoided. General rule states that the distance between the seams should correspond to the width of the fabric in the seam (that is, the distance between the seams and the width of the seam should form a square). Single stitches are the most commonly used and are the simplest of all methods of joining fabrics with thread. The thread is sequentially passed through the edges of the wound, held with tweezers.

To do this, the needle is passed perpendicularly through the skin and obliquely through the subcutaneous tissue. The distance from the puncture to the edge of the wound and the depth of the stitch should be the same on both sides of the wound. The threads should be tied with slight tension to avoid tissue ischemia (the tissue under the suture should not turn pale).

b) Continuous seam. A continuous suture saves time, but is technically more difficult because it requires good alignment of the wound edges and the passage of the thread by an assistant. A continuous suture can be placed as a simple Kirschner suture (a) or as a naval suture with an overlap (b).

Other video lessons on stomping are:

V) . The mattress suture provides excellent alignment of the wound edges.

In Donati's vertical mattress suture, the thread is visible on both sides of the wound. However, the best comparison is achieved only when the width and depth of the forward and reverse stitches are absolutely symmetrical, and if all four puncture and puncture points lie on one straight line perpendicular to the wound. The closer to the surface of the skin the reverse stitch is carried out, the better the closure of the wound.

G) . With this modification of the mattress suture, the thread is visible on only one side of the wound. On the other hand, the thread captures the subcutaneous layer and part of the skin. Thus, to achieve a good cosmetic result, the same conditions are necessary as for the Donati suture. However, it is more difficult to remove this seam, especially if the puncture and puncture sites are located quite close to each other and the thread is tied too tightly.

d) Continuous subcutaneous suture. With a continuous subcutaneous suture, the thread comes out to the skin only at the beginning and end of the wound. The suture passes completely into the skin and provides excellent matching through the precise joining of the thread through both edges of the wound. At each end of the wound, the thread is secured with a plastic clip.

Video lesson on applying a mattress suture

Other video lessons on stomping are:

e) Separate subcutaneous sutures. Separate subcutaneous sutures with 5-0 or 6-0 PGA sutures provide good skin matching, especially in children. No suture removal is required. However, it is recommended to relieve these sutures from any tension on the wound using the additional application of surgical self-adhesive tapes.

and) Surgical self-adhesive tapes (Steri-Strips). Modern surgical tapes are able to align the edges of the wound and hold them together without tension. They are rarely indicated as an independent means of closing a wound, as they easily come off when wet. They are most often used as an additional measure for superficial wounds.

h) . To remove sutures, the thread is lifted slightly with a clamp, cut close to the skin on one side, and then removed. This prevents the contaminated outer part of the thread from being pulled through its subcutaneous channel. Best time for removing sutures is determined by the condition of the wound, as well as the location of the suture.

Skin sutures on the face and neck can be removed on day 5, while skin sutures in other areas of the body should be left in place for 6 to 14 days, depending on their location.

And) . Most fast way Wound closure involves the use of an automatic stapler that inserts and bends square metal staples into the edges of the wound. The edges of the wound should be symmetrically grasped with toothed clamps and slightly turned out when the staple is applied. Applying such a suture requires good cooperation between the surgeon and the assistant.

To) Removing braces. The staples are removed using appropriate special forceps, which bend the closed staples into an M shape, causing their subcutaneous parts to release the scar.

Surgical sutures

the most common method of connecting biological tissues (edges, walls of organs, etc.), stopping bleeding, bile leakage, etc. using suture material. In contrast to sewing tissues (the bloody method), there are bloodless methods of joining them without the use of suture material (see Seamless joining of tissues) .

Depending on the timing of Sh. x. distinguished: primary, which is applied to a random wound immediately after primary surgical treatment or to a surgical wound; delayed primary is applied before the development of granulations in a period of 24 h up to 7 days after surgery if there are no signs of purulent inflammation in the wound; provisional suture - delayed primary suture, when the threads are inserted during the operation and tied 2-3 days later; early secondary suture, which is applied to a granulating wound that has cleared of necrosis after 8-15 days; a late secondary suture is applied to the wound after 15-30 days or more when scar tissue develops in it, which is previously excised.

Sutures can be removable, when removed after fusion, and embedded, which remain in the tissues, dissolving, encapsulating in the tissues, or cutting into the lumen of a hollow organ. Sutures placed on the wall of a hollow organ can be through or parietal (not penetrating into the lumen of the organ).

Depending on the tools used and the technique used, a distinction is made between manual and mechanical seams. For manual sutures, conventional and atraumatic needles, needle holders, tweezers, etc. are used (see Surgical instruments) , and as a suture material (Suture material) - absorbable and non-absorbable threads of biological or synthetic origin, metal wire, etc. Mechanical suture is performed using stitching machines in which the suture material is metal staples.

Depending on the technique of sewing fabrics and fixing the knot, manual sh. divided into nodal and continuous. Simple interrupted stitches ( rice. 1 ) are usually applied to the skin at intervals of 1-2 cm, sometimes more often, and when there is a threat of suppuration - less often. The edges of the wound are carefully compared with tweezers ( rice. 2 ). The sutures are tied with surgical, naval or simple (female) knots. To avoid loosening of the knot, the threads should be kept taut at all stages of the formation of seam loops. For tying a knot, especially ultra-thin threads with plastic and micro surgical operations, the instrumental (apodactyl) method is also used ( rice. 3 ).

Silk threads are tied with two knots, catgut and synthetic ones - with three or more. By tightening the first one, the tissues to be sewn are aligned without excessive force to avoid cutting through the seams. A correctly applied suture firmly connects tissues without leaving cavities in the wound and without disrupting blood circulation in the tissues, which ensures optimal conditions for wound healing.

When applying continuous sutures, the thread is kept taut so that the previous stitches do not weaken, and in the last one a double thread is held, which, after puncturing, is tied to its free end. Continuous Sh. x. have various options. A simple (linear) wrap stitch is often used ( rice. 7, a ), twist stitch according to Multanovsky ( rice. 7, b ) and mattress seam ( rice. 7, in ). These sutures invert the edges of the wound if they are applied from the outside, for example when suturing a vessel, and they are screwed in if they are applied from the inside of an organ, for example when forming the posterior wall of an anastomosis on the organs of the gastrointestinal tract.

Along with linear ones, various types of circular seams are used. These include: a circular suture, aimed at fixing bone fragments, for example, in case of a fracture of the patella with divergence of the fragments; so-called - fastening with wire or thread bone fragments in case of an oblique or spiral fracture or bone grafts ( rice. 8, a ); block polyspast suture for bringing the ribs together, used when suturing a wound of the chest wall ( rice. 8, b ), simple purse string suture ( rice. 8, in ) and its varieties - S-shaped according to Rusanov ( rice. 8, g ) and Z-shaped according to Salten ( rice. 8, d ), used for suturing the intestinal stump, immersing the stump of the appendix, plastic surgery of the umbilical ring, etc. A circular suture is applied different ways when restoring the continuity of a completely crossed tubular organ - vessel, intestine, ureter, etc. In case of partial intersection of the organ, a semi-circulatory or lateral suture is performed.

When suturing wounds and forming anastomoses, sutures can be applied in one row - a single-row (one-story, single-tier) suture or layer-by-layer - in two, three, four rows. Along with connecting the edges of the wound, sutures also stop bleeding. For this purpose, specially hemostatic sutures have been proposed, for example, a continuous chain (puncture) suture according to Heidenhain - Hacker ( rice. 9 ) on soft fabrics heads before their dissection during craniotomy. A variant of the interrupted chain suture is the Oppel suture for liver injuries.

Technique of application Sh. x. depends on the surgical techniques used. For example, during hernia repair and in other cases when it is necessary to obtain a durable one, they resort to doubling (duplication) of the aponeurosis with U-shaped sutures or Girard-Zick sutures ( rice. 10, a ). When suturing eventration or deep wounds, removable 8-shaped sutures according to Spasokukotsky are used ( rice. 10, b, c ). When suturing wounds of complex shape, situational (guide) sutures can be used to bring the edges of the wound together in places of greatest tension, and after applying permanent sutures they can be removed. If the sutures are tied on the skin with great tension or are intended to be left for a long period of time, to prevent eruption, so-called lamellar (plate) U-shaped sutures are used, tied on plates, buttons, rubber tubes, gauze balls, etc. ( rice. eleven ). For the same purpose, you can use secondary provisional sutures, when more frequent interrupted sutures are placed on the skin, and they are tied through one, leaving the other threads untied: when the tightened sutures begin to cut through, the provisional sutures are tied, and the first ones are removed.

Skin sutures are most often removed on the 6-9th day after their application, however, the timing of removal may vary depending on the location and nature of the wound. Earlier (4-6 days) sutures are removed from skin wounds in areas with good blood supply (on the face, neck), later (9-12 days) on the lower leg and foot, with significant tension on the edges of the wound and reduced regeneration. The sutures are removed by tightening the knot so that the skin reveals a part of the thread hidden in the thickness of the tissue, which is crossed with scissors ( rice. 12 ) and the entire thread is pulled out by the knot. If the wound is long or there is significant tension on its edges, the sutures are removed first after one, and the rest in the following days.

When applying III. X. Various types of complications may occur. Traumatic complications include accidentally puncturing a vessel or passing a suture through the lumen of a hollow organ instead of a parietal suture. from a punctured vessel usually stops when tying a suture, otherwise it is necessary to apply a second suture in the same place, capturing the bleeding one; When a large vessel is punctured with a rough cutting needle, it may be necessary to apply a vascular suture. If an accidental through-thickness of a hollow organ is detected, this place is additionally peritoneized with seromuscular sutures. Technical errors when applying sutures - this is poor alignment () of the edges of the skin wound or the ends of the tendons, the lack of inversion effect with intestinal and eversion with vascular sutures, narrowing and deformation of the anastomosis, etc. Such defects can lead to failure of the sutures or obstruction of the anastomosis, bleeding, peritonitis, intestinal, bronchial, urinary fistulas and other wounds, formation of external and internal ligature fistulas and ligature abscesses occur due to violation of asepsis during sterilization of suture material or during surgery. Complications in the form of delayed allergic reactions (see Allergy) more often occur when using catgut threads, and much less often when using silk and synthetic threads.

Rice. 8. Schematic representation of circular sutures: a - cerclage - fastening of bone fragments in an oblique fracture; b - block pulley seam to bring the ribs closer together; c - simple purse-string suture; d - S-shaped purse-string suture according to Rusanov; d - Z-shaped purse-string suture according to Salten.

Rice. 4. Schematic representation of a screw-in suture according to Pirogov - Mateshuk, applied to the intestinal wall: 1 - and the muscular layer of the intestinal wall; 2 - intestines; 3 - the suture thread is passed through the serous and muscular membranes; 4 - the knot is tied from the side of the mucous membrane.

Rice. 3. Schematic representation of the instrumental (apodactyl) method of tying a surgical knot: a - after puncturing the needle, the long end of the thread is wrapped around the needle holder, which is used to grasp the short end of the thread; b - after tightening the first loop, the long end of the thread is wrapped around the needle holder in the opposite direction.

1. Small medical encyclopedia. - M.: Medical encyclopedia. 1991-96 2. First aid. - M.: Great Russian Encyclopedia. 1994 3. encyclopedic Dictionary medical terms. - M.: Soviet encyclopedia. - 1982-1984.

- I Muscles (musculi; synonym muscles) Functionally, involuntary and voluntary muscles are distinguished. Involuntary muscles are formed by smooth (non-striated) muscle tissue. It forms the muscular membranes of hollow organs, the walls of blood vessels... Medical encyclopedia

I Esophagus (esophagus) is the section of the digestive tract that connects the pharynx to the stomach. Takes part in the swallowing of food; peristaltic contractions of the muscles of the stomach ensure the movement of food into the stomach. The length of the leg of an adult is 23 30 cm,... ... Medical encyclopedia

ABOMAZOTOMY- (from novolat. abomasum abomasum and Greek tome dissection), the operation of opening the abomasum. It is used in sheep to remove bezoars. horn. cattle when the abomasum is twisted and displaced or blocked by dense feed masses. A. sheep produce under... ...

BURSITIS- Rice. 1. Precarpal bursitis in a cow. Rice. 1. Precarpal bursitis in a cow. bursitis, inflammation of the synovial bursa (bursa). Cattle (Fig. 1) and horses are more often affected. According to the course of B. there are acute and chronic, by nature... ... Veterinary encyclopedic dictionary

GASTROTOMY- (from the Greek gastēr stomach and tomē incision), the operation of opening the lumen of the stomach. More often produced in dogs, cats and less often in piglets to remove foreign bodies from the stomach or from the initial part of the esophagus. General anesthesia is used after... Veterinary encyclopedic dictionary

aboiazotomy- (from Novolat. abomasum abomasum and Greek tomē; dissection), the operation of opening the abomasum. Used in sheep to remove bezoars, in large cattle when the abomasum is twisted and displaced or clogged with dense feed masses. A. in sheep... ... Veterinary encyclopedic dictionary

Devices for mechanical connection of organs and tissues during surgical operations. Their use reduces the time of suturing, simplifies the suturing process and increases the asepsis of the operation, reduces blood loss and tissue trauma,... ... Medical encyclopedia

COLONOTOMY- (from the Greek kólon large intestine and tomē cut, dissection), opening operation colon in a horse when it is blocked by intestinal stones. K. is performed 4-5 days after the displacement of intestinal stones into the gastric dilatation... Veterinary encyclopedic dictionary

SURGICAL OPERATION- (from Latin operatio action), a set of manual and instrumental techniques used to eliminate pathol. process (therapeutic O. x.), clarification of the diagnosis (diagnostic O. x.), restoration of tissue continuity (plastic, restoration. O. x.), ... ... Veterinary encyclopedic dictionary

Learning to put stitches. Some of the ones presented may not be useful, but it will be useful to know.

Surgical sutures are the most common way to connect biological tissues (wound edges, organ walls, etc.), stop bleeding, bile leakage, etc. using suture material. In contrast to sewing tissues (the bloody method), there are bloodless methods of connecting them without the use of suture material.
Depending on the timing of application of Sh. x. distinguished: primary suture, which is applied to a random wound immediately after primary surgical treatment or to a surgical wound; a delayed primary suture is applied before the development of granulation within 24 hours to 7 days after surgery in the absence of signs of purulent inflammation in the wound; provisional suture - a type of delayed primary suture, when the threads are inserted during surgery and tied 2-3 days later; early secondary suture, which is applied to a granulating wound that has cleared of necrosis after 8-15 days; a late secondary suture is applied to the wound after 15-

Depending on the timing of application of Sh. x. distinguished: primary suture, which is applied to a random wound immediately after primary surgical treatment or to a surgical wound; a delayed primary suture is applied before the development of granulation within 24 hours to 7 days after surgery in the absence of signs of purulent inflammation in the wound; provisional suture - a type of delayed primary suture, when the threads are inserted during surgery and tied 2-3 days later; early secondary suture, which is applied to a granulating wound that has cleared of necrosis after 8-15 days; a late secondary suture is applied to the wound after 15-30 days or more when scar tissue develops in it, which is previously excised.

Sutures can be removable, when the suture material is removed after fusion, and embedded, which remain in the tissue, dissolving, encapsulating in the tissue or cutting into the lumen of a hollow organ. Sutures placed on the wall of a hollow organ can be through or parietal (not penetrating into the lumen of the organ), and the suture material used is absorbable and non-absorbable threads of biological or synthetic origin, metal wire, etc. A mechanical suture is performed using stitching devices, in which the suture material is metal staples.

Depending on the technique of sewing fabrics and fixing the knot, manual sh. divided into nodal and continuous. Simple interrupted stitches

It is usually applied to the skin at intervals of 1-2 cm, sometimes more often, and if there is a threat of wound suppuration - less often. The edges of the wound are carefully compared with tweezers

The sutures are tied with surgical, naval or simple (female) knots. To avoid loosening of the knot, the threads should be kept taut at all stages of the formation of seam loops. For tying a knot, especially ultra-thin threads during plastic and microsurgical operations, the instrumental (apodactyl) method is also used

Silk threads are tied with two knots, catgut and synthetic ones - with three or more. By tightening the first knot, the stitched fabrics are aligned without excessive force to avoid cutting through the seams. A correctly applied suture firmly connects the tissues without leaving cavities in the wound and without disrupting blood circulation in the tissues, which provides optimal conditions for wound healing.

In addition to simple interrupted seams, other types of interrupted seams are also used. Thus, when applying sutures to the wall of hollow organs, screw-in sutures according to Pirogov-Mateshuk are used, when the knot is tied under the mucous membrane

To prevent tissue eruption, looped interrupted sutures are used - U-shaped (U-shaped) everting and inverting (a, b)
and 8-shaped (c). To better compare the edges of the skin wound, use an interrupted adapting U-shaped (loop-shaped) suture according to Donati
When applying continuous sutures, the thread is kept taut so that the previous stitches do not weaken, and in the last one a double thread is held, which, after puncturing, is tied to its free end. Continuous Sh. x. have various options. A simple (linear) wrap stitch(s) is often used.
wrapping seam according to Multanovsky (b), and mattress seam (c). These sutures invert the edges of the wound if they are applied from the outside, for example when suturing a vessel, and they are screwed in if they are applied from the inside of an organ, for example when forming the posterior wall of an anastomosis on the organs of the gastrointestinal tract.

Along with linear ones, various types of circular seams are used. These include: a circular suture, aimed at fixing bone fragments, for example, in case of a fracture of the patella with divergence of the fragments; so-called cerclage - fastening bone fragments with wire or thread in case of an oblique or spiral fracture or fixation of bone grafts (a)

a block pulley suture for bringing the ribs together, used when suturing a wound of the chest wall (b), a simple purse-string suture (c), and its varieties - S-shaped according to Rusanov (d), and Z-shaped according to Salten (e). used for suturing the intestinal stump, immersing the stump of the appendix, plasty of the umbilical ring, etc. A circular suture is applied in various ways to restore the continuity of a completely crossed tubular organ - vessel, intestine, ureter, etc. In case of partial intersection of the organ, a semi-circulatory or lateral suture is performed.

When suturing wounds and forming anastomoses, sutures can be applied in one row - a single-row (one-story, single-tier) suture or layer-by-layer - in two, three, four rows. Along with connecting the edges of the wound, sutures also stop bleeding. For this purpose, specially hemostatic sutures have been proposed, for example, a continuous chain (puncture) suture according to Heidenhain - Hacker

on the soft tissues of the head before their dissection during craniotomy. A variant of the interrupted chain suture is the Oppel hemostatic suture for liver injuries.

Technique of application Sh. x. depends on the surgical techniques used. For example, during hernia repair and in other cases when it is necessary to obtain a durable scar, they resort to doubling (duplication) of the aponeurosis with U-shaped sutures or sutures according to Girard-Zik (a),
When suturing eventration or deep wounds, removable 8-shaped sutures according to Spasokukotsky are used (b, c). When suturing wounds of complex shape, situational (guide) sutures can be used to bring the edges of the wound together in places of greatest tension, and after applying permanent sutures they can be removed. If the sutures are tied on the skin with great tension or are intended to be left for a long period of time, so-called lamellar (plate) U-shaped sutures tied on plates, buttons, rubber tubes, gauze balls, etc. are used to prevent eruption.
For the same purpose, you can use secondary provisional sutures, when more frequent interrupted sutures are placed on the skin, and they are tied through one, leaving the other threads untied: when the tightened sutures begin to cut through, the provisional sutures are tied, and the first ones are removed.

Skin sutures are most often removed on the 6-9th day after their application, however, the timing of removal may vary depending on the location and nature of the wound. Earlier (4-6 days) sutures are removed from skin wounds in areas with good blood supply (on the face, neck), later (9-12 days) on the lower leg and foot, with significant tension on the edges of the wound and reduced regeneration. The sutures are removed by tightening the knot so that a part of the thread hidden in the thickness of the tissue appears above the skin, which is crossed with scissors

and the entire thread is pulled out by the knot. If the wound is long or there is significant tension on its edges, the sutures are removed first after one, and the rest in the following days.

When applying III. X. Various types of complications may occur. Traumatic complications include accidental puncture of a vessel with a needle or passing a suture through the lumen of a hollow organ instead of a parietal suture. Bleeding from a punctured vessel usually stops when a suture is tied; otherwise, a second suture must be placed in the same place, capturing the bleeding vessel; When a large vessel is punctured with a rough cutting needle, it may be necessary to apply a vascular suture. If an accidental through puncture of a hollow organ is detected, this place is additionally peritoneized with seromuscular sutures. Technical errors when applying sutures are poor alignment (adaptation) of the edges of the skin wound or the ends of the tendons, lack of inversion effect with intestinal and eversion with vascular sutures, narrowing and deformation of the anastomosis, etc. Such defects can lead to failure of the sutures or obstruction of the anastomosis, bleeding , peritonitis, intestinal, bronchial, urinary fistulas, etc. Suppuration of the wound, the formation of external and internal ligature fistulas and ligature abscesses occurs due to violation of asepsis during sterilization of suture material or during surgery. Complications in the form of delayed allergic reactions occur more often when using catgut threads, and much less often when using silk and synthetic threads.

P.S. Don't take it as plagiarism. I found this here http://medarticle.moslek.ru/articles/46106.htm

Surgical sutures are the most common way to connect biological tissues (wound edges, organ walls, etc.), stop bleeding, bile leakage, etc. using suture material.

Most general principle When performing any stitch, care must be taken to respect the edges of the wound being stitched. In addition, the suture should be applied, trying to accurately match the edges of the wound and the layers of the organs being sutured. IN Lately These principles are usually united by the term “precision”.

Depending on the tools used and the technique used, a distinction is made between manual and mechanical seams. To apply manual sutures, ordinary and atraumatic needles, needle holders, tweezers, etc. are used, and as suture material - absorbable and non-absorbable threads of biological or synthetic origin, metal wire, etc. Mechanical sutures are performed using stitching machines in which the suture material are metal brackets.

When applying a skin suture, it is necessary to take into account the depth and extent of the wound, as well as the degree of divergence of its edges. Most common the following types seams: nodular cutaneous, subcutaneous nodular, subcutaneous continuous, intradermal continuous single-row, intradermal continuous multi-row.

Continuous intradermal suture It is currently used most widely, as it provides the best cosmetic result. Its features are good adaptation of the wound edges, good cosmetic effect and less disruption of microcirculation compared to other types of sutures. The suture thread is passed through the layer of skin itself in a plane parallel to its surface. With this type of seam, to facilitate thread pulling, it is better to use monofilament threads. Absorbable threads are often used, such as biosin, monocryl, polysorb, dexon, vicryl. Non-absorbable threads used are monofilament polyamide and polypropylene.

No less common simple interrupted stitch. The skin is most easily pierced with a cutting needle. When using such a needle, the puncture is a triangle, the base of which faces the wound. This form of puncture holds the thread better. The needle is inserted into the epithelial layer at the edge of the wound, retreating from it by 4-5 mm, then passed obliquely into the subcutaneous tissue, increasingly moving away from the edge of the wound. Having reached the same level as the base of the wound, the needle turns towards the midline and is injected at the deepest point of the wound. The needle must pass strictly symmetrically through the tissues of the other edge of the wound, then the same amount of tissue gets into the seam.

If it is difficult to compare the edges of a skin wound, it can be used horizontal mattress U-shaped seam. When applying a conventional interrupted suture to a deep wound, a residual cavity may be left. Wound discharge can accumulate in this cavity and lead to suppuration of the wound. This can be avoided by suturing the wound in several layers. Stage-by-stage suturing of the wound is possible with both interrupted and continuous sutures. In addition to floor-by-floor suturing of the wound, in such situations it is used vertical mattress seam (according to Donatti). In this case, the first injection is made at a distance of 2 cm or more from the edge of the wound, the needle is inserted as deep as possible to capture the bottom of the wound. A puncture on the opposite side of the wound is made at the same distance. When passing the needle in the opposite direction, the injection and puncture are made at a distance of 0.5 cm from the edges of the wound so that the thread passes through the layer of skin itself. When suturing a deep wound, the threads should be tied after all the sutures have been applied - this facilitates manipulation in the depths of the wound. The use of the Donatti suture allows the edges of the wound to be compared even with their large diastasis.

The skin suture must be applied very carefully, since the cosmetic result of any operation depends on it. This largely determines the authority of the surgeon among patients. Inaccurate alignment of the wound edges leads to the formation of a rough scar. Excessive efforts when tightening the first knot cause ugly transverse stripes located along the entire length of the surgical scar.

Silk threads are tied with two knots, catgut and synthetic ones - with three or more. By tightening the first knot, the stitched fabrics are aligned without excessive force to avoid cutting through the seams. A correctly applied suture firmly connects the tissues without leaving cavities in the wound and without disrupting blood circulation in the tissues, which provides optimal conditions for wound healing. For suturing postoperative wounds, a special suture material with microprotrusions has been developed - APTOS Suture, due to the specifics of the threads themselves, there is no need to apply interrupted sutures at the beginning and end of the wound, which shortens the suture time and simplifies the entire procedure.

Skin sutures are most often removed on the 6-9th day after their application, however, the timing of removal may vary depending on the location and nature of the wound. Earlier (4-6 days) sutures are removed from skin wounds in areas with good blood supply (on the face, neck), later (9-12 days) on the lower leg and foot, with significant tension on the edges of the wound and reduced regeneration. The sutures are removed by tightening the knot so that a part of the thread hidden in the thickness of the tissue appears above the skin, which is crossed with scissors and the entire thread is pulled out by the knot. If the wound is long or there is significant tension on its edges, the sutures are removed first after one, and the rest in the following days.

Any damage to the body is associated with a violation of the integrity of the skin. A scar is a healed wound and its condition is influenced by the nature of the traumatic agent (mechanical, thermal, chemical or radiation damage). The use of APTOS Suture thread allows you to reduce the length of the wound by moderately sagging its edges, as a result of which the scar remains much smaller and less noticeable compared to the use of conventional suture materials.

The Volot company produces a wide range of suture material for use in various types operations, the quality and properties of threads and needles are evaluated by many clinics in the country.

A surgical suture is a connection of tissues after surgery or injury using a needle and thread, made with the aim of speedy healing, as well as protecting the wound from foreign bodies.

Sutures can be placed both on the surface of the body and on internal organs and fabrics. Modern medicine also uses methods for seamlessly joining wound edges using adhesives.

Methods and materials for applying surgical sutures

Threads (suture material) used in surgery are divided into two main types: those that are absorbed into the tissue some time after the operation and non-absorbable, which are removed after the wound has healed.

The first type of thread is made from animal intestines (catgut) and synthetic polymer materials(dexon, polysorb, biosin, vicryl), the second type - from silk, flax, polymers (nylon); sometimes metal wire is also used.

You can connect the edges of the wound in various ways. You can use a continuous seam with fixing knots at the ends, or you can fasten the fabrics with separate stitches, each of which is fixed with its own knots. The latter method (separate seams) provides more reliable connection, since in this case the seam will remain intact even if the knot comes undone or the thread of one of the stitches breaks.

Skin stitching

There are several ways to connect the skin with sutures: either continuous or separate sutures can be used, and both absorbable and non-absorbable sutures can be used. The cut wound can also be held together with metal clips, staples, or even adhesive tape (for shallow cuts).

A special type of external sutures are cosmetic sutures, applied to the skin using very thin threads. Absorbable materials are usually used when placing subcutaneous sutures when the suture material cannot be removed after the wound has healed.

Most often, a separate vertical mattress or subcutaneous suture is used in surgery. In the latter case, the risk of scar formation at the sites of skin punctures is eliminated. Deep sutures are applied together with other types if there is a danger of divergence of the subcutaneous tissues. In all these seams, every stitch is fixed. Therefore, unlike continuous seams, if one of the stitches comes apart, the others will hold the fabrics together. The choice of suturing technique is determined by the surgeon's preference and specific circumstances, such as the type of tissue being sutured, the location of the suture, and its effect on the patient's appearance.

Consultation with a surgeon regarding sutures

How painful is it to remove a suture after surgery?

This procedure is not very painful, since the materials currently used for stitching the skin have smooth surface. They glide easily through tissues without causing severe pain. But if you cannot tolerate even mild pain, ask the surgeon to use absorbable sutures.

How long do they last? internal seams after major operations?

Some materials used for suturing internal organs and tissues last a lifetime. For example, nylon monofilament is completely inert and, while in the body, does not cause any reaction in surrounding tissues. It does not dissolve, although over time its strength may decrease somewhat.

I recently had stomach surgery. How long will it take for my stitches to be removed?

After the operation, only the threads of the external sutures are removed. This is done on the 7-10th day. If you remove the threads earlier, the seam may come apart, and if later, an inflammatory process may begin around them.

Can a cough or fever physical exercise cause suture dehiscence after abdominal surgery?

Nowadays this happens extremely rarely. In such operations, in addition to external sutures, internal sutures are also usually applied. They determine the strength of tissue connections. To ensure long-term strength of sutures when connecting muscle tissue, most surgeons prefer non-absorbable materials such as nylon. Previously, threads from animal intestines (catgut) were used for this, but since they lose strength very quickly (catgut resorption time does not exceed 30 days), the danger of the seam coming apart was quite high. Nowadays, if the abdominal muscles are properly sutured with non-absorbable suture, the sutures can easily withstand the stresses caused by coughing.

Skin sutures: application technique, suture materials used. Stitching

Video lesson on applying a mattress suture

Methods and materials for applying surgical sutures

Skin stitching

Consultation with a surgeon regarding sutures

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