How and with what should I treat a postoperative suture for better healing at home? How to remove postoperative sutures at home? Stitching the wound.

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 during plastic and microsurgical 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 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 they are tied under the mucous membrane ( rice. 4 ). To prevent tissue eruption, looped interrupted sutures are used - U-shaped (U-shaped) everting and inverting ( rice. 5, a, b ), and 8-shaped ( rice. 5, in ). For better comparison edges of the skin wound, use an interrupted adapting U-shaped (loop-shaped) suture according to Donati ( rice. 6 ).

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 they use different kinds circular seams. 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, 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 ( rice. 9 ) on the soft tissues of the head 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 are poor alignment () 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 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 of 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

Buyanov V.M., Egiev V.N., Udotov O.A.
Chapter 2. Surgical sutures.

The most general principle for making any suture is to be careful with 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”.

Skin suture
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 sutures: Continuous intradermal cosmetic suture 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 are monofilament polyamide and polypropylene. If you use polyfilament threads, then after every 6-8 cm of the seam it is necessary to puncture the skin. The thread is subsequently removed in parts between these punctures.

The second most common skin suture is metal staples. Metal braces are widely used by Western surgeons, as they provide cosmetic results comparable to cosmetic sutures. Why does using braces give such cosmetic results? The staple is designed in such a way that when it is applied, the back of the staple is above the wound. During healing, the volume of tissue connected by the staple increases, but the back does not put pressure on the tissue and does not create a transverse strip (unlike a thread).

A simple interrupted suture is no less common. The skin is most easily pierced with a cutting needle, and it is believed that it is better to use a “reverse 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. Injections and gouges should be located on the same line, strictly perpendicular to the wound, at a distance of 0.5-1 cm from its edge. Optimal distance between stitches is 1.5-2 cm. More frequent stitches lead to disruption of the blood supply in the suture area; with sparser stitches it is difficult to accurately match the edges of the wound. To prevent the wound edges from turning in, which prevents healing, the deeper layers should be grasped more “massively” than the skin. The knot should be tightened only until the edges match; excessive force leads to disruption of skin trophism and the formation of rough transverse stripes. In addition, it is recommended to remove these sutures as early as possible (3-5 days after surgery) for the same purpose - to prevent the formation of rough transverse stripes. The tied knot should be located at the puncture or puncture points, but not above the wound itself.

If it is difficult to compare the edges of the skin wound, a horizontal mattress U-shaped suture can be used. 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 a vertical mattress suture is used (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. This can cause patients not only moral, but also physical suffering.

Aponeurosis suture
IN last years There have been major changes in the technique of suturing the aponeurosis. The most widely used continuous suture is synthetic absorbable sutures, such as polysorb, biosin, vicryl. In this case, threads with a nominal diameter of 1, 2 are used, and double threads (loop) are often used. After the initial stitching, the needle is threaded through a loop of thread and tightened. Then a blanket suture is applied. At the end, one of the threads is cut and stitched in the opposite direction, after which both threads are sewn together. If any problems in wound healing are suspected, non-absorbable sutures such as polypropylene can be used for such a suture.

No less often, an interrupted suture of the aponeurosis is used using non-absorbable materials such as lavsan. General requirement For all methods of suturing the aponeurosis, care must be taken in matching the edges to exclude interposition of fat. This ensures the formation of a durable scar, that is, the formation of postoperative hernias is prevented. The use of absorbable materials has led to the fact that in recent years we have practically not observed the formation of ligature fistulas.

Seam of fatty tissue and peritoneum.
Currently, among surgeons the issue of the need for a suture of fatty tissue and a suture of the peritoneum is being discussed. The peritoneum heals well even without its precise adaptation. Moreover, the use of catgut to suture the peritoneum causes an inflammatory reaction. Therefore, now wounds after median laparotomy are sutured without a peritoneal suture. There is also disagreement about the need to suture the fatty tissue. As you know, the suture disrupts the blood supply and increases the likelihood of suppuration. Therefore, if there is fascia of fatty tissue (as is the case with inguinal hernia repair), it is advisable to stitch only it. If the fiber is not expressed, it is not recommended to stitch it. Aspiration drainage of the residual cavity is possible.

If you consider it necessary to sew the fatty tissue, then it is better to use a continuous suture with absorbable suture materials (monocryl material is specifically designed for suture of fatty tissue and peritoneum).

Intestinal suture
While there is a wide variety of intestinal sutures, only a few types of suture are most widely used. We strongly recommend using a single-row continuous seam as the method of choice.

The technique for applying this suture is quite simple and the same. The suture is used for anastomosis and suturing of gastrointestinal incisions. The distance between stitches is 0.5 - 0.8 cm, depending on the thickness of the walls of the organs being stitched, the distance from the edge of the organ being stitched to the needle insertion is 0.8 cm for the intestine, 1.0 cm for the stomach (Fig. 3) . For operations on the stomach and small intestine, we use threads with a nominal diameter of 3/0-4/0, and for operations on the large intestine, threads with a diameter of 4/0-5/0. Of other types of sutures, single-row interrupted serous-muscular-submucosal sutures with the node located on the serosa (Pirogov suture) are used.

Mateshuk's suture differs in that the node is located on the side of the intestinal lumen. The idea of the Mateshuk suture is to facilitate the migration of the thread into the intestinal lumen. This type of suture was widely recommended when non-absorbable materials were used, which also caused a reaction in the body tissues. When using synthetic absorbable threads, the problem of knot location ceases to be fundamental.

Another single-row suture, the Gambi suture, is used in colon surgery. This suture resembles the Donatti skin suture. In this case, the intestine is initially punctured at a distance of at least 1 cm from the edge of the wound with a puncture of the mucous membrane. After puncturing the second intestine, both intestinal lumens are punctured in the opposite direction at a distance of 2-3 mm from the edge. When the suture is tightened, the serous layers of the intestinal wall are accurately compared over a fairly large area.

In this manual we do not describe the technique of applying two - three-row sutures, since, firstly, they are described in numerous manuals. Secondly, we believe that all techniques except single-row seam techniques have no future. Stapling devices are often used for gastric and intestinal sutures. In this case, two methods of applying anastomosis are used - the first involves the application of an inverted anastomosis, the second - the application of an everted anastomosis. How it's done? When applying an inverted anastomosis, the branches of the GIA apparatus are inserted into the lumen of the organs being sutured, which, when used, stitches the tissue with two rows of staple sutures and dissects it in the middle. In this case, a ready-made anastomosis is obtained. Depending on the length of the working part of the device, anastomosis with a length of 5, 6, 7 and 8 cm can be applied.

In the second technique, the walls of the organs are everted in such a way that the mucous membranes of the stitched organs are compared. After this, the anastomosed organs are sutured using linear suture devices, such as UO-40, TA-55. Hepaticocholedochus suture. Sutures of the bile ducts are used after choledochotomy, in case of accidental damage to the ducts. If possible, a precision continuous overlap suture should be used, which involves precise alignment of the layers of the duct wall without entrapping the mucosa. Particular care should be taken to apply a suture to the thin-walled common bile duct. For this purpose, monofilament absorbable threads (biosin) with a nominal diameter of 5/0 - 7/0 are used. This technique differs from the traditional one due to the increased tightness of the seam, minimum quantity complications in early and late periods. We use this seam as the method of choice.

When applying biliodigestive anastomoses, only a single-row continuous suture is also used, which is the easiest to use and produces fewer complications. For anastomosis, absorbable monofilament or polyfilament sutures with two needles are used. Initially, the posterior lip of the anastomosis is sutured; both threads with needles are located on both sides of the future anastomosis. After this, the right and left parts of the anastomosis are applied alternately from the right and left until the threads meet on the anterior lip of the anastomosis. The threads are tied together and after this the anastomosis is performed.

Liver suture
To date, liver suturing remains a very difficult problem. Most modern methods Prevention of postoperative bleeding and bile leakage from the liver is ultrasonic cavitation, treatment of the liver parenchyma with hot air, application of fibrin glue to the liver tissue. With this technique, a liver suture is not expected. However, due to the insufficient availability of the necessary equipment, liver suture is currently used very widely.

Basically, various techniques of U- and 8-shaped seams are used. When suturing the gallbladder bed, it is more convenient to use a continuous overlapping suture. When suturing the liver, it is advisable to use absorbable suture materials (Polysorb, Vicryl, Dexon) of large diameters with large atraumatic blunt needles.

Vascular suture
The main requirement for a vascular suture is its tightness. The simplest technique is to apply a continuous suture without overlap. The continuous mattress seam is more reliable, but at the same time more complex. A common disadvantage of both sutures is the possibility of corrugation of the vessel wall when tying the thread. Therefore, for microsurgical restoration of a small-diameter vessel, a single-row interrupted suture technique is used. To sew the prosthesis to the vessel (if it is a polytetrafluoroethylene prosthesis), the same thread is used, which allows you to obtain a “dry” anastomosis due to the fact that the thread completely fills the suture channel.

Tendon suture
When suturing a tendon, you should avoid using rough clamps or surgical tweezers. Directly suturing the tendon requires strong threads on atraumatic needles round section. Of the many techniques for suturing a tendon, the most widely used are the Cuneo and Lange methods. When restoring a tendon, special attention should be paid to the conditions for the regeneration of its sliding surface. To do this, the edges of the tendon are adapted with separate sutures using absorbable threads with a nominal diameter of 6/0-8/0. It is especially important to follow this rule when restoring hand tendons. To prevent seams from coming apart, external sealing is usually required.

Information about the types and healing process of postoperative sutures. It also tells what actions need to be taken in case of complications.

After a person has undergone surgery, scars and stitches remain for a long time. From this article you will learn how to properly process a postoperative suture and what to do in case of complications.

Types of postoperative sutures

A surgical suture is used to connect biological tissues. The types of postoperative sutures depend on the nature and scale of the surgical intervention and are:

bloodless, which do not require special threads, but are glued together using a special adhesive
bloody, which are stitched with medical suture material through biological tissues

Depending on the method of applying bloody sutures, the following types are distinguished:

simple nodal– the puncture has a triangular shape, which holds the suture material well
continuous intradermal– most common which provides a good cosmetic effect
vertical or horizontal mattress – used for deep, extensive tissue damage
purse string – intended for plastic fabrics
entwining - as a rule, serves to connect vessels and hollow organs

The following techniques and instruments are used for suturing vary:

manual, when applying which a regular needle, tweezers and other instruments are used. Suture materials – synthetic, biological, wire, etc.
mechanical carried out using a device using special brackets

The depth and extent of the injury dictates the method of suturing:

single-row - the seam is applied in one tier
multilayer - application is made in several rows (muscle and vascular tissues are first connected, then the skin is sutured)

In addition, surgical sutures are divided into:

removable– after the wound has healed, the suture material is removed (usually used on covering tissue)
submersible– cannot be removed (suitable for joining internal tissues)

Materials that are used for surgical sutures can be:

absorbable - removal of suture material is not required. Typically used for ruptures of mucous and soft tissues
non-absorbable - removed after a certain period of time determined by the doctor

When applying sutures, it is very important to connect the edges of the wound tightly so that the possibility of cavity formation is completely excluded. Any type of surgical sutures requires treatment with antiseptic or antibacterial drugs.

How and with what should I treat a postoperative suture for better healing at home?

The healing period of wounds after surgery largely depends on the human body: for some this process occurs quickly, for others it takes a longer time. But the key to a successful result is proper therapy after suturing. The timing and nature of healing are influenced by the following factors:

sterility
materials for processing the suture after surgery
regularity

One of the most important requirements care for injuries after surgery is maintaining sterility. Treat wounds only with thoroughly washed hands using disinfected instruments.

Depending on the nature of the injury postoperative sutures treated with various antiseptic agents:

potassium permanganate solution (it is important to follow the dosage to avoid the possibility of burns)
iodine (in large quantities may cause dry skin)
brilliant green
medical alcohol
fucarcin (difficult to wipe off from the surface, which causes some inconvenience)
hydrogen peroxide (may cause a slight burning sensation)
anti-inflammatory ointments and gels

Folk remedies are often used at home for these purposes:

tea tree oil (pure)
tincture of larkspur roots (2 tbsp., 1 tbsp. water, 1 tbsp. alcohol)
ointment (0.5 cups beeswax, 2 cups vegetable oil cook over low heat for 10 minutes, let cool)
cream with calendula extract (add a drop of rosemary and orange oils)

Before using these medications, be sure to consult your doctor. In order for the healing process to occur as quickly as possible short time without complications, it is important to follow the rules for processing seams:

disinfect hands and tools that may be needed
carefully remove the bandage from the wound. If it sticks, pour peroxide on it before applying antiseptic.
Using a cotton swab or gauze swab, lubricate the seam with an antiseptic drug
apply a bandage

In addition, do not forget to comply with the following conditions:

carry out processing twice a day, if necessary and more often
regularly carefully examine the wound for inflammation
To avoid the formation of scars, do not remove dry crusts and scabs from the wound
When showering, do not rub the seam with hard sponges
If complications occur (purulent discharge, swelling, redness), consult a doctor immediately

How to remove postoperative sutures at home?

The removable postoperative suture must be removed on time, since the material used to connect the tissue acts as a foreign body to the body. In addition, if the threads are not removed in a timely manner, they can grow into the tissue, leading to inflammation.

We all know that a postoperative suture must be removed by a medical professional in suitable conditions using special tools. However, it happens that there is no opportunity to visit a doctor, the time for removing the stitches has already come, and the wound looks completely healed. In this case, you can remove the suture material yourself.

To get started, prepare the following:

antiseptic drugs
sharp scissors (preferably surgical, but you can also use nail scissors)
dressing
antibiotic ointment (in case of infection in the wound)

Perform the seam removal process as follows:

disinfect instruments
wash your hands thoroughly up to the elbows and treat them with an antiseptic
choose a well-lit place
remove the bandage from the seam
using alcohol or peroxide, treat the area around the seam
Using tweezers, gently lift the first knot slightly
holding it, use scissors to cut the suture thread
carefully, slowly pull out the thread
continue in the same order: lift the knot and pull the threads
make sure to remove all suture material
treat the seam area with an antiseptic
apply a bandage for better healing

If you remove postoperative sutures yourself, in order to avoid complications, strictly follow these requirements:

You can remove only small superficial seams yourself
Do not remove surgical staples or wires at home
make sure the wound is completely healed
if bleeding occurs during the process, stop the action, treat with an antiseptic and consult a doctor
protect the seam area from ultraviolet radiation, since the skin there is still too thin and susceptible to burns
avoid the possibility of injury to this area

What to do if a seal appears at the site of the postoperative suture?

Often, after the operation, a patient experiences a seal under the suture, which is formed due to the accumulation of lymph. As a rule, it does not pose a threat to health and disappears over time. However, in some cases complications may arise in the form of:

inflammation– accompanied by painful sensations in the suture area, redness is observed, and the temperature may rise
suppuration– when the inflammatory process is advanced, pus may leak from the wound
the formation of keloid scars is not dangerous, but has an unaesthetic appearance. Such scars can be removed using laser resurfacing or surgery.

If you observe the listed signs, contact the surgeon who operated on you. And if this is not possible, go to the hospital at your place of residence.

If you see a lump, consult a doctor

Even if it later turns out that the resulting lump is not dangerous and will resolve on its own over time, the doctor must conduct an examination and give his opinion. If you are convinced that the postoperative suture seal is not inflamed, does not cause pain and there is no purulent discharge, follow these requirements:

Follow the rules of hygiene. Keep bacteria away from the injured area
treat the seam twice a day and change the dressing material promptly
When showering, avoid getting water on the unhealed area
don't lift weights
make sure that your clothes do not rub the seam and the areola around it
Before going outside, apply a protective sterile bandage
Do not under any circumstances apply compresses or rub yourself with various tinctures on the advice of friends. This can lead to complications. A doctor must prescribe treatment

Compliance with these simple rules– the key to successful treatment of suture seals and the possibility of getting rid of scars without surgical or laser technologies.

The postoperative suture does not heal, it is red, inflamed: what to do?

One of a number of postoperative complications is inflammation of the suture. This process accompanied by such phenomena as:

swelling and redness in the suture area
the presence of a seal under the seam that can be felt with your fingers
increased temperature and blood pressure
general weakness and muscle pain

The reasons for the appearance of the inflammatory process and further non-healing of the postoperative suture can be different:

infection in a postoperative wound
During the operation, the subcutaneous tissues were injured, resulting in the formation of hematomas
suture material had increased tissue reactivity
in overweight patients, wound drainage is insufficient
low immunity of the patient being operated on

Often there is a combination of several of the listed factors that may arise:

due to an error by the operating surgeon (instruments and materials were not processed sufficiently)
due to patient non-compliance with postoperative requirements
due to indirect infection, in which microorganisms are spread through the blood from another source of inflammation in the body

If you see redness in the suture, consult a doctor immediately

In addition, the healing of a surgical suture largely depends on individual characteristics body:

weight– y fat people the wound may heal more slowly after surgery
age – tissue regeneration occurs faster at a young age
nutrition – lack of proteins and vitamins slows down the recovery process
chronic diseases – their presence prevents rapid healing

If you notice redness or inflammation of a postoperative suture, do not delay visiting a doctor. It is the specialist who must examine the wound and prescribe the correct treatment:

remove stitches if necessary
washes the wounds
install drainage to drain purulent discharge
will prescribe the necessary medications for external and internal use

Timely implementation of the necessary measures will prevent the likelihood of severe consequences (sepsis, gangrene). After medical procedures have been performed by your attending physician, to speed up the healing process at home, follow these recommendations:

treat the suture and the area around it several times a day with the medications prescribed by the attending physician
While showering, try not to touch the wound with a washcloth. When you get out of the bath, gently blot the seam with a bandage.
change sterile dressings on time
take multivitamins
add extra protein to your diet
do not lift heavy objects

In order to minimize the risk of an inflammatory process, it is necessary to take preventive measures before surgery:

boost your immunity
sanitize your mouth
identify the presence of infections in the body and take measures to get rid of them
strictly observe hygiene rules after surgery

Postoperative fistula: causes and methods of control

One of negative consequences after surgery is postoperative fistula, which is a channel in which purulent cavities are formed. It occurs as a consequence of the inflammatory process when there is no outlet for purulent fluid.
The reasons for the appearance of fistulas after surgery can be different:

chronic inflammation
the infection is not completely eliminated
rejection by the body of non-absorbable suture material

The last reason is the most common. The threads that connect tissues during surgery are called ligatures. Therefore, a fistula that occurs due to its rejection is called ligature. Around the thread is formed granuloma, that is, a compaction consisting of the material itself and fibrous tissue. Such a fistula is formed, as a rule, for two reasons:

entry of pathogenic bacteria into the wound due to incomplete disinfection of threads or instruments during surgery
patient's weak immune system, due to which the body weakly resists infections, and there is a slow recovery after the introduction of a foreign body

A fistula can appear in different postoperative periods:

within a week after surgery
after a few months

Signs of fistula formation are:

redness in the area of inflammation
the appearance of compactions and tubercles near or on the seam
painful sensations
discharge of pus
temperature increase

After surgery, a very unpleasant phenomenon may occur - a fistula.

If you experience any of the above symptoms, be sure to consult a doctor. If measures are not taken in time, the infection can spread throughout the body.

Treatment of postoperative fistulas is determined by the doctor and can be of two types:

conservative
surgical

The conservative method is used if the inflammatory process has just begun and has not led to serious disorders. In this case, the following is carried out:

removal of dead tissue around the seam
washing the wound from pus
removing the outer ends of the thread
patient taking antibiotics and immune-boosting drugs

The surgical method includes a number of medical measures:

make an incision to drain the pus
remove the ligature
wash the wound
if necessary, perform the procedure again after a few days
if there are multiple fistulas, you may be prescribed complete excision of the suture
the stitches are reapplied
a course of antibiotics and anti-inflammatory drugs is prescribed
complexes of vitamins and minerals are prescribed
standard therapy prescribed after surgery is carried out

Recently, a new method of treating fistulas has emerged - ultrasound. This is the most gentle method. Its disadvantage is the length of the process. Except listed methods, healers offer folk remedies for the treatment of postoperative fistulas:

mumiyo dissolve in water and mix with aloe juice. Soak a bandage in the mixture and apply to the inflamed area. Keep it for several hours
wash the wound with a decoction St. John's wort(4 tablespoons of dry leaves per 0.5 liters of boiling water)
take 100 g of medical tar, butter, flower honey, pine resin, crushed aloe leaf. Mix everything and heat in a water bath. Dilute with medical alcohol or vodka. Apply the prepared mixture around the fistula, cover with film or plaster
Apply a sheet to the fistula at night cabbage

However, do not forget that folk remedies are only auxiliary therapy and do not cancel a visit to the doctor. To prevent the formation of postoperative fistulas it is necessary:

Before the operation, examine the patient for the presence of diseases
prescribe antibiotics to prevent infection
carefully handle instruments before surgery
avoid contamination of suture materials

Ointments for healing and resorption of postoperative sutures

Used for resorption and healing of postoperative sutures. antiseptics(brilliant greens, iodine, chlorhexidine, etc.). Modern pharmacology offers other drugs of similar properties in the form of ointments for local use. Using them for healing purposes at home has a number of advantages:

availability
wide spectrum of action
the fatty base on the surface of the wound creates a film that prevents tissue from drying out
skin nutrition
Ease of use
softening and lightening of scars

It should be noted that the use of ointments for wet wounds of the skin is not recommended. They are prescribed when the healing process has already begun.

Based on the nature and depth of skin damage, various types of ointments are used:

simple antiseptic(for shallow superficial wounds)
containing hormonal components (for extensive, with complications)

Vishnevsky ointment- one of the most affordable and popular pulling agents. Promotes accelerated release from purulent processes
levomekol– has a combined effect: antimicrobial and anti-inflammatory. It is a broad spectrum antibiotic. Recommended for purulent discharge from the suture
vulnuzan– a product based on natural ingredients. Apply to both wound and bandage
levosin– kills microbes, removes inflammation, promotes healing
stellanine– a new generation ointment that removes swelling and kills infection, stimulates skin regeneration
eplan– one of the most powerful means of local treatment. Has an analgesic and anti-infective effect
solcoseryl- Available in the form of a gel or ointment. The gel is used when the wound is fresh, and the ointment is used when healing has begun. The drug reduces the likelihood of scar formation. Better to put under a bandage
actovegin– more cheap analogue solcoseryl. Successfully fights inflammation and practically does not cause allergic reactions. Therefore, it can be recommended for use by pregnant and lactating women. Can be applied directly to damaged skin
agrosulfan– has a bactericidal effect, has an antimicrobial and analgesic effect

Ointment for treating seams

naftaderm – has anti-inflammatory properties. Additionally, it relieves pain and softens scars.
Contractubex - used when the healing of the suture begins. Has a softening, smoothing effect in the scar area
Mederma – helps increase tissue elasticity and lightens scars

The listed medications are prescribed by a doctor and used under his supervision. Remember that you cannot self-medicate postoperative sutures in order to prevent wound suppuration and further inflammation.

Plaster for healing postoperative sutures

One of the effective means for caring for postoperative sutures is a patch made from medical silicone. This is a soft self-adhesive plate that is fixed to the seam, connecting the edges of the fabric, and is suitable for minor damage to the skin.
The advantages of using the patch are as follows:

prevents pathogenic microorganisms from entering the wound
absorbs discharge from the wound
does not cause irritation
breathable, allowing the skin under the patch to breathe
Helps soften and smooth out scars
retains moisture well in fabrics, preventing drying out
prevents scar enlargement
easy to use
There is no skin injury when removing the patch

Some patches are waterproof, allowing the patient to shower without risk of suture damage. The most commonly used patches are:

cosmopore
mepilex
mepitak
hydrofilm
fixopore

To achieve positive results in the healing of postoperative sutures, this medical product must be applied correctly:

remove the protective film
apply the adhesive side to the seam area
change every other day
periodically peel off the patch and check the condition of the wound

We remind you that before using any pharmacological agent, you must consult your doctor.

Video: Treatment of postoperative suture

It can be said with confidence that most Any surgical intervention is not a separation (separation) of tissues, but their connection. The main goal This surgical manipulation is to restore the anatomical integrity of organs (tissues) and resume their function. The connection of tissues is carried out by applying surgical sutures or seamlessly.

Methods for seamless joining of fabrics involve the use of medical glue (for example, cyanoacrylate - M-1, M-2, M-3, M-4 or polyurethane - KL-2, KL-3, compositions - MK-2, MK-6), adhesive plasters, ultrasonic welding of bone tissue, a device for “sealing” large vessels, etc. In recent years, tissue joining has been done using a laser beam focused to a minimum size. It is used to stop bleeding from parenchymal organs, connect vessels of the dura mater, etc. However, the lack of consistent positive results, the prejudiced attitude of practicing doctors, and the fairly high prices for sutureless materials significantly limit their use in surgery.

Therefore, surgical sutures are mainly used to connect tissues. A surgical suture is a connection of tissues using suture material. It provides a strong, hermetically sealed contact between the tissues being connected for the time required for the formation of a connecting scar.

Seams are distinguished:
1) according to the application technique:
- manual;
- mechanical.

2) according to the technique of applying and fixing the node: - separate nodes;
- continuous,.
A knotted seam is a connection of fabrics with stitches. Continuous - a suture applied with one thread to the entire wound;

3) in form:
- simple nodal;
- U-shaped;
- Z-shaped;
- purse string;
- 8-shaped.

4) by function:
- hemostatic;
- invaginating (screwing);
- inverting.

5) by the number of rows:
-single-row;
- double row;
-multi-row.

6) by duration of stay in the tissue:
- removable (provide for removal of suture material after the suture has performed its function);
- permanent (when applied, the suture material is not subsequently removed).

7) by location to the tissues
- external;
- internal.

A suture located on the skin or on the mucous membrane that is easily accessible for manipulation is called an external suture. If tissue dissection is required to apply a suture, then such a suture is classified as internal. Unlike internal sutures, external sutures are removed after tissue fusion.

8) erupting into the lumen of the organ (sutures placed on most hollow organs);

9) depending on the suture material used for immersion seams:
- dissolving biological (catgut, chrome-plated catgut, collagen, etc. are used to apply them)
- absorbable synthetic (Vicryl, Dexon, Polysorb, Oxelon, Cacelon, etc. are used for their application)
- non-absorbable (applied with lavsan, prolene, vitaphone, metal wire, etc.).

The choice of method and method of suturing is determined, on the one hand, by the characteristics of the tissues and organs being connected, and on the other, by the properties of the thread used. There are many factors to consider:

Anatomical and histological structure of connected organs and tissues; -their functional activity and regenerative abilities;
- topographical features and changes that occur in tissues as a result of a pathological process or surgical procedure;
- the result of the interaction between the fabric being sewn and the thread used;
- quality, chemical composition and structure of suture material, etc.

Taking these factors into account, different requirements are placed on seams. All of them are presented in the corresponding chapters. However, it is necessary to remember: the main function of the suture is to keep the separated tissues in contact until a union is formed. Based on this, we can formulate the conditions necessary for the implementation main function suture, regardless of what tissue or organ it is applied to.

First of all, it is necessary that the surfaces of the wound touch throughout. It is necessary to accurately compare the edges of the wound and the layers of the organs being sutured. There should be no pockets (spaces) between them where blood or wound discharge could accumulate. The easiest way to avoid such complications is to pass the needle under the bottom of the wound. Undoubtedly, in this case no cavity can form. With this suture, prima intentio is most easily achieved to the entire depth of the wound. At the same time, it is necessary to strive to connect tissues that are homogeneous in histological structure or similar in structure in the suture. Only homogeneous tissues grow together by primary intention to form a gentle and at the same time durable scar.

The second condition for rapid wound healing is a complete stop of bleeding before suturing. This is always taken care of, but at the same time it is often not given importance. Sutures must ensure hemostasis along the line of their application and, in some cases, biological tightness of organs.

Third condition - mechanical strength threads and the absence of any tension on the seams. The force aimed at holding the juxtaposed tissues must be greater than the force of separation that occurs during their inevitable swelling, functional activity or physical activity. This requires choosing a thread that is strong enough.

At the same time, it is necessary to avoid tightly tying knots or strongly tightening the edges of the wound. Otherwise, taking into account the fact of post-traumatic tissue swelling, this is dangerous possible complications. If the threads are not elastic, then the associated tissues from this edema (for example, skin) will still thin out a little (Fig. 3.1). Small wounds form at the puncture sites, which can become infected. At the same time, forced rapprochement of the edges is accompanied by impaired circulation and necrosis.

Rice. 3.1 Cutting through tissue in the suture area due to post-traumatic edema

The fourth condition is reliable asepsis and antisepsis, both regarding the sutures themselves and regarding the patient’s skin (surgical field). Since the mentioned condition is mandatory for any operation, we will not dwell on this.