How and with what should I treat a postoperative suture for better healing at home? How to remove postoperative sutures at home? How long does it take for stitches to be removed?

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

The most general principle for making any seam is careful attitude to 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 stitching. 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 injected 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 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 of operations; the quality and properties of threads and needles are evaluated by many clinics in the country.

7.1. TISSUE SEPARATION

The general principle of tissue separation is strict layering. There is dissection and tissue delamination.

Dissection is carried out with a cutting instrument - a scalpel, knife, scissors, saw. The main tool when performing tissue dissection is a scalpel.

The abdominal rock pellet is used to make long cuts on a horizontal or convex surface of the body, and the pointed one is used for deep cuts and punctures.

Holding the scalpel in the form of a bow provides the movement of the hand with greater range, but less force; the position of the table knife allows you to reach and greater strength pressure, and significant incision size; It is held in the writing pen position when making small incisions or sharply extracting anatomical structures. The amputation knife is held in the fist with the cutting edge facing the surgeon.

All cuts are made from left to right (for right-handers) and towards you.

Technique for dissecting skin and subcutaneous fat. The direction of the skin incisions is chosen in accordance with the location of the projection of the organ to be operated on the skin. At the same time, they try to ensure that the incision line is (if possible) parallel to the visible folds of the skin, which, in turn, correspond to the Langer tension lines. With incisions perpendicular to Langer's lines, the edges of the wound gape, which is convenient in the treatment of purulent diseases. However, with such incisions, the connection of the wound edges and their fusion occur worse. Such incisions in the joint area can cause skin contracture. The cuts in the joint area should be parallel to the flexion plane.

Stretching and fixing the skin on both sides of the intended incision line with the thumb and forefinger of the left hand, the operator carefully inserts the scalpel at an angle of 90? into the skin, after which, tilting it at an angle of 45?, it smoothly leads to the end of the incision line. When the cut is completed, the scalpel is again moved to the position

perpendicular to the skin. This technique is necessary to ensure that the depth of the incision is the same throughout the wound.

Technique for cutting fascia and aponeurosis. After making an incision in the skin with subcutaneous fatty tissue, the operator, together with an assistant, lifts the fascia with two surgical tweezers, incises it and inserts a grooved probe into the fascia incision. By moving the scalpel with the blade upward along the groove of the probe, the fascia is dissected along the entire length of the skin incision.

Technique for cutting and separating muscles. The muscle is either stripped along the fibers or dissected. When dissecting, the perimysium is first cut with a scalpel, and then, using two folded tweezers or two Kocher probes, the muscles are moved apart, introducing Farabeuf lamellar hooks into the wound. In some cases, it is necessary to cross the muscle fibers in the transverse direction. Sometimes, before crossing, the muscle is clamped with two hemostatic clamps and cut between them. The edges of the transected muscle are sutured with an enveloping catgut suture for the purpose of hemostasis. It must be borne in mind that due to contractility, the crossed muscles diverge over a fairly significant distance.

Technique of dissection of the parietal peritoneum. The parietal sheet of peritoneum, incised between two tweezers, is cut along the entire length of the skin wound with Richter scissors, lifting it on the index and middle fingers of the surgeon’s left hand inserted into the peritoneal cavity. The edges of the peritoneal incision are fixed to gauze napkins using Mikulicz clamps.

7.2. CONNECTION OF TISSUE

Tissue joining is performed as the final stage of surgery or during surgical treatment of a wound. It is necessary to remember:

The edges of the wound must not be sutured under tension; the sutures should only hold the adjacent edges of the tissue;

Foreign bodies (ligatures) should not be left in the wound for a long time, as they interfere with its normal healing;

To connect tissues, only special tools are used; it is unacceptable to use other tools for this purpose.

7.2.1. Types of suture material and needles

When joining tissues, they use special threads loaded into surgical needles, which are fixed in needle holders. For the method of loading thread into a needle and the rules for holding needles, see section 3.

Types of surgical needles

Cutting (triangular):

■ thick (gynecological);

■ thin (surgical);

Curved (curvature 120?):

■ ophthalmic;

■ for stitching leather.

Piercing (round):

Direct:

Curved (curvature 180?):

■ thin (vascular);

■ medium thickness (intestinal);

■ thick (prickly).

Flat (liver):

Straight, semi-curved, curved.

Atraumatic:

Straight, curved.

Microsurgical.

Suture material used in surgery can be classified according to several criteria:

According to the degree of resorption - absorbable, conditionally absorbable and non-absorbable;

By thickness;

By structure.

The oldest absorbable suture material, catgut, was made from the submucosa of the small intestine of small cattle. Depending on the treatment method, the time for complete resorption ranges from 1 week to 1-1.5 months. In the second half of the twentieth century, synthetic absorbable sutures were developed, the first of which were deson and vicryl.

Conditionally absorbable materials include silk and nylon.

The group of non-absorbable threads includes horsehair, wire (steel, nichrome, etc.), various synthetic materials.

Catgut is produced in 9 numbers: 000, 00, 0, 1, 2, 3, 4, 5, 6.

Surgical silk is produced in 12 numbers: 000, 00, 0, 1, 2, 3, 4, 5, 6, 7, 9, 10; thickness? 1 - 0.1 mm, each subsequent number is 0.1 mm thicker than the previous one.

According to its structure, suture material can be divided into two groups: monofilament (in the form of a single fiber); complex threads, which, in turn, are divided into three groups - braided, twisted and coated threads.

Among the new types of suture material, it is worth noting antibacterial suture material (caprogen, caproag, capromed, etc.), as well as threads that can stimulate wound healing processes - rimin, biofil. These groups of suture material are in their infancy and are not yet widely used in surgical practice.

All types of suture material are supplied to surgical departments in two forms: sterile (in ampoules); non-sterile (in skeins).

Surgical needles and suture threads must be selected in a strictly differentiated manner. In this case, you should take into account what fabric the seam is applied to, what type of seam is used and what purpose the seam serves. The size and diameter of the needle should always match the thickness of the suture thread.

Atraumatic suture materials - disposable needle + thread complex, manufactured in a factory. A distinctive feature of this suture material is that a single thread is pulled behind the needle, approximately equal to the diameter of the needle, and not a double thread, as with classic sutures. Under these conditions, the thread almost completely covers the tissue defect after the needle passes, which makes it possible to use atraumatic suture material in vascular operations, as well as in cosmetic surgery.

7.2.2. Types of seams and knots

Three types of nodes are used in surgery: simple (female), marine, surgical (Fig. 7.1).

When tying knots, it is necessary to keep the ends of the threads taut, since when they relax, the knot can unravel and will

Rice. 7.1.Technique of knitting “marine” (a) and surgical (b) knots: 1-6 - successive moments of knitting knots

fragile.

Manipulations are performed with the thumbs and index fingers of both hands. When tying a simple knot, there are 8 moments. To tie a sea knot, the first 5 moments are initially repeated, and the second knot is tied so that the stroke of its turn is directed in the direction opposite to the first turn. Tying a surgical knot requires double overlapping of the thread at the first moment and tying a counter second turn like a sea knot.

7.2.3. Suture technique

There are interrupted, continuous twisting, continuous screwing, continuous mattress, U-shaped, purse-string, Z-shaped sutures. Interrupted suture

produced by suturing the skin and subcutaneous tissue, aponeuroses of the broad muscles. The first injection of the needle is made from the surface side of the fabric, after which the needle is punctured

and a second stitch from the inside of the second edge being stitched. In this case, the distance of the first injection and the second injection from the edge of the fabrics to be sewn should be equal. After applying the suture, the threads are tied with one of the knots. When applying an interrupted suture, a possible mistake is the mismatch of the stitched edges of the fabrics and their tucking. This happens due to the unequal distance between the needle insertion and the puncture from the edges being stitched and the resulting tissue creeping onto each other when the knot is tightened. Continuous suture application

produced by suturing fascia, aponeuroses, serous membranes (peritoneum, pleura) (Fig. 7.2). The technique is as follows. An interrupted suture is placed at the edge of the wound so that one end of the thread is much longer than the other. Then, using a needle threaded with the long end of the thread, the fabric is continuously sewn stitch to stitch throughout. The distance between the stitches should be 0.5-0.7 cm. During the last stitching, the thread is not completely removed, but is used to tie the last knot with the working end of the ligature. ab Rice. 7.2.

Technique for applying a continuous entwining suture to the peritoneum: a - beginning of suturing of the peritoneum; b - completion of the seam Application of a continuous mattress suture.

Application of a continuous screw-in suture (Schmieden) used as one of the stages of interintestinal anastomosis (Fig. 7.3). The technique of applying a Schmieden suture is similar to the technique of a continuous wrapping suture. The difference is that the needle is inserted in all cases from the inner surface of the stitched edges.

Applying a U-shaped seam used for suturing muscles, tendons, aponeuroses (see Fig. 7.3). The technique is as follows: a needle is inserted from the surface of one edge of the wound, then injected from the depths, and punctured on the surface of the other side being connected. Having retreated 0.4-0.6 cm, from the same side make the same stitch in the opposite direction. When tying the ends of the thread, the seam is U-shaped.

Rice. 7.4.Technique for applying purse-string (a) and Z-shaped (b) sutures

Purse-string suture. A gray-serous or serous-muscular suture is placed around the wound opening or the organ to be removed along its entire circumference so that the last needle injection corresponds to the site of the very first injection. When tightened, both ends of the thread collect the wall of the organ being sewn together, as if in a pouch. A Z-shaped suture is placed on top of the tightened purse-string suture (Fig. 7.4).

7.2.4. Soft tissue suturing technique

Suturing a wound of the stomach, small and large intestine produced by an intestinal suture in a direction transverse to the axis of the organ. In this case, double-row sutures are placed on the stomach and small intestine, and three-row sutures on the large intestine. The first row of sutures (through, continuous screwing) is applied through the entire thickness of the organ wall with catgut of the appropriate size on a round needle. The second and third rows of sutures (serous-muscular, gray-serous, interrupted or continuous) are applied with a silk thread on a round needle. For small wound defects, a purse-string suture and a Z-shaped suture above it can be used.

Stitching of the parietal peritoneum carried out with catgut (? 4) on a round needle with a continuous twisted suture.

Stitching the musclecarried out with catgut (? 4, 5) with U-shaped sutures.

Stitching of fascia and aponeuroses produced with a silk thread (? 1, 2) charged into a round needle. Separate interrupted, U-shaped or continuous sutures are applied. When stitching, it is necessary to ensure that the distance between the puncture on one side and the puncture on the other is equal. The distance between individual interrupted seams or stitches of a U-shaped and continuous seam should be no more than 5 mm. The sutures are tightened with a marine or surgical knot.

Skin stitchingcarried out with a silk or nylon thread (? 4, 5, 6), charged into a cutting needle with a curvature of 120?. Stitching is done using separate interrupted sutures. The technique is as follows (Fig. 7.5). Using serrated or surgical tweezers, the alternately stitched edges of the skin are held. The needle is inserted from the outside of one of the edges to be stitched, and the needle is punctured from its inside. Then the opposite edge of the skin is grabbed with tweezers, a puncture is made from the inner surface of the skin flap and a puncture is made on its outer surface. In this case it is necessary

Rice. 7.5.Application of interrupted sutures to the skin: a - correct; b - incorrect

Make sure that the distance between the puncture on one side and the puncture on the opposite side with respect to the edges of the edges being sewn is the same. Tighten a simple or marine knot so that it is located on the side of the cut edges being connected. When applying skin sutures, the following rules should be followed: minimize tissue trauma; It is necessary to suture the edges of the wound separately.

To apply a corner adaptive suture, it is necessary to strictly follow the technique of its implementation (Fig. 7.6). The corner suture is used in cases where two triangular sections of skin need to be connected to the longitudinal edge of the wound (T-shaped wound), as well as when a small wound has a triangular shape.

If it is necessary to achieve a high degree of cosmeticity, intradermal sutures are used (Fig. 7.7). In the presence of superficial wounds, a single-row suture is applied, and in the presence of deep wounds, a double-row suture is performed.

When applying a single-row continuous suture, the thread is passed into the thickness of the dermis. Application begins by stitching the skin at a distance of 1 cm from one of the corners of the wound. Next, they sew parallel to the skin surface at the same height, capturing the same layer of fabric on both sides. Having finished applying the suture, both ends of the ligature are stretched in opposite directions, ensuring complete adaptation of the edges of the wound. The ends of the thread are fixed to the skin either with a plaster or with interrupted skin sutures.

When applying a double-row continuous suture, the deeper ligature passes through the subcutaneous fatty tissue, and the second, more superficial one, through the dermis. Complete adaptation of wound edges

Rice. 7.6.Technique for applying an adaptive fillet suture (from: Zoltan Y., 1974)

Rice. 7.7.Closure of superficial (1) and deep (2) skin wounds with single- and double-row sutures (from: Zoltan Y., 1974)

achieved by stretching both ligatures in opposite directions simultaneously. The ends of the superficial and deep ligatures are tied at the corners of the sutured wound.

Removing skin sutures carried out using tweezers and pointed scissors (Fig. 7.8). Having grabbed a knot or one of the free threads with tweezers, lightly pull the subcutaneous part of the thread above the skin and, bringing the sharp jaw of the scissors under the thread, cross it at the surface of the skin (see Fig. 7.8), after which the thread is easily removed.

Rice. 7.8.Technique for removing interrupted skin suture

A continuous suture is removed by pulling the knot of connected superficial and deep ligatures, followed by their simultaneous intersection and pulling from the opposite side (Fig. 7.9).

Rice. 7.9.Technique for removing a double-row continuous seam (from: Zoltan Y., 1974)

7.3. STOP BLEEDING

Bleeding refers to the release of blood outside the vascular bed. Bleeding can be external (blood flows into the external environment) and internal (blood flows into serous cavities, soft tissues, the lumen of hollow organs). There are also arterial, venous, capillary and mixed bleeding. Bleedings that occur as a result of the direct action of a traumatic agent are called primary, bleeding that develops as a result of slipping of the ligature, necrosis of the vascular wall, or bedsores from foreign bodies are called secondary. To temporarily stop bleeding, digital pressure on the vessel and application of a pressure bandage or tourniquet are used. Methods for definitively stopping bleeding include the application of a hemostatic clamp followed by ligation of the vessel in the wound, its electrocoagulation, and ligation of the vessel along its length.

Technique for ligating a blood vessel in a wound. In almost any operation, when dissecting tissue, the surgeon is forced to dissect small-caliber blood vessels along the cut. Bleeding in this case (especially from small vessels) can stop on its own, which is associated with the development of vascular spasm and thrombosis of the cut ends of the vessel, however, reliable hemostasis can be achieved by ligating the vessel with a ligature after grasping it with a hemostatic clamp. The position of the hemostatic clamp in the hand should be as follows: nail phalanx thumb in one ring, the distal phalanx of the IV or III finger in the other, forefinger on the clamp. After dissecting the tissue, the surgeon or assistant applies hemostatic clamps to the vessels, always in a perpendicular direction to the tissues, and it is necessary to grasp the smallest possible volume of surrounding tissue with the clamp. Obliquely grasping the bleeding area with a clamp is incorrect, since this takes a lot of surrounding tissue, and ligating a large area of it can lead to necrosis, which prevents primary healing of the wound. After capturing the bleeding vessel, the surgeon places a ligature under the clamp, the assistant lifts the tip of the clamp upward so that the ligature lies under it, otherwise it will tighten at the tip of the clamp. After inserting the ligature, the surgeon ties the first knot, preferably a surgical one, making sure that the knot is not tightened on the instrument itself. While the surgeon tightens the knot, the assistant gently

removes the clamp, and the operator, making sure that the ligature does not slip off, applies a second knot. The assistant cuts the ends of the thread short (up to 5 mm). For ligation of blood vessels, silk, nylon and lavsan threads are used. It is better not to use catgut threads due to the possibility of developing secondary bleeding. When using silk, a double knot is sufficient; when using nylon and lavsan, it is necessary to tie a triple knot.

When ligating blood vessels in a wound, the operator’s hand movements should be smooth. It is necessary to be able to apply and remove the clamp with one right or left hand equally.

Electrocoagulation of a blood vessel in a wound. In a number of cases, for example, during the removal of malignant tumors, brain surgery, microsurgery, and also in order to reduce the operation time, electrocoagulation of a vessel in the wound is used. To do this, you need to have a diathermocoagulation apparatus. Any of its models has a power transformer, a current generator high frequency, control pedal, shielded wires ending in electrodes. It is possible to use both monoactive and biactive coagulation. In the first case, one of the electrodes (passive) in the form of a plate is fixed to the patient, and the second electrode is active - working. In the biactive coagulation mode, special tweezer electrodes are used, the jaws of which are the active and passive electrodes. The operating principle of the device is to transform electrical energy into thermal when the device circuit is closed at the point of contact of the active electrode with tissue. The thermal effect first of all occurs in the blood (a blood clot forms), and then spreads in the vessel wall from the inside out, causing protein coagulation.

In both coagulation modes, it is possible to directly touch the bleeding vessels with electrodes, but this technique is more convenient when using biactive coagulation. When using the monoactive coagulation mode, it is better to clamp the vessels with hemostatic clamps, and then touch the clamps with electrodes, making sure that the clamp does not come into contact with other tissues to avoid burning them.

Technique of ligation of the main blood vessel throughout. Indications for ligation of vessels throughout are the impossibility of applying hemostatic clamps with subsequent ligation within the wound;

the need for preliminary

dressings before certain operations (amputation, jaw resection, tongue resection).

Dressing is carried out under general anesthesia or local anesthesia. Incisions are usually made along the projection lines of the vessels. In addition to incisions along the projection, indirect approaches are used to expose some vessels, making incisions at some distance from the projection lines through the sheaths of adjacent muscles. The skin, subcutaneous tissue, superficial and intrinsic fascia of the area are dissected. Then it is necessary, by retracting the muscle with a lamellar hook, to open the wall of the vagina of the neurovascular bundle using a grooved probe. Isolation of the artery is carried out bluntly. Holding a grooved probe in his right hand and tweezers in his left, the operator grabs the perivascular fascia (but not the artery!) on one side with tweezers and, carefully stroking the tip of the probe along the vessel, isolates it. The same technique is used to expose the artery on the other side for 1-2 cm. The vessel should not be isolated over a larger length so as not to disrupt the blood supply to the vessel wall. A silk or nylon ligature is placed under the artery using a Deschamps or Cooper ligature needle. When ligating large arteries, the needle is inserted from the side on which the accompanying vein is located (between the artery and vein), otherwise it may be damaged by the end of the needle. Ligature on

large arteries

Vascular suture is both one of the ways to finally stop bleeding and one of the surgical interventions on blood vessels.

Carrel's circular vascular suture technique (Fig. 7.10). For arterial injuries, vascular suture is currently the operation of choice.

The technique for performing this intervention according to Carrel’s method is as follows. Vascular clamps are applied to both ends of the vessel segments isolated over a short distance. For overlay

Rice. 7.10.Vascular suture according to Carrel:

a - application of stay sutures; b - application of a blanket suture

round piercing atraumatic needles are used to stitch the seam. Three fixation sutures are placed along the perimeter of the vessel at equal distances from each other. The assistant stretches the wall of the vessel using two adjacent stay sutures, giving it a linear shape. Then, with frequent (at a distance of 1 mm from each other) continuous stitches, the walls of the vessel segments are connected between the holders. The beginning of the suture thread is connected to the 1st holder, the end - to the 2nd. In the same way, sequentially stretching the wall of the vessel between the 2nd and 3rd holders, 3rd and 1st holders, a suture is applied along the entire circumference of the vessel.

After finishing the suture, the vascular clamps are removed: on arteries, first from the peripheral, then from the central segment, on veins, vice versa.

If blood leaks along the suture line, the bleeding site is pressed with a tampon moistened with hot saline, or additional interrupted sutures are placed at this site.

Microsurgical vascular suture. Performing a microvascular suture requires an operating microscope or a surgical loupe, microsurgical suture material code number 8/0-10/0, and microsurgical instruments. The conditions for successful application of a microvascular suture are good visualization of the ends of the vessel, careful hemostasis, grasping the vascular wall with instruments only by the adventitia, matching the ends of the vessel without tension, excision of the adventitia at the ends of the vessel to prevent it from entering the lumen of the vessel.

To stitch a vessel with a diameter of 1 mm, 7-8 interrupted sutures are required. Two stay sutures are first applied. Sutures are first placed on the anterior wall of the anastomosis, and then the vessel is rotated using holders and the posterior wall is sutured. You can use a technique when, after tying a knot, one of the ends of the thread is cut off, and the second is used as a holder for rotation of the vessel wall. When suturing small veins, more sutures are required, since the guarantee of success of a venous suture is the exact comparison of the sutured vessel segments. To tie knots, they use the apodactyl technique, in which one end of the thread is wrapped around the jaws of the needle holder using tweezers, and the other is grabbed by the jaws of the needle holder. When the first thread slips, a knot is formed. If you circle the first end of the sponge thread twice, you get a surgical knot. After applying a microsurgical vascular suture, the first to remove the clamp is from the distal end of the vessel when suturing an artery and from the proximal end when suturing a vein.

7.5. VENESECTION

Indications:the need for long-term intravenous infusions or the inability to perform catheterization of the main veins, as well as during puncture of the superficial veins.

Position of the patient on the operating table: lying on your back; If venesection is performed on an upper limb, the limb should be abducted at a right angle on an extension table.

Venesection technique (Fig. 7.11) .

Under local anesthesia with a 0.25% novocaine solution, an incision is made in the projection of the corresponding vein 1.5-2 cm long. The vein is exposed along the entire length of the incision. Using folded clamps or tweezers, the vein is isolated from the surrounding tissue and two ligatures are placed under it, which are placed in opposite corners of the wound. In the distal corner of the wound, the vein is ligated. Then the vein is lifted using the distal ligature and incised to 1/2 the diameter. The incision is made obliquely relative to the axis of the vein. A polyethylene catheter is inserted into the incision. It is carried out to a depth of 1.5-2 cm. A proximal ligature is tied on the catheter. The ends of the ligatures are cut off. Sutures are placed on the skin. The catheter is fixed to the skin with a plaster, and an aseptic bandage is applied on top.

After inserting the catheter into the vein, it is washed with novocaine and a heparin plug is placed.Rice. 7.11.

Stages of venesection

To restore the anatomical integrity of the nerve, separate interrupted sutures are applied to its outer shell (epineurium) and to the shells of each of the bundles (perineurium). For this purpose, it is necessary to use atraumatic (when applying an epineural suture) or microsurgical (when applying a perineural suture) round needles.

When suturing a nerve, it is advisable to use optical magnification using a bifocal loupe or surgical microscope. The technique is as follows (Fig. 7.12). Mobilized

and the matched ends of the crossed nerve are stitched around the circumference of the shells of each of the stitched ends with separate interrupted sutures. After all sutures have been placed, they are tied alternately with a naval or surgical knot so that a diastasis of 1-2 mm remains between the proximal and distal ends of the nerve being sutured. The number of sutures should be proportional to the thickness of the nerve trunk being sutured.

Microsurgical suture of the nerve can significantly improve the results of this operation. For suturing, an operating microscope with a working magnification of 25-40 times and suture material with the conventional number 10/0-11/0 are used.

Based on the location of the suture thread, there are perineural suture (when the needle and thread pass through the perineurium of individual bundles), interfascicular suture (when the thread captures the connective tissue between adjacent nerve bundles and brings two adjacent bundles together), epineural suture (when the thread also captures part of the external epineurium). Epineurial sutures strengthen the nerve suture but can be used alone to suture small nerves. The most reasonable is the interrupted suture of the nerve (the interrupted suture technique is described in the section on vascular microsurgery). Most often, no more than one suture is placed per bundle. Sometimes only the largest bundles are connected, due to which smaller ones are compared.

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 for 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 stitching. 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 ). 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 ). To better compare the 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 turned 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 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 when deep wounds use removable 8-shaped sutures according to Spasokukotsky ( 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 place 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, 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 allergic reactions delayed type (see Allergies) more often occur when using catgut threads, much less often - 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) section digestive tract connecting 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. It is used in sheep to remove bezoars, and in cattle for volvulus and displacement of the abomasum or its blockage 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), the operation of opening the 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

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 for postoperative injury care is maintaining sterility. Treat wounds only with thoroughly washed hands using disinfected instruments.

Depending on the nature of the injury, postoperative sutures are 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 (it is difficult to wipe off the surface, which causes some inconvenience)
hydrogen peroxide (may cause a slight burning sensation)
anti-inflammatory ointments and gels

Often used at home for these purposes. folk remedies:

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 it with peroxide before applying the 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 in time, since the material that is used to connect the tissue is exposed to the body foreign body. In addition, if the threads are not removed in a timely manner, they can grow into the tissue, which will lead 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 is 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 is 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– in obese people, the wound after surgery may heal more slowly
age – tissue regeneration in at a young age happens faster
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 the 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. In addition to the methods listed, 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

For resorption and healing of postoperative sutures, antiseptic agents (brilliant, iodine, chlorhexidine, etc.) are used. 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. Is an antibiotic wide range. 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 suture begins to heal. 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 effective means for the care of postoperative sutures is a plaster made on the basis of 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 pathogens 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

Sutures are placed only on healthy, viable tissue. The fabrics are joined in layers.

At the same time, care is taken to connect tissues that are anatomically homogeneous (muscles are connected to muscles, fascia to fascia, etc.). Sutures are placed after bleeding has completely stopped on clean wounds, free not only from blood clots, tissue scraps and mechanical contamination, but also from microbes. To do this, surgical treatment of the wound is first performed.

When applying sutures to a particular tissue, the peculiarities of tissue regeneration are taken into account. Thus, when applying sutures to vessels, it is necessary to remember that regeneration begins from the intima, so the sutures are placed so that the inner surface of the vessel is brought closer together. On the contrary, when sutures are applied to the intestines, scar, or uterus, the outer (serous) membrane, which is prone to adhesive inflammation, is brought together, which ensures quick and reliable sealing of the suture.

When choosing a suture, the depth of the wound, the tendency of the skin to fold inward, the degree of stretching of the edges of the wound, the load on the sutures, the stage of the wound process, and the presence of a purulent-inflammatory complication of the wound are also taken into account. In addition, when applying sutures, the entire range of aseptic and antiseptic measures should be carried out. It must be remembered that catgut and silk can be absorbed if they are sterile. Otherwise, purulent-inflammatory complications in the form of ligature fistulas, etc. are possible. When applying sutures, the following technical rules should be taken into account:

the injection and puncture should be at the same distance from the edges of the wound;
when placing sutures on the skin, muscles, the suture is used to pick up the bottom of the wound to avoid the appearance of pockets and streaks; knots are tied on the side and not above the wound channel;
make sure that the edges of the wound touch evenly throughout;
When tying a knot, excessive tightening of the wound tissue should be avoided;
the thickness of the suture material and its type must correspond to the type of animal, the degree of tension of the wound edges, and the function of the organ.

Depending on what tissues connect the sutures, they are divided into skin, muscle, fascial, tendon, intestinal, etc.

When applying sutures, the following purposes are pursued:

protect wound tissue from microbial, mechanical contamination and hypothermia;
create optimal conditions for tissue regeneration, taking into account their biological characteristics;
accelerate the healing of granulating wounds;
reduce tissue tension and wound gaping;
help stop bleeding.

When suturing, the needle is inserted perpendicular to the wound tissue. After the puncture, it is grabbed from the inside of the wound, passed through the tissue in accordance with the shape of the wound, and brought out on the other side. To facilitate suturing, the tissue of the wound edges is fixed with tweezers. If the tissue is loose, then you can pierce both edges of the wound without catching the needle with a needle holder. In this case, the edges of the wound are grabbed with tweezers individually or together.

If the wound surfaces co-opt well with each other, and the tissue tension is small, then the distances between stitches can be increased to 12...15 mm. When tying knots, it is necessary to take into account that after some time the wound tissues will swell and swell, which will significantly worsen blood and lymph circulation in them and create good conditions for tissue necrosis of the wound edges, the occurrence and development of purulent-inflammatory complications, and dehiscence of the wound edges.

Classification of seams

All seams are divided into: continuous and intermittent; removable and non-removable; 1…4-storey; primary (applied to a fresh wound), secondary (applied to a granulating wound); temporary (provisional, for temporary rapprochement of tissues, holding tampons, drainages, etc.). The most commonly used seams are shown in the figure.

Types of seams: a - knotted; b - seam with a roller; c - horizontal loop-shaped; g - eight-shaped Spasokukotsky seam; d - furrier; e - mattress; g - Lambert seam: 1 - knotty; 2 - continuous; h, i - herringbone seam; k - purse string; l - Sadovsky-Plahotin seam; m - double knotty; n - I-shaped seam; o - Albert seam; p - Schmieden seam; r - Sultan seam (I-shaped)

TO continuous seams include: furrier; Reverden seam; mattress; Sadovsky-Plahotin suture; Lambert's seam (may be intermittent); purse string; "herringbone"; intradermal suture.

TO interrupted seams include: simple nodular; double knotty; seam with roller; loop-shaped seams (horizontal-loop-shaped, vertical-loop-shaped); U-shaped seams (U-shaped in duplicate; U-shaped according to Hans; U-shaped on polyethylene tubes, on buttons, on gauze rollers, U-shaped with additional reduction); doubling; I-shaped (Sultan seam); eight-shaped (Spasokukotsky seam); multi-stitch seam.

Intermittent stitches include all types of seams that require a separate thread for each stitch of the seam. Of the intermittent seams, the most commonly used are knotted seams, beaded seams, loop seams and figure-of-eight seams. In this case, intermittent sutures can be applied as situational or reducing tension (relieving).

Depending on the type of tissue, the suture can be: skin, musculocutaneous, fascial, vascular, intestinal, tendon.

Depending on the type of material used, seams are divided into absorbable And non-absorbable.

Methods of joining fabrics

There are two main methods of joining tissues: bloody and bloodless. At in a bloody way tissues are joined using suture material or staples by applying sutures. With the bloodless method, the edges of the wound are connected using surgical glue or adhesive tape.

After the tissues are properly connected with sutures in the wound, the risk of infection is reduced, the wound cavity is eliminated, bleeding stops, the tissues are provided with rest, which has a beneficial effect on regenerative processes.

Blind connection of tissues is contraindicated in the presence of purulent inflammation, dead tissue, foreign objects, or mechanical contamination in the wound. In such cases, approximating (provisional) sutures are applied, which ensure adequate drainage, and after the wound cavity is cleansed and granulations appear, secondary sutures are applied.

Suture technique

In order to reduce the resistance of skin tissue, the needle is inserted vertically. Then it is grabbed from the inside of the wound, passed through the tissue in accordance with its shape and brought out on the other side. Fixing the edge of the wound with tweezers makes it easier to pass the needle through the tissue and manipulate the needle. If the wound is small and the tissue resistance is insignificant, then the needle can pierce both edges of the wound without intercepting it with the needle holder. To do this, the edges of the wound are fixed with tweezers individually or together.

To ensure uniform distribution of the load on both edges of the wound and their good alignment, the injection site and the exit hole of the needle should be at the same distance from the edge of the wound. The distance from the injection site to the edge of the wound depends on the nature of the tissue and is approximately 3...10 mm, and when applying unloading sutures, depending on the situation, it is 20 mm or more. It is important that the needle on both sides of the wound goes in the same direction and at the same time captures such a volume of tissue that would ensure good alignment of the wound surfaces and in the depths of the wound. If the punctures are not deep enough on both sides, a cavity may remain inside the wound in which blood or exudate (effusion) will accumulate, which at best will slow down the healing process, and at worst, create conditions for the occurrence of septic complications. If the stitches are very shallow and too wide, the edges of the wound are folded inward and turned outward using an appropriate suture (according to Donati, vertical loop, etc.).

The cutting of the thread occurs at the points most distant from each other, where the tissue experiences maximum compression. In this regard, the thread should be drawn at an equal distance from the edges and walls of the wound, and when tying a knot, the thread should be moderately tightened without squeezing the tissue. The larger the area of contact of the suture material with the tissues, the less pressure it exerts on them.

When a wound heals by primary intention, adhesion formation and epithelization do not occur until the source of pressure on the tissue is removed. Any pressure on the nerve has an extremely adverse effect on its functional state and regenerative functions. connective tissue wounds (A. N. Golikov, 1953, 1961).