Surgeons use surgical sutures in their work, there are different types of them, this is one of the most common methods used to connect biological tissues: walls of internal organs, wound edges, and others. They also help stop bleeding, the flow of bile, all thanks to properly selected suture material.
Recently, the main principle of creating any type of suture is considered to be careful attitude to each edge of the wound, regardless of its type. The suture should be applied so that the edges of the wound and each of the layers of the internal organ that requires the suture are precisely aligned. Today, these principles are combined in the term "precision."
Depending on which tool is used to create the seam, as well as the execution technique, two types can be distinguished: manual and mechanical seams. For suturing manually use conventional and traumatic needles, needle holders, tweezers and other devices. For crosslinking, absorbable sutures of synthetic or biological origin, metal wire or other materials can be selected.
A mechanical seam is applied with a special apparatus where metal staples are used.
During the suturing of wounds and the formation of anastomoses, the doctor can stitch both in one row - single-row, and in layers - in two or even four rows. Along with the fact that the seams connect the edges of the wound together, they also stop the blood perfectly. But what types of suture material exist today?
Classification of surgical sutures
As we have already said, the seams can be both manual and mechanical, but there are several more classes of their separation:
- according to the technique of applying them, they are nodal, as well as continuous;
- if you divide them by shape - simple, nodal, in the form of the letter P or Z, purse-string, 8-shaped;
- by their functionality they can be divided into hemostatic and screw-in;
- by the number of rows - from one to four;
- according to the period of stay inside the tissue - removable and immersed, in the first case, the stitches are removed after a certain time, and in the second case they remain in the human body forever.
It is also worth mentioning that surgical sutures, their types are divided according to the material used: they can be absorbable if they use catgut - this is a biological species and vicryl, dexon is synthetic. Cutting into the lumen of the organ - this kind of suture is superimposed on the hollow organs. Permanent - these are the types of sutures that are not removed, they remain in the body forever and are surrounded by a connective tissue capsule.
Types of raw materials for suturing
Suture material includes various materials used for ligation of blood vessels, applying surgical sutures. The types of material for stitching tissues and skin each year changed greatly depending on how the surgery developed. What surgeons just didn’t use to connect tissues of internal organs and skin:
- mammalian tendons;
- fish skin;
- strands obtained from rat tails;
- nerve endings of animals;
- hair taken from the mane of horses;
- umbilical cord of a newly born person;
- strips from vessels;
- hemp or coconut fiber;
- rubber tree.
But, thanks to modern developments, synthetic threads are now popular. There are also cases where metal can also be used.
Certain requirements are attached to any suture material:
- high strength;
- Smooth surface;
- elasticity;
- moderate extensibility;
- high level of gliding over fabrics.
But one of the important criteria that apply to suture material is compatibility with the tissues of the human body. Currently known materials used for joints have antigenic and reactogenic properties. Absolute species according to these characteristics do not exist, but their severity should be minimal.
It is also very important that the suture material is sterilizable and also retains it as long as possible, while its main characteristics should remain the same. Suture thread can consist of one or more fibers that are connected by twisting, knitting or weaving, and to make their surface smooth, they are coated with wax, silicone or Teflon.
Currently, in surgery, absorbable and non-absorbable types of suture material are used. Classification of surgical sutures, most of it involves the use of absorbable sutures - catgut, which is made from the muscular membrane of the small intestine of a sheep, and the submucous layer can also be used to create it. Today there are 13 sizes of catgut, which differ in diameter.
The strength of the joint material increases with size. So, for example, the strength of a three-zero species is about 1400 g, but the sixth size is 11500 g. This type of thread can dissolve from 7 to 30 days.
Of non-absorbable suture material in surgery, threads from silk, cotton, flax and horse hair are used.
Types of seams
When suturing the skin, the doctor must take into account how deeply the wound is cut or torn, its extent and how much its edges have parted. The place of injury is also taken into account. The following surgical sutures are considered the most popular in surgery; photos in the article will show how they look:
- subcutaneous continuous;
- subcutaneous nodal;
- skin nodules;
- continuous multi-row applied inside the skin;
- continuous in one row, applied inside the skin.
This will help to understand which methods of surgical suturing are most often used when stitching an external wound.
Continuous intradermal type
Recently, it has been used most frequently, providing the best cosmetic result. Its main advantage lies in the excellent adaptation of the edges of the wound, excellent cosmetic effect and minimal disturbance of microcirculation, when compared with other types of sutures. The thread for stitching is carried out in a layer of the actual plane of the skin parallel to it. However, for easier pulling of the thread, it is better to take monofilament material.
After the initial surgical treatment of wounds, the types of sutures can be chosen different, but often doctors give preference to absorbable suture material: biosin, monocryl, polysorb, dexon and others. And of the threads that do not absorb, monofilament polyamide or polypropylene is perfect.
Nodal seam
This is another of the popular types of outer seam. When you create it, the skin is best pierced by a cutting needle. If you use it, then the puncture looks like a triangle, the base of which is directed to the wound. This form of puncture allows you to reliably hold the suture material. The needle is inserted into the epithelial layer as close to the edge of the wound as possible, retreating only 4 mm, after which it is carried out to the oblique tissue, while slightly moving away from the edge, as far as possible.
After one level is reached with the edge of the wound, the needle is turned towards the midline and injected into the deepest point of the wound. The needle in this case passes strictly symmetrically into the tissue on the other side of the wound, only in this case the same amount of tissue will fall into the suture.
Horizontal and vertical mattress seam
The types of surgical sutures and nodes are chosen by the surgeon depending on the severity of the wound, if there is slight difficulty in comparing the edges of the wound, it is recommended to use a mattress seam in the form of the letter P, which runs horizontally. If a nodular primary surgical suture is applied to a deep wound, then in this case, you can leave a residual cavity. It can accumulate what separates the wound and leads to suppuration. This can be avoided by stitching several floors. This method of suturing is possible with both nodal and continuous type.
In addition, Donatti (vertical mattress seam) is often used. In its implementation, the first puncture is carried out 2 cm from the edge of the wound. The puncture is done on the opposite side and at the same distance. At the next injection and puncture, the distance from the edge of the wound is already 0.5 cm. The threads are connected only after all the sutures have been sutured, thus, manipulation in the very depth of the wound can be facilitated. The use of Donatti suture makes it possible to stitch wounds with large diastasis.
In order for the result to be cosmetic, during any operation, primary surgical treatment of wounds must be carefully carried out, the types of sutures are chosen correctly. If the edges of the wound are not carefully aligned, this will result in a rough scar. If you exert excessive force when tightening the first node, then ugly transverse stripes appear along the entire length of the scar.
As for knotting, all silk threads are knitted by two knots, and synthetic and catgut - three.
Types of surgical sutures and methods for their application
When applying any type of suture, and a lot of them are used in surgery, it is extremely important to strictly observe the execution technique. How to apply a knotted seam?
Using a needle on the needle holder, first pierce the edges at a distance of 1 centimeter, holding with tweezers. All injections are carried out one opposite the other. The needle is allowed to be carried out immediately through both edges, but can be carried out alternately, then through one, then through the other. After completion, the end of the thread is held with tweezers and the needle is removed, and the thread is tied, while the edges of the wound should be brought one to the other as close as possible. So do the rest of the stitches until the wound is completely sutured. Each seam should be 1-2 cm apart. In some cases, the knots can be tied when all the seams are already laid.
How to tie a knot
Most often, surgeons use a simple knot to bind suture material. And they do it like this: after the suture material is pierced into the edges of the wound, the ends bring together and tie a knot, and one more above it.
The surgical node can be performed in another way: they also thread the thread into the wound, take it with one hand at one end, and the second after the other and, drawing the edges of the wound closer, make a double knot, and already above it is simple. The ends of the thread are cut at a distance of 1 cm from the site.
How to stitch a wound using metal staples
Types of surgical sutures and methods for their application can be different, which is determined by the location of the wound. One option may be stapling with metal staples.
The brackets are metal plates, the width of which is several mm, and the length is about a centimeter, but may be more. Both ends are presented in the form of rings, and from the inside they have a point that penetrates the tissue and prevents the staples from slipping.
To put brackets on the wound, you should grab its edges with special tweezers, bring them together, put it well, holding it with one hand, the second you need to take another tweezers bracket. After that, put it on the seam line, squeezing the ends, applying force. As a result of such manipulation, the bracket bends and covers the edges of the wound. It should be applied at a distance of 1 cm from each other.
Staples are removed, as well as stitches, after 7-8 days after their application. For this, a hook and special tweezers are used. After removal, the staples can be leveled, sterilized and used again for suturing wounds.
Types of seams in cosmetology
A cosmetic surgical suture can be made using any of the existing suture materials: silk, catgut, linen, fine wire, Michel braces or horsehair. Among all these materials, only catgut is absorbable, and all the others are not. Seams can be submerged or removable.
According to the overlay technique in cosmetology, continuous and knotted sutures are used, the latter can also be divided into several types: sea, ordinary female or surgical.
The knotted look has one main advantage over the continuous one: it reliably holds the edges of the wound. But the continuous seam is in demand because it is applied faster and more economically as the material used. In cosmetology, the following types can be used:
- mattress;
- Reverden continuous seam;
- continuous furrier;
- tailor (magical);
- subcutaneous (American Halstead suture).
In cases where the patient has a strong tissue tension, the doctor can use lamellar or lead-lamellar seams, as well as a seam with rollers, due to which it becomes possible to close large defects and reliably hold tissues in one place.
In plastic surgery, the doctor can also sometimes use an apodactyl suture. Its essence lies in the fact that it is imposed and tied only with a special tool: a needle holder, tweezers and torsion pean.
Horse hair is the best suture material. The types of surgical sutures and knots that exist in cosmetology are well created with its help. It is often used during ENT operations, because it practically does not become infected, does not irritate the skin and tissues, and there are no suppurations and scars in its places of application. Horse hair is elastic, so unlike silk, it will not cut into the skin.
The use of stitches in dentistry
Dentists also use different types of sutures to stop bleeding or stitch the edges of a large wound. All types of sutures in surgical dentistry are very similar to those that we have already described, the only thing is that there are slight differences in the types of instrument. For suturing in the oral cavity are most often used:
- needle holder;
- ophthalmic forceps;
- small two-toed hook;
- eye scissors.
It can be difficult to carry out operations in the oral cavity, and only a professional in his field will be able to perform this work efficiently, because not only high-quality primary treatment of wounds is important here. It is also important to choose the right types of sutures in dentistry, but most often it is a simple nodal suture. And it overlaps like this:
- Sequentially, it is necessary to pierce both sides of the wound at a sufficient distance from one another, the thread should be stretched as much as possible, leaving only a small end - 1-2 cm.
- The long end of the thread and the needle are held in the left hand, after which they need to wrap the needle holder clockwise 2 times.
- Using a needle holder, grab a short tip and stretch it through the formed loop - this is the first part of the knot, tighten it gently, slowly bringing the wound edges together.
- Also, holding the loop, you need to do the same manipulations, only scroll counterclockwise once.
- Tighten an already fully formed knot, be sure to monitor the evenness of the thread tension.
- Move the knot from the cut line, cut the end of the thread, that's all, the seam is ready.
It is also worth remembering that it is necessary to stitch correctly from the middle of the wound and do not do stitches too often so as not to disturb the blood circulation in the tissues. In order for healing to proceed steadily, especially with regard to wounds resulting from trauma, it is necessary to install drainage between the joints for several days.
Varieties of surgical sutures and methods of suturing
Not only must external seams be applied correctly, the inside of the fabric must also be sewn securely. The internal surgical suture can also be of several types and each of them is intended for stitching certain parts. Let's look at each of the types in order to better understand everything.
Aponeurosis seam
Aponeurosis is the place where the fusion of tendon tissues occurs, which have high strength and elasticity. The classic place of the aponeurosis is the midline of the abdomen - where the right and left peritoneum are fused. Tendon tissues have a fiber structure, which is why their splicing along the fibers enhances their divergence, surgeons call this effect the effect of a saw.
Due to the fact that these fabrics have an increased strength, for their stitching it is necessary to use a certain type of seams. The most reliable is considered a continuous twisting seam, which is done using synthetic absorbable sutures. These include Polysorb, Biosin, Vikril. Through the use of absorbable sutures, the formation of ligature fistulas can be prevented. Also, to create such a seam, you can use non-absorbable sutures - "Lavsan". With their help, the formation of hernias can be avoided.
Fatty and peritoneal suture
Recently, these types of tissues are rarely sutured, because they themselves provide excellent adhesion and quick healing. In addition, the absence of sutures does not disturb blood circulation at the site of scar formation. , , , – "".
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Due to the fact that this organ is quite “crumbly” and is richly saturated with blood and bile, it is very difficult to make a seam on its surface even for a professional surgeon. Most often in this case, the doctor imposes a continuous seam without an overlay or a continuous mattress seam.
On the gall bladder use a U-shaped or 8-shaped surgical sutures.
Seams on the vessels
Types of surgical sutures used in traumatology have their own characteristics. If you need to stitch the vessels, then in this case, a continuous seam without overlap, which provides reliable tightness, will help the best. Using it often leads to the formation of an "accordion", but this effect can be avoided if you use a single-row nodal seam.
Surgical sutures, types used in traumatology and surgery are similar. Each species has its own drawbacks and advantages, but if you correctly approach their application and choose the best option for the thread, then any suture can fulfill the tasks assigned to it and reliably fix the wound or stitch the organ. The timing of removal of suture material in each individual case is determined individually, but basically they are removed already for 8-10 days.