Types of sutures in surgery. Names, technique of applying them, areas of application

Many people learn basic handmade stitches in childhood, during labor lessons, or through their parents’ help in everyday life. Knowing the technique of making stitches solves small tasks for which a sewing machine is not suitable. Sew, hem, mend, sew on a button and even create a new outfit - experienced housewives know that it is difficult to do without hand stitches. This is where the mastery of sewing skills begins. However, the variety of stitches can seem daunting. Let's look at the types, names and features of the main handmade seams.

Classification of suture materials

The types of sutures in surgery, depending on the suture material, have several classifications.

The following divisions are distinguished:

• by composition;
• according to characteristics.

Based on their composition, suture material is divided into the following types:

• organic suture material (catgut, silk, linen);
• inorganic suture material (metal plates);
• artificial suture material (polyester threads).

Suture material is also divided into:

• absorbable threads;
• non-absorbable threads.

And there is also an intermediate type, which are partially absorbable threads.

Absorbable suture material includes threads made of catgut and synthetics. They are used in plastic surgery, minor gynecological operations, and urology. In most cases, the use of such material is based on a faster recovery period for the patient and a less pronounced (or complete absence) surgical scar.

The resorption time of the threads depends on the material from which they are made, as well as on the speed of metabolic processes of a particular patient. On average, for standard suture material it ranges from 10 days to 2–3 months.

Absorbable sutures are widely used in general surgery, oncology, vascular surgery and traumatology. They are used when fastening fabrics is necessary for a longer period.

Such threads are removed after the wound has healed. As a rule, such sutures can be removed 10–14 days after surgery. But in some cases this period can extend to several months.

If metal plates are used, the timing of their removal depends on the extent of the damage, the speed of healing, the nature of the damage, as well as the condition of the patient. There are certain requirements for suture material.

They include:

• strength;
• smooth surface;
• stretchability;
• increased elasticity;
• hypoallergenic;
• optimal period of resorption in the body.

What is important to consider when working on stitches?

The easiest way to master hand stitches is by embroidering with floss threads on a special fabric. This is the best option for training beginners. If you want to hone your crafting skills, you can start by marking your stitches with a water-soluble marker. Then it will be much easier to make an even, beautiful and smooth seam. Do not forget that the aesthetics of the finished product depends on the equal length of the stitches and the appropriate distance between them.

Special attention should be paid to working with knitwear. This popular material tends to shrink after washing. Therefore, before cutting, it is recommended to wash the fabric in advance and take this feature into account when leaving allowances. Dozens of patterns and samples of hand stitches for knitted and other fabrics are available in special books and on the Internet. Mastering sewing skills depends only on your desire and perseverance. Here, as in many other activities, it is important to systematically hone your skills.

Types of surgical sutures and methods of applying them

The types of sutures in surgery are quite varied. Sutures can be performed in a bloodless manner or with bleeding.

The bloodless method of joining tissues includes:

• application of metal staples;
• fastening tissues using surgical tape.

  
  Types of sutures in surgery

The bloody method involves the classic fastening of tissues using suture material. Sutures with this method are applied using a needle and a needle holder.

Also, surgical sutures can be classified according to the number of rows of application:

• single-row surgical sutures;
• double row surgical sutures.

Depending on the area of ​​stitching, external and internal seams are distinguished.

Sutures of the first type (for external use) are used by surgeons when stitching, for example, skin. Internal ones are used to connect the tissues of internal organs (mucous membranes).

The choice of method for suturing the edges of the surgical wound depends on the specific case. At the time of the operation, the surgeon selects the most appropriate technique for connecting tissues. Also, in some cases, for example, with ruptures of internal organs, methods of suturing the edges of the wound can be combined.

Regardless of the choice of technique, it is important to correctly align the edges of the wound so that in the future the suture does not form a cosmetic defect. Therefore, suturing of the wound edges is carried out without excessive tension, so that there is no additional tissue injury.

Simple interrupted stitch

To apply this suture, the edges of the wound are fixed, and then a needle is injected perpendicular to the area being stitched.

The skin and subcutaneous fat are sutured. Repeated puncture is carried out using the same principle.

Donati suture (vertical mattress suture)

The surgical suture according to Donati is called a vertical mattress suture. It is applied at a distance of 5 mm from the edges of the wound, directing the needle inward towards the area of ​​damage.

Intradermal continuous suture

Intradermal continuous suture is used for surgical operations on internal organs. His technique involves continuous stitching.

Horizontal mattress seam

A horizontal mattress suture is used in cases where it is necessary to align the edges of the wound with each other. It is used for lacerations, and is also used in pathological-anatomical practice after autopsy (for example, this type of suture is used after a Shore incision).

The seam is distinguished by its ease of execution. It differs from other types in that the seam lies parallel to the line of tissue dissection.

Double row continuous seam

Double-row sutures are used for suturing organs of the gastrointestinal tract (esophagus, intestines). A double-row seam is necessary for better bonding of fabrics. It ensures the integrity of the tissues of the gastrointestinal tract, and also ensures a low risk of developing blood supply disorders.

The first row of sutures ensures suturing of the edges of the mucous membrane, and the second - the muscle layer. It is this technique that provides greater reliability against divergence of the edges of the surgical wound.

There are several types of double-row continuous seams:

• Albert's seam.
• Seam Czerny.
• Seam Tupe.
• Lambert seam.

In some cases, double-row seams are combined with each other. For example, the Cherny seam and the Lambert seam.

The disadvantage of this type of seams is the difficulty of execution. Thus, if sutures are placed incorrectly, their failure, the formation of adhesions, and infection of the operated area can occur.

According to the type of welded joint

The classification of welds according to the type of welded joint is divided into butt and corner. The master decides which connection to make in a given situation, based on the position of the parts in space.

• Corner welds are made when the workpieces are at an angle to each other.
• Welding of butt joints is formed as a result of the adjacency of two parts or parts with their ends facing each other, which are located on the same plane. The track itself can be of three types - concave, convex or flat. The latter is used most often, since it does not have a particularly pronounced transition at the junction of parts, which looks more natural in comparison with the other two types. This method is most often used when electric arc welding at low currents, so as not to scorch the workpiece. For example, sheet steel is an ideal material for butt welding applications.
• Slotted (electric rivet) is made in the hole that is on the part and is made in the form of spot rivets. That is, in this case, a weld pool and a seam are not formed as a result, and the parts are soldered in small sections through grooves in the workpiece.

How to tie a knot correctly

In order for surgical sutures to provide reliable fastening, you must be able to tie a surgical knot.

The technique can be manual or instrumental. The manual method is used for many operations. Instrumental is used in microsurgery (for example, during surgery on the organs of vision), when performing specialized operations, as well as with difficult access to the surgical wound. Often the instrumental method of tying knots is used when performing operations on blood vessels.

Surgical nodes are:

• consisting of 1 loop;
• consisting of 2 loops;
• consisting of 3 loops.

A single-loop surgical knot is used for short-term tissue fixation. Other types of knots are used for long-term or permanent fixation of tissues.

Each of these types has its own characteristics and tying techniques.

Features of the surgical unit:

• The 1st knot is carefully tightened to the limit;
• The 2nd one fixes the first node;
• The 3rd is used for additional fixation.

Some surgical procedures require one additional turn of the knot.

Method of tying a surgical suture:

• fixing the end of the thread with your fingers;
• cross the surgical material (grab the right one with your left hand, place the left part in your right hand);
• the place where the threads cross is grasped with the thumb and index finger of the left hand;
• the ends of the ligature in the right hand are pulled up as much as possible and brought together under the index finger of the left hand;
• turn the left hand, with a nodding movement of the index finger, the ligature is passed into the gap and securely fixed.

After the manipulation, long pieces of suture material may remain. They need to be shortened as much as possible, since the presence of foreign parts in the area of ​​the surgical wound can lead to the formation of inflammation.

In order to make the suture as safe as possible for the patient, you must adhere to the following rules:

• the threads of suture material must always be in the surgeon’s hand;
• the tension of the threads should be optimal, that is, excessive overtension should be avoided;
• sew the edges of the wound as carefully as possible to avoid cutting through them (to avoid the formation of bedsores in the suture area);
• If there is any doubt about the correctness of the suture, you need to remove it and apply a new one.

Modern methods of wound suturing make it possible to avoid the appearance of scar changes in the tissue area.

By length

Classification of welds by length is of two types: continuous or intermittent.

• Intermittent is a seam that is made of a certain length with a synchronous interval. It, in turn, is divided into two types - chain track and checkerboard seam. For example, double-sided intermittent joints on one side of the wall are located opposite the welded sections of the seam on the other side. These types of coupling can be either one-way or two-way. That is, the part is soldered on both sides. The distance between these welded sections is called the “welding pitch”.
• Continuous welding methods are also divided into short and long tracks, and are performed along the entire workpiece.
• The spot method of butt welds differs significantly from others, due to the fact that there is no weld pool and track. In this case, the workpieces are connected at points using an overlap weld. This method is often used for soldering thin metal or batteries.

Methods of extended seams: a) continuous b) intermittent, c) point, d) intermittent checkerboard, e) intermittent continuous (chain)

Using metal staples

Metal staples in surgical practice are a modern alternative to suture material. They promote a shorter healing period and reduce the likelihood of infection in the operated area.

But metal staples are not used in all areas of surgery. As a rule, they are used in operations on the limbs, face (in case of trauma) and in some operations on the abdominal cavity.

The surgeon uses tweezers to apply the staples. He picks up the staple and places it at the edges of the wound, pressing on it. The staples are placed 1 cm apart to form a line.

Types of surgical sutures and methods of applying internal sutures The connection between internal tissues must be carried out as carefully as external ones. Since, if applied incorrectly, sutures may come apart, fistulas may form, peritonitis and bleeding may develop.

Aponeurosis

The aponeurosis is a tendon connection. Such fabrics are best joined using a continuous seam. A continuous upholstery stitch placed over this area is considered more appropriate.

The edges of the aponeurosis can be sutured in the following ways:

• edge seam;
• "overlapping"

On fatty tissue and peritoneum

The types of sutures in surgery are different for each area of ​​the body. Absorbable ones are applied to the area of ​​fatty tissue and peritoneum. As a rule, surgeons use a simple interrupted suture for this.

Intestinal

For operations on the gastrointestinal tract, continuous sutures or a simple interrupted Donati suture are used. Liver

During liver operations, continuous sutures are used, which are placed transversely to stitch the damaged areas; a continuous suture or a vertical mattress suture is used.

On vessels

Vascular sutures are used to suture large vessels. Such sutures should be placed so that the suture edge does not protrude beyond the vessel. Since this can lead to the development of thrombosis.

Therefore, the most suitable technique is to apply a continuous suture.

Fern stitch

It is one of the popular decorative seams and has a magnificent appearance. The stitch got its name based on its appearance: three straight stitches very much resemble a fern branch. Using a fern stitch, beautiful patterned lines are created. Most often, various plant elements are embroidered with it: tree branches, leaves, sea vegetation.

Compliance with the laws of asepsis and antisepsis when applying sutures

Asepsis and antisepsis in surgical practice are of great importance. Asepsis consists of carrying out a set of measures aimed at preventing the entry of microbes into the wound. Antiseptics are measures aimed at destroying microorganisms in a wound.

Careful adherence to asepsis and antisepsis significantly reduces the risk of developing bacterial complications in the wound, improves the prognosis for the recovery and life of the patient, and also shortens the recovery process after injury.

Primary surgical treatment is carried out at the stage of first aid. It consists of removing foreign bodies in the wound (if this does not threaten the development of bleeding), stopping the bleeding, and draining the wound.

Before suturing, the wound is cleaned and then treated with a 60% alcohol solution. After which they are treated with iodine again. Then the surgical field is limited using sterile sheets.

During the initial cleansing of the wound, the instruments are constantly changed so that no infection gets into the wound. After this, nonviable tissue is excised, the cavity is drained, and antibiotics are administered. All manipulations are carried out in a sterile operating room using sterile instruments.

After suturing, the surgical area must be cleaned and secured with a sterile swab or bandage. It is also possible to install drainage, with the help of which accumulated fluid, blood or purulent discharge drains from the wound.

Hand stitches for working with beads

Types of beading differ in the method of attaching the beads and their location. The most common option is the monastery stitch.

How to perform monastic:

1. Fasten the thread from the wrong side. Define a square.
2. Insert the needle from below into the lower left part, pull it out in the upper right corner.
3. Pull up the thread with the bead and repeat the stitches.
4. The beads will be secured with the same tilt to the side.
5. The last and first bead are reinforced twice.

Important! The thread should always be taut.

When working with beads, needlewomen also use the stem-shaped, arched, circular, “attached”, forward needle, and lowercase.

Convenient option for working with beads

Removing surgical sutures

The types of sutures in surgery are designed in such a way that they can be easily removed. Sutures must be removed within a specified period after surgery. They are removed within 7 to 10 days. Before removing them, you need to assess the condition of the wound to see if there is inflammation. Assess how the wound is healing.

The procedure can be performed by a doctor, paramedic or dressing nurse. Removal of surgical sutures occurs in a sterile dressing room.

Before the manipulation, the doctor puts on a sterile apron, washes his hands, and puts on gloves. Then he prepares the necessary tools in the tray. It includes tweezers, suture cutters and swabs.

The procedure is clearly regulated:

• remove the sterile bandage covering the wound;
• examine the postoperative wound for inflammation;
• estimate the number of seams;
• treat with an antiseptic;
• grab the edge of the seam with tweezers and lift it slightly (do not pull);
• cut the thread with suture cutters;
• gently pull the seam to remove the suture material;
• examine the wound, assess its condition;
• treat with an antiseptic;
• Cover the wound with a sterile swab or apply a bandage and secure.

When removing sutures, special attention must be paid to observing aseptic and antiseptic measures. If done incorrectly, there is a risk of infection entering the wound. Therefore, it is necessary not only to treat the area of ​​the postoperative wound with an antiseptic, but also to ensure that the surfaces in contact with the patient’s body are disinfected with special solutions.

For some manipulations, for example, when making an incision in the perineum, suture removal is not necessary. Since currently, absorbable sutures are used for such manipulations. The only limitation for the patient is the inability to sit in a sitting position for 10 days.

The types of seams may vary depending on each specific case. For minor wounds, simpler suturing techniques are used; for serious wounds, with the development of internal bleeding, more complex methods are used.

When applying sutures, it is necessary not only to know the main points of suturing the surrounding tissue, but also to follow measures to prevent wound infection. If pathogenic microorganisms enter a failed suture, a serious surgical infection can develop.

Split seam

Another name is split seam. In the technique of volumetric embroidery, it denotes the contours of the image. To make a seam, it is necessary to use a thread in two folds. Having made a stitch similar to the “forward needle” stitch, you need to return the needle to the front side at the end of the stitch between the two threads. Using this technique, we “split” the stitch into two parallel lines.

What are the types of stitches in machine sewing?

There are also different types of stitches for machines. There are several groups:

• old;
• tuning;
• invoices;
• double;
• sewing;
• interstitial;
• marginal;
• folds.

The machine performs all types of stitches better, faster and more reliably than a person. The advantage is that the buttonhole or overlock stitch follows the same pattern as the overlock stitch.

Types of machine seams

Even when working on a sewing machine, it is important to know the basic types of stitches and stitches, their pattern, and purpose. You can manually stitch the fabric where the machine cannot reach. Fur garments are sewn exclusively by hand, provided that the machine is a household one.