Surgical suture

Sewing referred to in medicine, the shape of the tissue association by means of a needle and thread, the ends are knotted. It is a basic and indispensable to this day surgical or surgical technique because a wound healed without complications fastest when grouping layers wound tension are exposed to each other. This is made possible by a variety of suture techniques and is intended to bridge the period until wound healing by a reliable biological scar has formed.

Materials

Threads

Sewing is a historically very old form of treatment. The most important advances have been and are in the materials, that is, the needles and the threads made ​​. Different tasks require doing various suture materials. You used to have, for example, natural silk and sheep gut ( catgut ) was used as suture material. Today, ultra-modern plastics are used almost exclusively.

Absorbable and non- absorbable sutures

First, a distinction is absorbable by non- absorbable sutures. The seam has, as described above, only a time-limited task and unnecessarily in the body remaining suture is a risk of inflammation dar. Therefore, accessible, non-absorbable sutures are removed after sufficient time. This is called " pull strings ".

For areas where you can not reach the strings to pull, for example seams on internal organs or in the subcutaneous adipose tissue, we therefore used threads that degraded by the body itself ( absorbed ) are. Surgical suture material will be differentiated according to the resorption time after time, in which it has lost half its strength, while the resolution time is the time that elapses until its complete dissolution.

The absorption is not only a material-specific property, but also a function of time ( hyperbole ). The modern yarns are hydrolytically cleaved by the presence of bodies of water. Therefore, the size of the surface (and thus the diameter ) of the thread play as important a role as the type of fabric sewn whose moisture content is different.

Thick and thin filaments

Thick fibers have the advantage of being able to withstand large forces, since the tensile strength, among other things depends on the cross section. So when sewing under tension like thick threads are used. Thickness threads left but after pulling even thick branch ducts, which can for example cause unsightly scars at skin suture in the face. Therefore, the industry is now a very wide range of different threads prepared from which the surgeon selects the appropriate thread after each task and experience.

Monofilament, braided and pseudo- monofilament threads

Monofilament ( single-thread ) of synthetic threads are like fishing line little flexible. Although they glide through the fabric when sewing well, but are stubborn in handling and prevent by their smooth surface a secure node support.

By weaving a thread of several thin, comparable to the knotting of a rope, creates a braided or polyfilament thread, easier to knot much more supple and whose nodes seat is safe. Such threads saw the tissue penetration and its unlocked surface acts like a wick. So germs can enter the body and promote infections. For seams in the face, therefore, braided filaments are no longer considered contemporary. For example, the sewing of the skin they are optimal.

As Hybrid offers the industry pseudo- monofilament threads. It is woven yarns having the aforementioned advantages in handling, but the surface thereof is smoothed by covering, whereby the saw and the wick effect are avoided.

Needles

Earlier threads were often supplied as a sterile, stored under liquid in bottles meter and clamped into reusable needles as required using a Spring Eye, which are the only nearly still used for sewing of fabrics similar. The latter never had an open Spring Eye.

Today usable needle - thread combinations are again common. Needle and thread form a unit, the filament is connected to the needle unrepeatable. In addition to the appropriate thread material, the physician must also yet to pick a needle, because there are suitable for every situation: large or small, straight, slightly or strongly curved, circular in cross-section or triangular with sharp edges and much more.

The atraumatic suture maximum caliber of the needle is identical with the thread and is continuously into one another. This ensures that the thread completely fills the puncture channel and no blood appears, even with vascular sutures from inside the vessel at the puncture channel. Monofilament or pseudo- monofilament suture material is a matter of course. Especially critical in the production and use is the hollow needle end which encloses the thread start. In general, the needle in the needle holder is clamped in their posterior third, and never in the field of Hohlöhrs in use.

Special types of seams

The typical standard is the interrupted suture (A), in which by a circular run through the fabric thread with a multiple node a punctate wound adaptation is produced. Therefore Lange wounds need more. But the sewing long wounds can also be done with a continuous thread, with different thread guides are available: überwendlig or only in one plane back and forth. Here, in order to prevent skin exit channels, we developed the fully recessed intradermal suture.

Special forms of the seams you can even run in tension of the fabric, so the vertical backstitch seam Donati suture (B). By alternating only unilateral Hautausstich in Allgöwer - seam ( C), the number of skin withdrawals can be halved even. The paired other side is taken to have only intra-and subcutaneously.

Anesthetic

In many cases you may have an anesthetic.

Surgeons knot

A stressed seam is closed by the surgeon knots.

Needle holder

The former driving the needle by hand is no longer used nowadays. Nowadays, it is a special metal terminal, the needle holder, of which there are two fundamentally different ways with many modifications, pierced through the tissue and therefore also pulled out again. This has several advantages: The risk of infection for the operator from accidental needlestick injuries is low and it can be taken smaller needles. Also you can so penetrate into deeper wound cavities. With surgical gloves, the use of the needle holder is lighter than the guiding of the needle by hand.

Even the knots of the thread can be carried out in many situations with the needle holder. In other situations presented by the hand and guided his finger into the depths node is irreplaceable.

Alternatives

There are now a number of alternatives to sewing. But none of these methods achieved the universal applicability and diversity of sewing. Sorted by the effort can be identified as follows:

• Paving trains - they absorb the forces that allow a wound gape, and allow a tension-free adaptation and healing. Naturally, such techniques are used exclusively for external use. There are aseptically produced sterile plasters and in an airtight package ( Steristrip as the oldest example of this is taken as a proxy. ).
• Bonding - In the body, the interior can seal seams with fibrin glue, seal large wound surfaces in the same way or close defects. The tensile strength is limited. That is why so glued defects will never be charged immediately, for example when bonding after Achilles tendon rupture. It is advantageous that fibrin is converted or degraded than protein, so no foreign body remains in the body. Synthetic polycyanoacrylate (seconds ) adhesives are currently used exclusively for external use due to unavoidable toxic monomers, for example in skin wounds for a cosmetically good result. Superficial bonds are repelled during skin regeneration.

• Brackets (English staples ) - When brackets, " tacking " or " stacks " are designed for closure of skin wounds put metal brackets that hold the outside of the skin. The benefit is a reduced duration of surgery in the first place. Also located inside brackets can be used, only these are not set individually, as a rule, but there are staplers used.
• Stapling devices ( stacker ) - hollow organs such as esophagus, stomach, small intestine, colon or rectum can be combined with such special equipment together or cut in one operation and management together to plow again. Even trucks are developed for vascular surgery, but found no significant acceptance.

History