Sutures are required for severe cuts, cuts, or after operations. Sutures are placed so that the wound heals faster and grows together. This is literally stitching two pieces of fabric together. In case of severe cuts, if you do not put a suture, the wound will constantly “open up” and as a result you may end up with a very unsightly scar, not to mention the fact that during the healing process the likelihood of dirt getting into the wound increases.

It is probably clear to everyone that suturing a wound is not the primary task of the average person. The first step is to stop the bleeding and call an ambulance or go to the emergency room, but we are considering situations where it is not possible to contact a specialist, and for faster healing of the wound it is necessary to apply a suture.

Preparation for surgical sutures

Let's consider a more or less good situation when we have a clean cloth, tweezers or forceps, scissors or a knife, a disinfectant solution (even strong alcohol from 40 degrees and above will do), and of course, to apply a suture you will need a thread and a needle.

1) The first thing you need to do is stop the bleeding.
Apply a towel or bandages to the wound and press firmly for 10-15 minutes. If you use a tourniquet, remember that disruption of blood flow can lead to very bad consequences, including amputation of a limb. Therefore, a tourniquet can be applied only for the duration of the operation. To ease bleeding, you can raise the limb above the level of the heart. Do not stitch until the bleeding has stopped!

2) Rinse the wound with warm water and make sure that there are no foreign objects or dirt left in the wound. Remove any foreign bodies with tweezers. Treat with hydrogen peroxide, chlorhexidine or other
an antiseptic, or strong alcohol, but this will add to the pain.

3) Sterilize your instruments and wash your hands.
If possible, first wash the tools with soap or simply wipe them well and dip them in antiseptic or alcohol, then lay them out on a clean cloth to dry. You can also work with a wet needle in antiseptic, the main thing is that it does not slip off.
Washing your hands and using an antiseptic is just as important as sterilizing your instruments.

4) Prepare a clean work area.
Ideally, cut a hole in the center of the towel and place it over the injured limb so that the wound is completely visible.

5) Preparing the needle and thread
If you don’t have a special surgical needle, you can use an ordinary sewing needle or, as a last resort, make a suitable needle from a fishing hook. This, of course, will turn out to be very severe, but if the wound is serious and stitching is simply necessary, then it is better than nothing.
To make a more suitable suture needle from a regular sewing needle, you need to heat the sewing needle and use tongs or other improvised means to shape it into a “C” shape.
You need to choose a thread that is strong and elastic; regular fishing line is not the best option here, but it can also be used. Dental floss or synthetic fishing floss, which by the way is found in all paracord bracelets called . Thread
after you cut the desired size (and this is about 10 times the length of the cut), you need to thread the needle into the eye and sterilize everything together.

Suturing while traveling

Please note that the tissues are sutured in layers. That is, in this case we are talking about shallow cuts where internal organs and muscles are not injured. Only the top layer of fabric, the skin, is sutured. To suture muscles, you must contact a specialist. It is most likely impossible to carry out such an operation on your own.

1) Place the first seam stitch.
The first suture should be placed directly in the center of the wound. Take the needle with pliers and pinch the eye of the needle with them. Then turn the forceps so that the tip of the needle is pointing up. Aim the needle so that the tip points straight down into the skin. Of course, if you don’t have tweezers, you’ll have to do it all with your fingers, holding it in another
hand tweezers, align the edges of the wound. Then pierce the skin with a needle about 6mm from the edge of the wound, pass the needle through the wound, and bring it out on the other side of the edge of the wound (again 6mm from the edge).

2) Each stitch will need to be secured with a knot.
Pass the needle through the skin using forceps, then pull the thread until a 5 cm long thread tail remains at the point where the needle enters the skin. Place two loose loops of thread on the tip of the working surface of the forceps. Then, with the tips of the forceps, grab the five-centimeter tail of the thread and, with a gentle upward movement, connect both edges of the wound. Pull the tail of the thread back through the two loops to form a knot. Then gently pull the thread so that the knot lies flat on the skin.

3) Secure the knot.
Using the pliers, quickly pull both ends of the thread toward the skin. This action “fixes” the node and moves it from the wound to the surface of intact skin.

4) Continue placing stitches.
Repeat the procedure with the loop and the “tail” of the thread five times, constantly changing the location of the loop, which will avoid the formation of “blind” knots that will not be able to hold the seam. If your hands work rhythmically while tightening the knots, you are doing everything correctly. Remember to make sure that the knots are on the side and not on the wound itself.

5) Cut the thread.
Trim both ends of the thread, but leave 5mm on one end so that the seam can be removed later.

6) Apply the following stitches.
Choose a middle position between the first stitch and one of the edges of the wound. Repeat steps 2 through 5. Continue placing stitches halfway between existing stitches and tightening knots until the wound is completely closed.

After all the stitches are applied, wipe the surgical site with an antiseptic and apply bandages.

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 suture is to be careful with the edges of the wound being stitched. In addition, the suture should be applied, trying to accurately match the edges of the wound and the layers of the organs being sutured. Recently, these principles have been commonly combined under 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 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.

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. The most common types of seams are:: 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 located 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 properly 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) the 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.

Stitching the edges of a wound has been known to mankind for 4,000 years. One of the first suture materials were threads of plant origin and silk, widely used in Chinese medicine. Modern surgery is rich in a variety of methods, suture materials and directly the types of various sutures that are used depending on the type, location and size of the wound surfaces. In addition, the range of capabilities in this direction is constantly updated.

What is a surgical suture, classification of suture materials

A surgical suture is used to stitch the edges of wound surfaces in living tissue. Today, a large number of different surgical sutures are widely used, used for tissues with different characteristics of strength, ability to join and heal.

The quality of a surgical suture is determined by modern requirements for the characteristics of suture materials and instruments. The success of the outcome of the operation as a whole directly depends on their quality and characteristics. Requirements for suture material began to form already in the middle of the 19th century and were finally established in 1965. Surgical suture material must have the following characteristics:

• Be unpretentious to sterilization. This requirement, today, is perhaps relevant only in the conditions of field surgery. For operating rooms, mainly ready-made kits are used, sterilely prepared by the manufacturer.
• Inertia. Surgical threads, ideally, should not cause any response from the body.
• Thread strength must necessarily exceed the strength of the wound edges for which this thread is used.
• Surgical knots should ensure good reliability of securing the thread at the suture site.
• Resistance of the thread to the development of infection in its structure.
• Threads used for suturing wound edges in internal organs should have the quality of resorption (biodegradation). The initial processes of thread resorption should begin no earlier than the moment of initiation. It is imperative to take into account the biodegradation characteristics on the marking of the suture material.
• Provide good quality comfort in the hand, first and foremost - The threads should not slip out of the surgeon’s fingers and should be sufficiently elastic and flexible.
• Applicable for all types abdominal and external operations.
• Does not have carcinogenic or allergenic activity.
• The thread must be strong enough to break in the area of ​​the node and below it. The strength of a thread is determined by its cross-sectional diameter. The selection of thickness depends on the biological characteristics of the wound edges and the location of the damaged tissue.
• Characterized by low production costs.

Suture materials are classified according to several criteria that determine the physical and biological characteristics of the product.

Depending on the possibilities of biodegradation, they are divided into:

• Absorbable suture materials - catgut, collagen, silk, nylon, cacelon, polysorb, vicryl, polyurethane and others;
• Non-absorbable- lavsan, mersilene, etibond, prolene, polyprolene, coralene, vitaphone, as well as metal wire and brackets.

According to the structure of the threads:

1. Monofilament threads, representing a homogeneous structure;
2. Multifilament- in cross-section, such a thread consists of many smaller threads. Among this group there are twisted, braided and complex threads. When producing a complex of them, it is treated with a special layer of polymer coating in order to reduce the “saw effect”.

It is worth noting that absorbable threads of organic origin, such as catgut and silk, due to their biological nature, are quite reactogenic. This especially applies to catgut. This is the only material in the history of which the development of anaphylactic shock in the patient was recorded.

And under test conditions, it is enough to place one hundred units of staphylococcus bacteria on a thread to cause an infectious inflammatory process in its structure. Currently, there are no indications for the use of catgut in medical surgery - this material can be replaced with synthetic analogues in each surgical case.

Surgical needles are also an important component of a successfully performed surgical operation. Modern medicine uses only atraumatic needles, instead of the traumatic ones that disappeared not so long ago. The difference between these two types is that the instrument is atraumatic due to the equal diameter of the needle and thread, as well as one-time use. Traumatic needles, due to their larger diameter, created a much larger channel in which the thread lay. This condition often contributed to the development of infectious microflora.

In addition, repeated use led to the blunting of the needle, thereby increasing the trauma of the wound edges. Modern surgical kits often contain threads rolled into the needle channel, which significantly reduces the number of manipulations during preparation for surgery, and also allows you to keep the needle diameter within 20-25% larger than the thread diameter. To reduce the “saw effect”, micro-roughness on the surface of atraumatic needles is coated with silicone.

In addition, important parameters of surgical needles are their sharpness and narrowing coefficient. The sharper the needle, the less it injures the tissue, but also the weaker it is at its sharp end. The taper ratio is the ratio of the length of the tip to the diameter of the tool. For sharp needles, this ratio is 1:12. The accuracy of these characteristics is calculated at the time of production by electronic equipment, and production is carried out using a laser.

The next two important characteristics of atraumatic needles are strength and malleability. In fact, these are two interdependent characteristics - when the indicator of one increases, the quality of the other decreases. The strength of a needle is its ability to withstand deformation when passing through tissue, and malleability is the level of bending with the exception of fracture. The markings of the needles indicate the indices of these qualities of the instrument, which allows them to be accurately selected for each specific operation.

There is a certain classification of needles by shape, which further determines their scope of application:

• Stabbing needles used primarily in working with internal organs for applying anastomoses, suturing the edges of soft tissue wounds, and so on;
• Piercing with cutting end used when working with aponeuroses, calcified vessels and other hard tissues. This type of needle is the most common in modern surgery;
• Cutting needles used for hard, durable tissues - when suturing hernias, aponeurosis sutures and on the skin;
• Reverse cutting needles- a special form of the instrument, with the base of the needle facing the wound, thereby ensuring the physical safety of the seam;
• Spatula needles very effective in surgical ophthalmology due to the ability to penetrate between thin, layer-by-layer tissues without causing any significant damage. This type of needle is flat-shaped with side cutting edges;
• Blunt needles are used to work with fragile, collapsing parenchymal tissue, without fear of additional surgical trauma.

Types of surgical sutures

The basis for applying any surgical suture is an extremely careful attitude to the edges of the wound and the most accurate, layer-by-layer comparison of its edges. This phenomenon in surgery is called precision.

Living tissues have different physical properties and biological criteria for healing, based on which different surgical sutures are used. Each type of suture is aimed at better fastening of wound edges and rapid healing.

A feature of working on the skin is always the subsequent cosmetic changes that any surgeon must take into account. In addition, the skin has increased elasticity and the ability to change its surface tension depending on the position of the body and skeletal muscles, which also affects the choice of a particular type of seam.

When surgically treating deep wounds, the knots are usually tightened after all the threads have been inserted. Particular attention is paid to the first node - the correctness of further reduction of the wound edges will depend on its quality.

Most often, the following is used for suturing wound skin edges:

• Continuous intradermal cosmetic suture

It is considered the best in terms of preserving the cosmetic benefits of the skin at the site of stitching. When using this type of suture, the edges of the wound are better connected and, in addition, the microcirculatory effect in the layers of the skin is better ensured. The thread is passed inside the skin - between its layers, parallel to its outer surface. The most commonly used polyfilament absorbable sutures are biosin, monocryl and vicryl. Less commonly used are non-absorbable monofilament ones, such as polyamide and polypropylene.

• Metal staples

Also a common choice in skin surgery, it is preferred when working with skin on visible areas of the body. A characteristic feature of the braces is the absence of the formation of transverse stripes on the skin during healing - as the scar forms, the back of the brace stretches along with the increase in its volume, thereby leaving no mark on the skin.

• Simple interrupted stitch.

In modern skin surgery it is used less frequently due to sufficient visible cosmetic defects after wound healing. In order to reduce the quality of such negative characteristics, It is recommended to remove interrupted sutures on the third to fifth day.

Interrupted sutures are applied one at a time, at a distance between stitches of 1.5-2.0 cm and 0.5-1.0 cm from the edge of the wound. Such indicators increase the level of trophic provision of tissue at the site of a surgical wound. In addition, the deeper skin tissues are captured more actively - this eliminates the divergence of the edges and their eversion at the suture site. The knots begin to be tightened until the wound is aware, and the knot is placed at the points of insertion and removal of the thread, but in no case in the middle of the seam;

• Mattress horizontal U-shaped seam.

It is used in cases where it is difficult to close the edges of the wound. A negative quality of this variety is the possible formation of wound cavities, where during the healing process, wound exudates can accumulate and purulent inflammation develop. To avoid this phenomenon, a multi-layer suture is used.

• Mattress vertical seam according to Donnati.

A distinctive feature of this type of seam is the unequal distance from the edges of the wound to the puncture and puncture of each subsequent stitch. For example, the first stitch is placed at a distance of 2.0 cm from the edges, the second - 0.5 cm, the third - again 2.0 cm, the fourth - 0.5 cm and so on. Moreover, the thread on small stitches passes inside the skin, under the epidermis, and on large stitches - in the deeper layers.

Aponeurosis suture

An aponeurosis is a place of fusion of tendon tissues that have increased strength, thickness and elasticity. The classic place of aponeurosis is the place of fusion of the right and left halves of the abdominal wall. It is worth noting that tendon tissues have a fibrous structure, so stitching them along the fibers increases their divergence with a “saw effect”. Taking into account the increased strength of the tendon tissue and the increased load in the area of ​​the aponeuroses, a separate series of sutures are used, designed specifically for these purposes.

The most common type of suture for connecting the edges of the aponeurosis is continuous wrapping stitch with synthetic absorbable threads- polysorb, biosin, vicryl, often - double threads with the formation of a tightening loop. The use of absorbable threads ensures the absence of the formation of ligature fistulas in the late postoperative period.

In addition, to work in the aponeurosis, it is possible to use non-absorbable suture materials, for example, lavsan. This approach ensures better matching of the edges and, accordingly, a stronger connection and the absence of hernias.

Seam of fatty tissue and peritoneum

Taking into account the physiological characteristics of these tissues, stitching of their edges is now carried out less and less. The edges of surgical wounds on the peritoneum are brought together quite firmly on their own, which ensures their successful fusion and subsequent healing. The same can be said for fatty tissue. Moreover, the absence of stitches does not disrupt the local blood supply at the site of scar formation.

An exception may be the presence of excess fat deposits at the suturing site - the absence of a tight suture of the fatty omentum often leads to the formation of hernias. For these purposes, it is better to use continuous types of sutures with absorbable threads, for example, monocryl.

Intestinal sutures

For suturing large-diameter cavitary tubular organs, there are a sufficient number of different sutures, but most often a single-row continuous suture is used. The distance between the stitches is about 0.5-0.8 cm, which depends on the thickness and strength of the walls. From the edge of the wound to the insertion of the needle, about 0.8 cm is reserved for the intestinal wall and about 1.0 cm for the stomach walls.

In addition, when working on the walls of the digestive tube, the following types of sutures are used:

• Single-row serous-muscular-submucosal Pirogov suture with placement of the node on the outer surface of the organ - the serous membrane.
• Seam Mateshuk. Its characteristic feature is the location of the node inside the organ - on the mucous membrane. Absorbable sutures are most often used.
• The single-row Gambi suture is used to work with the large intestine, reminiscent of the Donatti suture in technique. One of the positive characteristics of this type of suture is the correct tightening of the serous surfaces of the stitched edges.

Liver sutures

Due to a certain “crumbiness” of the organ and its abundant saturation with blood and bile, surgery on the surface and parenchyma of the liver remains a rather difficult task in modern practice. One of the relatively effective methods is the application of a continuous suture without overlap and a continuous mattress suture.

Liver suturing is especially common in small operating rooms. In the presence of modern equipment for ultrasonic cavitation, hot air treatment or the use of fibrin glue, the use of sutures is abandoned.

Various methods of U-shaped and 8-shaped surgical sutures are often used on the gallbladder. It is recommended to use a continuous overlapping suture on the organ bed.

Working on the liver is always preferable with the use of synthetic absorbable sutures and large, blunt needles.

Vascular sutures

The use of a simple continuous suture without overlap on large and small blood vessels provides sufficient tightness. The quality of this condition also ensures a more complex continuous mattress seam. Significant disadvantages of both types include the formation of an “accordion” when the edges of the vessel are pulled together and the knot is tightened. This effect eliminates the use of a single-row interrupted seam.

Stitches on tendons

To work on these fabrics, especially strong threads are used on round needles using the Cuneo and Lange techniques. Working on tendons is complicated by their smoothness and ability to separate fibers. In addition, the physiological effect of the smooth tissue surface should be restored as much as possible. When working on the limbs, they are most often immobilized in a state of maximum unloading of the damaged tendon.

Features of tying surgical knots

Tying a knot is the true key to the success of absolutely any operation. The favorable prognosis of the operation depends on the personal skill and technique of the surgeon, where suturing is one of the key points. The success of fusion of wound edges and the elimination of complications depend on skill in this area.

The main requirements for performing a surgical knot include:

• The number of knots on one seam is not regulated- you need as many of them as will ensure the reliability of the fastening.
• When applying a node n It is important to avoid excessive tension on the fabrics and pulling the edges together.- this will avoid a lack of blood supply to the tissue at the site of fusion and the subsequent development of necrosis.
• The force when tensioning the thread should always be weaker than the moment it breaks.
• Clips are not used in places where knots form, especially for monofilament threads. Their crushing entails a decrease in strength, incorrect tying and possible subsequent unraveling of the knot.
• The knot is tightened until it slides along the thread. It is recommended to use your index finger for control.
• The knot must be tightened in one step, without allowing weakening, otherwise this will lead to divergence of the edges of the wound and a general weakening of the node.

Compliance with the laws of asepsis and antisepsis when applying sutures

In medicine there is such a definition as iatrogenicity. Iatrogenic, as a rule, are complications caused by specialists during the treatment process. Thus, these are additional pathological disorders or diseases that arose due to the fault of the doctor. In surgery, jarogenicity is a fairly common phenomenon, caused, first of all, by the low qualifications of the specialist and his little experience in practical activities.

The most common iatrogenic risks include non-compliance with aseptic and antiseptic measures when working with tissues. First, it is worth accurately distinguishing these two consonant definitions. Asepsis is a system of measures aimed at preventing the entry and development of pathogenic microorganisms - bacteria, fungi and, less commonly, viruses - into surgical cavities and wounds.

TO antiseptics it is necessary to include all actions that prevent further pathological development of the microflora already present in the wound.

Thus, asepsis is more about preventing infection, and antisepsis is about treating and excluding infection, which is more common when working on purulently affected tissues and organs, for example, during the surgical treatment of abscesses, purulent necrosis, gangrene.

Any surgical interventions are carried out in the most accessible sterility of the operating rooms, where regular aseptic treatment is carried out. The same applies to surgical instruments. It is worth noting that most consumables are supplied to the surgery pre-sterilized for single use.

Treatment of the surgical field and wounds is also subject to significant aseptic and antiseptic treatment, the level of which depends on the nature of the operation.

Methods and timeliness of removing surgical sutures

Removal of surgical sutures does not require the presence of a surgeon, provided that complications are excluded. Often this process is carried out by a paramedic or dressing nurse.

Preliminary preparation is aseptic treatment of the seam with disinfectants - most often ordinary iodine. After this, the suture knot is slightly pulled up from the skin until the thread, unstained with iodine, exits the channel. At this point the thread is cut and removed. Subsequent treatment of the seam with iodine solution or other disinfectants is mandatory.

The use of absorbable sutures does not require removal. Sutures are usually removed 7-12 days after the operation, if no complications are found. Stitches in visible areas of the skin are removed first to prevent severe scarring ( 1 ratings, average: 1,00 out of 5)

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To apply a surgical suture you will need a needle holder, tweezers, a surgical needle and thread.

The needle holder is fixed with the right hand, like scissors (see above). The index finger is on the surface of the jaws, which allows for precise, controlled movements (Fig. 4.1). The needle is fixed near the tip of the needle holder branches (at the border of the distal and middle third of the working ends). The extremely distal position of the needle in the needle holder is unreliable - the needle can slip out when suturing dense tissue. It is not advisable to place it near the needle holder lock. In this case, due to excessive force applied by the short arm of the jaw, the needle may be damaged (Fig. 4.2).

Rice. 4.1 Method of holding the needle holder

Rice. 4.2 Fixing the needle with a needle holder

The point of the needle is turned towards the wound, the eye along with the thread loaded into the needle is turned upward (the thread should hang freely), and the threaded section should be approximately a third of the entire length. The length of the thread depends on the characteristics of the intended seam. For continuous seams, you need to take a long thread, and for individual knotted seams, the length of the thread must correspond to the method of tying the knot.

The tweezers, which are used to fix the stitched fabric, are held in the left hand. For adequate fixation, the tissue should be grasped as close as possible to the needle puncture point. This makes the puncture and its advancement easier. The denser the tissue, the closer the tweezer jaws should be placed to the injection point.

The needle is inserted strictly perpendicular to the plane of the fabric being stitched (Fig. 4.3). When injecting and, especially, when removing the needle, the hand should be in a pronated position (Fig. 4.4).

Rice. 4.3 Position of the needle relative to the plane of the fabric being sewn

Rice. 4.4 Position of the hand when pricking and removing the needle from the tissue

It is necessary to correctly form the trajectory of the needle. After the injection, the needle is guided through the tissue, causing it to move in a circle corresponding to its curvature. Ideally, the needle should pass through both edges of the wound strictly symmetrically, capturing the same amount of tissue in the suture. However, one should not always strive to simultaneously pass the needle through both edges. Two-stage execution with exit deep into the wound allows for more correct formation of the suture stitch. This is especially true for deep wounds.

If, at the moment of stitching, the end of the needle lifts the fabric in a lever-like manner, stringing large masses, then the needle, as a rule, breaks.

The needle should be pricked out in close proximity to the branches of the tweezers. As soon as the tip of the needle appears on the surface of the tissue, it is captured by the needle holder. In this case, the hand should be in a pronated position, which will ensure a sufficient amplitude of subsequent movements when removing the needle. Otherwise (i.e., when the hand is in a supinated position), the range of motion will be limited, which provokes unwanted involvement of the forearm and shoulder.

The needle should be removed from the tissue in a circular motion of the hand (supination) along a trajectory corresponding to the curvature of the needle (Fig. 4.5). If this rule is not followed, the needle will be difficult to remove, damaging the tissue.

Rice. 4.5 Location of the knot loops on the side of the wound

When suturing soft tissues, manipulations should be carried out carefully, avoiding sharp, forceful pushing of the needle. The tissue should be threaded onto the tip of the needle carefully, using tweezers for this purpose (Fig. 4.6).

Rice. 4.6 Threading tissue onto a needle with tweezers

It is necessary to flash “on yourself”, i.e. Inject the needle into the edge of the wound farthest from the surgeon, and prick it into the closest one. At the same time, you need to remember that if one of the two edges of the wound is mobile and the other is fixed, then the mobile one should be sutured first. If you plan to sew edges of different thicknesses, start sewing with the thinner one.

Care should be taken to ensure that the distance from the edges of the wound, respectively, to the injection site and to the puncture site, is the same.

When connecting fabrics with interrupted sutures, the assistant holds the free end of the thread throughout the entire manipulation and grabs its other end as soon as it leaves the eye of the needle. During the process of applying a continuous seam, it constantly holds the end of the thread in tension, thereby fixing the connection of the stitched fabrics.

To correctly apply an interrupted suture, the nodes are placed on the side of the wound, and not above it (Fig. 4.7). If the edges of the wound are the same thickness, then it does not matter which side they are placed on. But, nevertheless, it is advisable to place the nodes alternately on different sides of the wound. Previously, this rule was followed for both deep (immersed) and surface (removable) seams. Today this is not given much importance.

In some cases, suturing a wound is the only way to prevent large-scale bleeding and the entry of pathogenic microflora into it. By artificially gathering damaged tissues together, natural regeneration processes proceed much faster. How to stitch wounds depends entirely on the situation. There are a number of tips and recommendations that can save a person’s life in critical situations.

Suturing is a mechanical manipulation to connect the edges of damaged skin, which helps prevent microbes from getting inside and ensures accelerated regeneration. Sutures are placed to restore the natural anatomical position of the epithelial tissues. In the absence of suturing, the wound takes on a chaotic appearance, is often injured, and the surface heals incorrectly, which is fraught not only with cosmetic defects, but also with restrictions on mobility.

Methods of suturing wounds

Not all injuries require stitches, but in especially dangerous situations this manipulation can save a person’s life.

You need to know which wounds need to be sutured:

• 1. If not only the epithelium is damaged, but also the subcutaneous tissue, which is accompanied by a long healing process and a high probability of infection.
  2. If there are cuts in areas of skin tension: knees, elbows, joints, limbs.
  3. If there is a laceration that requires matching of all edges.

Only a specialist can assess the importance of manipulation. If there is a wound, it is better to see a doctor, who will decide whether suturing is necessary or suggest alternative treatment methods.

The following are not subject to stitching:

• scratches, abrasions;
• wounds with divergence of edges up to 1 cm;
• puncture wounds without damage to vital organs;
• penetrating wounds.

Suturing is contraindicated if the victim is in shock and there is a pronounced purulent-inflammatory process in the wound.

Types of sutures depending on the timing of application

There are several types of seams, each of which is used in specific cases:

• 1. Primary blind suture - applied after preliminary treatment and sterilization of the wound to prevent pathogenic microflora from entering the bloodstream.
  2. Primary delayed suture - applied after the 3rd day of injury, when the swelling and inflammatory process in the wound have significantly decreased. A drainage is introduced, with the help of which the purulent contents will be drained out without stagnating inside the wound.
  3. Early secondary suture - used to identify the first signs of regeneration of the deep layers of the dermis. Drainage is installed between the sutures, and the newly formed pink cells are not excised.
  4. Secondary late suture - applied in the presence of a very deep wound, the regeneration of which is carried out from the inside. The manipulation is performed in the absence of pathological processes in the wound.

What types of seams are there?

Currently, staged suturing is not used except in critical situations requiring immediate assistance without the possibility of visiting a qualified specialist. Suturing in the field is often necessary for injuries during hiking, crossings and extreme tourism, when an open deep wound appears.

What is needed for the procedure?

In a surgical setting, the procedure is carried out using sterile needles, suture material, sterile bandages, tweezers and the qualifications of a doctor. If it is necessary to apply primary sutures to save a person’s life, the following materials should be prepared:

• sterile bandages or any clean cloth;
• needle and silk thread or any other thread, fishing line;
• scissors and tweezers;
• vodka, alcohol, hydrogen peroxide, brilliant green.

What types of needles are used for different wounds?

The victim should be placed on a flat surface covered with a clean cloth or blanket. Remove all unnecessary items and cut the clothing at the wound site. If there is bleeding, it is stopped with hydrogen peroxide. If the bleeding is severe, a tourniquet may be needed. This procedure is temporary, and after the bleeding stops, the tourniquet is removed, since there is a high probability that the compressed cells will die due to metabolic disturbances.

The wound is washed with water, removing dust, dirt and debris from it. If there are fragments, they must be carefully removed using tweezers. All necessary tools are calcined over a fire or treated with alcohol-containing substances.

Hands are washed with soap and then treated with alcohol or vodka, which will minimize the likelihood of wound infection. If possible, it is better to move the patient indoors, protected from wind and precipitation.

If there are painkillers in the form of solutions, they can be used to inject the wound site, which will reduce the pain during suturing (Lidocaine, Novocaine, Ultracaine).

Stages of wound suturing

There are several stages of suturing a wound, following the sequence of which you can correctly apply stitches:

• 1. Preparing the needle and suture material - take any needle or fishhook and thread a small piece of thread. Next, moisten the thread with the needle in an alcohol solution or vodka. For convenience, the needle can be bent into an arc using forceps.
  2. Applying the first suture - the dissected tissues are compressed on both sides, after which they pass through the center with a needle, capturing two edges. Each seam is applied separately. First, the center is stitched, after which the edges are processed.
  3. Application of subsequent sutures and fastening of nodules - the sutures should be located on the intact edges of the epidermis, and the nodules should be fixed to the side of the wound. The distance between stitches is 0.5-1 cm.
  4. Treatment of the resulting seam - the seam is generously lubricated with any antiseptic agent. The advantage is brilliant green and Chlorhexidine.
  5. Applying a sterile dressing - a bandage is made from a bandage, gauze or any clean fabric, the size of which protrudes beyond the edges of the wound by 2-3 cm. It is tightly fixed to the seam and bandaged to prevent slipping.
  6. Immobilization of the damaged area - a splint is bandaged to the limbs, which reduces the likelihood of seams coming apart due to additional tissue tension.

If there is a rapid deterioration of the condition or bleeding, ichor or pus from under the sutures, immediate assistance from qualified specialists is required.

Rules for caring for seams

To reduce the likelihood of suture infection, it is necessary to assess the condition of the wound several times a day. Dressing of sutured wounds on the skin is carried out 2-3 times a day. The sterile dressing is carefully removed. If it is difficult to remove, the bandage is first soaked in hydrogen peroxide.

The seam is treated with antiseptics, giving preference to brilliant green and Chlorhexidine. After 2-3 days, when dry removal of the sterile bandage is noted during dressing, the latter need not be applied. Open wound management involves treating the suture without additional application of a bandage.

It is recommended to refrain from hygienic procedures during tissue fusion, as water can cause suppuration and aggravate the postoperative period. After 5-7 days, water procedures in the shower are allowed, after which the seam is blotted with a terry towel and additionally treated with an antiseptic.

Healing time for sutured wounds

On average, epithelial regeneration lasts 5-12 days, but the speed depends on the individual characteristics of the body and the presence or absence of an inflammatory process. Deep wounds with dissection of subcutaneous tissue, muscles and tendons take longer to heal, and their treatment has its own characteristics.

In the presence of a purulent-inflammatory process, the suture may be removed prematurely, which is necessary to destroy pathogenic microflora. How long a sutured wound heals in this case depends entirely on the degree of neglect of the inflammatory process and the complexity of treatment.

In areas of increased skin tension, the regeneration process takes a little longer, and the risk of suture dehiscence is higher. This requires additional fixation and immobilization of the damaged area of ​​the body.

The sutures are removed on days 10-14, when the damaged skin has grown together. Using scissors with thin long ends, the suture material is cut, resulting in two ends. Take tweezers, pinch one end and pull out the thread. There are punctures that will heal soon.

How to remove stitches from a wound

The procedure is quite painful, so it is performed under local anesthesia. After the sutures are removed, the wound is treated twice a day with any disinfectant solutions. It is not recommended to take baths until complete healing.

Features of suturing wounds at home

At home, it is not possible to achieve complete sterility, so suturing is always accompanied by an inflammatory process in the wound. But in the presence of a strong tissue discrepancy, this procedure is a necessary measure that can reduce the risks of developing sepsis.

To do this, prepare boiling water, alcohol, sterile bandages, gloves and a needle and thread. It makes no difference what kind of thread is used to stitch the wound, since if it falls into the hands of specialists, the stitches will definitely be removed and remade using suitable suture material.

Hands are washed with soap and then treated with alcohol. The thread is threaded through a needle and dipped in alcohol or any disinfectant solution for several minutes. Using the left hand, the parts of the diverging tissues are brought closer to each other, and with the right hand, the first suture is placed in the middle of the wound. Each suture must have a knot, and their number depends on the length of the wound.

All manipulations must be carried out carefully with minimal contact of the wound and objects. A sterile bandage or bandage is applied on top, after which the victim should be taken to surgery or an emergency room.

If there is heavy bleeding or a state of shock, no stitches are applied, and all efforts are directed to maintaining the vital processes of the body until the ambulance arrives.

If it is possible to visit a doctor, it is best to suture the wound in an operating room. Incorrectly applied sutures and contact with the wound surface of non-sterile objects can provoke the development of an extensive inflammatory process. This in turn will aggravate the situation and slow down the wound healing process.

How to sew up a wound with an adhesive plaster?

It is difficult to call this a full-fledged seam, but if you have an adhesive plaster, you can reduce the amount of tissue divergence. For these purposes, take several strips of plaster, squeeze the healthy ends of the wound with your left hand and attach the plaster. This allows you to speed up the regeneration process and also reduces the likelihood of pathogenic microflora penetrating inside.

This method is suitable for stitching shallow cuts and wounds. In the future, you will need to consult a surgeon, who will indicate the need for sutures or make sure that this procedure is unnecessary.

Long but shallow wounds require sutures to prevent germs from entering. This is done by the surgeon, but in the absence of the possibility of receiving medical assistance, the sutures are applied independently. If you are unsure of what to do, it is best to cover the wound with a clean rag or bandages and provide the victim with prompt, qualified assistance.