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 it is widely used large number various surgical sutures used for tissues with different characteristics of strength, ability to fusion and healing.
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, perhaps, is 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 qualities convenience in hand, first of all - 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:
- Monofilament threads, representing a homogeneous structure;
- 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, the indications for the use of catgut are: medical surgery does not exist - this material can be replaced with synthetic analogues in every 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.
Besides, reusable led to 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 atraumatic needles are durable and malleable. 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, on the basis of which various 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. Subject to availability modern equipment For ultrasonic cavitation, hot air treatment or the use of fibrin glue, the use of sutures is avoided.
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. From personal excellence and the surgeon’s technique determine the favorable prognosis of the operation performed, 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 the majority 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. First, stitches are removed in visible areas of the skin to prevent the formation of severe scars (No ratings yet)
Features of suture removal after various operations.
Many of us have experienced surgery. These are most often abdominal operations. Many women are familiar with the operation of caesarean section.
There are two options for sutures after Caesarean:
- Horizontal. Most often, a horizontal cosmetic suture is used. It is performed using self-absorbing threads. There is no need to remove the stitches. The threads dissolve completely after 2-3 months. The seams are treated as usual, using an antiseptic.
- Vertical. This incision is rarely used, in this case the suture is vertical. It starts at the navel and ends at the pubic area. This seam is sutured using the interrupted method. Each stitch is tied with a knot. Such suture materials are removed 5-10 days after the intervention. The doctor cuts the stitches and uses tweezers to remove the threads.
Laparoscopy is a minimally invasive operation during which the doctor makes three small incisions to insert probes and tubes. The size of the incisions does not exceed 1.5 cm.
Features of suture removal after laparoscopy:
- Most often, doctors use threads that dissolve as suture material. This results in a neat cosmetic seam.
- In some cases, 1-2 sutures are applied using regular threads.
- The suture material is removed 5 days after surgery.
How are sutures removed from the perineum after childbirth?
Many women have experienced an operation such as an episiotomy. This is an incision of the perineum during childbirth. This operation allows you to increase the diameter of the hole and quickly remove the newborn. The inside is always sutures made of self-absorbing material.
Features of suture removal after episiotomy:
- Such sutures are removed 5-10 days after the intervention.
- The doctor cuts one stitch at a time and quickly pulls out the suture material with tweezers.
- After removing the seams, this area is treated with brilliant green or an antiseptic.
- The internal sutures are not removed; they completely dissolve after three months.
The technique for removing stitches in front of the eyes is completely different from stitches on the body. The fact is that the mucous membrane is very sensitive. After surgery for astigmatism, the sutures are removed no earlier than after 3 months.
Features of suture removal after eye surgery:
- The sutures are removed directly from the eyeball no earlier than after 3 months.
- It all depends on the patient’s well-being. You can definitely say about the advisability of removing sutures after examination by an ophthalmologist.
- Ideally, sutures are removed from 3 to 12 months after the intervention. Further, the threads dissolve on their own, but can cause a lot of inconvenience.
- If the threads break, irritation and tearing may occur.
After lacerations or cuts, cosmetic surgical sutures are often applied. How carefully you remove the stitches will determine how the scar will look.
The procedure for removing sutures after surgery:
- First, remove the bandage; do not tear off the patch or gauze that has dried. Water dressing peroxide and wait until everything gets wet. Carefully remove the bandages.
- Now, using tweezers, gently pull the thread, when the suture material is taut, insert the nail scissors and cut the thread.
- Now use tweezers to carefully remove the threads. Hold the skin with a napkin so that it does not stretch. Otherwise, the seam may come apart.
The skin on the lips is quite delicate and thin. In this area, neat cosmetic sutures are applied. It is worth noting that such sutures are not made with self-absorbing threads, as they can tighten the skin.
Features of removing sutures from the lip:
- There is a mucous membrane in the lip area. Sutures are removed on the 8th day after their application.
- To begin with, the wound is treated with an antiseptic. After this, the seams are cut and the threads are carefully removed.
- It is necessary to hold the skin to prevent it from stretching and the seams from coming apart.
- After the manipulation, the scar is processed. By the time the stitches are removed, the swelling should disappear.
Stitches are also often placed on the fingers. In these places the seams are very small, since the finger area is small.
Features of removing sutures on fingers:
- First, remove the bandage. After this, the wound is disinfected.
- After this, it is worth sterilizing all instruments. Using tweezers, pull the end of the thread towards you.
- Run the scissors through the loop and cut it. When using tweezers, carefully remove the suture material.
- Treat the scar with brilliant green.
The stitches on the leg should be removed a little later. Usually this is 9-12 days after the intervention. In these places, the skin slowly regenerates and grows together. In addition, the timing of removal of suture materials depends on how well everything is with the wound. If it is clean, the suture material is removed faster.
Features of removing stitches from the leg:
- Most often, the wound is stitched using silk or synthetics. Such threads are strong and ensure rapid healing of the wound edges. They are very easy to remove.
- You need to pull the edge of the thread, and when you see a loop and a knot, cut the thread.
- Gently pull the thread with tweezers, holding the skin. If the wound is large, the sutures are removed in two steps with an interval of several days. Stitches are removed one at a time.
- Often staples or wires are used instead of threads. It is better to remove them at the clinic. This is due to the rigidity of the material and the possibility of repeated damage to the epidermis.
Time frame for suture removal:
- 12 days - for amputation
- after 6 days - during surgery in the area of the skull and head
- after 7 days - after shallow intervention in the peritoneum and 9-12 - with deep surgery
- 10-14 days – for breast surgery
- 14 days - for surgical intervention of elderly people, patients with weak immunity and cancer patients
- 7-10 days - after caesarean section
For more information on how to remove suture material yourself, watch the video.
VIDEO: Removing stitches yourself
In any case, it is best to go to the clinic to remove the stitches. Everything is there necessary tools and experienced staff.
VIDEO: Suture removal technique
In most cases, a cesarean section ends with the application of an external cosmetic suture, which heals with the formation of a thin, invisible scar. The duration of the recovery period and the quality of the formed scar largely depends on the care of the wound surface. Complications after applying suture material are rare and can be successfully eliminated with timely consultation with a doctor. Over time, the appearance of the scar can be corrected through cosmetic, hardware, and surgical procedures.
Caesarean section (CS) is an abdominal operation, accompanied by sequential dissection of several layers of soft tissue, which, after removing the child, are connected using suture material.
In most cases, the edges of the external incision of the anterior abdominal wall are fixed by applying a cosmetic suture, after healing of which a thin, invisible scar is formed that does not cause physical and psychological discomfort to the patient.
Types of external cuts and seams
Regardless of the position, size and other features of the incision on the uterus, the dissection of external tissues can be longitudinal and transverse. A longitudinal (vertical) incision is called a corporal cesarean section and is performed along the entire surface of the abdominal wall from the navel to the womb.
As a rule, this type operations are carried out only in emergency situations when emergency care is required for the mother or baby. In this case, due to the high risk of tissue divergence under load, their integrity is restored with a regular, rather than cosmetic, suture.
Other indications for corporal caesarean section:
- pronounced adhesions and inability to gain access to the lower segment of the uterus;
- varicose veins in the lower segment of the uterus;
- significant prematurity of the fetus and the unpreparedness of the woman’s body for childbirth (unformed lower uterine segment);
- planned removal of the uterus after surgery;
- the presence of a longitudinal scar after a previous operation;
- fetal pathology: transverse position, conjoined twins, etc.;
- the need to extract a living fetus from a dead or dying woman.
Currently, for uncomplicated planned CS, Pfannenstiel laparotomy is most often used, which provides the best aesthetic effect with high scar strength. A small transverse incision is made in an arc above the pubis. The resulting scar actually merges with the fold of skin in the lower abdomen and often becomes difficult to distinguish.
Performing a cosmetic seam
The technique for suturing the edges of the wound and the type of threads are selected in accordance with the characteristics of the operation and the presence of certain diseases or complications. To apply a cosmetic suture, special atraumatic needles and other instruments used in plastic surgery are used that do not injure the skin and subcutaneous fat. Suture material is a very thin mono- or poly-fiber thread made of lavsan, silk or synthetic material.
Currently, subcutaneous sutures are most often used, which dissolve on their own within a few weeks after surgery. If their application for some reason is not possible, the integrity of the tissues is restored with non-absorbable threads. In this case, the ligature is removed approximately 7-8 days after the operation. Removal of suture material usually coincides with the day the patient is discharged home.
Features of the cosmetic seam
The cosmetic seam has its own distinctive features:
- It is performed with atraumatic needles (the thread is a natural extension of the needle) and very thin threads.
- Passes inside the skin.
- Practically not visible on the surface of the skin.
- Forms a thin and invisible scar that does not cause discomfort.
When applying a cosmetic suture, the surrounding tissues are much less injured than when using the conventional technique of sewing through all layers of the skin. This technique not only allows you to achieve an optimal aesthetic result, but also significantly reduces the risk of complications and speeds up recovery.
A thin postoperative scar is formed through the use of special self-absorbing threads: silk, lavsan, vicryl or prolene. This material is able to withstand significant loads and ensure reliable healing of the postoperative wound.
Often, after discharge from the maternity hospital, women ask the question: how to remove a cosmetic stitch on their own? Obstetricians-gynecologists answer: there is no need to remove cosmetic intradermal sutures. After 70-120 days, the suture will resolve on its own without the use of any additional procedures. If complications develop (inflammation of the suture or divergence of the threads), it is necessary to urgently seek help from a doctor.
Seam care
Women who have had a cesarean section wonder how long it takes for the stitch to heal. In the absence of complications, superficial tissue restoration occurs within two weeks, and the scar is finally formed after 12-18 months. The duration of the recovery period directly depends on the quality of care for the wound surface.
Postoperative care
While in the hospital, the wound surface is treated daily with antiseptic solutions and sterile bandages made of breathable materials are applied.
For two to three days after the operation, the woman in labor is advised to take painkillers. To prevent infectious and inflammatory complications, broad-spectrum antibiotics are prescribed.
Physical activity is increased gradually to prevent possible damage to the ligature.
Home care
For normal tissue scarring after discharge, the following rules and recommendations must be followed:
- Until complete healing, disinfect the wound surface (hydrogen peroxide, chlorhexidine and other antiseptics as prescribed by the doctor).
- Wear a postpartum bandage that limits the mobility of soft tissues and eliminates the possibility of their divergence.
- Take air baths several times a day, exposing the lower abdomen.
- Limit physical activity and lifting heavy objects weighing more than 2 kg (the child should be picked up and pressed to the chest).
- Avoid mechanical impact on the wound surface (rubbing or scratching the stomach, wearing uncomfortable clothes with tight straps and belts, using hard towels or cosmetics).
- Showering is allowed only after the suture material has been removed.
- Monitor the recovery of the uterus and muscle layer using ultrasound at the time prescribed by the doctor.
A healed scar can be lubricated with sea buckthorn, olive and other oils. After consultation with a doctor, to speed up the scarring process, you can use drugs such as Solcoseryl and Contractubex.
Feeling after surgery
The rehabilitation period largely depends on the individual characteristics of the mother's body, the professionalism of doctors and the quality of the operation performed. However, for some time, the vast majority of women after surgical delivery may experience discomfort of varying nature and intensity.
The following symptoms are normal:
- Moderate pain in the anterior abdominal wall for 3-5 weeks.
- Discharge of ichor (clear or yellowish liquid) with a slight admixture of blood from the wound during the first 5-8 days.
- The scar is convex and dense to the touch (up to 2 months after surgery).
- Moderate skin itching for 1-2 weeks after birth.
Even if the listed symptoms do not cause significant concern to the patient, they should be reported to the attending physician. If pain, itching, burning and discharge do not stop within the specified period or increase over time, mandatory medical attention is required.
Possible complications
Early complications after surgery include:
- Inflammation of the wound after infection. Accompanied by suppuration and swelling of the suture and the surrounding skin, fever, chills, and deterioration in general well-being.
- Divergence of wound contours and rupture of threads. Most often it occurs due to early removal of threads, high physical activity or injury.
- Bleeding and hematomas as a result of extensive damage to blood vessels or certain vascular diseases in a woman in labor.
The listed early complications are diagnosed in the hospital or in the first days after discharge. Treatment depends on the nature and severity of the pathology and includes taking antibiotics, hemostatic drugs, additional dressings or additional suturing of the wound.
Many of the effects of a cesarean section become apparent months after birth. The most common late complication is ligature fistulas, which form as a result of the body’s rejection of suture material or infection of the threads. Their symptoms are:
- redness and slight pain in the scar area;
- periodically occurring suppurations;
- the gradual formation of one or more holes in the skin (fistulas), in which ligature stitches are visible.
If signs of ligature fistulas are detected, you must immediately consult a doctor to surgically remove the remaining threads and treat the wound.
Other rarer long-term consequences of surgical delivery include hernias (bulging of soft tissue on the surface of the scar) and keloid scars. The seal does not pose a threat to health and is purely a cosmetic defect. Such scars usually occur only in patients who are predisposed to excessive tissue growth.
Re-suturing
In advanced cases, surgeons are forced to completely excise the existing scar and re-apply the ligature. It depends on how badly the muscle layers, subcutaneous tissue and skin are damaged. Often, the cosmetic stitch is replaced with a regular one.
The rehabilitation period after repeated surgery increases several times, and the newly formed scar will be more convex, rougher and noticeable. Therefore, if any suspicious symptoms occur that indicate disturbances in normal wound healing, you must immediately seek help. medical care without allowing serious consequences to occur.
Behavior of the scar during subsequent pregnancies
During their second pregnancy, many women who have had a cesarean section report pain and a feeling of tightness in the scar area. Unpleasant sensations increase as the abdomen grows and are most pronounced at the ends of the arched scar. This is due to the denser structure of the skin and subcutaneous fat at the site where the threads pass and the formation of strong adhesions in the surrounding tissues.
If more than 2 years have passed since the previous operation, the scar is considered healthy and there are no contraindications for a new pregnancy, there is nothing to worry about. To soften and increase the elasticity of the skin, the scar can be lubricated with oil or ointments and gels recommended by the doctor. Do not forget that uncontrolled use of medications can seriously harm not only the expectant mother, but also the fetus.
Cosmetic and surgical scar correction
Unfortunately, a well-executed cosmetic stitch does not guarantee the formation of a neat, thin scar in the future. Some women, years after a CS, complain of uneven width, brightly colored, bulging or depressed scars.
There are several correction methods:
- Peeling and scrubbing using special cosmetics, which can be used at home. Recommended for minor improvement only appearance scar after consultation with a cosmetologist or therapist.
- Hardware polishing of a scar using abrasive attachments in specialized aesthetic medicine clinics. To achieve lasting visible result It is necessary to carry out several sessions of procedures.
- Laser resurfacing(fractional thermolysis), which provides a deep effect on the scar and allows you to get rid of pronounced irregularities.
- Drug injections, preventing the growth of keloid scars.
- Abdominoplasty- surgical tightening of the abdominal muscles with the formation of a new smaller scar.
It should be remembered that each of the listed methods of influencing deep defects of the skin and muscles has a number of contraindications and does not allow you to completely get rid of scars.
Everyone knows that after childbirth through a cesarean section, a scar remains on the abdomen, since during this operation, doctors make an incision in the soft tissues of the abdominal cavity and the wall of the uterus. In this case, the incision is quite large so that the baby can be easily pulled out into the light without injuring him.
The types of incisions during a caesarean section directly depend on the course of labor, for example, in case of acute fetal hypoxia or heavy bleeding in the expectant mother, the doctor may decide to perform corporal caesarean section. This means that the incision on the abdomen will be vertically from the navel to the pubic area.
And the wall of the uterus is opened with a longitudinal incision. However, this type of cesarean section is performed quite rarely, since such a suture after a cesarean section is not particularly beautiful - it is very noticeable, tends to become thicker over time, and increases in size.
Typically, a caesarean section is performed Pfannenstiel laparotomy. This is an incision into the skin and subcutaneous fat tissue in the transverse direction, passing along the suprapubic fold. In this case, the abdominal cavity is not opened, and due to the transverse direction of the incision and the fact that it is located inside a natural skin fold, the cesarean section scar will subsequently become almost invisible.
Cosmetic seam after a caesarean section, it is usually applied precisely with a Pfannenstiel incision. With a corporal incision, the strength of tissue joining must be very high, which requires interrupted sutures, and a cosmetic suture after such a cesarean section is absolutely not suitable.
Internal seams, which are applied to the wall of the uterus, have a large number of options, for example, you can use the hardware technique of applying ligatures. The main thing here is to achieve better conditions for the healing of the uterus and reduce blood loss, since the outcome of subsequent pregnancies depends on the strength of the sutures.
Pain relief after caesarean section
As a rule, so that the suture after a cesarean section does not hurt too much, the woman in labor is prescribed painkillers. They are usually used only in the first days, and then they are gradually abandoned. In addition to painkillers, antibiotics may also be prescribed to avoid complications caused by infection.
Also, after a cesarean section, one cannot do without medications that will help contract the uterus and help normalize functions. gastrointestinal tract. After the third day, almost all women in labor refuse to use medications, and already six days after a cesarean section, the sutures are removed, unless, of course, they are self-absorbing.
After the suture heals, it will become almost invisible and will not cause unnecessary trouble to the mother. Of course, if she follows the doctor’s recommendations and takes proper care of him.
How to care for caesarean section stitches?
While you are in the maternity hospital, daily dressings and treatment of the suture after cesarean with antiseptics will be carried out by the medical staff, and after discharge the doctor will tell you how to care for your baby. postoperative suture on your own at home.
The main thing is to remember that doctors will allow you to pamper yourself with a shower only a day after the stitches are removed, and to rub the stitch with a washcloth after a week. If the postoperative period is accompanied by complications, the doctor may prescribe special ointments that will help the suture heal as quickly as possible.
What complications can there be in the postoperative period?
These may be early complications or those that appear after some time. Usually early complications manifest themselves even before the removal of stitches placed after a caesarean section - in the maternity hospital. These include minor bruises and bleeding.
You will easily notice them - the bandage on the seam will get wet with blood. If this happens, inform the medical staff immediately so that the wound does not begin to fester.
It may also occur seam divergence. This complication is dangerous 1-2 days after removal of the ligatures, that is, 7-10 days after cesarean section. To prevent this from happening, avoid strenuous exercise.
If you notice a seam divergence even in a small area, do not try to treat it yourself, but immediately seek qualified help.
Still possible suppuration of the suture. In order to prevent this, you undergo antibacterial therapy in the maternity hospital, but despite this, in some cases the suture still begins to fester.
First, swelling and redness appear, painful sensations are possible, and the skin around the suture left after a cesarean section is tense, then the medical staff makes dressings with a special antibacterial solution, and if the mother’s condition worsens - the temperature rises, the general condition worsens, then doctors can prescribe antibiotics and send you to the gynecological department for treatment.
Late complications
Such complications do not appear immediately; it may take more than one month. The most common complication among them is ligature fistulas. This complication after cesarean section occurs in many women in labor. It occurs due to the body’s rejection of suture material.
The process of developing ligature fistulas is quite long: first there is swelling, then redness, pain, and then pus breaks out. If you carefully examine the wound, you can see in it the culprit of all the troubles - the remaining ligature.
Treating it yourself - applying antiseptic solutions and creams - is useless; the fistula will either close or burst again. Therefore, you need to contact a specialist to remove the thread.
Methods for correcting scars after cesarean section
Usually, when performing a caesarean section, doctors try to make the suture as carefully as possible so that after eight to twelve months it becomes almost invisible.
However, an operation is an operation, and in any case, after it, the scar will be less noticeable for some and more noticeable for others. Therefore, a few months after surgery, you will begin to wonder whether how to remove a scar, left after a caesarean section.
Today, special aesthetic surgery clinics cope with this problem very effectively, where in a few sessions you will get rid of scar tissue using a laser.
Before you go for laser correction, you should consult with your doctor so that he can determine, based on the condition of the seam, when it would be best to undergo the procedure.
A caesarean section is a surgical process that results in the birth of a child if a woman is unable or unwilling to give birth through the natural birth canal. Factors such as multiple pregnancies, malpresentation of the fetus, ophthalmological problems in the expectant mother, and many others may influence the doctor’s decision on surgical delivery. During the operation, an incision is made in the abdominal tissue to remove the newborn from the uterus. After such manipulations, a seam will remain at the site where the skin tissue is cut on the woman’s body. What could he be like? What are the possible complications with the seam and how to remove it?
Sutures after cesarean section: types and features
Caesarean section is abdominal surgery, in which soft tissues are sequentially dissected, subsequently connected with sutures. Taking into account the process of childbirth and the complications that arise, the mother’s abdomen can be cut in different ways: vertically and horizontally. Sutures are applied both externally and internally.
External seams: vertical, horizontal
Vertical tissue dissection is performed from the navel to the pubic area and is called a corporal cesarean section. This type of operation is never planned. It is carried out only in emergency situations when it is necessary to provide immediate assistance to a woman in labor or a baby.
A vertical suture remains after a caesarean section when the operation has to be performed urgently
The decision to perform a corporal caesarean section can be made:
- in case of acute fetal hypoxia (oxygen starvation resulting from disruption of air transport from the placenta to the child);
- if a woman giving birth begins to experience heavy bleeding;
- if it is not possible to penetrate the lower segment of the uterus during adhesions;
- with varicose veins in the uterus (due to the risk of heavy blood loss);
- if a woman gives birth again by caesarean section, and there is already a longitudinal suture;
- in emergency conditions requiring urgent termination of pregnancy in order to save the life of the mother.
The vertical seam becomes denser and rougher over time. Heals slower than horizontal. With a corporal incision, interrupted sutures are applied for the most durable connection, since the abdominal cavity is also opened. In this case, applying a cosmetic (continuous, neat) seam is impossible.
If a cesarean section is planned and no complications arise, a horizontal tissue incision is made, which is called a Pfannenstiel laparotomy. The incision is made just above the pubis.
This zone coincides with a natural fold of skin, the incision of which does not affect the abdominal cavity. When using the Pfannenstiel method, a cosmetic suture is applied, which over time will turn into a thin strip that is completely invisible under the underwear.
With a horizontal incision, the abdominal cavity is not opened
Most often, sutures are placed subcutaneously and dissolve on their own.
If applying self-absorbing sutures is impossible for any reason, the tissues are connected with threads, which are removed from the suture after about a week.
Internal seams
In order to reduce blood loss and speed up the healing process, an internal suture is placed on the walls of the uterus. The tissues are connected with a self-absorbing thread.
An internal suture is placed on the uterus to speed up the healing of the organ and reduce blood loss
Such seams are connected longitudinally when cut vertically, and transversely when cut horizontally. Since the suture is performed inside the body, only self-absorbable materials are used.
The internal suture can be applied either manually or mechanically, depending on the equipment of the clinic (maternity hospital). The main thing is to make it durable, which is what the surgeon’s efforts are aimed at, since subsequent pregnancies will directly depend on this.
There is no such thing as stitch care. But a woman needs to know that to prevent internal seams from coming apart, precautions must be taken. It is advisable to lie down more or be in a reclining position. Get up smoothly, without jerking. It is advisable not to carry a child in your arms. You will have to follow these measures for about a month.
You should also exclude sexual relations for at least 2 months. During this period, the sutures will become elastic, and the walls of the uterus will grow together well. Otherwise, unhealed tissue may become injured or infected.
What are self-absorbing sutures?
Absorbable sutures are those that break down naturally in the human body under the influence of enzymes. Depending on the type of material, they disappear within a period of 10 days to 2 months.
Absorbable sutures are characterized by their ability to dissolve over a period of time
The following types of absorbable materials exist:
- Catgut is a natural surgical suture material made from the intestines of sheep or cows. It is considered the fastest disappearing. Resorption time ranges from 7 to 12 days;
- vicryl, dexon, polysorb - synthetic threads that are an alternative to catgut, but more convenient to use. They are less slippery and more durable. However, in some cases, the human body may perceive synthetics as foreign body. Complete resorption of the material occurs within 8 weeks.
On what day after surgery are sutures removed?
With a vertical section, the suture is usually removed after seven days. As a rule, the procedure is carried out on the day of discharge, although the thread can be removed starting from the fifth day.
Cosmetic sutures are most often performed with absorbable sutures, so they do not require removal. If a non-absorbable thread was used, the suture is removed on the seventh day after surgery.
The sensations experienced when sutures are removed can be described as unpleasant rather than painful. The procedure lasts a matter of minutes.
How long do stitches take to heal?
The speed of healing depends on the method of suture application:
- with a horizontal incision, the suture will heal for about two months;
- If the suture is applied vertically, healing will last at least two months.
During the healing of the suture, the following phenomena may be observed:
- pain. The phenomenon is natural, since there was a dissection of the skin tissue and the uterus. Since the pain is usually severe, the doctor prescribes painkillers;
- hardness. The vertical suture remains hard for approximately 1.5 years after the operation, then gradually softens, but looks very unaesthetic. The horizontal seam becomes soft and unnoticeable throughout the year;
- itching About a week after surgery, severe pain will be replaced by itching, which is a sign of healing. During this period, it is important to restrain yourself and not comb the seam. Unpleasant sensations can be reduced by stroking;
- discharge. Just like itching, they are a natural, although optional, healing process. The release of translucent fluid should not be alarming if it occurs during the first week after surgery. If the suture continues to become moist in the second week, and (or) the discharge contains blood or pus, you should immediately notify your doctor.
Problems with suture healing
In some cases, after a cesarean section, complications may arise, which can be divided into early (occurring in the first days after the suture) and late.
Early complications
Some time after surgical delivery, various complications may arise during the healing of the suture.
Bleeding
Bleeding is manifested by bloody discharge from the suture. As a rule, such a complication is nothing more than a consequence medical error, in particular, improper suturing of blood vessels. Also, bleeding may occur due to careless handling or wrong shift bandages.
Hematoma
Hematoma is a blood plug resulting from rupture of blood vessels. Just like blood leaking from a suture, it may be a consequence of incorrect suturing of blood vessels. This phenomenon can also occur due to the fact that the stitches were removed ahead of schedule or not very carefully.
If we consider the reasons not related to the incorrect actions of doctors, then these include:
- varicose veins in a woman in labor;
- kidney problems;
- diseases of the cardiovascular system;
- anemia and blood diseases.
Suppuration
Suppuration of the sutures can occur due to infection entering the wound. A cloudy liquid with a slightly sticky consistency with a characteristic unpleasant smell. Symptoms preceding suppuration will be redness and swelling. Pain and fever may subsequently occur.
Antibacterial therapy started in a timely manner will correct the situation quite quickly. It is important not to self-medicate, so as not to wait until surgery.
The suture may begin to separate due to an infection, as a result of which the tissues slowly grow together. But the most common reason is heavy lifting. After surgery, a woman is not recommended to lift more than 4 kg. But this becomes almost impossible if a happy mother gives birth to a strong baby. It is very important to shift some of the responsibilities around the house to someone close to you.
Seam dehiscence is one of the most common problems during the recovery period.
Sometimes the stitches come apart within a few days after the threads are removed. To prevent this complication, women are recommended to get proper rest and lifting heavy objects is prohibited.
Late complications
Late complications do not appear immediately, perhaps even a month will pass.
A ligature is a thread used to tie off blood vessels. A fistula is a cavity inside the body connecting the organ in which it formed with the external environment.
Ligature fistula is inflammation around the area where the ligature is applied. It looks like a small lump from which pus periodically leaks. There may be redness around the area. Often the ligature fistula is warmer than other areas of the body. It causes pain.
Ligature fistula occurs due to inflammation and suppuration of non-absorbable surgical sutures with which the tissue is sewn
It can be formed due to an infected thread, or the body simply rejects the ligature as a foreign body.
Self-medication is unacceptable. At the first sign of complications, you should immediately consult a doctor. In some cases, it may go as far as cutting the suture and then reapplying it.
A keloid suture is an aesthetic defect in which there is no pain or discomfort. A keloid suture is formed due to the growth of a dense layer of tissue on the scar. The result is a wide, curved scar. Most often, its formation is associated with the characteristics of the skin. The defect can be almost completely eliminated through cosmetic or laser intervention.
A keloid scar is a cosmetic defect that does not pose a threat to health.
Hernia
The emergence of an organ from the cavity it occupies and its protrusion under the skin into the space between the muscles is called a hernia. It looks like a lump under the surgical scar, causing pain.
A hernia can occur:
- due to constipation in a woman, during which the muscles damaged after surgery become very tense;
- due to poor nutrition, since indigestion increases intra-abdominal pressure;
- after lifting weights.
If a hernia is detected, you should seek medical help. Surgery may be performed to eliminate it. In some cases, for small hernias, wearing a bandage is prescribed.
When to do an ultrasound of the suture
The condition of the sutures after a cesarean section needs to be monitored. The most effective diagnostic method is ultrasound, since it is a safe, accurate and painless study that allows you to identify or exclude various abnormalities in the healing process of the suture.
Ultrasound of the suture after cesarean section allows you to find out about its condition
An ultrasound after surgical delivery is usually performed on the third or fourth day or on the day of discharge from the maternity hospital and is designed to assess the integrity of the sutures on the uterus and the condition of the perisuture space.
After discharge, a routine ultrasound is not prescribed; it can be performed in cases where the woman experiences severe pain or there is a suspicion of complications.
What is seam failure?
An incompetent suture is a pathology that represents areas of skin that have not fused or have become scarred in such a way that the uterus is not capable of stretching. This means the impossibility of subsequent pregnancy.
The reasons for the development of this pathology may be:
- emergency caesarean section;
- early onset of the next pregnancy after surgical birth;
- inflammation of the suture;
- abortion soon after caesarean section.
Failure of the suture requires immediate surgical intervention, during which the scar is dissected in order to apply new sutures. If the outcome of therapy is favorable, a full-fledged scar will subsequently form on the uterus.
Accordingly, the suture can be called sound if its healing proceeded without pathologies.
Suture care after surgery
On the first day after transfer from the ward intensive care Processing of the seam begins as usual. As a rule, it is carried out nurses once (less often twice) once a day with a solution of brilliant green.
By treating the seam with brilliant green, you will speed up the healing process
The procedure is performed by applying brilliant green to the suture area with a cotton swab, followed by covering the wound with a bandage or postoperative plaster.
The patch is a sterile bandage made of elastic non-woven material. Thanks to its special structure and manufacturing tricks, it retains biological fluids released from the wound inside the tampon, while at the same time allowing air to pass through, allowing the skin to breathe. In addition, these adhesive plasters are hypoallergenic.
Postpartum stitch care also includes wearing a special bandage. It will help reduce pain and help cut muscles return to normal faster.
Postpartum bandage is a well-known and long-tested means of getting in shape
On the day of discharge, the doctor should give the young mother recommendations for caring for the suture at home. They will be something like this:
- wash the scar regularly with soap intimate hygiene or baby bath products without a washcloth;
- wipe the seam with soft blotting movements;
- continue processing the seam until the ichor finally stops oozing (usually this period lasts about two weeks);
- do not lift more than two kilograms for at least two months;
- try not to make sudden movements.
Video: caring for seams
What is a cosmetic stitch
When performing a cosmetic suture, precise suturing of the sides of the wound is ensured. When applying it, atraumatic needles are used that do not injure the skin and subcutaneous fat. The threads are made from very fine silk or synthetic material.
Cosmetic seam looks more aesthetically pleasing
Within a year, such a seam will be practically invisible on the skin.
How to remove a seam
The natural desire of a young woman is to have a beautiful body, the concept of which does not include a scar. There are some methods of influencing the seam, allowing you to remove it or at least visually reduce it.
Metroplasty
Metroplasty is an operation that corrects an incompetent scar on the uterus. Typically, women undergo open laparotomy surgery, in which the previous scar is cut and new sutures are placed. Open plastic in this case, it is convenient, since during the manipulation it is necessary to provide access to the area under the bladder, which is an area of abundant blood supply. If it is necessary to urgently stop bleeding, the open method of surgery is considered optimal.
However, metroplasty is also performed using the laparoscopic method, which minimizes the risk of formation of adhesions in the abdominal cavity. With this method of operation, cosmetic effect and short term rehabilitation.
The method of performing the operation is chosen by the attending physician.
Grinding
You can grind the seam to soften and reduce it with microparticles of aluminum oxide. The polishing procedure can be carried out by a cosmetologist. This method involves about eight sessions.
Laser resurfacing
More in an efficient way Laser resurfacing is considered. During this procedure, thin layers of connective tissue are removed. As a result, the scar smoothes out and becomes less noticeable. The procedure requires multiple repetitions to achieve the best results. Laser resurfacing is usually repeated five to ten times, after which a course of antibiotics is prescribed to prevent the risk of infection.
Laser resurfacing - effective and safe method eliminating scars
Massage
You shouldn’t expect a global effect from the massage, but you will still get results. Special creams will help enhance the effect of softening and reducing the scar, the possibility of using which should be discussed with a dermatologist and cosmetologist.
You can start the massage after the stitch has completely healed, pressing on it with your fingertips using gentle, smooth movements. You need to repeat the procedure several times a day for five minutes.
Complications after surgical delivery by cesarean section are very diverse. None of us are immune from them. However, it is within our power to use basic preventative measures and not to self-medicate. The main result of childbirth is the birth of a long-awaited baby, even if the tummy is now not as beautiful as before.
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