BASIC AND SPECIAL SUTURING TECHNIQUES IN SURGERY Andrea

BASIC AND SPECIAL SUTURING TECHNIQUES IN SURGERY Andrea Ferencz Semmelweis University, Faculty of Medicine Department of Surgical Research and Techniques www. semmelweis. hu/mutettan

THE PRIMARY GOALS Medieval period • Gentle handling of the tissues • Closing dead space • Supporting and strengthening wounds until healing • Approximating wound edges for structural, functional and an aesthetically pleasing result • Minimizing the risks of bleeding and infection

THE CHOICE OF SUTURE TECHNIQUE • Type and anatomic location of the wound • Thickness of the tissue • Degree of tension • Desired cosmetic result in the case of skin

WOUND CLOSURE Basic types of sutures Interrupted sutures: simple interrupted suture vertical mattress suture (sec. Donati, sec. Allgöwer) horizontal mattress suture Running sutures: simple running suture running-lock suture running intradermal suture running vertical mattress suture sec. Donati running horizontal mattress suture Special techniques Clips Staplers Wound closure without knotting Zip. Line Adhesive strips

BASIC SUTURE TYPES SIMPLE INTERRUPTED SUTURE

BASIC SUTURE TYPES Simple Interrupted Suture

BASIC SUTURE TYPES Simple Interrupted Suture - Skin

BASIC SUTURE TYPES Simple Interrupted Suture – fixation of drains Roman sandal

BASIC SUTURE TYPES Simple Interrupted Suture - gingiva

BASIC SUTURE TYPES Simple Interrupted Suture - cornea

BASIC SUTURE TYPES Simple Interrupted Suture– mikrovessel 1 mm

BASIC SUTURE TYPES Simple Interrupted Suture – nerve suture n. medianus

BASIC SUTURE TYPES Simple Interrupted Suture– mesenterium

BASIC SUTURE TYPES Dehiscence

BASIC SUTURE TYPES Evisceration - Disruption – „platzbau”

BASIC SUTURE TYPES Simple Interrupted Stithes, as a retention suture

BASIC SUTURE TYPES Complications

BASIC SUTURE TYPES Vertical Mattress Suture sec. Donati

BASIC SUTURE TYPES Vertical Mattress Suture sec. Donati - skin Mario Donati (1879 -1946)

BASIC SUTURE TYPES Vertical Mattress Suture sec. Allgöwer

BASIC SUTURE TYPES Vertical Mattress Suture sec. Allgöwer - skin Martin Allgöwer (1917 -2007)

BASIC SUTURE TYPES Horizontal Mattress Suture

BASIC SUTURE TYPES Horizontal Mattress Suture - skin

BASIC SUTURE TYPES Horizontal Mattress Suture, as retention suture

BASIC SUTURE TYPES Simple Running Suture

BASIC SUTURE TYPES Simple Running Suture - skin

BASIC SUTURE TYPES Simple Running Suture – abdominal wall

BASIC SUTURE TYPES Simple Running Suture - GIT

BASIC SUTURE TYPES Simple Running Suture - uterus

BASIC SUTURE TYPES Simple Running Suture - tongue

BASIC SUTURE TYPES Simple Running Suture – vessel suture

BASIC SUTURE TYPES Simple Running Suture – vessel anastomosis

BASIC SUTURE TYPES Simple Running Suture - cornea

BASIC SUTURE TYPES Simple Running Suture, as retention suture

BASIC SUTURE TYPES Running-locked Suture

BASIC SUTURE TYPES Running-locked Suture - skin

BASIC SUTURE TYPES Running-locked Suture - gingiva

BASIC SUTURE TYPES Running Intracutan Suture

BASIC SUTURE TYPES Running Intracutan Suture - skin

BASIC SUTURE TYPES Complications

SPECIAL TECHNIQUES

SPECIAL TECHNIQUES Clips - skin

SPECIAL TECHNIQUES Linear Staplers - GIT Hümér Hültl (1868– 1940) Aladár Petz (1888 -1956)

SPECIAL TECHNIQUES Circular Staplers - GIT

SPECIAL TECHNIQUES Staplers – lungs, bronchi, big vessels a. pulm. sin. v. pulm. superior sin.

SPECIAL TECHNIQUES Wound closure with knotless suture

SPECIAL TECHNIQUES Zip. Line® - skin 1936, Kenya

SPECIAL TECHNIQUES Steri-Strip Adhesive strips

SPECIAL TECHNIQUES Alternative abdominal wall closure techniques

SPECIAL TECHNIQUES Ants - skin Dorylus, army ants Recovered wound

PRACTICE OF THE SUTURES