爱爱医资源-基础手术指切口缝合

基础手术技巧之消毒铺巾打结切开缝合黄久佐，PUMC2001，外科第三年住院医师huangjiuzuo01@PUMC2006外科实践课2012年01月11日简介刀：持弓式、持笔式；垂直进刀刀：运用刀腹；装刀卸刀持针器：正确握持、正确夹针持针器：旋转手腕、打外科结线剪：双手稳定、沿线下滑线剪：旋转显露、线尾长度缝合原则：二分之一、垂直进针缝合原则：不留死腔、皮缘外翻垂直下刀，利用刀腹持弓式持笔式装卸刀片持针器：握法、手腕夹针：角度、位置器械打结线剪：双手稳定、沿线下滑、旋转显露不留线尾：深部打结；丝线

留线尾：缝皮；可吸收线缝合：二分之一原则二分之一原则沿鼻唇沟缝合原则：垂直进针、顺针弧度、不留死腔垂直进针

顺针弧度

皮缘外翻

垂直进针，皮缘外翻：愈合快、瘢痕小调整线结，精确对合总结刀：持弓式、持笔式；垂直进刀刀：运用刀腹；装刀卸刀持针器：正确握持、正确夹针持针器：旋转手腕、打外科结线剪：双手稳定、沿线下滑线剪：旋转显露、线尾长度缝合原则：二分之一、垂直进针缝合原则：不留死腔、皮缘外翻总结刀：持弓式、持笔式；垂直进刀刀：运用刀腹；装刀卸刀持针器：正确握持、正确夹针持针器：旋转手腕、打外科结线剪：双手稳定、沿线下滑线剪：旋转显露、线尾长度缝合原则：二分之一、垂直进针缝合原则：不留死腔、皮缘外翻参考文献1.杨学颖编译，基础外科技巧，合记国书出版社（清华）2.EssentialSurgicalSkills,Elsevier3.Coloratlasofcutaneousexcisionsandrepairs.NewYork:Cambridge,2008（协和）4.AdrianM.Richards.Keynotesonplasticsurgery.London:Blackwell,2002Practicemakesperfect!Practicemakesperfect!Thankyouforyourattention!Let’spractice!提高课程设计切口：皮肤张力松弛线、梭形切除比例减小张力：皮下缝合、皮下游离缝合方法：垂直褥式、水平褥式、皮内缝合特殊情况：三角/四角缝合、两边高度不一致缝线的特点：可吸收缝线、不可吸收缝线设计切口：

皮肤张力松弛线梭形切除理想比例减小张力：皮下游离减小张力：

皮下缝合减小张力：

皮下缝合减小张力：

皮下缝合

二分之一原则

沿鼻唇沟垂直褥式水平褥式

皮内缝合两边不一样平三角/四角缝合SuturesAbsorbablevs.non-absorbableSyntheticvs.naturalBraidedvs.monofilament不可吸收缝线的特点可吸收缝线的特点Catgut羊肠线Catgutisderivedfromthesubmucosallayerofsheepintestine.Itelicitsasignificantinflammatoryresponse.Itsabsorptionisunpredictable.Itlosesitsstrengthby8–9days.Itisabsorbedby1month.Adecreasedrateofabsorptionoccursifthesutureischromatized(chromiccatgut).Clinicallycatgutisusuallyusedas:AmucosalsutureAdermalsutureinthefaceAskinsutureinchildren.Polyglycolicacid聚羟乙酸Dexonisasyntheticsuturecomposedofpolyglycolicacid.Itisdegradedbyhydrolization.Itlosesitsstrengthby21daysandisabsorbedby90days.Polyglactin910聚糖乳酸910Vicryl（薇乔）isabraidedsyntheticsuturecomposedofpolyglactin910.Itlosesitsstrengthby21daysandisabsorbedby90days.Itsbraidednaturemaymakeitmorepronetobacterialcolonizationthanmonofilamentalternatives.(VicrylPlus)Itmayprovokeasignificantinflammatoryreactionandsomerecommendthatitisnotusedasadermalsutureintheface.Poliglecaprone25聚糖乙内酰胺Monocryl（单乔/玻璃丝）isamonofilamentsyntheticsuturecomposedofpoliglecaprone25.Ithassimilarabsorptioncharacteristicstovicryl.ItsmonofilamentcompositionmaymakeitlesspronetobacterialcolonizationPolydioxanone聚二氧六环酰胺PDS（普迪思）isamonofilamentsyntheticsuturecomposedofpolydioxone.Itisabsorbedmoreslowlythaneithervicryl,monocrylordexon.Itlosesitsstrengthby3monthsandisabsorbedby6months.Itisprimarilyusedasadermalsutureinareaspronetodevelopingstretchedscars.Non-absorbablesuturesCutaneousstitcheswhichwillneedtoberemoved.Deepstitchestoprovidepermanenttissuefixation.Non-absorbablesuturesNaturalSilk丝线SyntheticPolyamideNylon尼龙线So-namedbecauseitwasdevelopedjointlyinNewYo