BASIC AND SPECIAL SUTURING TECHNIQUES

IN SURGERY

BASIC AND SPECIAL SUTURING TECHNIQUES

IN SURGERY

Andrea FerenczSemmelweis University, Faculty of Medicine

Department of Surgical Research and Techniques

www.semmelweis.hu/mutettan

• 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 PRIMARY GOALSMedieval period

• Type and anatomic location of the wound• Thickness of the tissue• Degree of tension• Desired cosmetic result in the case of skin

THE CHOICE OF SUTURE TECHNIQUE

Basic types of suturesBasic types of sutures

WOUND CLOSURE

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 techniquesSpecial techniques

ClipsStaplersWound closure without knottingZipLineAdhesive strips

SIMPLE INTERRUPTED SUTURE

BASIC SUTURE TYPESBASIC SUTURE TYPES

BASIC SUTURE TYPESBASIC SUTURE TYPES

Simple Interrupted Suture

Simple Interrupted Suture - Skin

BASIC SUTURE TYPESBASIC SUTURE TYPES

BASIC SUTURE TYPESBASIC SUTURE TYPES

Simple Interrupted Suture - Skin

Simple Interrupted Suture – fixation of drains

BASIC SUTURE TYPESBASIC SUTURE TYPES

Roman sandal

Simple Interrupted Suture - gingiva

BASIC SUTURE TYPESBASIC SUTURE TYPES

Simple Interrupted Suture - cornea

BASIC SUTURE TYPESBASIC SUTURE TYPES

Simple Interrupted Suture– mikrovessel

BASIC SUTURE TYPESBASIC SUTURE TYPES

1 mm

Simple Interrupted Suture – nerve suture

n. medianus

BASIC SUTURE TYPESBASIC SUTURE TYPES

Simple Interrupted Suture– mesenterium

BASIC SUTURE TYPESBASIC SUTURE TYPES

BASIC SUTURE TYPESBASIC SUTURE TYPES

Simple Interrupted Suture– mesenterium

Dehiscence

BASIC SUTURE TYPESBASIC SUTURE TYPES

Evisceration - Disruption – „platzbau”

BASIC SUTURE TYPESBASIC SUTURE TYPES

Simple Interrupted Stithes, as a retention suture

BASIC SUTURE TYPESBASIC SUTURE TYPES

Complications

BASIC SUTURE TYPESBASIC SUTURE TYPES

Vertical Mattress Suture sec. Donati

BASIC SUTURE TYPESBASIC SUTURE TYPES

Vertical Mattress Suture sec. Donati - skin

Mario Donati (1879-1946)

BASIC SUTURE TYPESBASIC SUTURE TYPES

Vertical Mattress Suture sec. Allgöwer

BASIC SUTURE TYPESBASIC SUTURE TYPES

Martin Allgöwer (1917-2007)

Vertical Mattress Suture sec. Allgöwer - skin

BASIC SUTURE TYPESBASIC SUTURE TYPES

Horizontal Mattress Suture

BASIC SUTURE TYPESBASIC SUTURE TYPES

Horizontal Mattress Suture - skin

BASIC SUTURE TYPESBASIC SUTURE TYPES

Horizontal Mattress Suture, as retention suture

BASIC SUTURE TYPESBASIC SUTURE TYPES

Simple Running Suture

BASIC SUTURE TYPESBASIC SUTURE TYPES

Simple Running Suture - skin

BASIC SUTURE TYPESBASIC SUTURE TYPES

Simple Running Suture – abdominal wall

BASIC SUTURE TYPESBASIC SUTURE TYPES

Simple Running Suture - GIT

BASIC SUTURE TYPESBASIC SUTURE TYPES

Simple Running Suture - uterus

BASIC SUTURE TYPESBASIC SUTURE TYPES

Simple Running Suture - tongue

BASIC SUTURE TYPESBASIC SUTURE TYPES

Simple Running Suture – vessel suture

BASIC SUTURE TYPESBASIC SUTURE TYPES

Simple Running Suture – vessel anastomosis

BASIC SUTURE TYPESBASIC SUTURE TYPES

BASIC SUTURE TYPESBASIC SUTURE TYPES

Simple Running Suture – vessel anastomosis

Simple Running Suture - cornea

BASIC SUTURE TYPESBASIC SUTURE TYPES

Simple Running Suture, as retention suture

BASIC SUTURE TYPESBASIC SUTURE TYPES

Running-locked Suture

BASIC SUTURE TYPESBASIC SUTURE TYPES

Running-locked Suture - skin

BASIC SUTURE TYPESBASIC SUTURE TYPES

Running-locked Suture - gingiva

BASIC SUTURE TYPESBASIC SUTURE TYPES

Running Intracutan Suture

BASIC SUTURE TYPESBASIC SUTURE TYPES

Running Intracutan Suture - skin

BASIC SUTURE TYPESBASIC SUTURE TYPES

Running Intracutan Suture - skin

BASIC SUTURE TYPESBASIC SUTURE TYPES

Complications

BASIC SUTURE TYPESBASIC SUTURE TYPES

SPECIAL TECHNIQUESSPECIAL TECHNIQUES

SPECIAL TECHNIQUESSPECIAL TECHNIQUES

Clips - skin

Linear Staplers - GIT

Hümér Hültl (1868–1940)

Aladár Petz (1888-1956)

SPECIAL TECHNIQUESSPECIAL TECHNIQUES

Circular Staplers - GIT

SPECIAL TECHNIQUESSPECIAL TECHNIQUES

v. pulm. superior sin.

Staplers – lungs, bronchi, big vessels

a. pulm. sin.

SPECIAL TECHNIQUESSPECIAL TECHNIQUES

Wound closure with knotless suture

SPECIAL TECHNIQUESSPECIAL TECHNIQUES

ZipLine® - skin

1936, Kenya

SPECIAL TECHNIQUESSPECIAL TECHNIQUES

Steri-Strip Adhesive strips

SPECIAL TECHNIQUESSPECIAL TECHNIQUES

Alternative abdominal wall closure techniques

SPECIAL TECHNIQUESSPECIAL TECHNIQUES

Dorylus, army ants

Ants - skin

SPECIAL TECHNIQUESSPECIAL TECHNIQUES

Recovered wound

PRACTICE OF THE SUTURESPRACTICE OF THE SUTURES

PRACTICE OF THE SUTURESPRACTICE OF THE SUTURES