Types of sutures placed on the wound after surgical treatment. Surgical sutures
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 germs 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 sutures, but 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 on the need for suturing or suggest alternative methods treatment.
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 disorders.
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 heated 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 fishing hook 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 infection of the suture, 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. Wound management open method involves treating the seam 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 are allowed water procedures under the shower, after which the seam is blotted 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 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, parts of diverging tissues are brought closer to each other, and right hand Place the first suture 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.
After performing surgical access and the surgical intervention itself, as well as ensuring complete hemostasis in the wound, the wound is sutured.
The basic principle of joining fabrics is their layer-by-layer stitching in the reverse order of separation, with their maximum approach and matching of edges.
In this case, it is necessary to strictly comply with the following requirements:
stitching of the tissues of the surgical wound is carried out in the reverse order of dissection,
stitching is carried out strictly layer by layer,
homogeneous tissues must be sewn together,
layer-by-layer tissues are stitched together in such a way that there are no voids left between them in the future, to prevent the accumulation of blood and subsequent suppuration,
when stitching each layer, the injection and puncture of the needle should be at the same level and strictly perpendicular to the cut line,
suturing must be performed with an accurate and even comparison of the edges of the wound, that is, strictly precision,
When joining tissues, it is imperative to take a careful, gentle attitude towards the edges of the wound being stitched, in order to avoid unnecessary trauma and the likelihood of suture failure.
The joining of fabrics is carried out with silk, nylon, lavsan, absorbable threads (catgut), tantalum staples using Gagara, Mathieu needle holders or various stitching devices.
Sutures are applied with surgical needles: straight and curved:
cutting (the cross section of which is a triangle)
round or intestinal (in cross section which circle)
atraumatic (in which the eye of the needle is soldered to the thread in the factory).
To sew stitches, the needle must be threaded correctly. The three-thirds rule is used:
One third - the needle is fixed by the tips of the branches of the needle holder, namely between the distal 1/3 and proximal 2/3 branches.
The second third - the needle is fixed with a needle holder so that 1/3 of it from the eye is to the right of the jaws, and 2/3 of the tip of the needle is to the left of the jaws of the needle holder.
Third third - the thread is inserted into the needle from the side of the “nose” of the needle holder against the bend of the needle and threaded in such a way that the short tip of the thread is 1/3 of the long one.
There are interrupted and continuous sutures. The advantage of an interrupted suture over a continuous one is that if one of the stitches accidentally cuts through, the adjacent stitches hold the edges of the wound, and if the wound becomes suppurated, one of the sutures can be removed to drain the pus without touching the others. When one of the stitches of a continuous suture is cut through, the entire suture can relax, and if the wound becomes suppurated, the entire suture must be removed. The advantage of a continuous suture is greater hemostaticity and speed of application compared to an interrupted suture.
APPLICATION OF CONNECTED SUTURES.
An interrupted suture is used on the skin, subcutaneous tissue, fascia, hollow organs, etc.
The knotted seam consists of individual stitches, each of which includes four moments: pricking, pricking, pulling the ligature and tying it. The distance between stitches depends on the thickness of the fabrics being sewn: the thinner the fabric, the more frequent the stitches. Interrupted sutures are placed on the skin at a distance of 1.0-1.5 cm from each other. The edges of the skin of the wound are grabbed with tweezers, injecting the needle from the outside inward at a distance of 1.0-1.5 cm from the edge and placing the tissue on the needle with tweezers, while moving the hand according to the curvature of the needle, draw the needle through the entire thickness of the skin. On the other side of the wound, a puncture is made from the inside out using the same technique, at a distance of 1.0-1.5 cm from the edge of the skin, fixed with tweezers, strictly opposite the needle insertion. When suturing the skin, the subcutaneous tissue must be sutured to avoid the formation of spaces where hemorrhagic exudate can accumulate. After application, the interrupted suture is tightened until the skin edges touch without squeezing the tissue. The assistant adapts the edges of the wound using surgical tweezers, accurately matching homogeneous tissues with each other. The suture knot should be placed to the side of the wound line.
APPLICATION OF U-SHAPED SUTURES.
U-shaped sutures are used for suturing muscles, blood vessels, tendons, nerves, aponeurosis, for repairing umbilical hernias, etc.
When applying a U-shaped suture, the surgeon stitches the fixed muscle with tweezers from the outside to the inside, moving 1.0-1.5 cm from its edge. Without pricking out the needle, the other edge of the muscle is grabbed with tweezers and stitched from the inside out on the other side of the wound, pulling the thread along the curvature needles and pricking at a distance of 1.5-2 cm strictly opposite the needle insertion. Then the surgeon shifts the needle in the needle holder so that he sews away from himself: 1/3 of the needle from the eye to the left of the jaws of the needle holder and 1/3 of the needle from the tip to the right of the jaws. At a distance of 1.0-1.5 cm from the puncture of the first suture, the surgeon uses the same thread to inject from the edge of the muscle 1.0-1.5 cm and draws the needle from the outside to the inside, piercing the entire thickness of the muscle without puncturing the needle, grasping it with tweezers the other edge of the muscle, the surgeon stitches this edge of the muscle from the inside out, passing the needle through the tissue along its curvature, puncturing at a distance of 1.0-1.5 cm from the edge strictly opposite the second needle insertion. With this stitching, a seam is formed in the form of the Russian letter P with the ends of the threads on the assistant’s side. The suture is tightened only until the muscle touches without compressing it and tied.
APPLICATION OF Z-SHAPED SEAM.
The Z-shaped suture is used when suturing muscles and as an aseptic suture on the intestine for immersing the stump of the appendix during appendectomy and when forming stumps during intestinal resection and side-to-side anastomoses.
A Z-shaped suture is placed on the muscle as follows. The surgeon fixes the edge of the muscle with tweezers, which is stitched from the outside to the inside, 1.0-1.5 cm away from the edge. Without pricking out the needle, the other edge of the muscle, fixed with tweezers, is stitched from the inside outwards, the needle and thread are pulled along the curvature of the needle and the needle is pricked out 1 .0-1.5 cm from the edge of the wound strictly opposite the needle insertion. Using the same thread, the surgeon makes the same suture at a distance of 1.0-1.5 cm from the first one: he sews the edge of the muscle towards himself from the outside inward and, without inserting a needle, stitches the other edge of the muscle from the inside out along the curvature of the needle. Prick and poke the needle strictly opposite each other and at a distance of 1.0-1.5 cm from the edge. As a result, a Z-shaped seam is formed, which is tightened only until the edges of the muscles touch and is finally tied.
APPLICATION OF A CONTINUOUS SUTURE.
Continuous sutures are placed on vessels, the parietal peritoneum when suturing a laparotomy wound, on the posterior lip of the anastomosis after resection of the stomach or intestine, etc.
When applying any continuous suture, first the edges of the wound are sutured with the usual separate interrupted suture, but the length of the thread should be about 30 cm. When tying a knot, leave 1 end of the thread short (it is cut off, leaving a section of thread along the width of the jaws of the scissors) and the other long, which the seam is made. When applying a continuous suture with this length of thread at a distance of 0.5-1.0 cm from each other and retreating 0.5-1.0 cm from the edge of the wound, stitching the tissues fixed with tweezers towards you from the outside inwards and from the inside outwards (peritoneum , vessels) and from outside to inside (intestines, stomach). After tightening each stitch, the assistant fixes the thread with anatomical tweezers so that the seam does not unravel (do not relax). All continuous seams end in the same way: after sewing the last stitch, tie the end of the thread to the last loop of the seam.
APPLICATION OF THE MULTNOVSKY SUTURE.
The Multanovsky suture is applied to the parietal peritoneum when suturing the laparotomy wound and to the posterior lip of the anastomoses after resection of the stomach and intestines.
The Multanovsky or twisting suture, like all continuous ones, begins with the application of a separate interrupted suture with a long thread (as when applying a continuous suture). After cutting off the short end of the ligature with a long thread, a suture is applied in the same way as a continuous one, but each stitch is sewn into a loop and tightened. Such a seam ends, like all continuous ones, by tying the end of the thread to the last loop of the seam.
APPLICATION OF MATTRESS SUTURE.
Mattress sutures are used when suturing blood vessels, applying cosmetic sutures, and when applying secondary sutures.
Like all continuous ones, the mattress suture is applied with a long thread and begins with sewing a separate interrupted suture. After tying such a seam on the assistant’s side and cutting off the short end of the thread, the fabric is sewn with a long thread according to the principle of applying a U-shaped seam. Stepping back 0.5-1.0 cm from the tied knot, the surgeon stitches the tissue towards himself from the outside inwards and from the inside outwards. Then the needle is moved in the needle holder so as to sew away from you, as when applying a U-shaped seam, and at a distance of 0.5-1.0 cm from the puncture of the previous stitch, the surgeon stitches the edges of the wound, fixed with tweezers, from the outside inwards and from the inside outwards, pulling needle with thread along the curvature of the needle and making an injection 0.5-1.0 cm from the previous injection and at a distance of 0.5-1.0 cm from the edge strictly opposite the injection, etc. In this case, the assistant fixes the thread with anatomical tweezers in avoid seam divergence. Such a seam ends after applying the last stitch by tying the end of the thread with the last loop of the seam.
Upon completion of the primary surgical treatment You always have to decide whether to sew the wound tightly, partially, or leave it open. The desire to stitch a wound tightly is very understandable and is explained primarily by the fact that a sutured wound heals in a shorter time. This issue is especially important when treating gunshot wounds, which have their own characteristic pathomorphological features.
Deadlines for their application.
The suture applied to the wound at the completion of PSO is called primary. Such a suture is permissible to apply only in cases where there is complete confidence in the absolutely radical primary surgical treatment, i.e.:
Treatment was performed in the first 6-8 hours after damage;
Completely removed foreign bodies, necrotic tissue, hematomas and areas of microbial contamination;
Reliable hemostasis is ensured;
There is no damage to the main vessels and nerve trunks;
The edges of the wound come together freely without tension;
The general condition of the wounded is satisfactory;
It is possible to continuously monitor the operated patient for 4-5 days.
Confidence in meeting these conditions can only be when treating shallow musculocutaneous wounds, which limits the scope of application of primary sutures. If there is no such confidence, the wound is loosely packed.
Packing the wound should be carried out in such a way that the gauze swab loosely fills the entire wound cavity. Large quantity medications, proposed for wetting tampons, makes their final choice difficult. However, wound packing has three purposes:
Keep the wound open;
Ensure the outflow of wound fluid (for this, the tampon must be hygroscopic);
Create an antiseptic environment in the wound.
Hypertonic sodium chloride solution.
Primary provisional sutures can be applied when, upon completion of the primary surgical treatment, there is no complete confidence in its radicality, however, the nature of the wound and the degree of its contamination do not inspire any particular concern. In such cases, sutures are applied without tightening the threads. After 3-4 days, with a calm wound, the threads are pulled and tied.
Delayed primary suture applied in cases where on the 3-6th day after PSO it turns out that the swelling has decreased or subsided, the color of the wound walls has not changed, the walls are actively bleeding, there is no pus or necrotic tissue in the wound.
In the case of a gunshot wound, by this time the tissues caught in the zone of molecular shock either become necrotic or restore their viability. If inflammatory-necrotic changes are noted during dressing, the wound still cannot be sutured.
Secondary early suture applied when, after suppuration of the wound and subsequent cleansing of pus, its bottom and walls are filled with granulations.
This usually occurs on the 10-18th day after injury. At the same time, during this period, contraction of the wound edges usually occurs and they diverge somewhat. In some cases, special techniques must be used to bring together and hold the edges of such a wound.
When stitches have to be placed after more than long term after injury, the walls of the wound become rigid, the edges of the wound and partially granulations degenerate into scar tissue.
When you try to bring the edges of such a wound closer together, they tuck under. To apply secondary late sutures, it is necessary to excise the edges and walls of the wound, and in some cases also to mobilize the tissue in its circumference. Sometimes such mobilization does not bring success. In these cases, it is necessary to resort to various types skin plastic surgery.
Thus, it becomes clear that, given the specific characteristics of gunshot wounds, only secondary sutures (early or late) can be applied to them.
The only exceptions are wounds of the face, scalp, hand, penis, i.e. those areas that, on the one hand, are well supplied with blood (which reduces the risk of developing infectious complications), and, on the other hand, the formation of scar tissue in these areas (which is inevitable if primary sutures are not applied) is extremely undesirable. In addition, primary sutures are applied to the gunshot wound for combined radiation injuries.
In all other cases the application of primary sutures to a gunshot wound is strictly prohibited!
Information about the types and healing process of postoperative sutures. It also tells what actions need to be taken in case of complications.
After a person has undergone surgery, scars and stitches remain for a long time. From this article you will learn how to properly process a postoperative suture and what to do in case of complications.
Types of postoperative sutures
A surgical suture is used to connect biological tissues. The types of postoperative sutures depend on the nature and scale of the surgical intervention and are:
- bloodless, which do not require special threads, but are glued together using a special adhesive
- bloody, which are stitched with medical suture material through biological tissues
Depending on the method of applying bloody sutures, the following types are distinguished:
- simple nodal– has a puncture triangular shape which holds well suture material
- continuous intradermal– most common which provides a good cosmetic effect
- vertical or horizontal mattress – used for deep, extensive tissue damage
- purse string – intended for plastic fabrics
- entwining - as a rule, serves to connect vessels and hollow organs
The following techniques and instruments are used for suturing vary:
- manual, when applying which a regular needle, tweezers and other instruments are used. Suture materials – synthetic, biological, wire, etc.
- mechanical carried out using a device using special brackets
The depth and extent of the injury dictates the method of suturing:
- single-row - the seam is applied in one tier
- multilayer - application is made in several rows (muscle and vascular tissues are first connected, then the skin is sutured)
In addition, surgical sutures are divided into:
- removable– after the wound has healed, the suture material is removed (usually used on covering tissue)
- submersible– cannot be removed (suitable for joining internal tissues)
Materials that are used for surgical sutures can be:
- absorbable - removal of suture material is not required. Typically used for ruptures of mucous and soft tissues
- non-absorbable - removed after a certain period of time determined by the doctor
When applying sutures, it is very important to connect the edges of the wound tightly so that the possibility of cavity formation is completely excluded. Any type of surgical sutures requires treatment with antiseptic or antibacterial drugs.
How and with what should I treat a postoperative suture for better healing at home?
The healing period of wounds after surgery largely depends on the human body: for some this process occurs quickly, for others it takes longer. long time. But the key to a successful result is proper therapy after suturing. The timing and nature of healing are influenced by the following factors:
- sterility
- materials for processing the suture after surgery
- regularity
One of the most important requirements for postoperative injury care is maintaining sterility. Treat wounds only with thoroughly washed hands using disinfected instruments.
Depending on the nature of the injury, postoperative sutures are treated with various antiseptic agents:
- potassium permanganate solution (it is important to follow the dosage to avoid the possibility of burns)
- iodine (in large quantities can cause dry skin)
- brilliant green
- medical alcohol
- fucarcin (it is difficult to wipe off the surface, which causes some inconvenience)
- hydrogen peroxide (may cause a slight burning sensation)
- anti-inflammatory ointments and gels
Often used at home for these purposes. folk remedies:
- tea tree oil (pure)
- tincture of larkspur roots (2 tbsp., 1 tbsp. water, 1 tbsp. alcohol)
- ointment (0.5 cups of beeswax, 2 cups of vegetable oil, cook over low heat for 10 minutes, let cool)
- cream with calendula extract (add a drop of rosemary and orange oils)
Before using these medications, be sure to consult your doctor. In order for the healing process to occur as quickly as possible without complications, it is important to follow the rules for processing sutures:
- disinfect hands and tools that may be needed
- carefully remove the bandage from the wound. If it sticks, pour it with peroxide before applying the antiseptic.
- Using a cotton swab or gauze swab, lubricate the seam with an antiseptic drug
- apply a bandage
In addition, do not forget to comply with the following conditions:
- carry out processing twice a day, if necessary and more often
- regularly carefully examine the wound for inflammation
- To avoid the formation of scars, do not remove dry crusts and scabs from the wound
- When showering, do not rub the seam with hard sponges
- If complications occur (purulent discharge, swelling, redness), consult a doctor immediately
How to remove postoperative sutures at home?
The removable postoperative suture must be removed on time, since the material used to connect the tissue acts as a foreign body to the body. In addition, if the threads are not removed in a timely manner, they can grow into the tissue, which will lead to inflammation.
We all know that a medical professional must remove the postoperative suture. suitable conditions by using special tools. However, it happens that there is no opportunity to visit a doctor, the time for removing the stitches has already come, and the wound looks completely healed. In this case, you can remove the suture material yourself.
To get started, prepare the following:
- antiseptic drugs
- sharp scissors (preferably surgical, but you can also use nail scissors)
- dressing
- antibiotic ointment (in case of infection in the wound)
Perform the seam removal process as follows:
- disinfect instruments
- wash your hands thoroughly up to the elbows and treat them with an antiseptic
- choose a well-lit place
- remove the bandage from the seam
- using alcohol or peroxide, treat the area around the seam
- Using tweezers, gently lift the first knot slightly
- holding it, use scissors to cut the suture thread
- carefully, slowly pull out the thread
- continue in the same order: lift the knot and pull the threads
- make sure to remove all suture material
- treat the seam area with an antiseptic
- apply a bandage for better healing
In case self-removal postoperative sutures, in order to avoid complications, strictly follow the following requirements:
- You can remove only small superficial seams yourself
- do not remove surgical staples or wires at home
- make sure the wound is completely healed
- if bleeding occurs during the process, stop the action, treat with an antiseptic and consult a doctor
- protect the seam area from ultraviolet radiation, since the skin there is still too thin and susceptible to burns
- avoid the possibility of injury to this area
What to do if a seal appears at the site of the postoperative suture?
Often, after the operation, a patient experiences a seal under the suture, which is formed due to the accumulation of lymph. As a rule, it does not pose a threat to health and disappears over time. However, in some cases complications may arise in the form of:
- inflammation– accompanied by painful sensations in the suture area, redness is observed, and the temperature may rise
- suppuration– when the inflammatory process is advanced, pus may leak from the wound
- the formation of keloid scars is not dangerous, but has an unaesthetic appearance. Such scars can be removed using laser resurfacing or surgery.
If you observe the listed signs, contact the surgeon who operated on you. And if this is not possible, go to the hospital at your place of residence.
If you see a lump, consult a doctor Even if it later turns out that the resulting lump is not dangerous and will resolve on its own over time, the doctor must conduct an examination and give his opinion. If you are convinced that the postoperative suture seal is not inflamed, does not cause pain and there is no purulent discharge, follow these requirements:
- Follow the rules of hygiene. Keep bacteria away from the injured area
- treat the seam twice a day and change the dressing material promptly
- When showering, avoid getting water on the unhealed area
- don't lift weights
- make sure that your clothes do not rub the seam and the areola around it
- Before going outside, apply a protective sterile bandage
- Do not under any circumstances apply compresses or rub yourself with various tinctures on the advice of friends. This can lead to complications. A doctor must prescribe treatment
Compliance with these simple rules is the key to successful treatment of suture seals and the possibility of getting rid of scars without surgical or laser technologies.
The postoperative suture does not heal, it is red, inflamed: what to do?
One of a number of postoperative complications is inflammation of the suture. This process accompanied by such phenomena as:
- swelling and redness in the suture area
- the presence of a seal under the seam that can be felt with your fingers
- increased temperature and blood pressure
- general weakness and muscle pain
The reasons for the appearance of the inflammatory process and further non-healing of the postoperative suture can be different:
- infection in a postoperative wound
- During the operation, the subcutaneous tissues were injured, resulting in the formation of hematomas
- suture material had increased tissue reactivity
- in overweight patients, wound drainage is insufficient
- low immunity of the patient being operated on
Often there is a combination of several of the listed factors that may arise:
- due to an error by the operating surgeon (instruments and materials were not processed sufficiently)
- due to patient non-compliance with postoperative requirements
- due to indirect infection, in which microorganisms are spread through the blood from another source of inflammation in the body
If you see redness in the suture, consult a doctor immediately In addition, the healing of a surgical suture largely depends on the individual characteristics of the body:
- weight– y fat people the wound may heal more slowly after surgery
- age – tissue regeneration occurs faster at a young age
- nutrition – lack of proteins and vitamins slows down the recovery process
- chronic diseases – their presence prevents rapid healing
If you notice redness or inflammation of a postoperative suture, do not delay visiting a doctor. It is the specialist who must examine the wound and prescribe the correct treatment:
- remove stitches if necessary
- washes the wounds
- install drainage to drain purulent discharge
- will prescribe the necessary medications for external and internal use
Timely implementation of the necessary measures will prevent the likelihood of severe consequences (sepsis, gangrene). After medical procedures have been performed by your attending physician, to speed up the healing process at home, follow these recommendations:
- treat the suture and the area around it several times a day with the medications prescribed by the attending physician
- When showering, try not to touch the wound with a washcloth. When you get out of the bath, gently blot the seam with a bandage.
- change sterile dressings on time
- take multivitamins
- add extra protein to your diet
- do not lift heavy objects
In order to minimize the risk of an inflammatory process, it is necessary to take preventive measures before surgery:
- boost your immunity
- sanitize your mouth
- identify the presence of infections in the body and take measures to get rid of them
- strictly observe hygiene rules after surgery
Postoperative fistula: causes and methods of control
One of the negative consequences after surgery is postoperative fistula, which is a channel in which purulent cavities are formed. It occurs as a consequence of the inflammatory process when there is no outlet for purulent fluid.
The reasons for the appearance of fistulas after surgery can be different:
- chronic inflammation
- the infection is not completely eliminated
- rejection by the body of non-absorbable suture material
The last reason is the most common. The threads that connect tissues during surgery are called ligatures. Therefore, a fistula that occurs due to its rejection is called ligature. Around the thread is formed granuloma, that is, a compaction consisting of the material itself and fibrous tissue. Such a fistula is formed, as a rule, for two reasons:
- entry of pathogenic bacteria into the wound due to incomplete disinfection of threads or instruments during surgery
- patient's weak immune system, due to which the body weakly resists infections, and there is a slow recovery after the introduction of a foreign body
A fistula can appear in different postoperative periods:
- within a week after surgery
- in a few months
Signs of fistula formation are:
- redness in the area of inflammation
- the appearance of compactions and tubercles near or on the seam
- painful sensations
- discharge of pus
- temperature increase
After surgery, a very unpleasant phenomenon may occur - a fistula. If you experience any of the above symptoms, be sure to consult a doctor. If measures are not taken in time, the infection can spread throughout the body.
Treatment of postoperative fistulas is determined by the doctor and can be of two types:
- conservative
- surgical
The conservative method is used if the inflammatory process has just begun and has not led to serious disorders. In this case, the following is carried out:
- removal of dead tissue around the seam
- washing the wound from pus
- removing the outer ends of the thread
- patient taking antibiotics and immune-boosting drugs
The surgical method includes a number of medical measures:
- make an incision to drain the pus
- remove the ligature
- wash the wound
- if necessary, perform the procedure again after a few days
- if there are multiple fistulas, you may be prescribed complete excision of the suture
- the stitches are reapplied
- a course of antibiotics and anti-inflammatory drugs is prescribed
- complexes of vitamins and minerals are prescribed
- standard therapy prescribed after surgery is carried out
IN lately appeared new way treatment of fistulas - ultrasound. This is the most gentle method. Its disadvantage is the length of the process. In addition to the methods listed, healers offer folk remedies for the treatment of postoperative fistulas:
- mumiyo dissolve in water and mix with aloe juice. Soak a bandage in the mixture and apply to the inflamed area. Keep it for several hours
- wash the wound with a decoction St. John's wort(4 tablespoons of dry leaves per 0.5 liters of boiling water)
- take 100 g of medical tar, butter, flower honey, pine resin, crushed aloe leaf. Mix everything and heat in a water bath. Dilute with medical alcohol or vodka. Apply the prepared mixture around the fistula, cover with film or plaster
- Apply a sheet to the fistula at night cabbage
However, do not forget that folk remedies are only auxiliary therapy and do not cancel a visit to the doctor. To prevent the formation of postoperative fistulas it is necessary:
- Before the operation, examine the patient for the presence of diseases
- prescribe antibiotics to prevent infection
- carefully handle instruments before surgery
- avoid contamination of suture materials
Ointments for healing and resorption of postoperative sutures
For resorption and healing of postoperative sutures, antiseptic agents (brilliant, iodine, chlorhexidine, etc.) are used. Modern pharmacology offers other drugs of similar properties in the form of ointments for local use. Using them for healing purposes at home has a number of advantages:
- availability
- wide spectrum of action
- the fatty base on the surface of the wound creates a film that prevents tissue from drying out
- skin nutrition
- ease of use
- softening and lightening of scars
It should be noted that the use of ointments for wet wounds of the skin is not recommended. They are prescribed when the healing process has already begun.
Based on character and depth skin lesions, are used various types ointments:
- simple antiseptic(for shallow superficial wounds)
- containing hormonal components (for extensive, with complications)
- Vishnevsky ointment- one of the most affordable and popular pulling agents. Promotes accelerated release from purulent processes
- levomekol– has a combined effect: antimicrobial and anti-inflammatory. It is a broad spectrum antibiotic. Recommended for purulent discharge from the suture
- vulnuzan– a product based on natural ingredients. Apply to both wound and bandage
- levosin– kills microbes, removes inflammation, promotes healing
- stellanine– a new generation ointment that removes swelling and kills infection, stimulates skin regeneration
- eplan– one of the most powerful means of local treatment. Has an analgesic and anti-infective effect
- solcoseryl- Available in the form of a gel or ointment. The gel is used when the wound is fresh, and the ointment is used when healing has begun. The drug reduces the likelihood of scar formation. Better to put under a bandage
- actovegin- a cheaper analogue of solcoseryl. Successfully fights inflammation, practically does not cause allergic reactions. Therefore, it can be recommended for use by pregnant and lactating women. Can be applied directly to damaged skin
- agrosulfan– has a bactericidal effect, has an antimicrobial and analgesic effect
Ointment for treating seams - naftaderm – has anti-inflammatory properties. Additionally, it relieves pain and softens scars.
- Contractubex - used when the healing of the suture begins. Has a softening, smoothing effect in the scar area
- Mederma – helps increase tissue elasticity and lightens scars
Listed medicinal products prescribed by a doctor and used under his supervision. Remember that you cannot self-medicate postoperative sutures in order to prevent wound suppuration and further inflammation.
Plaster for healing postoperative sutures
One of effective means for the care of postoperative sutures is a plaster made on the basis of medical silicone. This is a soft self-adhesive plate that is fixed to the seam, connecting the edges of the fabric, and is suitable for minor damage to the skin.
The advantages of using the patch are as follows:
- prevents pathogenic microorganisms from entering the wound
- absorbs discharge from the wound
- does not cause irritation
- breathable, allowing the skin under the patch to breathe
- Helps soften and smooth out scars
- retains moisture well in fabrics, preventing drying out
- prevents scar enlargement
- easy to use
- There is no skin injury when removing the patch
Some patches are waterproof, allowing the patient to shower without risk of suture damage. The most commonly used patches are:
- cosmopore
- mepilex
- mepitak
- hydrofilm
- fixopore
To achieve positive results in the healing of postoperative sutures, this medical product must be used correctly:
- remove the protective film
- apply the adhesive side to the seam area
- change every other day
- periodically peel off the patch and check the condition of the wound
We remind you that before using any pharmacological agent, you should consult your doctor.
Video: Treatment of postoperative suture
Sutures are necessary if there is a severe cut, cut, or postoperative incision. At home and in the field last speech does not work, therefore suturing the wound surface will be somewhat different. Those people who love extreme recreation and other similar entertainment quite often encounter similar types injuries. At home, you can also get a severe cut that will need to be stitched. But when you get injured, you can’t always hope for medical help, so every person should know how to stitch a wound and provide first aid for such an injury.
A suture is placed so that the wound surface can grow together and heal faster. In fact, the suture is a mechanical connection of two parts of the skin. If sutures are not applied in time for severe cuts, the wound will not heal and, as a result, an ugly scar will appear on its bridge after healing. In addition, pathogenic microorganisms and dirt can get into it, which will cause serious inflammation and other dangerous consequences.
Probably every person understands that before starting to stitch up a wound, it is necessary not only to prepare an improvised site for surgical intervention, but also to clean the surface of the cut and stop the bleeding at the same time. If you have the opportunity to call a doctor or go to the emergency room yourself, then be sure to take advantage of this. But if this is not possible, you will have to help yourself or the victim yourself. How to provide assistance and sew up, apply a suture to the wound surface, read on.
Preparation
Stitching
First you need to find clean fabric strips or dressings, tweezers, scissors or a knife, alcohol or strong alcoholic drink, as well as threads and a surgical needle. In extreme cases, you can use a regular one.
First of all, you need to stop the bleeding. To do this, apply a cloth or bandage to the damaged area. When using a tourniquet, it is important to remember that incorrect application may result in negative consequences, which can even lead to amputation of the damaged limb. Therefore, application of a tourniquet in this case is allowed only for the duration of the “surgical intervention.” To reduce blood loss, you need to raise the sore limb above the level of the heart. The wound cannot be sutured until the bleeding has stopped.
When the bleeding stops, the wound surface should be washed under a weak stream of warm water to wash away foreign bodies and contaminants. If there is glass or wood chips in the wound, remove them with tweezers and make sure the surface is completely clean. Then treat the damaged area with peroxide, chlorhexedine, a weak solution of manganese or any other antiseptic. When treating the wound surface with alcohol, you risk increasing algia and even getting a painful shock. So if there are alternatives, be sure to use them.
Wash your hands and sterilize working tools in alcohol. If you have the opportunity, first wash your tools with soap and then dip them in alcohol and lay them out on a clean cloth. When working, you can use a wet needle treated with an antiseptic, the main thing is that it does not slip during the procedure. After you wash your hands with detergent, treat them with alcohol, just like instruments, to reduce the risk of wound infection to zero.
Take care of your workplace. It must be clean. It is best if it is a towel with a circle cut in the middle, in which the wound will be visible or, as surgeons call it, the “working field”.
Prepare a needle and thread. If you do not have a special needle for performing operations, use a sewing needle for this purpose. This, of course, is not very correct and looks harsh, but for lack of better suited and this option, especially if the wound is serious and cannot be done without suturing. To refine a regular needle, bend it into an arched shape using pliers. You need to choose strong and elastic threads; it is better not to use fishing line, but if there is no way out, it will do. A good substitute for surgical threads are dental or fishing threads. It can also be pulled out from a woven bracelet if you are wearing one. When the thread is ready, cut off the required amount of material, thread it through the eye of a needle and sterilize it all together in an antiseptic.
Stitching
Applying a suture to the wound surface
It is necessary to pay attention to the fact that the fabrics must be sewn together in layers. But if the wound is so deep that muscles and tendons are affected, the injured person must be urgently taken to the hospital, since it will be very difficult for a person without preparation to make a layer-by-layer suture. But, if the wound is shallow, only the cut epidermis is sutured. It is quite possible to carry out such an operation independently without the help of a specialist. So, the wound surface is sutured as follows.
Take your suture and place the first stitch. The first suture should be located in the center of the wound surface. Then you need to take the needle with tweezers and pinch its eye. Then turn it so that the wound being sutured does not stretch, and the tip of the needle is directed upward. Next, guide the needle so that its tip goes down under the epidermis. If it is inconvenient to do this with tweezers, you can sew with your fingers. Then you need to align the edges of the wound surface, pierce the skin six millimeters from the wound and pass the needle through it, bringing out the thread at the same distance from the other edge.
Each seam must be secured with a knot. The next thing to do is to pass the needle under the skin with tweezers, then pull it up until a thread five centimeters long remains at its exit point. The next step is to place two loops on the end of the tweezers. Then grab the remaining tip of the thread to connect the two edges of the wound surface. Then you need to pull the tail of the thread back through the left loops and form a knot. After which it needs to be tightened so that it lies flat on the skin.
Tie the resulting knot. Quickly pull both ends of the thread towards the epidermis. In this way, it will be possible to fix the knot and move it from the wound to intact skin.
After this, you need to continue suturing the wound in a similar way, forming nodules after each stitch, which should be on the intact epidermis on the side, and not on the wound itself. Do everything firmly and confidently, then the wound will close on its own and the stitches will be even.
Cut both ends of the thread, but leave a five-millimeter longer tail on either end so that the longer end can be used to remove the stitch when the injury has healed.
After this, continue stitching until the wound is completely closed.
When you are done with the stitches and the wound is stitched, treat it with an antiseptic, apply a bandage and see a doctor as soon as possible. Stay healthy.
Help (video)
