The surgeon’s basic operation is the basis for other complex surgeries, and suturing is to buttress or reconstruct the patency and restore the function of tissues and organs that have been cut or separated and broken. It is the basic condition to ensure good healing and is one of the important basic surgical operation techniques. Different parts of the tissues and organs need to be sutured in different ways and methods. Suturing can be performed with needle-holding forceps or directly with straight needles with bare hands, in addition to skin staplers, digestive tract anastomoses, closures, etc.
1. Interrupted sutures: for skin, subcutaneous weave, fascia, mucosa, blood vessels, nerves, and gastrointestinal tract sutures.
Advantages: easy to operate and quick to complete. During the healing process, even if individual sutures break, other adjacent sutures are not affected and do not cause the whole wound to split. Ability to correctly adjust each suture tension according to the elongation tension of various trauma margins. If there is a possibility of infection in the wound, a few sutures can be removed to drain the fluid. Less impact on blood circulation to the incisional wound edges, which facilitates wound healing.
Disadvantages: more time is needed and more sutures are used.
2.Simple continuous suture: Simple continuous suture is used to close a wound continuously from beginning to end with one long suture and finally tying a knot. The first stitch and knotting operation is the same as the nodal suture, and before each subsequent stitch, the wound edges are aligned to avoid the formation of folds in the wound, using the same suture at equal distances, pulling the suture tight, and finally leaving the end of the thread and tying the knot on one side. It is often used for longer wounds with elasticity and without too much tension. Used for skin, subcutaneous tissue, fascia, blood vessels, and gastrointestinal sutures.
Advantages: suture saving and time, good airtightness.
Disadvantages: one break, all sutures pull off, wounds do open.
3.Subcutaneous suture: This suture is suitable for subepidermal suturing. The suture is started at one end of the incision, the suture needle is pierced under the dermis, then the suture needle is flipped and pierced into the dermis on the other side, and the knot is tied deep in the tissue. Continuous horizontal mattress sutures are applied to close the parallel incision. The final suture needle is flipped and pierced under the dermis on the opposite side and knotted, buried deep within the tissue. Absorbable suture material is generally chosen.
Advantages: It eliminates small scarring of the normal suture stitches. Cosmetic, fast operation, suture saving.
Disadvantages: Has the disadvantage of continuous suturing. This suture method has poor tension strength.
4.Pressing and squeezing suture method: Pressing and squeezing suture is used for intestinal anastomosis with single layer interrupted suture method. The suture needle of the pressure squeeze suture method pierces the plasma membrane, muscle layer, submucosa and mucosa layer into the intestinal cavity. Before crossing the incision, the mucosa is then punctured from the intestinal lumen to the submucosa. Crossing the incision, turn to the opposite side and stab from the submucosal layer into the mucosal layer into the intestinal cavity. On the same side, the intestinal surface is punctured from the mucosal layer, submucosal layer, and muscular layer to the plasma membrane. The sutures at both ends are pulled tight and knotted. This suture is the plasma membrane and muscle layer opposite each other; the mucosa and submucosa layer are turned inward. This suture is the mutual compression of the intestinal tissue itself tissue, with good prevention of fluid leakage, close docking of intestinal anastomosis and maintenance of normal intestinal lumen volume.
5. Cross suture method.
The first stitch starts with the suture needle making a nodal suture from one side to the other, the second parallel to the first stitch from one side to the other across the incision, and the ends of the sutures are crossed over the incision to form an X-shape, pulled tight and knotted. It is used for skin suture with large tension.
6. Continuous locked edge suture method.
This suture method is basically similar to simple continuous suturing. The sutures are interlocked one at a time during suturing. This type of suture provides good margin alignment and allows each suture to be secured before the next suture is made. It is mostly used for straight skin incisions and for sutures in thin, mobile areas.
Internal turning sutures Internal turning sutures are used to close cavernous organs such as the stomach and intestines, uterus, and bladder.
1. Lombardt’s suture: Lombardt’s suture is the traditional suture method for gastrointestinal surgery. It is also known as vertical mattress inversion suture method. It is divided into two types: interrupted and continuous, and the commonly used one is interrupted Lembert’s suture. It is used to suture the plasma membrane muscle layer during gastrointestinal or intestinal anastomosis.
A. Interrupted Lombardt’s suture: The sutures are passed through the plasma membrane and muscle layer on both sides of the incision and are knotted so that part of the plasma membrane is turned inward to close the outer layer of the gastrointestinal tract.
B. Continuous Lombard’s suture: Starting from one end of the incision, an interrupted inversion suture of the plasma membrane muscle layer is made first, and then a continuous suture of the plasma membrane muscle layer is made with the same suture to the other end of the incision. Its use is the same as interrupted inversion suture.
2. Cushing’s suture: Also known as the continuous horizontal mattress invagination suture, this suture evolved from the Lombardt’s continuous suture. The suture method is to make an interrupted inversion suture of the plasma layer at one end of the incision, and then to make a continuous suture of the plasma layer parallel to the incision to the other end of the incision with the same suture. It is suitable for suturing the plasma membrane muscle layer of stomach and uterus.
3.Connell’s suture: This suture is the same as continuous horizontal mattress inversion suture, except that the suture needle should penetrate the whole layer of tissue when the suture is pulled tight, then the intestinal canal cut surface is turned to the intestinal cavity. It is mostly used for suturing the stomach, intestine and uterine wall.
4. purse-string suture: i.e., continuous suturing of the plasma membrane muscle layer in a circular pattern. It is mainly used for small inversion sutures on the gastrointestinal wall, such as suturing small gastrointestinal perforations. It is also used for drainage fixation of gastrointestinal and cystostomy sutures
Tension suture
1. Interrupted vertical mattress suture: Interrupted vertical mattress suture is a tension suture. The needle is pierced into the skin, the trabecular edges are aligned with each other, the skin is pierced out across the incision to the corresponding contralateral side, and then the suture needle is flipped to pierce the skin on the same side, pierced out across the incision to the corresponding contralateral side from the incision, and knotted with the suture at the other end. This suture requires that when the suture needle is pierced into the skin, it can only pierce under the dermis, and the piercing points on both sides close to the incision are required to be close to the incision so that the trabecular edges of the skin are well aligned and cannot be turned out. The suture spacing is 5 mm.
Advantages: This suture method has a stronger antitension strength than the horizontal mattress suture. The blood supply to the trabecular margin is less affected.
Disadvantages: The suture requires more time and more sutures.
2. Interrupted horizontal mattress suture: Interrupted horizontal mattress suture is a tension suture in which the needles are pierced into the skin, the trabecular edges are conjoined with each other, the skin is pierced across the incision to the corresponding part on the opposite side, then the sutures are pierced parallel to the incision forward, then the skin is pierced, the skin is pierced across the incision to the corresponding opposite side, and the sutures are knotted with the other end. This suture requires that the suture needles pierce the skin under the dermis and not into the subcutaneous tissue so that the skin edges are well aligned and do not flare out.
Advantages: The use of sutures is economical and the operation is faster. The suture has certain anti-tension conditions, and for skin with high tension, a tube or button can be placed on the suture to increase the anti-tension strength.
Disadvantages: This suture is more difficult to operate for beginners. According to the geometry of the horizontal mattress suture, this suture can reduce the blood supply to the wound edge.
3. Proximo-distal-near suture: The proximo-distal-near suture is a tension suture. The first stitch is inserted vertically into the skin close to the trabecular edge, crosses over the base of the wound, and goes to the opposite side to the skin vertically distant from the incision. The suture is flipped, crossed over the incision to the side where the first stitch was inserted, farther from the incision, inserted vertically into the skin, crossed over the base of the incision, to the opposite side where the skin was inserted vertically close to the incision, and tied with the end of the first stitch pulled taut.
Advantages: This suture method has a good wound edge alignment and a certain tension resistance strength.
Disadvantages: There are double sutures at the incision and more sutures are required.