基礎(chǔ)手術(shù)指切口縫合教學(xué)課件

1、基礎(chǔ)手術(shù)技巧之消毒鋪巾打結(jié)切開(kāi)縫合2021/7/91簡(jiǎn)介刀：持弓式、持筆式；垂直進(jìn)刀刀：運(yùn)用刀腹；裝刀卸刀持針器：正確握持、正確夾針持針器：旋轉(zhuǎn)手腕、打外科結(jié)線剪：雙手穩(wěn)定、沿線下滑線剪：旋轉(zhuǎn)顯露、線尾長(zhǎng)度縫合原則：二分之一、垂直進(jìn)針縫合原則：不留死腔、皮緣外翻2021/7/92垂直下刀，利用刀腹2021/7/93持弓式2021/7/94持筆式2021/7/95垂直進(jìn)刀，利用刀腹2021/7/96裝卸刀片2021/7/97持針器：握法、手腕2021/7/98夾針：角度、位置2021/7/99器械打結(jié)2021/7/9109、 人的價(jià)值，在招收誘惑的一瞬間被決定。2022/7/142022/7/1

2、4Thursday, July 14, 202210、低頭要有勇氣，抬頭要有低氣。2022/7/142022/7/142022/7/147/14/2022 9:21:58 PM11、人總是珍惜為得到。2022/7/142022/7/142022/7/14Jul-2214-Jul-2212、人亂于心，不寬余請(qǐng)。2022/7/142022/7/142022/7/14Thursday, July 14, 202213、生氣是拿別人做錯(cuò)的事來(lái)懲罰自己。2022/7/142022/7/142022/7/142022/7/147/14/202214、抱最大的希望，作最大的努力。14 七月 20222022

3、/7/142022/7/142022/7/1415、一個(gè)人炫耀什么，說(shuō)明他內(nèi)心缺少什么。七月 222022/7/142022/7/142022/7/147/14/202216、業(yè)余生活要有意義，不要越軌。2022/7/142022/7/1414 July 202217、一個(gè)人即使已登上頂峰，也仍要自強(qiáng)不息。2022/7/142022/7/142022/7/142022/7/142021/7/911線剪：雙手穩(wěn)定、沿線下滑、旋轉(zhuǎn)顯露2021/7/912不留線尾：深部打結(jié)；絲線留線尾：縫皮；可吸收線2021/7/913縫合：二分之一原則2021/7/914二分之一原則沿鼻唇溝2021/7/915縫

4、合原則：垂直進(jìn)針、順針弧度、不留死腔2021/7/916垂直進(jìn)針順針弧度皮緣外翻2021/7/917垂直進(jìn)針，皮緣外翻：愈合快、瘢痕小2021/7/918調(diào)整線結(jié)，精確對(duì)合2021/7/919總結(jié)刀：持弓式、持筆式；垂直進(jìn)刀刀：運(yùn)用刀腹；裝刀卸刀持針器：正確握持、正確夾針持針器：旋轉(zhuǎn)手腕、打外科結(jié)線剪：雙手穩(wěn)定、沿線下滑線剪：旋轉(zhuǎn)顯露、線尾長(zhǎng)度縫合原則：二分之一、垂直進(jìn)針縫合原則：不留死腔、皮緣外翻2021/7/920總結(jié)刀：持弓式、持筆式；垂直進(jìn)刀刀：運(yùn)用刀腹；裝刀卸刀持針器：正確握持、正確夾針持針器：旋轉(zhuǎn)手腕、打外科結(jié)線剪：雙手穩(wěn)定、沿線下滑線剪：旋轉(zhuǎn)顯露、線尾長(zhǎng)度縫合原則：二分之一、垂直

5、進(jìn)針縫合原則：不留死腔、皮緣外翻2021/7/921參考文獻(xiàn)1. 楊學(xué)穎編譯，基礎(chǔ)外科技巧，合記國(guó)書出版社（清華）2. Essential Surgical Skills, Elsevier3. Color atlas of cutaneous excisions and repairs. New York: Cambridge, 2008（協(xié)和）4. Adrian M. Richards. Key notes on plastic surgery. London: Blackwell, 2002 2021/7/922Practice makes perfect!2021/7/923Pract

6、ice makes perfect!2021/7/924Thank you for your attention!Lets practice!2021/7/925提高課程設(shè)計(jì)切口：皮膚張力松弛線、梭形切除比例減小張力：皮下縫合、皮下游離縫合方法：垂直褥式、水平褥式、皮內(nèi)縫合特殊情況：三角/四角縫合、兩邊高度不一致縫線的特點(diǎn)：可吸收縫線、不可吸收縫線2021/7/926設(shè)計(jì)切口：皮膚張力松弛線2021/7/927梭形切除理想比例2021/7/928減小張力：皮下游離2021/7/929減小張力：皮下縫合2021/7/930減小張力：皮下縫合2021/7/931減小張力：皮下縫合二分之一原則沿鼻唇

7、溝2021/7/932垂直褥式2021/7/933水平褥式2021/7/934 皮內(nèi)縫合2021/7/935兩邊不一樣平2021/7/936三角/四角縫合2021/7/937SuturesAbsorbable vs. non-absorbableSynthetic vs. naturalBraided vs. monofilament2021/7/938不可吸收縫線的特點(diǎn)2021/7/939可吸收縫線的特點(diǎn)2021/7/940Catgut羊腸線Catgut is derived from the submucosal layer of sheep intestine.It elicits a

8、significant inflammatory response.Its absorption is unpredictable.It loses its strength by 89 days.It is absorbed by 1 month.A decreased rate of absorption occurs if the suture is chromatized (chromic catgut).Clinically catgut is usually used as:A mucosal sutureA dermal suture in the faceA skin sutu

9、re in children.2021/7/941Polyglycolic acid聚羥乙酸Dexon is a synthetic suture composed of polyglycolic acid.It is degraded by hydrolization.It loses its strength by 21 days and is absorbed by 90 days.2021/7/942Polyglactin 910 聚糖乳酸910Vicryl （薇喬）is a braided synthetic suture composed of polyglactin 910.It

10、 loses its strength by 21 days and is absorbed by 90 days.Its braided nature may make it more prone to bacterial colonization than monofilament alternatives. (Vicryl Plus)It may provoke a significant inflammatory reaction and some recommend that it is not used as a dermal suture in the face.2021/7/9

11、43Poliglecaprone 25 聚糖乙內(nèi)酰胺Monocryl （單喬/玻璃絲）is a monofilament synthetic suture composed of poliglecaprone 25.It has similar absorption characteristics to vicryl.Its monofilament composition may make it less prone to bacterial colonization2021/7/944Polydioxanone 聚二氧六環(huán)酰胺PDS（普迪思） is a monofilament synth

12、etic suture composed of polydioxone.It is absorbed more slowly than either vicryl, monocryl or dexon.It loses its strength by 3 months and is absorbed by 6 months.It is primarily used as a dermal suture in areas prone to developing stretched scars.2021/7/945Non-absorbable suturesCutaneous stitches w

13、hich will need to be removed.Deep stitches to provide permanent tissue fixation.2021/7/946Non-absorbable suturesNaturalSilk絲線SyntheticPolyamideNylon尼龍線So-named because it was developed jointly in New York and LONdonPolypropylene (Prolene)聚丙烯（普理靈）Stainless steel不銹鋼絲2021/7/947Thank you for your attent

14、ion!Lets practice!2021/7/948Practice makes perfect!Lets make it better!2021/7/9499、 人的價(jià)值，在招收誘惑的一瞬間被決定。14-7月-2214-7月-22Thursday, July 14, 202210、低頭要有勇氣，抬頭要有低氣。*7/14/2022 9:21:58 PM11、人總是珍惜為得到。14-7月-22*Jul-2214-Jul-2212、人亂于心，不寬余請(qǐng)。*Thursday, July 14, 202213、生氣是拿別人做錯(cuò)的事來(lái)懲罰自己。14-7月-2214-7月-22*14 July 2022

15、14、抱最大的希望，作最大的努力。14 七月 2022*14-7月-2215、一個(gè)人炫耀什么，說(shuō)明他內(nèi)心缺少什么。七月 22*14-7月-22*14 July 202216、業(yè)余生活要有意義，不要越軌。*7/14/202217、一個(gè)人即使已登上頂峰，也仍要自強(qiáng)不息。*14-7月-22謝謝大家2021/7/9509、 人的價(jià)值，在招收誘惑的一瞬間被決定。2022/7/142022/7/14Thursday, July 14, 202210、低頭要有勇氣，抬頭要有低氣。2022/7/142022/7/142022/7/147/14/2022 9:21:58 PM11、人總是珍惜為得到。2022/7/142022/7/142022/7/14Jul-2214-Jul-2212、人亂于心，不寬余請(qǐng)。2022/7/142022/7/142022/7/14Thursday, July 14, 202213、生氣是拿別人做錯(cuò)的事來(lái)懲罰自己。2022/7/142022/7/142022/7/142022/7/14