愛愛醫(yī)資源-基礎(chǔ)手術(shù)指切口縫合

基礎(chǔ)手術(shù)技巧之消毒鋪巾打結(jié)切開縫合黃久佐，PUMC2001，外科第三年住院醫(yī)師huangjiuzuo01@PUMC2006外科實(shí)踐課2012年01月11日簡介刀：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、皮緣外翻垂直下刀，利用刀腹持弓式持筆式裝卸刀片持針器：握法、手腕夾針：角度、位置器械打結(jié)線剪：雙手穩(wěn)定、沿線下滑、旋轉(zhuǎn)顯露不留線尾：深部打結(jié)；絲線

留線尾：縫皮；可吸收線縫合：二分之一原則二分之一原則沿鼻唇溝縫合原則：垂直進(jìn)針、順針弧度、不留死腔垂直進(jìn)針

順針弧度

皮緣外翻

垂直進(jìn)針，皮緣外翻：愈合快、瘢痕小調(diào)整線結(jié)，精確對(duì)合總結(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、皮緣外翻參考文獻(xiàn)1.楊學(xué)穎編譯，基礎(chǔ)外科技巧，合記國書出版社（清華）2.EssentialSurgicalSkills,Elsevier3.Coloratlasofcutaneousexcisionsandrepairs.NewYork:Cambridge,2008（協(xié)和）4.AdrianM.Richards.Keynotesonplasticsurgery.London:Blackwell,2002Practicemakesperfect!Practicemakesperfect!Thankyouforyourattention!Let’spractice!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、不可吸收縫線設(shè)計(jì)切口：

皮膚張力松弛線梭形切除理想比例減小張力：皮下游離減小張力：

皮下縫合減小張力：

皮下縫合減小張力：

皮下縫合

二分之一原則

沿鼻唇溝垂直褥式水平褥式

皮內(nèi)縫合兩邊不一樣平三角/四角縫合SuturesAbsorbablevs.non-absorbableSyntheticvs.naturalBraidedvs.monofilament不可吸收縫線的特點(diǎn)可吸收縫線的特點(diǎn)Catgut羊腸線Catgutisderivedfromthesubmucosallayerofsheepintestine.Itelicitsasignificantinflammatoryresponse.Itsabsorptionisunpredictable.Itlosesitsstrengthby8–9days.Itisabsorbedby1month.Adecreasedrateofabsorptionoccursifthesutureischromatized(chromiccatgut).Clinicallycatgutisusuallyusedas:AmucosalsutureAdermalsutureinthefaceAskinsutureinchildren.Polyglycolicacid聚羥乙酸Dexonisasyntheticsuturecomposedofpolyglycolicacid.Itisdegradedbyhydrolization.Itlosesitsstrengthby21daysandisabsorbedby90days.Polyglactin910聚糖乳酸910Vicryl（薇喬）isabraidedsyntheticsuturecomposedofpolyglactin910.Itlosesitsstrengthby21daysandisabsorbedby90days.Itsbraidednaturemaymakeitmorepronetobacterialcolonizationthanmonofilamentalternatives.(VicrylPlus)Itmayprovokeasignificantinflammatoryreactionandsomerecommendthatitisnotusedasadermalsutureintheface.Poliglecaprone25聚糖乙內(nèi)酰胺Monocryl（單喬/玻璃絲）isamonofilamentsyntheticsuturecomposedofpoliglecaprone25.Ithassimilarabsorptioncharacteristicstovicryl.ItsmonofilamentcompositionmaymakeitlesspronetobacterialcolonizationPolydioxanone聚二氧六環(huán)酰胺PDS（普迪思）isamonofilamentsyntheticsuturecomposedofpolydioxone.Itisabsorbedmoreslowlythaneithervicryl,monocrylordexon.Itlosesitsstrengthby3monthsandisabsorbedby6months.Itisprimarilyusedasadermalsutureinareaspronetodevelopingstretchedscars.Non-absorbablesuturesCutaneousstitcheswhichwillneedtoberemoved.Deepstitchestoprovidepermanenttissuefixation.Non-absorbablesuturesNaturalSilk絲線SyntheticPolyamideNylon尼龍線So-namedbecauseitwasdevelopedjointlyinNewYo