What Is a Purse-String Suture?

Suture is the recombination or reconstruction of tissues and organs that have been cut or traumatized, and restore their function. It is the basic condition to ensure good healing, and it is also one of the important basic surgical techniques. Different tissues and organs need to be sutured in different ways. Sutures can be performed with needle holders or straight straight needles with bare hands. In addition, there are skin staplers, digestive tract staplers, and closures.

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Suture is the recombination or reconstruction of tissues and organs that have been cut or traumatized, and restore their function. It is the basic condition to ensure good healing, and it is also one of the important basic surgical techniques. Different tissues and organs need to be sutured in different ways. Suture can be used

The basic steps of suture take the skin suture as an example to illustrate the steps of suture:

(1) entering the needle; (2) pulling the needle; (3) exiting the needle; (4) pinching the needle

(1) When the needle is inserted and sutured, the left hand holds tooth forceps, lifts the edge of the skin, and the right hand holds

(1) To ensure suture

Suture simple suture

Straighten the sides of the incision wound

Simple intermittent suture

A type of suture method, such as skin suture.

(1) Simple intermittent suture

The operation is simple and the application is the most. Each stitch is knotted separately. It is mostly used for suture of skin, subcutaneous tissue, muscle, and aponeurosis. It is especially suitable for infected wounds.

(2) Continuous suture method

Continuous suture

Tie the knot after the first stitch, and then use the suture to sew the entire wound. Before the end of the stitch, pull out the heavy thread tail and leave it in the pair.

Continuous stitching

Side, forming a double line knotted with heavy line tail.

(3) Continuous stitching

The operation saves time and has good hemostatic effect. The threads are staggered each time during the suture process, which is mostly used for closing the stump of the gastrointestinal tract and for suture during skin transplantation.

Two 8-character stitching methods

(4), 8 stitches

Consisting of two intermittent sutures, the suture is firm and time-saving, such as the fascia suture.

(5), through suture method

Also known as suture method or suture hemostasis method, this method is mostly used for clamped tissues, when simple ligation is difficult or when the knot is easy to fall off. ^[1]

Suture varus suture

Make the wound margin tissue inversion and keep the outside smooth. ^[2] Such as gastrointestinal anastomosis and bladder suture.

(1) Intermittent vertical mattress inversion suture method: also known as Lembert suture method, which is often used to suture the serous muscle layer during gastrointestinal anastomosis.

Intermittent vertical varus suture

(2) Intermittent horizontal mattress inversion suture method: also known as Halsted suture method, which is mostly used for gastrointestinal serosal suture.

Intermittent horizontal varus suture

(3) Continuous horizontal mattress serous inversion suture: also known as Cushing suture, such as gastrointestinal serous suture.

Continuous horizontal mattress type inversion suture method

(4) Continuous full-layer horizontal mattress inversion suture method: also known as Connells suture method, such as full-thickness suture of the gastrointestinal tract.

Continuous horizontal mattress inversion suture method

(5), purse suture method: suture the tissue surface continuously in a circle for one week, bury the center inwardly during ligation, the surface is smooth, which is conducive to healing. Commonly used for small gastrointestinal incisions or closure of needles and eyes, embedment of appendix stump, fixation of ostomy tube in organs, etc.

Purse suture

(6) Half-pocket suture method: It is commonly used for embedding and inversion of duodenal stump corner and gastric stump corner ^[1] .

Half-pocket suture (embedding the lower corner of duodenal stump)

Suture eversion suture

Make the wound margin eversion, keep the inner surface of the cavity being sutured or anastomized smooth, such as suture or anastomosis of blood vessels.

(1) Intermittent vertical mattress eversion suture method: such as suture for loose skin.

Intermittent vertical valgus suture

(2) Intermittent horizontal mattress eversion suture method: such as skin suture.

Intermittent horizontal valgus suture

(3) Continuous horizontal mattress eversion suture method: mostly used for vascular wall anastomosis ^[1] .

Continuous horizontal mattress eversion suture

Suture reduction suture

When the tissue tension at the suture is large and the whole body is poor,

Reduction suture

Mouth dehiscence can be used in this method, which is mainly used for the reduction of abdominal wall incision. The suture is made of thicker silk or stainless steel wire, and the needle is inserted at a distance of 2 to 2.5 cm from the wound edge. After passing through the rectus abdominis sheath and the peritoneum, the needle is injected from the abdomen to the skin to ensure the accuracy of the level. Avoid damaging organs. The distance between sutures is 3-4cm. The suture of the rectus sheath or fascia should be slightly wider than the skin. Make it bear more incision tension. Pass the suture through a section of rubber tube or gauze cushion before ligation to prevent the skin from being cut. Do not tighten too much during ligation to avoid affecting blood flow ^[1] .

Intradermal suture

It can be divided into intradermal discontinuity and intradermal continuous suture. Intradermal suture application

Continuous intradermal suture

Ophthalmic small triangle needle, small needle-holding forceps, and No. 0 silk thread. Suture essentials: enter the needle from one end of the incision, then alternately pass through the skin of the incision edge on both sides, and sew until the other end of the incision is threaded out, and finally tighten, both ends can be used as bows or gauze ball pads. Commonly used for sutures of exposed skin incisions, such as neck thyroid surgery incisions.

Intradermal discontinuity

The quality of the suture is related to the density and level of suture of the subcutaneous tissue. If the tension of the incision is large and the subcutaneous suture is poor, this method should not be used. The advantages of this method are good alignment, early suture removal, small healing scars, and beautiful appearance.

With the continuous development of science and technology, in addition to the suture method, there are other methods to close the wound, such as staplers, closures, medical adhesives, skin zipper, etc. ^[1]