愛愛醫(yī)資源基礎(chǔ)手術(shù)指切口縫合

1、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@tsinghua.org.cn,PUMC2006外科實踐課2012年01月11日,簡介,刀：持弓式、持筆式；垂直進(jìn)刀刀：運用刀腹；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

2、腹,,持弓式,,持筆式,,垂直進(jìn)刀，利用刀腹,,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)，精確對合,,,,總結(jié),刀：持弓式、持筆式；垂直進(jìn)刀刀：運用刀腹；

3、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

4、科技巧，合記國書出版社（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,Practic

5、e makes perfect!,,,Practice makes perfect!,,,Thank you for your attention!,Let’s practice!,提高課程,設(shè)計切口：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：可吸收縫線、不可吸收縫線,設(shè)計切口：皮膚張力松弛線,,梭形切除理想比例,,減小張力

6、：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,Sutures,Absorbable vs. non-absorbableSynthetic vs. naturalBraided vs. monofilament,不可吸收縫線的特點,,,,,可吸收縫線的特點,,,Catgut羊腸線,Catgut is de

7、rived from the submucosal layer of sheep intestine.It elicits a significant inflammatory response.Its absorption is unpredictable.It loses its strength by 8–9 days.It is absorbed by 1 month.A decreased rate of absor

8、ption occurs if the suture is chromatized (chromic catgut).Clinically catgut is usually used as:A mucosal sutureA dermal suture in the faceA skin suture in children.,Polyglycolic acid聚羥乙酸,Dexon is a synthetic suture

9、composed of polyglycolic acid.It is degraded by hydrolization.It loses its strength by 21 days and is absorbed by 90 days.,Polyglactin 910 聚糖乳酸910,Vicryl （薇喬）is a braided synthetic suture composed of polyglactin 910.I

10、t 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 reac

11、tion and some recommend that it is not used as a dermal suture in the face.,Poliglecaprone 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 characteri

12、stics to vicryl.Its monofilament composition may make it less prone to bacterial colonization,Polydioxanone 聚二氧六環(huán)酰胺,PDS（普迪思） is a monofilament synthetic suture composed of polydioxone.It is absorbed more slowly than ei

13、ther 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.,Non-absorbable sutures,Cutaneous stitch

14、es which will need to be removed.Deep stitches to provide permanent tissue fixation.,Non-absorbable sutures,NaturalSilk絲線SyntheticPolyamideNylon尼龍線So-named because it was developed jointly in New York and LONdonPo