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BASIC AND SPECIAL SUTURING TECHNIQUES
IN SURGERY Andrea Ferencz Semmelweis University, Faculty of Medicine Department of Surgical Research and Techniques
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THE PRIMARY GOALS Gentle handling of the tissues Closing dead space
Medieval period Gentle handling of the tissues Closing dead space Supporting and strengthening wounds until healing Approximating wound edges for structural, functional and an aesthetically pleasing result Minimizing the risks of bleeding and infection
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THE CHOICE OF SUTURE TECHNIQUE
Type and anatomic location of the wound Thickness of the tissue Degree of tension Desired cosmetic result in the case of skin
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WOUND CLOSURE Basic types of sutures Special techniques
Interrupted sutures: simple interrupted suture vertical mattress suture (sec. Donati, sec. Allgöwer) horizontal mattress suture Running sutures: simple running suture running-lock suture running intradermal suture running vertical mattress suture sec. Donati running horizontal mattress suture Special techniques Clips Staplers Wound closure without knotting ZipLine Adhesive strips
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SIMPLE INTERRUPTED SUTURE
BASIC SUTURE TYPES SIMPLE INTERRUPTED SUTURE
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Simple Interrupted Suture
BASIC SUTURE TYPES Simple Interrupted Suture
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Simple Interrupted Suture - Skin
BASIC SUTURE TYPES Simple Interrupted Suture - Skin
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Simple Interrupted Suture - Skin
BASIC SUTURE TYPES Simple Interrupted Suture - Skin
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Simple Interrupted Suture – fixation of drains
BASIC SUTURE TYPES Simple Interrupted Suture – fixation of drains Roman sandal
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Simple Interrupted Suture - gingiva
BASIC SUTURE TYPES Simple Interrupted Suture - gingiva
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Simple Interrupted Suture - cornea
BASIC SUTURE TYPES Simple Interrupted Suture - cornea
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Simple Interrupted Suture– mikrovessel
BASIC SUTURE TYPES Simple Interrupted Suture– mikrovessel 1 mm
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Simple Interrupted Suture – nerve suture
BASIC SUTURE TYPES Simple Interrupted Suture – nerve suture n. medianus
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Simple Interrupted Suture– mesenterium
BASIC SUTURE TYPES Simple Interrupted Suture– mesenterium
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Simple Interrupted Suture– mesenterium
BASIC SUTURE TYPES Simple Interrupted Suture– mesenterium
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BASIC SUTURE TYPES Dehiscence
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Evisceration - Disruption – „platzbau”
BASIC SUTURE TYPES Evisceration - Disruption – „platzbau”
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Simple Interrupted Stithes, as a retention suture
BASIC SUTURE TYPES Simple Interrupted Stithes, as a retention suture
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BASIC SUTURE TYPES Complications
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Vertical Mattress Suture sec. Donati
BASIC SUTURE TYPES Vertical Mattress Suture sec. Donati
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Vertical Mattress Suture sec. Donati - skin
BASIC SUTURE TYPES Vertical Mattress Suture sec. Donati - skin Mario Donati ( )
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Vertical Mattress Suture sec. Allgöwer
BASIC SUTURE TYPES Vertical Mattress Suture sec. Allgöwer
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Vertical Mattress Suture sec. Allgöwer - skin
BASIC SUTURE TYPES Vertical Mattress Suture sec. Allgöwer - skin Martin Allgöwer ( )
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Horizontal Mattress Suture
BASIC SUTURE TYPES Horizontal Mattress Suture
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Horizontal Mattress Suture - skin
BASIC SUTURE TYPES Horizontal Mattress Suture - skin
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Horizontal Mattress Suture,
BASIC SUTURE TYPES Horizontal Mattress Suture, as retention suture
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BASIC SUTURE TYPES Simple Running Suture
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Simple Running Suture - skin
BASIC SUTURE TYPES Simple Running Suture - skin
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Simple Running Suture – abdominal wall
BASIC SUTURE TYPES Simple Running Suture – abdominal wall
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Simple Running Suture - GIT
BASIC SUTURE TYPES Simple Running Suture - GIT
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Simple Running Suture - uterus
BASIC SUTURE TYPES Simple Running Suture - uterus
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Simple Running Suture - tongue
BASIC SUTURE TYPES Simple Running Suture - tongue
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Simple Running Suture – vessel suture
BASIC SUTURE TYPES Simple Running Suture – vessel suture
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Simple Running Suture – vessel anastomosis
BASIC SUTURE TYPES Simple Running Suture – vessel anastomosis
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Simple Running Suture – vessel anastomosis
BASIC SUTURE TYPES Simple Running Suture – vessel anastomosis
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Simple Running Suture - cornea
BASIC SUTURE TYPES Simple Running Suture - cornea
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Simple Running Suture, as retention suture
BASIC SUTURE TYPES Simple Running Suture, as retention suture
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Running-locked Suture
BASIC SUTURE TYPES Running-locked Suture
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Running-locked Suture - skin
BASIC SUTURE TYPES Running-locked Suture - skin
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Running-locked Suture - gingiva
BASIC SUTURE TYPES Running-locked Suture - gingiva
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Running Intracutan Suture
BASIC SUTURE TYPES Running Intracutan Suture
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Running Intracutan Suture - skin
BASIC SUTURE TYPES Running Intracutan Suture - skin
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Running Intracutan Suture - skin
BASIC SUTURE TYPES Running Intracutan Suture - skin
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BASIC SUTURE TYPES Complications
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SPECIAL TECHNIQUES
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SPECIAL TECHNIQUES Clips - skin
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Linear Staplers - GIT SPECIAL TECHNIQUES Hümér Hültl (1868–1940)
Aladár Petz ( )
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Circular Staplers - GIT
SPECIAL TECHNIQUES Circular Staplers - GIT
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Staplers – lungs, bronchi, big vessels
SPECIAL TECHNIQUES Staplers – lungs, bronchi, big vessels a. pulm. sin. v. pulm. superior sin.
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Wound closure with knotless suture
SPECIAL TECHNIQUES Wound closure with knotless suture
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SPECIAL TECHNIQUES ZipLine® - skin 1936, Kenya
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Steri-Strip Adhesive strips
SPECIAL TECHNIQUES Steri-Strip Adhesive strips
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Alternative abdominal wall closure techniques
SPECIAL TECHNIQUES Alternative abdominal wall closure techniques
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SPECIAL TECHNIQUES Ants - skin Dorylus, army ants Recovered wound
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PRACTICE OF THE SUTURES
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PRACTICE OF THE SUTURES
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