皮肤和皮下组织的缝合课件.ppt

* Rotation Flap * Z-Plasty * Note Flap * Bilobe Flap * Rhombic Flap * 缝 线 选 择 * Suture Classification Natural or Synthetic (man made) Monofilament or Multifilament (braided) Absorbable or Non-Absorbable * The Ideal Suture Minimal tissue reaction Smoothness - minimum tissue drag Low Capillarity Max tensile strength Ease of handling - Minimum memory Knot security Consistency of performance Predictable performance Cost effectiveness * Multifilament (braided) Suture Classification Monofilament * Braided v Monofilament Has capillary action Increased infection risk Less smooth passage Less tensile strength Better handling Better knot security No capillary action Less infection risk Smooth tissue passage Higher tensile strength Has memory More throws required * These are absorbed within the living tissue Two main characteristics are: Tensile strength retention Absorption rate Absorbable Sutures Maxon: Day 14: 75% Absorption: 180 days Caprosyn: Day 10: 30% Absorption: 56 days * Characteristics of Non-Absorbable Sutures Permanent Only used when long term support is required Removed when used for skin (e.g. in A+E) Tissue reaction generally low (except silk) However silk, linen and even nylon will lose tensile strength over a period of time True non-absorbable sutures include polyester, polyethylene, polybutester, polypropylene and steel * 可吸收缝线 * 不可吸收缝线 * 缝合线— 规格与张力强度 * 技术 优点 缺点 缝线 历史悠久 需要拆除 精确细致的闭合 需要麻醉 抗张力强度最大 组织反应性最大 伤口裂开率最低 最昂贵 操作缓慢 钉皮钉 应用快捷 伤口对合精细度较缝线低 组织反应性低 可能会被CT或MRI干扰 廉价 针刺风险低 组织粘合剂 操作快捷 抗张力强度较缝线低 感觉舒适 高张力部位(关节)的伤口容易裂开 可抵抗细菌孳生 无需拆除 廉价 无针刺危险 手术带 组织反应性最低 抗张力强度较缝线低 感染风险最小 最易发生伤口裂开 操作快捷 必须使用有毒性的添加剂 感觉舒适 不能用在有毛发的部位 廉价 必须保持干燥 无针刺危险 * A Comparison of Three Methods of Wound Closure Following ArthroplastyA Prospective, Randomised, Controlled trial Khan,RJK, Fick D, Yao F. J Bone Joint Surg Br, 2006, 88-B: 238-42 * A Comparison of Three Methods of Wound Closure Following ArthroplastyA Prospective, Randomised, Controlled trial Khan,RJK, Fick