At the end of the primary surgical treatment, it is always necessary to decide whether to sew the wound tightly, partially, or leave it open. The desire to sew up the wound tightly is very understandable and is explained primarily by the fact that the sewn wound heals in a shorter time. This issue is especially important in the treatment of gunshot wounds, which have their own characteristic pathomorphological features.
The timing of their application.
The suture applied to the wound at the end of PXO is called primary. It is permissible to apply such a suture only in cases where there is complete confidence in the absolutely radical primary surgical treatment, i.e.:
Processing was performed in the first 6-8 hours after injury;
Foreign bodies, necrotic tissues, hematomas and areas of microbial contamination have been completely removed;
Provided reliable hemostasis;
There are no damage to the main vessels and nerve trunks;
The edges of the wound freely approach without tension;
The general condition of the wounded is satisfactory;
There is the possibility of constant monitoring of the operated within 4-5 days.
Confidence in compliance with these conditions can only be in the treatment of shallow musculocutaneous wounds, which limits the scope of primary sutures. If there is no such confidence, the wound is loosely packed.
Packing the wound should be carried out in such a way that the gauze swab loosely fills the entire wound cavity. A large number of medications proposed for wetting tampons makes it difficult to make a final choice. However, wound packing has three goals:
Keep the wound open;
Ensure the outflow of wound discharge (for this, the tampon must be hygroscopic);
Create an antiseptic environment in the wound.
Hypertonic sodium chloride solution.
Primary provisional sutures can be applied when, at the end of the primary surgical treatment, there is no complete confidence in its radicalness, however, the nature of the wound, the degree of its contamination do not inspire particular concern. In such cases, the sutures are applied without tightening the threads. After 3-4 days, with a calm wound, the threads are pulled and tied.
Delayed primary suture apply in those cases when, on the 3-6th day after PST, it turns out that the edema has decreased or subsided, the color of the wound walls has not changed, the walls are actively bleeding, there is no pus and necrotic tissues in the wound.
In the case of a gunshot wound, by this time the tissues that have fallen into the zone of molecular concussion either become necrotic or restore their viability. If inflammatory-necrotic changes are noted during dressing, the wound still cannot be sutured.
Secondary early seam apply when, after suppuration of the wound and subsequent cleansing of pus, its bottom and walls are performed by granulations.
This occurs, as a rule, on the 10-18th day after the injury. At the same time, contraction of the wound edges usually occurs during these periods, they diverge somewhat. In some cases, special techniques have to be used to approach and hold the edges of such a wound.
When sutures have to be applied after a longer period of time after injury, the walls of the wound become rigid, the edges of the wound and partially granulations degenerate into scar tissue.
When you try to bring together the edges of such a wound, they tuck. To impose secondary late sutures, it is necessary to excise the edges and walls of the wound, and in some cases also mobilize the tissues in its circumference. Sometimes such mobilization is not successful. In these cases, one has to resort to different types of skin plasty.
Thus, it becomes clear that, given the specific features of gunshot wounds, only secondary sutures (early or late) can be applied to them.
The only exceptions are wounds of the face, scalp, hand, penis, i.e. those areas that, on the one hand, are well supplied with blood (which reduces the risk of developing infectious complications), and, on the other hand, the formation of scar tissue in these areas (which is inevitable if primary sutures are not applied) is highly undesirable. In addition, primary sutures are applied to the gunshot wound in case of combined radiation injuries.
In all other cases the imposition of primary sutures on a gunshot wound is strictly prohibited!
As a rule, such fixation of human tissues has its own term of removal. It may vary depending on the part of the body on which the suture is applied. As a rule, there are three terms:
On average - 7-9 days;
head / neck - 6-7 days;
Legs, feet and chest surgery - 10-14 days.
It must be remembered that much depends on the nature of the wound and the age, immunity and regenerative abilities of the victim. So, older people should wear any stitch for at least two weeks. The same applies to seriously ill people whose body is weakened. In any case, it is advisable to consult a doctor before removing.
And most importantly, the sutures can be removed only when the edges of the wound have already grown together. Otherwise, there is a risk that it will disperse again. And then, provided that the wound has not inflamed: in this case, you need to run to the doctor.
By the way, you should not touch the seams from serious abdominal operations on your own - this is very dangerous. At home, you can only remove shovchiki from small wounds.
How to remove stitches yourself
For this you will need:
sharp scissors - surgical or manicure;
· tweezers;
gauze napkin, bandages, plaster;
iodine, medical alcohol, antibiotic ointment;
Boiling water and a vessel under it.
First you need to sterilize the tools - boil and thoroughly treat with alcohol. To be sure, you can also soak them in alcohol for half an hour. If you are tormented by the question of whether it hurts to remove the stitches, then the answer is: not really. As a rule, a person experiences mild discomfort. But this is if the seams are not grown. In this case, only a doctor can help.
Then the process of removing the stitches begins. Here accuracy is important. You must first fill the location of the seams with iodine, carefully processing them from all sides. Then, very carefully, with tweezers, it is necessary to lift the thread above the skin so that a clean piece of thread appears from the channel. This is where it needs to be cut. It is very important not to leave a dirty thread on the tip, which is closer to the skin - this is fraught with infection.
After cutting the thread from one edge of the seam, you need to take the other edge with tweezers and gently pull the thread. In no case should you make a dirty thread pass through the fabric. Only clean! After removing all the sutures, it is necessary to re-treat the wound and close it with a sterile bandage. It is advisable to treat with an antibiotic ointment.
I N S T R U K T I A
TECHNIQUE OF SUITATION AND REMOVAL.
Indications: treatment of wounds.
Contraindications: purulent processes in the wound, PST was not performed.
Equipment:
Sterile:
- anatomical tweezers -1, surgical - 2.
- Gegar needle holder - 1,
- Cooper scissors - 1,
- silk,
- triangular needles - 2,
- sterile wipes,
- iodine sticks (or optional tweezers),
- 1% solution of iodonate,
- cleol,
- trays,
- mask, oilcloth apron, rubber gloves,
- containers with solutions for disinfection.
SUITATION
- Examine the medical appointment (for paramedics, self-record the appointment).
- The patient is invited to the dressing room. Have a conversation with him, answer questions, reassure.
- Wear a mask, oilcloth apron.
- Wash hands and put on sterile gloves.
- Cover the microtable.
- Load the needle with silk thread (length 10-12 cm) using tweezers and a Hegar needle holder.
- Treat the edges of the wound with iodonate (from the center to the periphery).
- Grab the edge of the wound with tweezers, pierce the skin and subcutaneous tissue with a needle, stepping back from the edge of the wound 5 mm. Stitch the bottom of the wound. Sew the second edge from the inside to the outside, piercing the needle at the same distance.
- Bring the edges of the wound together (with two tweezers if they work together).
- Tie the ends of the thread to the side of the wound edge and cut at a distance of 0.5 cm from the knot.
- Apply the next seam with an interval of 1-2 cm.
- Treat the seam with iodonate with blotting movements.
- Apply a sterile bandage.
- Disinfect used equipment.
SEAM REMOVAL TECHNIQUE.
Indications: formed wound scar (6-16 days)
Equipment:
- dressing room standard equipment,
- suture removal kit: Cooper scissors - 1, anatomical tweezers - 1, surgical tweezers -1 (sterile in kraft packaging),
- sterile wipes, balls in bix in kraft packaging,
- solutions: 1% iodonate, cleol,
- tweezers - 3,
- tray,
- protective equipment for the health worker: apron, mask, gloves,
- containers for disinfection.
Execution sequence:
| Actions of the health worker | Rationale |
1. Study the medical prescription. 2. Invite the patient to the dressing room. 3. Sit or lay the patient in a comfortable position. 4. Carry out hygienic treatment of hands, put on protective equipment. 5. Set up the necessary equipment and soft material. 6. Remove the bandage with surgical tweezers (Keep the tweezers like a writing pen, scissor blades with curvature upwards) 7. Treat the scar and sutures with 1% iodonate with anatomical tweezers with a gauze ball. 8. Remove Stitches:
| Error exclusion Creation of psycho-emotional balance. For the convenience of the patient and the health worker EN-1500 Ensuring the course of manipulation Compliance with asepsis. Ensuring the course of manipulation Elimination of leaving the thread in the tissues. Fulfillment of assignment. Compliance with asepsis Infectious safety Continuity of nursing care. |
Sources used:
1. Obukhovets T.P. , Sklyarova T.A., Chernova O.V. Fundamentals of nursing. – Rostov-on-Don, 2002
2. Gritsuk I.R., Vankovich I.K. – Minsk, 2000.
Compiled by:Martishevskaya L.A.
APPROVE
Director of EE "Borisovsky
state medical
college"
Khorova T.I.
"___" _________________ 2007
I N S T R U K T I A
ON CARRYING OUT TRANSPORT IMMOBILIZATION IN FRACTURE OF THE BONES OF THE FOREARM
INDICATIONS: forearm fracture
CONTRAINDICATIONS: No
PATIENT PROBLEMS:
Valid Key words: pain, fear, limitation of movements, physio-atrogenicity
Potential: traumatic shock
Equipment: solution of novocaine 0.5% - 50.0 ml, solution of promedol 2% - 1.0 ml, sterile syringe, needle, skin antiseptic, cotton balls
transport tire Cramer medium (wrapped),
roller in a brush, cotton-gauze pads in the area of bone protrusions,
medium bandages - 3 pieces, scarf, pin:
| No. p / p | STAGES | RATIONALE |
| 1. | Establish contact with the patient, comfortably lay or seat, inspect the injury site | Assessment of the patient's condition |
| 2. | Produce anesthesia | |
| 3. | Model the Cramer splint on a healthy limb: the splint should protrude beyond the fingertips by 3 cm, bent at the elbow joint by 90 degrees and reach the middle third of the shoulder | Ensuring the course of manipulation |
| 4. | Give the limbs a position between pronation and supination, bend at the elbow joint at a right angle, the hand is in a grasping position | Correct physiological position of the limb, ease of immobilization |
| 5. | On your own or with the help of an assistant, attach the modeled splint to the injured limb, place rollers in the arm and axillary region, protruding gauze pads under the bone protrusions | Rules for splinting, prevention of soft tissue trauma |
| 6. | Start bandaging from the injury site for 2-3 circular rounds, then descend with a creeping bandage to the wrist joint and tightly fix the hand with a cruciform bandage. Next, apply a spiral bandage on the forearm, “turtle” on the elbow joint, and again apply a spiral bandage to the middle third of the shoulder. | Adequate fixation of the splint to the limb for transport purposes |
| 7. | We fasten the bandage with a pin or tie it on the shoulder | Bandage fixation |
| 8. | Putting on a bandage | Supportive immobilization |
| 9. | Transportation to hospital or emergency room | Nursing Process Continuity |
The instruction was considered at the meeting of the Central Committee No. 4
Minutes No. ___ dated _____________ 2007
Chairman of the Central Committee No. 4_____________ A.A. Lisov
Compiled by: Valutov V.A.
Sources used:
3. Syromyatnikova A.V. Brukman M.S. Guide to practical manipulations in surgery
APPROVE
Director of EE "Borisovsky
state medical
college"
Khorova T.I.
"___" _________________ 2007
I N S T R U K T I A
ON BANDAGE DESO
INDICATIONS: 1. Injuries of the upper limb
2. Fractures and dislocations of the collarbone
3. Condition after mastectomy
CONTRAINDICATIONS: No
PATIENT PROBLEMS:
Valid: pain, aggravation of the consequences of trauma or surgery, egogeny
Potential: traumatic shock, displacement of fragments, traumatization of soft tissues, nerve trunks and large vessels
MATERIAL SUPPORT: wide bandages - 3 pcs., cotton-gauze pads, an ampoule with an anesthetic (1 ml of 2% promedol solution, 2 ml of 50% analgin solution), syringe, sterile balls, 70% alcohol, pins - 8 pieces
| No. p / p | STAGES OF PERFORMANCE | RATIONALE |
| 1. | Establish contact with the patient, seat him or lay him down | |
| 2. | Examine the injured limb | Making a preliminary diagnosis and drawing up an action plan |
| 3. | Perform anesthesia (intramuscularly inject 1 ml of a 2% solution of promedol or 2 ml of a 50% solution of analgin) | Prevention of traumatic shock |
| 4. | Give the hand a physiological position: bend at a right angle in the elbow joint, take the elbow back a little, and slightly lift the shoulder up, put a roller in the axillary region | Prevention of complications |
| 5. | If the clavicle is damaged, apply a cotton-gauze pad to the fracture area | To avoid injury to soft tissues by sharp bone fragments |
| 6. | Become facing the patient and slightly to the right | Monitoring the patient's condition, work convenience |
| 7. | Start bandaging from the healthy side to the injured | Bandaging rules |
| 8. | With the 1st round, bandage the shoulder to the chest of the middle third | Precise fixation of the limb |
| 9. | 2nd round hold obliquely up the front surface of the chest on the shoulder girdle of the injured side and lower it vertically down the back surface of the shoulder | Shoulder fixation |
| 10. | 3rd round - remove from under the elbow joint obliquely upward through the wrist joint to the axillary region of the healthy side | Fixation of the elbow and wrist joints |
| 11. | 4th round lead from the axillary region of the healthy side to the shoulder girdle of the damaged one, then lower it along the shoulder on the forearm and picking up the elbow joint, return to the first round | Final and precise fixation of the limb |
| 12. | The 5th round is fixing and coincides with the first. The bandage is fixed with a pin in front | Bandaging rules |
| 13. | Each round is repeated 3-5 times, the bandage crosses are fastened with pins | Clear fixation of the limb, the possibility of long-term transportation |
| 14. | Transportation of the patient to the emergency room | Continuity of nursing care |
Compiled by: Valutov V.A.
Sources used:
1. Gritsuk I.R., Vankovich I.K. Nursing in surgery. – Minsk, 2000.
2. Buyanov V.M., Nesterenko Yu.A. Surgery. – Moscow, 1990.
APPROVE
Director of EE "Borisovsky
state medical
college"
Khorova T.I.
"___" _________________ 2007
I N S T R U K T I A
Compiled by: Valutov V.A.
APPROVE
Director of EE "Borisovsky
state medical
college"
Khorova T.I.
"___" _________________ 2007
I N S T R U K T I A
Compiled by: Martishevskaya
APPROVE
Director of EE "Borisovsky
state medical
college"
Khorova T.I.
"___" _________________ 2007
I N S T R U K T I A
Compiled by: Valutov V.A.
Sources used:
1. Gritsuk I.R., Vankovich I.K. Nursing in surgery. – Minsk, 2000.
2. Buyanov V.M., Nesterenko Yu.A. Surgery. – Moscow, 1990.
3. Syromyatnikova A.V. Brukman M.S. Guide to practical manipulations in surgery. Moscow, 1987.
APPROVE
Director of EE "Borisovsky
state medical
college"
Khorova T.I.
"___" _________________ 2007
I N S T R U K T I A
Compiled by: Valutov V.A.
Sources used:
1. Gritsuk I.R., Vankovich I.K. Nursing in surgery. – Minsk, 2000.
2. Buyanov V.M., Nesterenko Yu.A. Surgery. – Moscow, 1990.
3. Syromyatnikova A.V. Brukman M.S. Guide to practical manipulations in surgery. Moscow, 1987.
APPROVE
Director of EE "Borisovsky
state medical
college"
Khorova T.I.
"___" _________________ 2007
INSTRUCTIONS
"The role of the nurse in monitoring patients during blood transfusion (after a biological test)"
1. Evaluation of the recipient's condition: establishment (support) of psychological contact with him (appearance, P, blood pressure, respiratory rate, complaints - every 10-15 minutes), it is necessary to reassure the patient: "Everything is going well!"
2. Interpretation of the obtained data, informing the doctor.
3. Nursing plan: stay with the patient at all times
| PATIENT PROBLEMS | WAYS OF SOLUTION |
| Valid: fear of carrying out (outcome) of blood transfusion, | constant monitoring of its functioning, informing the doctor |
| constant psychological contact with the patient, informing him about the course of the operation (how much blood was transfused, indicators of P, blood pressure), information support by the doctor (emphasize the positive effect of blood | |
| on the body - detoxification, replacement, stimulating, hemostatic, nutritional, immunobiological) | |
| - physical activity | is a temporary state |
| Potential: - nutrition - drinking - physiological administration initial signs of incompatibility: - pain in the lower back, abdomen, behind the sternum - feeling of heat, redness of the face - shortness of breath - tachycardia - itching of the skin, allergic rashes | feed water give the duck, the vessel immediately stop the blood transfusion, turn off the system without removing the needle from the vein. Connect the system with 0.9% sodium chloride solution. immediate cessation of blood transfusion, without removing the needle from the vein, switch to physical. rr, call a doctor immediately! (behavior m / s is calm, movements are confident). It is necessary to calm the patient (explain the temporary nature of discomfort) |
| - thrombosis of the infusion system | turn off the system with blood without removing the needle from the vein, make sure it is patency, connect the system with physical. p-ohm, if the needle is thrombosed, call a doctor! |
At the end of the operation:
Leave in a bottle of 10-15 ml. blood
As prescribed by the doctor, inject intravenous CaCl10% -10.0
Warn the patient about the need for bed rest after blood transfusion
Evaluate the effectiveness of the measures taken:
PATIENT STATUS:
improved
worsened
Without changes
Instruction reviewed
at CMC surgery
Minutes No. ____ dated "____" _______________ 2005
Chairman of the Central Medical Committee of Surgery: V. N. Rozhko
Compiled by: teacher Lisov A. A.
Used sources:
APPROVE
Director of EE "Borisovsky
state medical
college"
Khorova T.I.
"___" _________________ 2007
I N S T R U K T I A
"PUTTING A NURSE IN STERILE CLOTHES AND GLOVES"
Indications: nurse operation preparation
Equipment: operating room --
* towel (napkin), balls, bathrobe (sterile in bix);
hand skin antiseptic
a sterile tray
forceps (tweezers) in solution,
a basin for discarding waste
preoperative -
cap, mask (in bix or in packages);
shoe covers,
forceps (tweezers) in an antiseptic solution;
Sterile wipes, towels;
warm running water, soap (Ph-neutral, preferably liquid)
Tray, basin, antiseptic for hand treatment (depending on the method of processing, the equipment can be expanded), watches, etc.
Technique:
Preparatory stage: in the preoperative.
Main stage: in the operating room.
| STAGES | RATIONALE |
| PREPARATORY STAGE | |
| 1. Take a hygienic shower, put on a surgical suit, shoes made of leather or leatherette | Compliance with the sanitary and epidemiological regime |
| 2. Put on a preoperative cap, mask, shoe covers. | |
| 3.Check the readiness of the operating room, preoperative room (make marks on the tags of the autopsy tags, release the ties from the ties). | Ensuring the operation of the operating room |
| 4. Wear an apron. Prepare an antiseptic solution for hand treatment, depending on the method | Ensuring the sequence of manipulation |
| 5. Wash hands according to EN-1500, treat in one of the ways | Ensuring subsequent sterility of manipulation |
Compiled by: Rozhko V.N.
Literature: 1. Obukhovets T.P. , Sklyarova T.A., Chernova O.V. Fundamentals of nursing. - Rostov-on-Don, 2002.2. Order of the Ministry of Health of the Republic of Belarus No. 165 dated November 25, 2002 “On disinfection and sterilization by healthcare institutions”.3. Sanitary rules for the arrangement, equipment and operation of medical institutions, No. 71 dated 11.07.
APPROVE
Director of EE "Borisovsky
state medical
college"
Khorova T.I.
"___" _________________ 2007
I N S T R U K T I A
"UNIVERSAL INSTALLATION OF MATERIAL IN BIX"
INDICATIONS: dressing preparation for surgery.
EQUIPMENT: KSK-18 (KF-18) sheet or diaper for lining bix, surgical gown (5 pieces), belts (5), medical caps (5), masks (5), towel (10),
sheets (5), dressings:
* gauze napkins of 3 sizes - 30 pieces
*tampons in 3 sizes - 30 pieces
* turundas - 1 skein
* gauze balls in a bag - 50 pieces
* hygroscopic cotton wool - 390 grams
* brushes - 10 pieces
* bandages -900 grams
Sterility control indicator - 3 pcs., external indicator - 1 pc., napkin - 4 pcs., kidney-shaped tray, disinfectant solution, medical oilcloth for the tag 13x10 cm, a piece of bandage for the tag, a pencil.
| No. p / p | STAGES OF PERFORMANCE | RATIONALE |
| PREPARATION | ||
| 1. | Wash hands, dry. Wear gloves, mask | Ensuring safety in the workplace |
| 2. | Check the correctness of the bix | Ensuring tightness after sterilization |
| 3. | Treat the bix with closed holes from the inside moistened with disinfectant in the following sequence: bottom, wall, lid, in a circular motion from the center to the periphery. Then outside, starting from the lid in a circular motion and going down. After 15 minutes, repeat the treatment with a second napkin moistened with disinfectant. | Compliance with the principle of processing "from clean to dirty" |
| 5. | Wash hands, wipe dry | Personal hygiene |
| 6. | Open windows. | |
| PERFORMANCE | ||
| 1. | Line the bottom and walls of the bix with a napkin so that it hangs down two-thirds of the bix height | Ensuring the tightness of packaging in bix, prevention of reinfection |
| 2. | Place a sterility indicator on the bottom of the bix (at the control point) | |
| 3. | Lay the dressing loosely, vertically, sectorally and in layers: bottom layer: gauze napkins in sizes of 10 pieces, tampons of 3 sizes in 10 pieces, a skein of turundas, balls - 50 pieces, absorbent cotton - 390 grams and shaving brushes - 10 pieces; middle layer: sheets - 5 pieces (folded in four layers and rolled up on both sides), towels - 9 pieces (folded twice perpendicularly, then rolled up), bandages - 900 g, 4 bathrobes (folded lengthwise into 4 layers with ribbons inside, roll up into a roll from the bottom up), 4 hats (usually), 4 masks (with ribbons inside), 4 belts (in the right pocket of the robe). | Convenience of sterilization and use of material |
| 4. | Place a sterility indicator in the middle of the 2nd layer | Sterility quality control |
| 5. | Wrap the edges of the napkin lining the bix one on top of the other. Put the top layer on top of the sheet: 1 bathrobe, 1 belt, 1 cap, 1 mask, 1 towel | Ensuring that the dressing room of the operating room nurse is prioritized |
| 6. | Place the sterility indicator on the top | Ensuring visual quality control of sterility |
| 7. | Close the lid with a padlock | Ensuring the tightness of the sterile bix |
| 8. | Tie a tag to the bix handle | Ensuring continuity in working with Bix |
| 9. | Indicate the date of laying, put the signature of the person responsible for laying | Personal responsibility |
| 10. | Stick an external indicator on the bix cover. | Temperature control |
| 11. | Deliver bixes to the CSO in a dense moisture-proof bag |
I N S T R U K T I A
Compiled by: Rozhko V.N.
APPROVE
Director of EE "Borisovsky
state medical
college"
Khorova T.I.
"___" _________________ 2007
INSTRUCTIONS
Compiled by: Lisov A.A.
Used source
1.Yaromich I.V., "Nursing"
2. "Medical knowledge" 2004
3. "World of Medicine" 2004
4. Pasheva N.R., "Handbook of m / s care" 2000
APPROVE
Director of EE "Borisovsky
state medical
college"
Khorova T.I.
"___" _________________ 2007
BANDAGE OF A PURULENT WOUND
Indications: - soaking the bandage with purulent discharge, blood
Another dressing
Bandage displacement
Contraindications: No
Patient problems:
Valid: fear of pain, discomfort.
Potential: psychogenic nausea, dizziness, fainting, an increase in the area and depth of the wound.
Equipment: bathrobe, hat, mask, gloves, apron, armlets,
sterile dressing material
tweezers - 4,
bulbous probe - 1,
scissors - 1.
rubber strip - 2,
1% iodonate, 3% hydrogen peroxide solution, furatsilin 1:5000, 0.9% sodium chloride.
| No. p / p | STAGES OF PERFORMANCE | RATIONALE |
| PREPARATORY STAGE | ||
| 1. | Inform the patient about the upcoming manipulation, obtain consent Invite the patient to the dressing room after 10 minutes. | Ensuring the patient's right to information. |
| 2. | Put on a surgical gown, mask, put on an apron, perform surgical treatment of hands - put on sterile gloves. | Compliance with the sanitary and anti-epidemic regime. |
| 3. | Put everything you need on the table. | |
| 4. | Invite the patient to the dressing room | |
| 5. | Sit or lay the patient in a comfortable position, explain the course of manipulation. | Creation of physiological comfort. |
| MAIN STAGE | ||
| 1. | Treat your hands with an antiseptic. | Compliance with the rules of asepsis |
| 2. | Remove the upper bandage (sticker) from the set with tweezers, using furatsilin for soaking (1st tweezers). Monitor the patient's condition, suggest not to look at the wound. | To reduce pain sensitivity |
| 3. | Treat the wound with a ball with 1% iodonate solution using the second tweezers from the set, then remove the rubber drainage (with the same tweezers) (2nd tweezers). | Ensuring the course of manipulation |
| 4. | Wash the wound with 3% hydrogen peroxide solution, dry with a sterile dry ball (3rd tweezers). | Wound decontamination |
| 5. | Take a rubber strip with the same tweezers and insert it into the wound with a button probe, leaving the tip outside (1-2 cm), then treat with 1% iodonate solution. (4th tweezers). | Ensuring the course of manipulation. |
| 6. | Close the wound with a sterile napkin with hypertonic sodium chloride solution, apply an aseptic dressing or sticker on top. | Compliance with the sterility of the wound, prevention of displacement of the dressing |
| THE FINAL STAGE | ||
| 1. | Will provide accompaniment of the patient, if necessary, to the ward, provide him with peace, explain the rules for caring for the bandage. | Ensuring the continuity of nursing care Ensuring the continuity of nursing care |
| 2. | Disinfect used equipment. | |
| 3. | Make an entry in the register of procedures. | |
| 4. | Evaluate nursing intervention. |
INSTRUCTIONS
"DETERMINATION OF THE RH FACTOR EXPRESS - METHOD"
(IN THE TUBE WITHOUT HEATING)
Indications: transfusion of blood and its components.
Equipment: universal reagent anti-rhesus anti-RHD; serum (to determine the Rh factor in a test tube without heating); test blood (in a vial); isotonic sodium chloride solution; Pasteur pipettes; hourglass for 5 minutes; syringe with a needle; test tube in a rack; soft material; antiseptic solution; protective equipment (mask, gloves, apron, sleeves, goggles); disinfectants in labeled containers; first aid kit in case of an accident when working with blood (Order No. 351 of the Ministry of Health of the Republic of Belarus).
| No. p / p | STAGES | RATIONALE |
| PREPARATORY STAGE | ||
| 1. | ||
| 2. | ||
| 3. | ||
| 4. | Mark a clean, dry tube, indicate: patient's full name (indicated on the vial). | |
| MAIN STAGE | ||
| 1. | Introduce a large drop of anti-Rhesus anti-RHD serum into the test tube with a Pasteur pipette, add a drop of test blood here (with a disposable syringe) - a ratio of 2-4: 1. | Ensuring the progress of the procedure. |
| 2. | Ensuring the clarity and efficiency of the procedure. | |
| 3. | Connect the serum with blood by shaking, turning, tilting the test tube to a horizontal position so that the contents spread along its walls in the lower third. | |
| 4. | After 5 min. add 2-3 ml to the test tube. physiological saline, continue to gently mix the contents, NOT SHAKING! | |
| 5. | Carefully examine the contents of the test tube, evaluate the results in transmitted light. | Evaluation of results. |
| 6. | Invite a doctor to read the result: · if there is agglutination – RH+ blood to be tested; If there is no agglutination, the test blood is RH-. | Evaluation of results. |
| 7. | ||
| 8. | If the result is doubtful, repeat the blood test using the serum of a different series. | Ensuring the reliability of the results obtained. |
| THE FINAL STAGE | ||
| 1. | Compliance with infectious safety. | |
| 2. | Soak a test tube, Pasteur pipettes, a syringe with a needle, soft material, gloves in a 1% solution of polydez for 45 minutes. | Compliance with infectious safety. |
| 3. | Treat the tripod, manipulation table, protective equipment (sleeves, glasses, apron) with 1% polydez solution 2 times with an interval of 15 minutes. | Compliance with infectious safety. |
INSTRUCTIONS
"DETERMINATION OF BLOOD GROUPS ON STANDARD SERUM"
Conducted by a doctor, and a nurse - a technical assistant-performer.
Indications: transfusion of blood and its components, the establishment of the hereditary properties of the body.
Equipment: standard hemagglutinating sera of four groups O(I), A(II), B(III), ABO(IV) of two series; test blood in a vial; plates (faience or covered with white enamel); glass slides; Pasteur pipettes; hourglass for 5 minutes; syringe with a needle; soft material; antiseptic solution; protective equipment (mask, gloves, apron, sleeves, goggles); disinfectants in labeled containers; first aid kit in case of an accident when working with blood (Order No. 351 of the Ministry of Health of the Republic of Belarus).
| No. p / p | STAGES | RATIONALE |
| PREPARATORY STAGE | ||
| 1. | Prepare your workspace. Wear protective equipment: gown, mask, goggles, apron, sleeves, gloves. | Ensuring the clarity and efficiency of the procedure; use of personal protective equipment. |
| 2. | Wash gloved hands under running water and soap. Dry with a disposable towel. | Compliance with infectious safety. |
| 3. | Expose sterile equipment, put the date, time of opening, signature. | Control of expiration dates. |
| 4. | Mark a clean dry plate, indicate on its upper edge: the name of the patient (indicated on the vial). | Ensuring the clarity and efficiency of the procedure. |
| MAIN STAGE | ||
| 1. | According to the designations of blood groups, apply one large drop (0.1 ml) of standard isohemagglutinating sera O (I), A (II), B (III), ABO (IV) blood groups of two series to the plate, each drop is applied with a separate pipette. | Ensuring the progress of the procedure. |
| 2. | From a vial of blood, draw some blood with a syringe and apply to a glass slide. | Ensuring the progress of the procedure. |
| 3. | Place on the signed plate, next to the serum, a drop of blood (0.01 ml), the ratio of serum and blood is 1:10. | Ensuring the progress of the procedure. |
| 4. | Mix serum and blood with an angled glass slide (each cell on a separate angle) until homogeneous staining. | Ensuring the progress of the diagnostic reaction. |
| 5. | Set the time control on the hourglass - 5 min. | Ensuring the clarity and efficiency of the procedure. |
| 6. | Take the plate in your hands and, periodically shaking, observe the onset of the agglutination reaction. | Evaluation of results. |
| 7. | After 3 min. add 1 drop (0.05 ml) of saline to each well. | Prevention of the appearance of false agglutination; ensuring the reliability of the results. |
| 8. | Observe the reaction until 5 minutes have elapsed. | Ensuring the clarity and efficiency of the procedure. |
| 9. | Invite a doctor to read the result: in the absence of agglutination in all drops - blood type O (I); In the absence of agglutination in the second drop (in two series), and the presence of such in the first and third drops - blood group A (II); In the absence of agglutination in the third drop (in two series), and the presence of such in the first and second drops - blood group B (III); In the presence of agglutination in all drops - blood type ABO (IV). An additional control study should be performed with standard ABO(IV) serum. The absence of agglutination in this drop will make it possible to consider the reaction as specific (true) and to attribute the studied blood to the ABO(IV) group. | Evaluation of results. |
| 10. | Make appropriate entries in the medical records. | Maintaining continuity in the nursing process. |
| THE FINAL STAGE | ||
| 1. | Disinfect used equipment. | Compliance with infectious safety. |
| 2. | Soak a plate, glass slides, Pasteur pipettes, a syringe with a needle, soft material, gloves in 1% polydez solution for 45 minutes. | Compliance with infectious safety. |
| 3. | Treat the manipulation table, protective equipment (armlets, glasses, apron) with 1% polydez solution 2 times with an interval of 15 minutes. | Compliance with infectious safety. |
SCORE SCORE
When performing manipulation
"Performing emergency prophylaxis of tetanus with toxoid"
| No. p / p | Possible mistakes | The amount of points deducted |
| 1. | Stage I of the nursing process has not been completed (psychological contact with the patient, assessment of his condition). | |
| 2. | The indications for the administration of the drug have not been determined. | |
| 3. | The indications for the administration of the drug are not fully listed. | |
| 4. | Indications for the administration of the drug are not listed. | |
| 5. | The patient's problems are not specified. | |
| 6. | The equipment for the manipulation is not fully prepared. | |
| 7. | The suitability of the drug and the syringe for use has not been verified. | |
| 8. | Ampoule not treated with antiseptic. | |
| 9. | Gloves not treated with antiseptic. | |
| 10. | The injection site has not been treated with an antiseptic or has not been properly treated. | |
| 11. | Nursing process not completed during and after manipulation | |
| 12. | Documentation on the introduction of the drug is not completed. |
APPROVE
Director of the EE "Borisov State
Medical College
T.I. Khorova
"___" __________________ 2007
INSTRUCTIONS
SCORE SCORE
When performing manipulation
« Temporary stop of bleeding by overlay method
Compiled by: Valutov V.A.
SCORE SCORE
When performing manipulation
"Imposition of a medical pneumatic splint".
Information about the types and healing process of the postoperative suture. And also told what actions need to be taken in case of complications.
After a person has survived the operation, scars and stitches remain for a long time. From this article you will learn how to properly process the postoperative suture and what to do in case of complications.
Types of postoperative sutures
With the help of a surgical suture, biological tissues are connected. Types of postoperative sutures depend on the nature and scale of the surgical intervention and are:
- bloodless that do not require special threads, but stick together with a special adhesive
- bloody, which are sutured with medical suture material through biological tissues
Depending on the method of suturing bloody, the following types are distinguished:
- simple nodal– the puncture has a triangular shape, which holds the suture material well
- continuous intradermal- most common providing a good cosmetic effect
- vertical or horizontal mattress - used for deep extensive tissue damage
- purse-string - intended for tissues of a plastic nature
- entwining - as a rule, serves to connect the vessels and organs of the hollow
From what technique and tools are used for suturing, they differ:
- manual, which are applied with a regular needle, tweezers and other tools. Suture materials - synthetic, biological, wire, etc.
- mechanical carried out by means of the apparatus using special staples
The depth and extent of the bodily injury dictates the method of suturing:
- single-row - the seam is superimposed in one tier
- multilayer - the imposition is carried out in several rows (first, muscle and vascular tissues are connected, then the skin is sutured)
In addition, surgical sutures are divided into:
- removable– after the wound has healed, the suture material is removed (usually used on integumentary tissues)
- submersible– not removed (applicable for joining internal tissues)
Materials that are used for surgical sutures can be:
- absorbable - removal of suture material is not required. They are used, as a rule, for ruptures of mucous and soft tissues.
- non-absorbable - removed after a certain period of time set by the doctor
When suturing, it is very important to connect the edges of the wound tightly so that the possibility of cavity formation is completely excluded. Any type of surgical suture requires treatment with antiseptic or antibacterial drugs.
How and with what to process the postoperative suture for better healing at home?
The period of wound healing after surgery largely depends on the human body: for some, this process occurs quickly, for others it takes a longer time. But the key to a successful result is the correct therapy after suturing. The following factors influence the timing and nature of healing:
- sterility
- materials for suture treatment after surgery
- regularity
One of the most important requirements for trauma care after surgery is observance of sterility. Treat wounds only with thoroughly washed hands using disinfected instruments.
Depending on the nature of the injury, postoperative sutures are treated with various antiseptic agents:
- potassium permanganate solution (it is important to follow the dosage to exclude the possibility of burns)
- iodine (in large quantities can cause dry skin)
- brilliant green
- medical alcohol
- fucarcinoma (it is difficult to wipe off the surface, which causes some inconvenience)
- hydrogen peroxide (may cause mild burning)
- anti-inflammatory ointments and gels
Often at home, folk remedies are used for these purposes:
- tea tree oil (whole)
- tincture of larkspur roots (2 tbsp, 1 tbsp water, 1 tbsp alcohol)
- ointment (0.5 cups of beeswax, 2 cups of vegetable oil, cook over low heat for 10 minutes, let cool)
- cream with calendula extract (add a drop of rosemary and orange oils)
Be sure to consult your doctor before taking these medications. In order for the healing process to occur as soon as possible without complications, it is important to follow the rules for processing sutures:
- sanitize hands and tools that may be needed
- carefully remove the bandage from the wound. If it sticks, pour peroxide before applying the antiseptic
- using a cotton swab or gauze swab, lubricate the seam with an antiseptic preparation
- bandage
In addition, do not forget to comply with the following conditions:
- do the processing twice a day, if necessary and more often
- check the wound regularly for inflammation
- to avoid scarring, do not remove dry crusts and scabs from the wound
- do not rub the seam with hard sponges during the shower
- in case of complications (purulent discharge, swelling, redness), consult a doctor immediately
How to remove postoperative sutures at home?
A removable postoperative suture must be removed on time, since the material used to connect the tissue acts as a foreign body for the body. In addition, if the threads are not removed in due time, they can grow into the tissues, which will lead to inflammation.
We all know that a medical worker should remove the postoperative suture in suitable conditions with the help of special tools. However, it happens that there is no opportunity to visit a doctor, the time for removal of stitches has already come, and the wound looks completely healed. In this case, you can remove the suture yourself.
To get started, prepare the following:
- antiseptic preparations
- sharp scissors (preferably surgical, but you can also use nail scissors)
- dressing
- antibiotic ointment (in case of infection in the wound)
The procedure for removing the seam is as follows:
- disinfect the instruments
- wash your hands thoroughly up to the elbow and treat with an antiseptic
- choose a well-lit place
- remove the bandage from the seam
- using alcohol or peroxide, treat the area around the location of the seam
- using tweezers, gently lift the first knot slightly
- while holding it, cut the suture thread with scissors
- carefully, slowly pull the thread
- continue in the same order: lift the knot and pull the threads
- be sure to remove all suture material
- treat the suture site with an antiseptic
- apply a bandage for better healing
In the case of self-removal of postoperative sutures, in order to avoid complications, strictly observe the following requirements:
- only small superficial seams can be removed independently
- do not remove surgical staples or wires at home
- make sure the wound is completely healed
- if bleeding occurs during the process, stop the action, treat with an antiseptic and consult a doctor
- protect the seam area from ultraviolet radiation, as the skin there is still too thin and prone to burns
- avoid injury to the area
What to do if a seal appears at the site of the postoperative suture?
Often, after the operation, a seal is observed under the suture in a patient, which was formed due to the accumulation of lymph. As a rule, it does not pose a threat to health and disappears over time. However, in some cases, complications may arise in the form of:
- inflammation- accompanied by painful sensations in the area of the seam, redness is observed, the temperature may rise
- suppuration- when the inflammatory process is running, pus can be released from the wound
- the formation of keloid scars - is not dangerous, but has an unaesthetic appearance. Such scars can be removed with laser resurfacing or surgery.
If you observe any of these symptoms, please contact your surgeon. And in the absence of such an opportunity, - to the hospital at the place of residence.
If you see a seal, then consult a doctor Even if it later turns out that the resulting bump is not dangerous and will eventually resolve on its own, the doctor must examine and give his opinion. If you are convinced that the seal of the postoperative suture is not inflamed, does not cause pain and there is no purulent discharge, follow these requirements:
- follow the rules of hygiene. Keep bacteria out of the injured area
- process the seam twice a day and change the dressing material in a timely manner
- when showering, avoid getting water on the unhealed area
- don't lift weights
- make sure that your clothes do not rub the seam and areolas around it
- before going outside, put on a protective sterile bandage
- in no case do not apply compresses and do not rub with various tinctures on the advice of friends. This can lead to complications. The doctor must prescribe treatment
Compliance with these simple rules is the key to successful treatment of suture seals and the possibility of getting rid of scars without surgical or laser technologies.
The postoperative suture does not heal, reddened, inflamed: what to do?
One of a number of postoperative complications is inflammation of the suture. This process is accompanied by such phenomena as:
- swelling and redness in the suture area
- the presence of a seal under the seam, which is groped with fingers
- increased temperature and blood pressure
- general weakness and muscle pain
The reasons for the appearance of the inflammatory process and further non-healing of the postoperative suture may be different:
- infection in the postoperative wound
- during the operation, trauma to the subcutaneous tissues occurred, as a result of which hematomas formed
- suture material had increased tissue reactivity
- In overweight patients, wound drainage is inadequate
- low immunity in the operated
Often there is a combination of several of the following factors that may arise:
- due to the error of the operating surgeon (instruments and materials were insufficiently processed)
- due to non-compliance by the patient with postoperative requirements
- due to indirect infection, in which microorganisms are spread through the blood from another focus of inflammation in the body
If you see redness in the suture, contact your doctor immediately. In addition, the healing of a surgical suture largely depends on the individual characteristics of the body:
- weight- in overweight people, the wound after surgery may heal more slowly
- age - tissue regeneration at a young age is faster
- nutrition - lack of proteins and vitamins slows down the recovery process
- chronic diseases - their presence prevents rapid healing
If you observe redness or inflammation of the postoperative suture, do not postpone a visit to the doctor. It is the specialist who must examine the wound and prescribe the correct treatment:
- remove stitches if necessary
- will wash the wounds
- install a drain to drain purulent discharge
- prescribe the necessary medicines for external and internal use
Timely implementation of the necessary measures will prevent the likelihood of serious consequences (sepsis, gangrene). After the medical manipulations performed by the attending physician, to speed up the healing process at home, follow these recommendations:
- treat the seam and the area around it several times a day with the drugs prescribed by the attending physician
- during the shower, try not to catch the wound with a washcloth. After leaving the bath, gently blot the seam with a bandage
- change sterile dressings in time
- take a multivitamin
- include extra protein in your diet
- do not lift heavy objects
In order to minimize the risk of an inflammatory process, it is necessary to take preventive measures before the operation:
- boost immunity
- perform oral hygiene
- identify the presence of infections in the body and take measures to get rid of them
- Strictly observe hygiene rules after surgery
Postoperative fistula: causes and methods of struggle
One of the negative consequences after surgery is postoperative fistula, which is a channel in which purulent cavities are formed. It occurs as a result of the inflammatory process, when there is no outlet for purulent fluid.
The causes of fistulas after surgery can be different:
- chronic inflammation
- infection is not completely eliminated
- rejection by the body of a non-absorbable suture material
The last reason is the most common. The threads that connect tissues during surgery are called ligatures. Therefore, the fistula that arose due to its rejection is called ligature. Around the thread is formed granuloma, that is, a seal consisting of the material itself and fibrous tissue. Such a fistula is formed, as a rule, for two reasons:
- entry of pathogenic bacteria into the wound due to incomplete disinfection of threads or instruments during surgery
- patient's weak immune system, due to which the body weakly resists infections, and there is a slow recovery after the introduction of a foreign body
The fistula can manifest itself in a different postoperative period:
- within a week after surgery
- after a few months
Signs of fistula formation are:
- redness in the area of inflammation
- the appearance of seals and tubercles near the seam or on it
- pain
- pus
- temperature increase
After the operation, a very unpleasant phenomenon may occur - a fistula. If you experience these symptoms, be sure to consult a doctor. If measures are not taken in time, the infection can spread throughout the body.
Treatment of postoperative fistulas is determined by the doctor and can be of two types:
- conservative
- surgical
The conservative method is used if the inflammatory process has just begun and has not led to serious violations. In this case, the following is done:
- removal of dead tissue around the seam
- washing the wound from pus
- removal of the outer ends of the thread
- patient taking antibiotics and immunosuppressants
The surgical method includes a number of medical measures:
- make an incision to drain the pus
- remove the ligature
- wash the wound
- if necessary, repeat the procedure after a few days
- in the presence of multiple fistulas, you may be prescribed a complete excision of the suture
- stitches are re-attached
- prescribed a course of antibiotics and anti-inflammatory drugs
- complexes of vitamins and minerals are prescribed
- standard therapy prescribed after surgery
Recently, a new method of treating fistulas has appeared - ultrasound. This is the most gentle method. Its disadvantage is the length of the process. In addition to these methods, healers offer folk remedies for the treatment of postoperative fistulas:
- mummy dissolve in water and mix with aloe juice. Soak a bandage in the mixture and apply to the inflamed area. Keep a few hours
- wash the wound with decoction Hypericum(4 tablespoons of dry leaves per 0.5 l of boiling water)
- take 100 g of medical fly in the ointment, butter, flower honey, pine resin, crushed aloe leaf. Mix everything and heat in a water bath. Dilute with medical alcohol or vodka. Apply the prepared mixture around the fistula, cover with a film or plaster
- put a sheet on the fistula at night cabbage
However, do not forget that folk remedies are only auxiliary therapy and do not cancel a visit to the doctor. To prevent the formation of postoperative fistulas, it is necessary:
- before the operation, examine the patient for the presence of diseases
- prescribe antibiotics to prevent infection
- clean instruments carefully before surgery
- prevent contamination of suture materials
Ointments for healing and resorption of postoperative sutures
For resorption and healing of postoperative sutures, antiseptic agents (brilliant green, iodine, chlorhexidine, etc.) are used. Modern pharmacology offers other drugs of similar properties in the form of ointments for local action. Using them for healing purposes at home has several advantages:
- availability
- wide spectrum of action
- the fatty base on the surface of the wound creates a film that prevents overdrying of tissues
- skin nutrition
- Ease of use
- softening and brightening of scars
It should be noted that for wet wounds of the skin, the use of ointments is not recommended. They are prescribed when the healing process has already begun.
Based on the nature and depth of skin lesions, various types of ointments are used:
- simple antiseptic(for shallow superficial wounds)
- containing hormonal components (for extensive, with complications)
- Vishnevsky ointment- one of the most affordable and popular pulling means. Promotes accelerated release from purulent processes
- levomekol- has a combined effect: antimicrobial and anti-inflammatory. It is a broad spectrum antibiotic. Recommended for purulent discharge from the suture
- vulnuzan- a product based on natural ingredients. Applied to both the wound and the bandage
- levosin- kills microbes, removes the inflammatory process, promotes healing
- stellanine- a new generation ointment that removes puffiness and kills the infection, stimulates the regeneration of the skin
- eplan- one of the strongest local remedies. Has analgesic and anti-infective effect
- solcoseryl- available in the form of a gel or ointment. The gel is used when the wound is fresh, and the ointment is used when healing has begun. The drug reduces the likelihood of scarring and scars. Better put under a bandage
- actovegin- a cheaper analogue of solcoseryl. It successfully fights inflammation, practically does not cause allergic reactions. Therefore, it can be recommended for use by pregnant and lactating women. Can be applied directly to damaged skin
- agrosulfan- has a bactericidal effect, has an antimicrobial and analgesic effect
Seam ointment - naftaderm - has anti-inflammatory properties. It also relieves pain and softens scars.
- contractubex - is used when the healing of the seam begins. Has a softening smoothing effect in the scar area
- mederma - improves tissue elasticity and brightens scars
The listed remedies are prescribed by a doctor and used under his supervision. Remember that self-treatment of postoperative sutures cannot be done in order to prevent suppuration of the wound and further inflammation.
Plaster for healing postoperative sutures
One of the effective care products for postoperative sutures is a patch made on the basis of medical silicone. This is a soft self-adhesive sheet that is fixed on the seam, connecting the edges of the fabric, and is suitable for small damage to the skin.
The benefits of using the patch are as follows:
- prevents pathogens from entering the wound
- absorbs discharge from the wound
- does not cause irritation
- breathable, thanks to which the skin under the patch breathes
- helps to soften and smooth the scar
- retains moisture well in tissues, preventing drying out
- prevents scar growth
- convenient to use
- when removing the patch, skin injury does not occur
Some patches are waterproof, allowing the patient to shower without risking the stitches. The most commonly used patches are:
- spaceport
- mepilex
- mepitac
- hydrofilm
- fixopore
To achieve positive results in the healing of postoperative sutures, this medical device must be used correctly:
- remove the protective film
- Apply the adhesive side to the seam area
- change every other day
- peel off the patch periodically and check the condition of the wound
We remind you that before using any pharmacological agent, it is necessary to consult a doctor.
Video: Postoperative suture treatment
Sutures are applied only to healthy, viable tissue. Fabrics are connected in layers.
At the same time, care is taken to connect anatomically homogeneous tissues (muscles are connected to muscles, fascia to fascia, etc.). Stitches are applied after a complete stop of bleeding on clean wounds, free not only from blood clots, tissue scraps and mechanical contamination, but also from microbes. For this, surgical treatment of the wound is preliminarily performed.
When suturing a particular tissue, the features of tissue regeneration are taken into account. So, when suturing vessels, it must be remembered that regeneration begins with the intima, so the sutures are applied so that the inner surface of the vessel approaches. On the contrary, when suturing the intestines, scar, uterus, the outer (serous) membrane is brought together, which is prone to adhesive inflammation, which ensures fast and reliable tightness of the suture.
When choosing a suture, the depth of the wound, the tendency of the skin to turn inward, the degree of stretching of the wound edges, the load on the sutures, the stage of the course of the wound process, and the presence of a purulent-inflammatory complication of the wound are also taken into account. In addition, when suturing, the whole complex of aseptic and antiseptic measures should be carried out. It must be remembered that catgut and silk can be absorbed if they are sterile. Otherwise, purulent-inflammatory complications are possible in the form of ligature fistulas, etc. When suturing, the following technical rules should be considered:
- puncture and puncture should be at the same distance from the edges of the wound;
- by suturing the skin, muscles, they pick up the bottom of the wound with a suture to avoid the appearance of pockets and streaks; knots are tied on the side, and not over the wound channel;
- make sure that the edges of the wound are in contact evenly throughout;
- tying a knot, excessive tightening of the wound tissues should be avoided;
- the thickness of the suture material and its type should correspond to the type of animal, the degree of tension of the edges of the wound, and the function of the organ.
Depending on what tissues connect the seams, they are divided into skin, muscle, fascial, tendon, intestinal, etc.
When suturing, the following goals are pursued:
- protect wound tissues from microbial, mechanical contamination and hypothermia;
- create optimal conditions for tissue regeneration, taking into account their biological characteristics;
- accelerate the healing of granulating wounds;
- reduce tissue tension and wound gaping;
- help stop bleeding.
When suturing, the needle is inserted perpendicular to the wound tissues. After the puncture, it is captured from the inside of the wound, passed through the tissue in accordance with the shape of the wound, and brought out from the other side. To facilitate suturing, the tissues of the edges of the wound are fixed with tweezers. If the tissues are loose, then both edges of the wound can be pierced without intercepting the needle with a needle holder. In this case, the edges of the wound are captured with tweezers individually or together.
If the wound surfaces co-opt well with each other, and the tension of the tissues is small, then the distance between the stitches can be increased to 12-15 mm. When tying knots, it is necessary to take into account that after some time the wound tissues will swell, swell, which will significantly worsen the blood and lymph circulation in them and create good conditions for tissue necrosis of the wound edges, the occurrence and development of purulent-inflammatory complications, divergence of the wound edges.
Seam classification
All seams are divided into: continuous and intermittent; removable and non-removable; 1…4-storey; primary (applied to a fresh wound), secondary (applied to a granulating wound); temporary (provisional, for temporary convergence of tissues, holding tampons, drains, etc.). The most commonly used seams are shown in the figure.
Types of seams: a - knotted; b - a seam with a roller; c - horizontally looped; g - eight-shaped seam of Spasokukotsky; d - furrier; e - mattress; g - Lambert's seam: 1 - knotted; 2 - continuous; h, i - herringbone seam; to - purse-string; l - Sadovsky-Plakhotin seam; m - double knotty; n - I-shaped seam; o - Albert's seam; p - Schmiden's seam; r - Sultan's seam (I-shaped)
TO continuous seams include: furrier; Reverden seam; mattress; Sadovsky-Plakhotin seam; Lambert suture (may be intermittent); purse-string; "herringbone"; intradermal suture.
TO broken seams include: simple knotty; double knotted; seam with a roller; looped seams (horizontal looped, vertical looped); U-shaped seams (U-shaped in duplicate; U-shaped according to Hans; U-shaped on polyethylene tubes, on buttons, on gauze rollers, U-shaped with additional information); doubling; I-shaped (Sultan's seam); eight-shaped (Spasokukotsky seam); multi-stitch seam.
Intermittent stitches include all types of stitches that require a separate thread to apply each stitch of the stitch. Of the intermittent seams, the most commonly used are knotted, rolled, looped and eight-shaped seams. In this case, interrupted sutures can be applied as situational or reducing stress (unloading).
Depending on the type of tissue, the suture can be: skin, musculocutaneous, fascial, vascular, intestinal, tendon.
Depending on the type of material used, the seams are divided into absorbable And non-absorbable.
Methods for joining tissues
There are two main ways of connecting tissues: bloody and bloodless. At bloody way tissues are connected using suture material or staples by suturing. With the bloodless method, the edges of the wound are connected with surgical glue or adhesive tape.
After the correct connection of the tissues with sutures in the wound, the risk of infection decreases, the wound cavity is eliminated, bleeding stops, the tissues are provided with peace, which favorably affects the renenerative processes.
Deaf connection of tissues is contraindicated in the presence of purulent inflammation, dead tissues, foreign objects, mechanical contamination in the wound. In such cases, closer (provisional) ones are applied, which provide adequate drainage, and after cleansing the wound cavity and the appearance of granulations, secondary sutures are applied.
Suture technique
In order to reduce the resistance of skin tissues, the needle is inserted vertically. Then it is captured from the inside of the wound, passed through the tissue in accordance with its shape and brought out from the other side. Fixing the edge of the wound with tweezers facilitates the passage of the needle through the tissue and the manipulation of the needle. If the wound is small and the tissue resistance is insignificant, then both edges of the wound can be pierced with a needle without intercepting it with a needle holder. To do this, the edges of the wound are fixed with tweezers individually or together.
To ensure even distribution of the load on both edges of the wound and their good alignment, the injection site and the exit hole of the needle should be at the same distance from the edge of the wound. The distance from the injection site to the edge of the wound depends on the nature of the tissue and is approximately 3 ... 10 mm, and when applying unloading sutures, depending on the situation, it is 20 mm or more. It is important that the needle on both sides of the wound goes in the same direction and at the same time captures such a volume of tissue that would ensure good alignment of the wound surfaces and in the depth of the wound. With insufficiently deep punctures on both sides, a cavity may remain inside the wound in which blood or exudate (effusion) will accumulate, which at best will slow down the healing process, and at worst, create conditions for the occurrence of septic complications. If the stitches are very shallow and too wide, the edges of the wound are turned inward and turned outward using an appropriate suture (according to Donati, vertical loop, etc.).
Thread cutting occurs at the most distant points from each other, where the fabric experiences maximum compression. In this regard, the thread should be drawn at an equal distance from the edges and walls of the wound, and when tying a knot, moderately tighten the thread without squeezing the tissue. The larger the area of contact of the suture with the tissues, the less pressure it exerts on them.
When a wound heals by primary intention, adhesions and epithelialization do not occur until the focus of pressure on the tissues is removed. Any pressure on the nerve has an extremely unfavorable effect on its functional state and regenerative functions of the connective tissue of the wound (AN Golikov, 1953, 1961).
