Surgical sutures are the most common way to connect biological tissues (wound edges, organ walls, etc.), stop bleeding, bile leakage, etc. using suture material.

The most general principle for performing any suture is to respect the edges of the wound to be sutured. In addition, the suture should be applied, trying to accurately match the edges of the wound and the layers of the organs to be sutured. Recently, these principles have been commonly referred to as "precision".

Depending on the tools used and the execution technique, manual and mechanical seams are distinguished. For manual sutures, ordinary and atraumatic needles, needle holders, tweezers, etc. are used, and absorbable and non-absorbable threads of biological or synthetic origin, metal wire, etc. are used as suture material. are metal brackets.

When suturing wounds and forming anastomoses, sutures can be applied in one row - a single-row (one-story, single-tier) suture or in layers - in two, three, four rows. Along with the connection of the edges of the wound, the sutures also provide a stop of bleeding.

When applying a skin suture, it is necessary to take into account the depth and extent of the wound, as well as the degree of divergence of its edges. The most common types of seams are:: nodular dermal, subcutaneous nodular, subcutaneous continuous, intradermal continuous single-row, intradermal continuous multi-row.

Continuous intradermal suture is currently the most widely used, as it provides the best cosmetic result. Its features are good adaptation of the wound edges, good cosmetic effect and less disturbance of microcirculation compared to other types of sutures. The suture thread is carried out in the layer of the skin itself in a plane parallel to its surface. With this type of seam, to facilitate thread pulling, it is better to use monofilament threads. Absorbable sutures are often used, such as Biosyn, Monocryl, Polysorb, Dexon, Vicryl. From non-absorbable threads, monofilament polyamide and polypropylene are used.

No less common simple knotted seam. The skin is most easily pierced with a cutting needle. When using such a needle, the puncture is a triangle, the base of which faces the wound. This shape of the puncture holds the thread better. The needle is injected into the epithelial layer at the edge of the wound, retreating from it by 4-5 mm, then obliquely carried out in the subcutaneous tissue, moving further and further away from the edge of the wound. Having reached the same level with the base of the wound, the needle turns in the direction of the midline and sticks at the deepest point of the wound. The needle must pass strictly symmetrically and in the tissues of the other edge of the wound, then the same amount of tissue enters the seam.

If it is difficult to match the edges of the skin wound, it can be used horizontal mattress U-shaped seam. When applying a conventional interrupted suture to a deep wound, it is possible to leave a residual cavity. In this cavity, wound discharge can accumulate and lead to wound suppuration. It is possible to avoid suturing the wound in several floors. Floor-by-floor suturing of the wound is possible with both nodal and continuous sutures. In addition to floor suturing of the wound in such situations, it is used vertical mattress suture (according to Donatti). In this case, the first injection is made at a distance of 2 cm or more from the edge of the wound, the needle is inserted as deep as possible to capture the bottom of the wound. The puncture on the opposite side of the wound is done at the same distance. When the needle is held in the opposite direction, the injection and injection are performed at a distance of 0.5 cm from the edges of the wound so that the thread passes through the layer of the skin itself. Threads should be tied when suturing a deep wound after all sutures have been applied - this facilitates manipulations in the depth of the wound. The use of the Donatti suture makes it possible to compare the edges of the wound even with their large diastasis.

The skin suture must be applied very carefully, since the cosmetic result of any operation depends on it. This largely determines the authority of the surgeon in patients. Inaccurate comparison of the edges of the wound leads to the formation of a rough scar. Excessive efforts when tightening the first knot are the cause of ugly transverse stripes located along the entire length of the surgical scar.

Silk threads are tied with two knots, catgut and synthetic - with three or more. By tightening the first knot, the stitched tissues are matched without excessive force to avoid cutting through the seams. A properly applied suture firmly connects the tissues without leaving cavities in the wound and without disturbing blood circulation in the tissues, which provides optimal conditions for wound healing. For suturing postoperative wounds, a special suture material with microprotrusions has been developed - APTOS Suture, due to the specific nature of the threads themselves, there is no need to apply interrupted sutures at the beginning and end of the wound, which shortens the time for suturing and simplifies the entire procedure.

Skin sutures are removed most often on the 6-9th day after their application, however, the timing of removal may vary depending on the location and nature of the wound. Earlier (4-6 days) sutures are removed from skin wounds in areas with good blood supply (on the face, neck), later (9-12 days) on the lower leg and foot, with a significant tension of the wound edges, reduced regeneration. The sutures are removed by pulling the knot so that a part of the thread hidden in the thickness of the tissues appears above the skin, which is crossed with scissors and the entire thread is pulled out by the knot. With a long wound or a significant tension of its edges, the sutures are removed first after one, and the rest in the following days.

Any damage to the body is associated with a violation of the integrity of the skin. A scar is a healed wound and its condition is affected by the nature of the traumatic agent (mechanical, thermal, chemical or radiation damage). The use of APTOS Suture allows to reduce the length of the wound by moderately gathering its edges, as a result of which the scar remains much smaller and less noticeable compared to the use of ordinary suture materials.

The company "Volot" produces a wide range of suture material for use in various types of operations, the quality and properties of threads, needles are evaluated by many clinics in the country.

Surgical sutures- the most common way to connect biological tissues (wound edges, organ walls, etc.), stop bleeding, bile leakage, etc. using suture material. In contrast to the stitching of tissues (bloody method), there are bloodless methods of their connection without the use of suture material (see. Seamless connection of fabrics).

Depending on the timing surgical sutures Distinguish: the primary suture, which is applied to an accidental wound immediately after the primary surgical treatment or to the surgical wound; delayed primary suture is applied until the development of granulations in terms of 24 h up to 7 days after surgery in the absence of signs of purulent inflammation in the wound; provisional suture - a kind of delayed primary suture, when the threads are carried out during the operation, and they are tied after 2-3 days; an early secondary suture, which is applied to a granulating wound cleared of necrosis after 8-15 days; a late secondary suture is applied to the wound after 15-30 days or more with the development of scar tissue in it, which is previously excised.

Sutures can be removable, when the suture material is removed after fusion, and submerged, which remain in the tissues, absorbing, encapsulating in the tissues, or erupting into the lumen of a hollow organ. The sutures placed on the wall of a hollow organ can be through or parietal (not penetrating into the lumen of the organ).

Depending on the tools used and the execution technique, manual and mechanical seams are distinguished. For manual sutures, ordinary and atraumatic needles, needle holders, tweezers, etc. are used (see. Surgical instruments), but as suture material - absorbable and non-absorbable threads of biological or synthetic origin, metal wire, etc. A mechanical suture is performed using staplers, in which metal staples are the suture material.

Depending on the technique of stitching fabrics and fixing the knot, manual surgical sutures subdivided into nodal and continuous. Simple knotted sutures ( rice. 1 ) is usually applied to the skin at intervals of 1-2 cm, sometimes more often, and with the threat of suppuration of the wound - less often. The edges of the wound are carefully compared with tweezers ( rice. 2 ). The sutures are tied with surgical, marine or simple (female) knots. To avoid loosening the knot, keep the threads taut at all stages of the formation of seam loops. For tying a knot, especially ultrathin threads during plastic and microsurgical operations, an instrumental (apodactyl) method is also used ( rice. 3 ).

Silk threads are tied with two knots, catgut and synthetic - with three or more. By tightening the first knot, the stitched tissues are matched without excessive force to avoid cutting through the seams. A properly applied suture firmly connects the tissues without leaving cavities in the wound and without disturbing blood circulation in the tissues, which provides optimal conditions for wound healing.

In addition to simple knotted sutures, other types of knotted sutures are also used. So, when suturing the wall of hollow organs, Pirogov-Mateshuk screw-in sutures are used, when the knot is tied under the mucous membrane ( rice. 4 ). To prevent tissue eruption, looped interrupted sutures are used - U-shaped (U-shaped) eversion and screw-in ( rice. 5, a, b ), and 8-shaped ( rice. 5, in ). For a better comparison of the edges of the skin wound, a nodal adaptive U-shaped (loop-shaped) suture according to Donati is used ( rice. 6 ).

When applying continuous seams, the thread is kept taut so that the previous stitches do not weaken, and in the last one they hold a double thread, which, after being punctured, is tied to its free end. Continuous surgical sutures have different options. Often a simple (linear) twist stitch is used ( rice. 7, a ), twisting seam according to Multanovsky ( rice. 7b ) and mattress seam ( rice. 7, in ). These sutures invert the edges of the wound if they are applied from the outside, for example, when suturing a vessel, and they are screwed in if they are applied from the inside of the organ, for example, when forming the posterior wall of the anastomosis on the organs of the gastrointestinal tract.

Along with linear, various types of circular seams are used. These include: a circular suture, which aims to fix bone fragments, for example, in case of a fracture of the patella with a divergence of fragments; the so-called cerclage - fastening with wire or thread of bone fragments in case of an oblique or spiral fracture or fixation of bone grafts ( rice. 8, a ); block pulley suture for bringing the ribs together, used when suturing a chest wall wound ( rice. 8, b ), a simple purse-string suture ( rice. 8, in ) and its varieties - S-shaped according to Rusanov ( rice. 8, g ) and Salten Z-shaped ( rice. 8, d ) used for suturing the stump of the intestine, immersing the stump of the appendix, plastics of the umbilical ring, etc. A circular suture is applied in various ways when restoring the continuity of a completely crossed tubular organ - a vessel, intestine, ureter, etc. With a partial intersection of the organ, a semicirculatory or lateral suture is performed.

When suturing wounds and forming anastomoses, sutures can be applied in one row - a single-row (one-story, single-tier) suture or in layers - in two, three, four rows. Along with the connection of the edges of the wound, the sutures also provide a stop of bleeding. For this purpose, specially hemostatic sutures are proposed, for example, a continuous chain (chopping) suture according to Heidenhain - Hacker ( rice. 9 ) on the soft tissues of the head before their dissection during craniotomy. A variant of the interrupted chain suture is the Oppel hemostatic suture for liver injuries.

Overlay technique surgical sutures depends on the operating methods used. For example, in hernia repair and in other cases when it is required to obtain a strong scar, they resort to doubling (duplicating) the aponeurosis with U-shaped sutures or Girard-Zik sutures ( rice. 10, a ). When suturing eventration or for deep wounds, removable 8-shaped sutures are used according to Spasokukotsky ( rice. 10, b, c ). When suturing wounds of complex shape, situational (guide) sutures can be used, which bring the edges of the wound together in places of greatest tension, and after permanent sutures are applied, they can be removed. If the seams are tied on the skin with great tension or they are supposed to be left for a long time, the so-called lamellar (lamellar) U-shaped seams are used to prevent eruption, tied on plates, buttons, rubber tubes, gauze balls, etc. ( rice. eleven ). For the same purpose, secondary provisional sutures can be used, when more frequent interrupted sutures are applied to the skin, and they are tied through one, leaving the other threads untied: when the eruption of the tightened sutures begins, provisional sutures are tied, and the first ones are removed.

Skin sutures are removed most often on the 6-9th day after their application, however, the timing of removal may vary depending on the location and nature of the wound. Earlier (4-6 days) sutures are removed from skin wounds in areas with good blood supply (on the face, neck), later (9-12 days) on the lower leg and foot, with a significant tension of the wound edges, reduced regeneration. The sutures are removed by pulling the knot so that a part of the thread hidden in the thickness of the tissues appears above the skin, which is crossed with scissors ( rice. 12 ) and the entire thread is pulled by the knot. With a long wound or a significant tension of its edges, the sutures are removed first after one, and the rest in the following days.

When applying III. X. various types of complications may occur. Traumatic complications include an accidental puncture of a vessel with a needle or a suture through the lumen of a hollow organ instead of a parietal suture. Bleeding from a punctured vessel usually stops when the suture is tied, otherwise it is necessary to apply a second suture in the same place, capturing the bleeding vessel into it; when a large vessel is punctured with a coarse cutting needle, it may be necessary to apply a vascular suture. If an accidental through puncture of a hollow organ is detected, this place is additionally peritonized with serous-muscular sutures. Technical errors in suturing are poor alignment (adaptation) of the edges of the skin wound or the ends of the tendons, the lack of the effect of screwing in with an intestinal and eversion with a vascular suture, narrowing and deformation of the anastomosis, etc. Such defects can lead to suture failure or obstruction of the anastomosis, bleeding , peritonitis, intestinal, bronchial, urinary fistulas, etc. Suppuration of the wound, the formation of external and internal ligature fistulas and ligature abscesses occurs as a result of aseptic disorders during sterilization of the suture material or during surgery. Complications in the form of delayed-type allergic reactions (see. Allergy) more often occur when using catgut threads, much less often - silk and synthetic threads.

Surgical sutures- the most common way to connect biological tissues (wound edges, organ walls, etc.), stop bleeding, bile leakage, etc. using suture material. In contrast to the stitching of tissues (bloody method), there are bloodless methods of their connection without the use of suture material (see. Seamless connection of fabrics ).

Depending on terms of imposing Sh. x. Distinguish: the primary suture, which is applied to an accidental wound immediately after the primary surgical treatment or to the surgical wound; delayed primary suture is applied until the development of granulations in terms of 24 h up to 7 days after surgery in the absence of signs of purulent inflammation in the wound; provisional suture - a kind of delayed primary suture, when the threads are carried out during the operation, and they are tied after 2-3 days; an early secondary suture, which is applied to a granulating wound cleared of necrosis after 8-15 days; a late secondary suture is applied to the wound after 15-30 days or more with the development of scar tissue in it, which is previously excised.

Sutures can be removable, when the suture material is removed after fusion, and submerged, which remain in the tissues, absorbing, encapsulating in the tissues, or erupting into the lumen of a hollow organ. The sutures placed on the wall of a hollow organ can be through or parietal (not penetrating into the lumen of the organ).

Depending on the tools used and the execution technique, manual and mechanical seams are distinguished. For manual sutures, ordinary and atraumatic needles, needle holders, tweezers, etc. are used (see. Surgical instruments ), but as suture material - absorbable and non-absorbable threads of biological or synthetic origin, metal wire, etc. A mechanical suture is performed using staplers, in which metal staples are the suture material.

Depending on the technique of stitching fabrics and fixing the knot, manual Sh. x. subdivided into nodal and continuous. Simple knotted sutures ( rice. 1 ) is usually applied to the skin at intervals of 1-2 cm, sometimes more often, and with the threat of suppuration of the wound - less often. The edges of the wound are carefully compared with tweezers ( rice. 2 ). The sutures are tied with surgical, marine or simple (female) knots. To avoid loosening the knot, keep the threads taut at all stages of the formation of seam loops. For tying a knot, especially ultrathin threads during plastic and microsurgical operations, an instrumental (apodactyl) method is also used ( rice. 3 ).

Silk threads are tied with two knots, catgut and synthetic - with three or more. By tightening the first knot, the stitched tissues are matched without excessive force to avoid cutting through the seams. A properly applied suture firmly connects the tissues without leaving cavities in the wound and without disturbing blood circulation in the tissues, which provides optimal conditions for wound healing.

In addition to simple knotted sutures, other types of knotted sutures are also used. So, when suturing the wall of hollow organs, Pirogov-Mateshuk screw-in sutures are used, when the knot is tied under the mucous membrane ( rice. 4 ). To prevent tissue eruption, looped interrupted sutures are used - U-shaped (U-shaped) eversion and screw-in ( rice. 5, a, b ), and 8-shaped ( rice. 5, in ). For a better comparison of the edges of the skin wound, a nodal adaptive U-shaped (loop-shaped) suture according to Donati is used ( rice. 6 ).

When applying continuous seams, the thread is kept taut so that the previous stitches do not weaken, and in the last one they hold a double thread, which, after being punctured, is tied to its free end. Continuous Sh. x. have different options. Often a simple (linear) twist stitch is used ( rice. 7, a ), twisting seam according to Multanovsky ( rice. 7b ) and mattress seam ( rice. 7, in ). These sutures invert the edges of the wound if they are applied from the outside, for example, when suturing a vessel, and they are screwed in if they are applied from the inside of the organ, for example, when forming the posterior wall of the anastomosis on the organs of the gastrointestinal tract.

Along with linear, various types of circular seams are used. These include: a circular suture, which aims to fix bone fragments, for example, with the patella with a divergence of fragments; the so-called cerclage - fastening with wire or thread of bone fragments with oblique or spiral e or fixation of bone grafts ( rice. 8, a ); block pulley suture for bringing the ribs together, used when suturing a chest wall wound ( rice. 8, b ), a simple purse-string suture ( rice. 8, in ) and its varieties - S-shaped according to Rusanov ( rice. 8, g ) and Salten Z-shaped ( rice. 8, d ) used for suturing the stump of the intestine, immersing the stump of the appendix, plastics of the umbilical ring, etc. A circular suture is applied in various ways when restoring the continuity of a completely crossed tubular organ - a vessel, intestine, ureter, etc. With a partial intersection of the organ, a semicirculatory or lateral suture is performed.

When suturing wounds and forming anastomoses, sutures can be applied in one row - a single-row (one-story, single-tier) suture or in layers - in two, three, four rows. Along with the connection of the edges of the wound, the sutures also provide a stop of bleeding. For this purpose, specially hemostatic sutures are proposed, for example, a continuous chain (chopping) suture according to Heidenhain - Hacker ( rice. 9 ) on the soft tissues of the head before their dissection during craniotomy. A variant of the interrupted chain suture is the Oppel hemostatic suture for liver injuries.

Overlay technique Sh. x. depends on the operating methods used. For example, in hernia repair and in other cases when it is required to obtain a strong scar, they resort to doubling (duplicating) the aponeurosis with U-shaped sutures or Girard-Zik sutures ( rice. 10, a ). When suturing eventration or for deep wounds, removable 8-shaped sutures are used according to Spasokukotsky ( rice. 10, b, c ). When suturing wounds of complex shape, situational (guide) sutures can be used, which bring the edges of the wound together in places of greatest tension, and after permanent sutures are applied, they can be removed. If the seams are tied on the skin with great tension or they are supposed to be left for a long time, the so-called lamellar (lamellar) U-shaped seams are used to prevent eruption, tied on plates, buttons, rubber tubes,

gauze balls, etc. ( rice. eleven ). For the same purpose, secondary provisional sutures can be used, when more frequent interrupted sutures are applied to the skin, and they are tied through one, leaving the other threads untied: when the eruption of the tightened sutures begins, provisional sutures are tied, and the first ones are removed.

Skin sutures are removed most often on the 6-9th day after their application, however, the timing of removal may vary depending on the location and nature of the wound. Earlier (4-6 days) sutures are removed from skin wounds in areas with good blood supply (on the face, neck), later (9-12 days) on the lower leg and foot, with a significant tension of the wound edges, reduced regeneration. The sutures are removed by pulling the knot so that a part of the thread hidden in the thickness of the tissues appears above the skin, which is crossed with scissors ( rice. 12 ) and the entire thread is pulled by the knot. With a long wound or a significant tension of its edges, the sutures are removed first after one, and the rest in the following days.

When applying III. X. various types of complications may occur. Traumatic complications include an accidental puncture of a vessel with a needle or a suture through the lumen of a hollow organ instead of a parietal suture. Bleeding from a punctured vessel usually stops when the suture is tied, otherwise it is necessary to apply a second suture in the same place, capturing the bleeding vessel into it; when a large vessel is punctured with a coarse cutting needle, it may be necessary to apply a vascular suture. If an accidental through puncture of a hollow organ is detected, this place is additionally peritonized with serous-muscular sutures. Technical errors in suturing are poor alignment (adaptation) of the edges of the skin wound or the ends of the tendons, the lack of the effect of screwing in with an intestinal and eversion with a vascular suture, narrowing and deformation of the anastomosis, etc. Such defects can lead to suture failure or obstruction of the anastomosis, bleeding , a, intestinal, bronchial, urinary, etc. Suppuration of the wound, the formation of external and internal ligatures and ligatures occurs due to violations of asepsis during sterilization of the suture material or during surgery. Complications in the form of delayed-type allergic reactions (see.

The most common way to connect the edges of wounds is the imposition of surgical sutures.

Before we figure out how many days to remove the stitches, let's make it clear that there are two types of stitches: immersed and removable.

Submerged seams(or non-removable) - made from a material that eventually dissolves in the tissues of the body.

For non-removable sutures, a natural catgut material is used, made from thin sheep intestines.

It is good in that it is not rejected by the human body, but at the same time, the material does not provide great strength for the connection of tissues.

Removable seams must be removed after the edges of the wound have healed.

Removable seams are much stronger. They are made using various materials:

• natural threads - silk and linen;
• synthetic threads - nylon, capron, mersilene;
• metal parts - wire or brackets.

Properly applied surgical sutures firmly connect the tissues, do not interfere with blood circulation in the tissues adjacent to the wound, and do not leave cavities in the wound. This method of treatment provides optimal conditions for wound healing.

After the edges of the wound are fused, the skin sutures are removed: the knot stretches upward until a thread hidden in the tissue is shown above the skin, which is cut with scissors at the surface.

If the wound is very long, the stitches are first removed after one, and the second half after a few days.

The average period of removal of surgical sutures is 6-9 days after application, but usually the timing varies depending on various factors.

Features that affect the timing of suture removal

From parts of the body with good blood supply (on the neck and face), the sutures are removed earlier - for 4-6 days. From places with reduced regeneration (feet or lower legs), the sutures are removed later - on days 9-12.

Also, much depends on the nature of the wound itself. If the wound is infected, some of the sutures are removed the next day after application, so that the wound heals better in an open way. From a clean wound, the sutures are removed after 5-7 days.

The features of the organism of the operated patient are also important, because the ability to regenerate tissues in different people is different. So, the elderly should wear stitches longer, they are removed stitches no earlier than 14 days later. Also, the period of wearing stitches is extended for seriously ill people whose bodies are weakened by a long illness.

Another term for removing sutures depends on the complexity of the operation and the depth of the wound incision. Surgeons themselves claim that the edges of wounds during abdominal operations grow together faster if the patient does not have excessive fat deposits.

When stitches are removed from the wound after common operations

Here are the times when sutures are usually removed after the most common surgeries and for various parts of the body:

• after caesarean section: 8-10 days;
• after amputation: on day 12;
• after laparotomy: on day 7;
• after scleroplasty: on day 7;
• on the abdominal cavity: on day 7;
• on the chest: on day 7;
• on the face and neck: on the 7th day.

The sutures should be removed only when the edges of the wound are firmly fused. However, if the seam is not removed on time, this also threatens with problems. The seams can fester, and the threads can grow into the skin, then a more noticeable trace will remain from the wound.

In any case, the decision on the need or possibility of removing sutures should be made by the surgeon after examining the wound.

Due to damage, skin wounds are divided into operational (deliberate) and accidental.

Accidental wounds (cut, chopped, bruised, bitten, gunshot, etc.) are sutured only after careful primary surgical treatment. Its main tasks are to stop bleeding, remove foreign bodies and necrotic tissues, open additional pockets, drain and suture.

Depending on the timing of the imposition, there are:
- primary suture - is applied in the first 5 hours from the moment of damage;
- secondary suture - is used at a later date (from 4-6 weeks to several years).

Secondary suture is a collective concept that combines the totality of all delayed sutures that are applied to wounds at various times after surgical treatment. There are such types of secondary seams:
- initially delayed suture is applied to the wound until granulations appear and in the absence of clinical signs of infectious inflammation. Typically, such sutures are applied after 5-6 days after damage;
- an early secondary suture is applied to the granulating wound 8-15 days after the injury. The edges of the wound are usually not excised;
- a late secondary suture is used after cicatricial changes occur in the wound. It is applied to a granulating wound, having previously mobilized the edges and removed the scar tissue. The usual term for suturing is 20-30 days.

Secondary sutures are used only in the absence of acute inflammatory changes in the wound and the presence of a granulation cover. Secondary sutures should not be applied when:
- sluggish granulations covered with fibrinous plaque;
- not torn away necrotic tissues;
- edematous edges of the wound;
- the presence of pyoderma around the wound.

Starting to suture, first the skin should be thoroughly washed and disinfected. The formation of the seam must be carried out very carefully, since the cosmetic result of any operation depends on it. This largely determines the authority of the surgeon in patients.

The suture applied to the skin wound should ensure the contact of the edges, without forming a residual cavity (“dead space)))” (Fig. 13.1). In this cavity, wound discharge can accumulate, initiating an inflammatory process. This can be avoided by draining the residual cavity or suturing the wound in layers (several floors). The latter method is more rational.

If the wound is shallow, then intradermal cosmetic suture using absorbable materials (polysorb, biosyn, monocryl, vicryl, etc.) can be recommended as a method of choice for suturing surgical wounds of the skin. To apply it, you will also need an atraumatic needle with a sharp cutting triangular tip. The body of such a needle should be curved along a gentle arc with a trihedral cutting edge facing inwards. Good coaptation of the wound edges and minimal disruption of skin microcirculation provide the best cosmetic result.

The Halsted seam is a continuous internal adaptive seam. The suture runs in a plane parallel to the skin surface. To facilitate thread pulling, it is better to use monofilament materials. You can use absorbable (Biosin, monocryl, Polysorb, Dexon, Vicryl) and non-absorbable threads (monofilament polyamide and polypropylene).

Rice. 13.1 Formation of a skin suture: a - passing the thread under the bottom of the wound; b, c - formation of "dead" space in case of incorrect formation of the seam

Rice. 13.2 Scheme of the thread when forming a continuous internal adaptive Halsted suture

The needle is injected from the side of the epidermis, retreating 1 cm from the corner of the wound. They are punctured - in the middle of the dermis layer (Fig. 13.2). The free end of the thread is fixed with a gauze ball. The needle is sequentially injected and punctured on one side of the incision, passing it only intradermally in a horizontal plane. After that, they move to the other side of the cut and form the next stitch in the same way. On both sides, the same amount of dermis is captured in the suture. The seam pitch should correspond to the curvature of the needle. It is necessary to ensure that the injection site of the needle is different. As a result, when pulling the thread (drawing together the edges of the wound), these two points should touch.

At the end of the suture, the needle is punctured on the skin, stepping back from the angle of the wound 1 cm (Fig. 13.3). The thread is tied on a gauze ball.
When using polyfilament non-absorbable materials or when suturing the edges of long wounds, after every 6-8 cm of the suture, it is necessary to make a puncture on the skin surface and fix the thread with a knot or gauze ball (Fig. 13.4).