高张力切口皮肤缝线逐渐收紧闭合法在胫腓骨双骨折切开复位内固定术的应用

目的总结高张力切口皮肤缝线逐渐收紧闭合法在胫腓骨双骨折切开复位内固定术的应用效果。方法对32例胫腓骨双骨折行切开复位内固定术，应用高张力切口皮肤缝线逐渐收紧闭合法。结果32例获平均随访16个月，骨折愈合时间5-9个月，平均6．9个月。踝关节功能评定结果：优23例，良7例，可2例，优良率93．75％。结论高张力切口皮肤缝线逐渐收紧闭合法简单、安全、有效，既避免了因张力过高导致皮肤缺血性坏死、骨钢板外露和筋膜室综合征的风险，又避免了患者二次手术的痛苦，减少了患者医疗费用。     

预置拉拢缝合法延期闭合骨筋膜室减张切口的应用

目的观察应用预置拉拢缝合法延期直接闭合骨筋膜室减张切口的效果。方法因骨筋膜室综合征而行切开减压术导致皮肤缺损患者13例21处创面,其中小腿皮肤切开减压12例20处创面,前臂皮肤缺损1例。缺损区面积5 cm×12 cm-10 cm×28 cm(平均8 cm×22 cm)。骨筋膜室切开减压同时预置皮肤牵引缝线,术后3-5 d视肿胀情况每隔1 d于换药时逐渐拉拢缝线,一般经3-7次(平均4．7次)拉拢可使两侧皮缘靠近,延期缝合创口,2周后拆线。结果21处创口在9-18 d(平均13．5 d)后皮缘靠拢行一期缝合,创口愈合形成线状瘢痕。随访1-15个月,平均5个月,无创面感染。患肢远端关节活动自如,无肌肉挛缩现象。结论急性骨筋膜室综合征切开减压后,预置拉拢缝合法延期闭合创口,安全、有效。其优点有:①操作方法简便、快捷,病程短、费用低。②避免二次游离植皮术,愈合形成线状瘢痕,局部皮肤质量好,对美观影响小。     

十字缝合技术用于肠造口还纳手术的临床分析

目的总结十字缝合技术在肠造口还纳手术中的应用体会。方法接受双腔造口还纳手术22例,采用十字缝合技术。距离造口边缘0.2 cm横行连续缝合皮肤,关闭造口;游离肠管,行肠吻合后,肠管还纳入腹腔,连续缝合腹直肌鞘;可吸收缝线环形缝合皮下脂肪组织,打结时保留1 cm孔隙;标记0、3、6、9点4个位点,将4个位点造口边缘皮肤提拉到造口中心,在提拉后的皮肤上标记提拉前皮肤边缘的所处位置,三角形切除标记点到造口边缘的皮肤,可吸收缝线缝合皮肤边缘4个点的皮下组织,收紧打结,中央保留0.5 cm小孔,放置引流条。2-0可吸收缝线间断缝合切口。结果平均术中失血量20 ml(10～40 ml),平均手术时间70分钟(60～90分钟),平均术后住院时间6.5天(5～8天)。22例病人中,仅1例术后第2天发生切口感染,感染率4.5%。切口愈合平均时间17天(14～22天)。术后平均随访14个月(10～21个月),病人对切口美容效果平均满意度9分(6～10分)。结论十字缝合技术能够降低切口张力,缩短切口愈合和住院时间,术后美容效果满意,不增加手术时间和术后疼痛,可安全、有效用于肠造口还纳。     

预留缝线法在零缺血腹腔镜下肾部分切除术中的应用

目的:分析预留缝线法在零缺血腹腔镜下肾部分切除术(LPN)中的应用价值。方法:2015年1月~2016年2月我院共12例肾脏肿瘤患者运用预留缝线法在肾动脉无阻断条件下行LPN,其中男8例,女4例,平均年龄54.75(39~71)岁,肾脏肿瘤位于右侧7例、左侧5例,肿瘤直径1.95(1.5~2.5)cm。术前R.E.N.A.L评分为低危4.7(5~7)分,ASA评分为1.58(1~2)分。经后腹腔入路,采用预留缝线法行肾动脉无阻断下肾部分切除术:在肿瘤边缘1cm左右正常肾实质的位置预缝合一根1-0倒刺线,不收紧缝线,放置一旁备用。剪刀在预留缝线与瘤体之间分离肿瘤,配合使用吸引器边吸边切。若出血较多则对已预留缝线进行牵拉或收紧止血,出血仍无法控制时利用该缝线直接对已切除肿瘤部分暴露出的肾创面进行连续缝合修补至出血可控,重复至肿瘤完整切除;若出血量尚可,则直接完整切除肿瘤,后用预留的线缝进行肾实质的缝合修补。结果:12例患者均利用预留缝线方法完成肾动脉无阻断LPN术,手术全程无肾血供临时阻断,无中转开放手术病例。平均手术时间105.8(70~150)min、术中出血量85.8(40~150)ml,术中及术后均未输血,手术切缘阴性。术后病理提示11例患者为透明细胞癌,1例乳头状细胞癌。术后未见尿漏、切口感染、高热等并发症,平均引流管拔除时间3.5(3~5)d、住院时间5.3(4~7)d。随访6~12个月,肾功能未见明显异常,未见肿瘤复发。结论:预留缝线法能在不额外增加手术步骤情况下,确保无阻断LPN手术顺利完成,增加该术式的安全性和成功率,使患者避免热缺血所致肾功能损伤,从“零缺血”肾部分切除术获益。     

预置拉拢缝合法延期闭合骨筋膜室减张切口

目的 观察应用预置拉拢缝合法延期直接闭合骨筋膜室减张切口的效果.方法 2004年6月～2007年9月,因骨筋膜室综合征而行切开减压术导致皮肤缺损患者13例21处创面,年龄21～68岁.小腿皮肤切开减压12例20处创面,前臂皮肤缺损1例.缺损区最小5 cm×12 cm,最大10 cm×28 cm,于骨筋膜室切开减压同时预置皮肤牵引缝线,于术后3～5 d视肿胀情况每隔1日于换药时逐渐拉拢缝线,一般经3～7次拉拢可使两侧皮缘靠近.延期缝合创口,2周后拆线.结果 21处创口均一期愈合,形成线状瘢痕.随访1～15个月,患肢远端关节活动自如,无肌肉挛缩现象.结论 急性骨筋膜室综合征切开减压后,预置拉拢缝合法延期闭合创口,安全、有效.其优点:1)操作方法简便;2)病程短,费用低;3)局部皮肤质量好,瘢痕小.     

单人操作单、双缝线打结定位切割平面行环切缝合器式包皮环切术的临床观察

目的:观察单人操作单、双缝线打结定位切割平面行环切缝合器式包皮环切术的临床疗效.方法:120例患者随机分配到传统环切缝合器组(组1)、单缝线打结定位环切器缝合器组(组2)、双缝线打结定位环切器缝合器组(组3)各40例.观察3组手术时间、术中出血量、系带处缝扎率、非系带处缝扎率、系带对合不良率、腹侧包皮预留满意率、背侧包...     

延期手术治疗Pilon骨折的临床分析

目的探讨延期手术治疗Pilon骨折的临床疗效。方法回顾性分析本院自2001-01—2013-04诊治的34例Pilon骨折,均采用延期手术治疗。在局麻下先行跟骨牵引,根据软组织情况于伤后10-14 d手术。结果本组30例切口一期愈合,4例因减张切口术后1周再行清创缝合,未发生感染及皮肤坏死。所有患者均获得随访1-4年,平均2.4年。骨折愈合时间4-8个月,平均5.5个月。末次随访时踝关节功能按Teeny-Wiss评分标准评定：优20例,良12例,差2例,优良率94.1%。结论延期手术治疗胫骨Pilon骨折能够有效降低术后软组织感染和坏死的发生率,提高了临床疗效。     

严重腹腔感染手术腹壁切口的处理体会

目的总结严重腹腔感染后术的腹壁切口处理经验.方法对我科1999年1月～2000年12月68例严重腹腔感染手术在术中于腹壁皮肤切口预置缝线,术后延期结扎的方法进行回顾性分析.结果本组手术后伤口均愈合良好,未发生化脓感染.结论严重腹腔感染手术的皮肤切口采用延期缝合,具有切口感染率低,病人痛苦少,住院时间短及费用低等优点.     

皮肤环形缝扎术在整形外科中的应用

目的：探讨如何应用环形缝扎术关闭皮肤缺损创面。方法：用不可吸收缝线环绕创缘皮下或皮内缝合一周,收紧缝线打结将伤口缩拢关闭。结果：该法应用于32例共41处创面,术后形成瘢痕短小,外形好。结论：本法封闭创面简便、快速,效果好,可作为整形外科的一项基本技术应用。     

可吸收缝线连续缝合间断打结在关闭腹部正中切口中的应用

目的：观察可吸收缝线连续缝合间断打结在腹部正中切口缝合中的应用效果。方法回顾性分析2012年9∽12月,郑州大学附属肿瘤医院接受腹部手术的患者70例。随机分成二组,观察组采用可吸收缝线全层连续缝合间断打结,对照组采用普通缝线间断全层缝合。比较二组患者切口感染、线结反应、脂肪液化、切口裂开的发生情况。结果术后二组均有患者出现切口红肿和渗出,观察组脂肪液化3例,感染1例,线结反应0例,切口裂开0例,经换药和充分引流、抗感染后,愈合良好;对照组脂肪液化5例,切口感染6例,线结反应15例,切口裂开0例,经换药和充分引流、抗感染后,有部分需要拆除缝线。观察组切口感染、线结反应的发生率明显低于对照组,二组比较差异有统计学意义（χ2＝3．968、20．741,P＝0．026、0．000）;脂肪液化二组比较差异无统计学意义（χ2＝0．565, P＝0．452）。结论可吸收缝线全层连续缝合间断打结方法与普通缝线全层间断缝合方法相比具有预防切口裂开的特点,同时具备减少切口脂肪液化、感染、线结反应等发生的优点,值得推广。     

阴茎折断的诊治(附9例报告)

目的对阴茎折断病人的临床表现和治疗方法进行总结,分析手术治疗后的效果,提高该病的诊疗水平。方法1997年2月～2004年11月共诊治阴茎折断患者9例,伤后2～7h接受外科手术8例,36h手术1例。分别采用阴茎脱套式切口(7/9)和阴茎背侧正中切口(2/9)。术中阴茎海绵体白膜裂口缝合用4- 0号可吸收缝线(8/9)或0号丝线(1/9)。结果采用阴茎背侧正中切口者,寻找海绵体白膜裂口较困难,其中1例术中改为脱套式切口,7例脱套式切口均在20min内完成手术。1例用丝线缝合裂口者,性交伴有局部不适感:1例伤后36h接受手术的患者出现阴茎海绵体硬结伴痛性勃起;其余7例患者勃起功能均恢复,IIEF- 5评分为20.1分,未发现阴茎弯曲或粗大畸形。结论阴茎折断的外科手术宜采用阴茎脱套式切口,海绵体白膜裂口应选择可吸收缝线,早期手术是防治并发症的根本措施。     

双荷包埋线结扎法矫正乳头内陷

目的介绍一种方法简便、创伤小、效果确切、矫正轻度和重度乳头内陷的新方法。方法受术者平卧位,以患侧乳头为中心,分别画直径为2．5、3．5cm 2个圆,常规消毒后,在局部浸润麻醉下,先在内、外圆弧上各做1个0．3cm长小切口,再沿内、外圆皮下分别埋置4号、7号丝线各1条,然后在乳头中央不同层次“十”字贯穿缝合,2条牵引线提起内陷的乳头,再分别将7号、4号线收紧打结,注意不能太紧,然后用5-0丝线将切口各缝1针,术毕。术后7d拆线,3个月内不能挤压乳头。结果用此法共矫正56例,受术者乳头、乳晕感觉良好,形态满意,不影响哺乳。结论造成原发性乳头内陷的主要原因是乳头乳晕的平滑肌发育不良,乳头下缺乏足够的组织支撑所致。采用双荷包埋线结扎法矫正乳头内陷,既加强了乳头根部组织的支撑力,又封闭了乳头回缩的空间腔穴;既使乳头外形美观,又不影响哺乳功能。手术方法简便,创伤少,不损伤正常组织,康复快,术后效果确切。     

Polydioxanone or polypropylene for closure of midline abdominal incisions: a prospective comparative clinical trial

Seven hundred and fifty-seven consecutive patients undergoing a midline abdominal incision were stratified according to age, sex, type of operation and degree of operative contamination and were randomly allocated to mass closure of the abdominal wall with continuous 4 metric polydioxanone (PDX; 374 patients) or continuous 4 metric polypropylene (PPL; 383 patients). Wound infection was less common with PDX (PDX 3.5 per cent; PPL 7.0 per cent; P less than 0.05) and there was one dehiscence in each group. The incidence of defective wounds in patients surviving 1 year was similar (7.7 per cent PDX; 9.7 per cent PPL) but the PPL suture had to be removed because of persisting wound pain or sinus formation in five patients. PDX is the preferred suture material for closure of midline abdominal incisions.     

Suture length to wound length ratio and the integrity of midline and lateral paramedian incisions

A total of 349 patients were randomized to undergo laparotomy through a lateral paramedian incision with layered closure (n = 137), a midline incision with mass closure (n = 104) or a midline incision using layered closure (n = 108), endeavouring to close the latter two incisions with a measured suture length to wound length ratio of greater than 4:1. After 18 months follow-up, no patient in the lateral paramedian group had developed an incisional hernia whereas 7 of 104 patients undergoing a midline incision with mass closure and 7 of 108 patients undergoing a midline incision with layered closure had incisional hernias (P less than 0.01). The mean suture length to wound length ratios for the three groups were 2.6 (range 1.3-6.2), 5.0 (range 3.0-8.7) and 3.7 (range 2.0-6.3) respectively (P less than 0.0001). The lateral paramedian incision remains superior to the midline incision closed with the mass technique and its integrity is independent of the suture length to wound length ratio.     

Comportamiento mecánico de 3 tipos de anudados quirúrgicos usando monofilamentos de 4/0

ObjectiveTo experimentally study the behaviour of 4 types of monofilament with 3 knotting techniques, very often used in surgery, employing mechanical tests.Material and methodsFour 4/0 monofilaments were chosen, two of nylon, and the other two of polypropylene. Three types of knot designs were made with each thread. The first design (D-S-S) consisted of a double half-knot (D) followed by one single (S) in the opposite direction, a third S in turn in the opposite direction. The configuration of the second design was D-S-D, and the third, S-S-D. A mechanical fracture test was performed by stretching the thread at a rate of 4 N/s, the force and deformation being recorded at intervals of 100 ms.ResultsThere was a decrease in the force and deformation in the tests on threads with knots compared to threads without knots. In all cases the rupture of the thread occurred in the knot area, presumably due to damage caused to the thread during the knotting process. The D-S-D knot had the greatest resistance with polypropylene threads, and S-S-D provided the greatest resistance with nylon threadsConclusionsPolypropylene threads, with D-S-D knots, should be more indicated to suture tissues that have to support great forces and with little deformation of the suture (e.g., tendons). Nylon threads, with S-S-D knots, would be better indicated for tissues that have to support smaller forces and that require greater elasticity (e.g., skin).     

VADER (vacuum-assisted dermal recruitment): a new method of wound closure

Acute wounds which cannot be closed primarily are usually closed with a split skin graft. However a split skin graft has both functional (where tendons are exposed) and esthetic sequelae (contour deformity, different skin in color and texture). A novel technique is described which allows delayed primary closure of either fasciotomy wounds or full-thickness defects after harvest of a free or pedicle flap. The technique described combines the bootlace suture technique (which achieves wound closure by progressive suture tightening) with the VAC (vacuum-assisted closure) system (which reduces tissue edema, facilitating movement of tissue, and also reduces bacterial contamination of the wound). Twelve of 14 wounds (average width of wound after insertion and tightening of bootlace suture was 5 cm) were successfully closed after an average of 8 days (range, 4-23 days) in 11 patients (mean age, 45 years; range, 18-77 years) using this technique. Of the 2 patients where the technique was not successful, one patient was noncompliant and the other developed wound-edge necrosis. Other complications were self-limiting.The combined use of 2 methods of wound management facilitates delayed primary wound closure.     

Partial fistulotomy and modified cutting seton procedure in the treatment of high extrasphincteric perianal fistulae

AIM: In our prospective study the method of partial distal fistulotomy and modified cutting seton for high extrasphincteric perianal fistulae is discussed. METHODS: 10 patients (9 males and 1 female) with high extrasphincteric perianal fistulae were treated with partial distal fistulotomy and modified cutting seton. Four or five threads were introduced through the tract; one was tied tightly at the end of the operation, others were tightened every 10th day. While the tied thread cut the tissue, the others drained the tract. The follow-up period ranged from 3 months to 9 years. RESULTS: None of the patients developed major fecal incontinence. 2 of the 10 patients complained of incontinence due to flatus. CONCLUSION: Distal fistulotomy and modified cutting seton can be used in perianal fistulae with high anal or rectal opening, because it combines the effects of both cutting and loose setons and because the postoperative results regarding continence are satisfactory.     

Evaluating the use of a barbed suture for skin closure during autologous breast reconstruction

This study compared the use of barbed suture to a traditional skin closure method for incision closure in free flap breast reconstruction. A retrospective study compared the two closure methods in consecutive series of patients undergoing autologous breast reconstruction between January 2007 and January 2009. Outcomes included total duration of operation and wound complications. We also performed a cost analysis. Use of the barbed suture significantly decreased operative time for unilateral cases by an average of 45 minutes (405 versus 360 minutes, P = 0.02). For bilateral cases, the mean operative time was decreased by an average of 10 minutes (510 versus 500 minutes, P = 0.44). There were more episodes of delayed wound healing in the bilateral barbed suture group (33/46 [72%] versus 15/31 [48%], P = 0.04). No statistical difference was noted between the two groups with regard to dehiscence, infection, or suture extrusion. Use of the barbed suture was, however, more cost-effective. The use of a barbed suture in the closure of abdominal and breast incisions in free flap breast reconstruction may expedite wound closure and reduce the cost of the procedure but may increase wound complications.     

点状切口插入钢板复位固定耻骨支骨折

目的：设计点状切口插入钢板固定耻骨支骨折,探讨其治疗效果。方法：选择2002年至2005年不稳定性骨盆损伤患者10例18个耻骨支,男8例15个耻骨支,女2例3个耻骨支;年龄24～56岁,平均37.2岁。按Tile分型：B1型1例,B2型6例,C1型3例。受伤距手术治疗时间4～14d,平均8.7d。将常规腹股沟切口分解为2～3个点状切口,经点状切口行耻骨支内固定,观察治疗效果。结果：经28个点状切口顺利完成18个耻骨支骨折内固定,平均每点状切口失血30ml,完成一个耻骨支固定时间45min,术后功能经Majeed骨盆骨折评价标准评分属优。结论：经点状切口可以完成耻骨支内固定,手术创伤相对常规腹股沟开放切口小,术后并发症少,功能恢复好。     

Dermotaxis v/s loop suture technique for closure of fasciotomy wounds: a study of 50 cases

Fasciotomy incisions lead to large, unsightly, chronic wounds after surgical intervention. Classic management was to use split-thickness skin grafts, but this leads to insensate skin with reports that as many as 23% of patients are dissatisfied by the appearance of the wound. Since no skin loss has occurred with the fasciotomy incision, utilizing the dermal properties of creep, stress relaxation and load cycling, closure can be achieved in a better way. We describe using dermotaxis for skin edge approximation that is done using inexpensive equipment available readily in any standard operating room. Twenty-five patients had fasciotomy wounds closed either by dermotaxis or a loop suture technique with the inclusion criteria being closed fractures, no concomitant skin loss, fracture-related compartment syndrome and fasciotomy performed within 36 h. The fasciotomy incision was closed in a single stage by loop suture technique or gradually by dermotaxis once the oedema had settled between 3 and 5 days. Results were graded as excellent if approximation could be achieved, good if sutures had to be applied for protective care and poor if wounds needed to be skin-grafted. In the dermotaxis group, results were excellent in 15, good in 8 and poor in 2 cases. In the loop suture technique group, results were excellent in 20, good in 4 and poor in 1 case. Dermal apposition using inexpensive, readily available equipment is an alternative method for closure of fasciotomy wounds. If limb oedema has settled sufficiently, closure using a loop suture can be done in a single stage. If the limb remains oedematous, gradual closure can be done using dermotaxis.