Intestinal suture

Содержание

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Intestinal suture is the term that unites suturing of wounds and defects

Intestinal suture is the term that unites suturing of wounds and defects
of the abdominal part of the esophagus, stomach, intestines.

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Ⅰ – Internal sheath; Ⅱ – External sheath.
Layers: 1 – mucosa; 2

Ⅰ – Internal sheath; Ⅱ – External sheath. Layers: 1 – mucosa;
– Submucosa; 3 – Muscularis; 4 – Serosa.

STRUCTURE OF INTESTINAL WALL

Serosa

Muscularis

Mucosa

Submucosa

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Features of intestinal layers:
Serosa – layers can stick together in 12-14 hours

Features of intestinal layers: Serosa – layers can stick together in 12-14
and grow together in 1-2 days. This layer ensures containment of the intestinal suture (the suture pitch is not more than 2.5 mm);
Muscular – smooth muscles provide elasticity to the suture line.
Submucosa – its connection ensures mechanical toughness and good vascularization of suture.
Mucosa – connection of the edges of the wound provides good hemostasis.

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Requirements for intestinal suture:
Containment;
Hemostasis without serious interruption of blood circulation of the

Requirements for intestinal suture: Containment; Hemostasis without serious interruption of blood circulation
suture line;
According to layers structure;
Toughness;
Primary intention is most likely;
Minimal trauma of organ’s walls;
Prevention of extensive marginal necrosis of the organ’s walls;
Rightful layers connection;
Considering for the possibility of eruption of seams;
Using absorbable suture materials.

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TYPES OF INTESTINAL SUTURES

TYPES OF INTESTINAL SUTURES

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Le classification:

III. By overlay method:
Manual;
Mechanical.

I. By its location according to margins of

Le classification: III. By overlay method: Manual; Mechanical. I. By its location
the wound:
Marginal;
One-sheath sutures (serous-muscular or mucous-submucous);
Two-sheath sutures (through-and-through);
Non-marginal;
Combined.

II. By its location according to wound edges:
Inverting;
Everting.

V. By number of row:
One row;
Double row;
Triple row.

IV. By piercing through intestinal layers:
Aseptic;
Non-aseptic.

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1. Serous-muscular, unpenetrated, invaginate, aseptic (or “2-nd row”) Lambert suture

Can be used

1. Serous-muscular, unpenetrated, invaginate, aseptic (or “2-nd row”) Lambert suture Can be
only in combination with other sutures!

Non-marginal suture;
No hemostatic effect;
No toughness after applying;
Provides no adaptation to mucous and submucous layers.

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2. Marginal serous-muscular sutures.

Mateshuk suture

Bier suture

+ Toughness, good adaptation, according to layers

2. Marginal serous-muscular sutures. Mateshuk suture Bier suture + Toughness, good adaptation,
structure;
+ Prevents wall corrugation;
+ Prevents organ’s stenosis.
- Can be infected easily;
- High capillary effect (because of knot);
- High chances to healing with secondary intension (granulation).
ОДНОЗНАЧНО НЕ ТВОЙ БРО.

+ the same advantages as Mateshuk suture;
- Bad hemostatic effect;
- Bad adaptation of layers;
- Complexity.

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Double row combined Czerny separate suture

+ Toughness, good adaptation, according to layers

Double row combined Czerny separate suture + Toughness, good adaptation, according to
structure;
+ Prevents wall corrugation;
+ Prevents organ’s stenosis.
- Poor hemostatic effect;
- Difficulty of ensuring full adaptation of layers;
- Complexity.

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3. Serous-muscular-submucous marginal sutures

Pirogov suture

Kirpatovsky suture

+ Great toughness, good adaptation;
+ very good

3. Serous-muscular-submucous marginal sutures Pirogov suture Kirpatovsky suture + Great toughness, good
hemostatic effect;
+ No rigidity and infection on a suture line;
+ Fast wound healing with primary tension.
- Adhesions are possible;
- Infection in other layers is possible in case of thread wicking effect;
- Tissue reaction is possible;
- frequent anastomosis failure (1-19%).

+ the same advantages as Pirogov suture.
- Skin corrugation and stenosis;
High rigidity of a suture line;
Wicking effect is possible (depends on suture material);
Big postoperative scar.

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4. Double row combined sutures

Albert suture

Taupe suture

+ Toughness, good adaptation, according to

4. Double row combined sutures Albert suture Taupe suture + Toughness, good
layers structure, good hemostasis;
+ containment, aseptic;
+ Simplicity of applying.
- Inflammation on a suture line is possible;
- Slow tissue regeneration, massive skin corrugation;
- Secondary intension, necrosis can happen;
- Prolapse of mucous membrane;
- Adhesions are possible.

- More complex version of Albert suture.

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Double row combined inverting Schmiden suture

+ Has all the advantages of

Double row combined inverting Schmiden suture + Has all the advantages of
Albert suture;
+ Speed of applying.
- Bad layers adaptation of intestinal wall because of tissue corrugation.

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5. Triple row sutures

Versions:
Marginal through-and-through suture + serous-muscular marginal suture + serous

5. Triple row sutures Versions: Marginal through-and-through suture + serous-muscular marginal suture
muscular non-marginal suture;
Marginal mucous suture + serous-muscular marginal suture + serous muscular non-marginal suture;

Intestinal stump suturing by triple row suture.
1 – Continuous wrapping through-and-through suture;
2 – planar simple purse string serous-muscular suture;
3 – Z-shaped planar purse string serous-muscular suture.

1

2

3

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ANTERIOR ABDOMINAL WALL

ANTERIOR ABDOMINAL WALL

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Layers of anterior abdominal wall:
Skin;
Fatty tissue;
Proper fascia of external oblique muscles;
External oblique

Layers of anterior abdominal wall: Skin; Fatty tissue; Proper fascia of external
muscles;
Internal oblique muscles + its fascia;
Transversal abdominal muscles + its fascia;
Transversal fascia;
Parietal peritoneum.
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