基礎手術技巧之消毒鋪巾打結切開縫合黃久佐，PUMC2001，外科第三年住院醫師huangjiuzuo01@PUMC2006外科實踐課2012年01月11日簡介刀：持弓式、持筆式；垂直進刀刀：運用刀腹；裝刀卸刀持針器：正確握持、正確夾針持針器：旋轉手腕、打外科結線剪：雙手穩定、沿線下滑線剪：旋轉顯露、線尾長度縫合原則：二分之一、垂直進針縫合原則：不留死腔、皮緣外翻垂直下刀，利用刀腹持筆式垂直進刀，利用刀腹裝卸刀片持針器：握法、手腕器械打結不留線尾：深部打結；絲線

留線尾：縫皮；可吸收線二分之一原則沿鼻唇溝縫合原則：垂直進針、順針弧度、不留死腔垂直進針

順針弧度

皮緣外翻

垂直進針，皮緣外翻：愈合快、瘢痕小調整線結，精確對合總結刀：持弓式、持筆式；垂直進刀刀：運用刀腹；裝刀卸刀持針器：正確握持、正確夾針持針器：旋轉手腕、打外科結線剪：雙手穩定、沿線下滑線剪：旋轉顯露、線尾長度縫合原則：二分之一、垂直進針縫合原則：不留死腔、皮緣外翻參考文獻1.楊學穎編譯，基礎外科技巧，合記國書出版社（清華）2.EssentialSurgicalSkills,Elsevier3.Coloratlasofcutaneousexcisionsandrepairs.NewYork:Cambridge,2008（協和）4.AdrianM.Richards.Keynotesonplasticsurgery.London:Blackwell,2002Practicemakesperfect!Thankyouforyourattention!Let’spractice!設計切口：

皮膚張力松弛線梭形切除理想比例減小張力：皮下游離減小張力：

皮下縫合減小張力：

皮下縫合

二分之一原則

沿鼻唇溝垂直褥式水平褥式

皮內縫合兩邊不一樣平三角/四角縫合SuturesAbsorbablevs.non-absorbableSyntheticvs.naturalBraidedvs.monofilament不可吸收縫線的特點可吸收縫線的特點Catgut羊腸線Catgutisderivedfromthesubmucosallayerofsheepintestine.Itelicitsasignificantinflammatoryresponse.Itsabsorptionisunpredictable.Itlosesitsstrengthby8–9days.Itisabsorbedby1month.Adecreasedrateofabsorptionoccursifthesutureischromatized(chromiccatgut).Clinicallycatgutisusuallyusedas:AmucosalsutureAdermalsutureinthefaceAskinsutureinchildren.Polyglycolicacid聚羥乙酸Dexonisasyntheticsuturecomposedofpolyglycolicacid.Itisdegradedbyhydrolization.Itlosesitsstrengthby21daysandisabsorbedby90days.Polyglactin910聚糖乳酸910Vicryl（薇喬）isabraidedsyntheticsuturecomposedofpolyglactin910.Itlosesitsstrengthby21daysandisabsorbedby90days.Itsbraidednaturemaymakeitmorepronetobacterialcolonizationthanmonofilamentalternatives.(VicrylPlus)Itmayprovokeasignificantinflammatoryreactionandsomerecommendthatitisnotusedasadermalsutureintheface.Poliglecaprone25聚糖乙內酰胺Monocryl（單喬/玻璃絲）isamonofilamentsyntheticsuturecomposedofpoliglecaprone25.Ithassimilarabsorptioncharacteristicstovicryl.ItsmonofilamentcompositionmaymakeitlesspronetobacterialcolonizationPolydioxanone聚二氧六環酰胺PDS（普迪思）isamonofilamentsyntheticsuturecomposedofpolydioxone.Itisabsorbedmoreslowlythaneithervicryl,monocrylordexon.Itlosesitsstrengthby3monthsandisabsorbedby6months.Itisprimarilyusedasadermalsutureinareaspronetodevelopingstretchedscars.Non-absorbablesuturesCutaneousstitcheswhichwillneedtoberemoved.Deepstitchestoprovidepermanenttissuefixation.Non-absorbablesuturesNaturalSilk絲線SyntheticPolyamideNylon尼龍線So-namedbecauseitwasdevelopedjointlyinNewYorkandLONdon