1、基础手术技巧之消毒铺巾打结切开缝合,黄久佐，PUMC2001，外科第三年住院医师,PUMC2006外科实践课2012年01月11日,简介,刀：持弓式、持笔式；垂直进刀刀：运用刀腹；装刀卸刀持针器：正确握持、正确夹针持针器：旋转手腕、打外科结线剪：双手稳定、沿线下滑线剪：旋转显露、线尾长度缝合原则：二分之一、垂直进针缝合原则：不留死腔、皮缘外翻,垂直下刀，利用刀腹,持弓式,持笔式,垂直进刀，利用刀腹,装卸刀片,持针器：握法、手腕,夹针：角度、位置,器械打结,线剪：双手稳定、沿线下滑、旋转显露,不留线尾：深部打结；丝线留线尾：缝皮；可吸收线,缝合：二分之一原则,二分之一原则沿鼻唇沟,缝合原则：垂直
2、进针、顺针弧度、不留死腔,垂直进针顺针弧度皮缘外翻,垂直进针，皮缘外翻：愈合快、瘢痕小,调整线结，精确对合,总结,刀：持弓式、持笔式；垂直进刀刀：运用刀腹；装刀卸刀持针器：正确握持、正确夹针持针器：旋转手腕、打外科结线剪：双手稳定、沿线下滑线剪：旋转显露、线尾长度缝合原则：二分之一、垂直进针缝合原则：不留死腔、皮缘外翻,总结,刀：持弓式、持笔式；垂直进刀刀：运用刀腹；装刀卸刀持针器：正确握持、正确夹针持针器：旋转手腕、打外科结线剪：双手稳定、沿线下滑线剪：旋转显露、线尾长度缝合原则：二分之一、垂直进针缝合原则：不留死腔、皮缘外翻,参考文献,1. 杨学颖编译，基础外科技巧，合记国书出版社（清华）
3、2. Essential Surgical Skills, Elsevier3. Color atlas of cutaneous excisions and repairs. New York: Cambridge, 2008（协和）4. Adrian M. Richards. Key notes on plastic surgery. London: Blackwell, 2002,Practice makes perfect!,Practice makes perfect!,Thank you for your attention!,Lets practice!,提高课程,设计切口：皮肤
4、张力松弛线、梭形切除比例减小张力：皮下缝合、皮下游离缝合方法：垂直褥式、水平褥式、皮内缝合特殊情况：三角/四角缝合、两边高度不一致缝线的特点：可吸收缝线、不可吸收缝线,设计切口：皮肤张力松弛线,梭形切除理想比例,减小张力：皮下游离,减小张力：皮下缝合,减小张力：皮下缝合,减小张力：皮下缝合二分之一原则沿鼻唇沟,垂直褥式,水平褥式,皮内缝合,两边不一样平,三角/四角缝合,Sutures,Absorbable vs. non-absorbableSynthetic vs. naturalBraided vs. monofilament,不可吸收缝线的特点,可吸收缝线的特点,Catgut羊肠线,Ca
5、tgut is derived from the submucosal layer of sheep intestine.It elicits a significant inflammatory response.Its absorption is unpredictable.It loses its strength by 89 days.It is absorbed by 1 month.A decreased rate of absorption occurs if the suture is chromatized (chromic catgut).Clinically catgut
6、 is usually used as:A mucosal sutureA dermal suture in the faceA skin suture in children.,Polyglycolic acid聚羟乙酸,Dexon is a synthetic suture composed of polyglycolic acid.It is degraded by hydrolization.It loses its strength by 21 days and is absorbed by 90 days.,Polyglactin 910 聚糖乳酸910,Vicryl （薇乔）is
7、 a braided synthetic suture composed of polyglactin 910.It loses its strength by 21 days and is absorbed by 90 days.Its braided nature may make it more prone to bacterial colonization than monofilament alternatives. (Vicryl Plus)It may provoke a significant inflammatory reaction and some recommend t
8、hat it is not used as a dermal suture in the face.,Poliglecaprone 25 聚糖乙内酰胺,Monocryl （单乔/玻璃丝）is a monofilament synthetic suture composed of poliglecaprone 25.It has similar absorption characteristics to vicryl.Its monofilament composition may make it less prone to bacterial colonization,Polydioxanon
9、e 聚二氧六环酰胺,PDS（普迪思） is a monofilament synthetic suture composed of polydioxone.It is absorbed more slowly than either vicryl, monocryl or dexon.It loses its strength by 3 months and is absorbed by 6 months.It is primarily used as a dermal suture in areas prone to developing stretched scars.,Non-absor
10、bable sutures,Cutaneous stitches which will need to be removed.Deep stitches to provide permanent tissue fixation.,Non-absorbable sutures,NaturalSilk丝线SyntheticPolyamideNylon尼龙线So-named because it was developed jointly in New York and LONdonPolypropylene (Prolene)聚丙烯（普理灵）Stainless steel不锈钢丝,Thank you for your attention!,Lets practice!,Practice makes perfect!,Lets make it better!,
