In order to use the arsenal of hand seams, we suggest getting to know them better. Such knowledge can be useful to you in your work, since the tailoring of each product begins with manual work - we perform copy stitches, basting parts and many other sewing operations manually. Stitch by stitch, lines are born, although not poetic, but created with the help of threads, but no less beautiful. So, let's deal with stitches and lines - what they are, which ones we regularly use in our work, and which ones we may have forgotten, but it's worth remembering!

Hand stitches - classification

All hand stitches are divided according to the location of the stitches on the fabric (straight oblique, cruciform, loop-shaped, looped). And the lines themselves are divided according to their purpose: basting, basting, scribing, hemming, finishing, etc. For simplicity of the picture and greater clarity, we present hand stitches and lines in the form of a table.

Table. Types of hand stitches and stitches

The lines, as mentioned above, consist of stitches, and the stitches are divided into straight oblique, cruciform, loop-shaped, looped. Let's study them in more detail.

Straight stitches

Straight stitches are used to temporarily connect and secure parts in preparation for fitting. With the help of straight stitches, chalk lines of seam allowances, markings of adjusting parts (pockets, belt loops), control marks for sewing in sleeves, collars, etc., the formation of assemblies are indicated.

Rice. Straight stitches

Straight stitches can be used for basting, basting, basting, basting, copying and gathering stitches. Straight stitches make up the stitches that we will discuss below.

Rice. Transfer marking to the front side of the part with straight stitches

Basting line

Basting line is performed for temporary connection (basting) of product parts. The parts are folded, the cuts are leveled along the edge, the parts are swept away without tension or with a slight fit of one of the parts (shoulder and side cuts, sleeve seams are swept away, sleeves are sewn into the armhole, collar details, etc.). The length of the stitches may vary depending on the fabric and purpose of the stitch (from 0.5 to 5 cm). When sewing a line without landing, the stitch length is from 1.5 to 2 cm, with a landing - from 0.7 to 1.5 cm.

Note stitch

Rice. Remark stitch straight stitches

With note lines with a straight stitch, fold and fasten allowances along the bottom of the product and sleeves. The stitch length of the note stitch is 1-3 cm depending on the type of fabric.

Basting stitch

Rice. Basting stitch straight stitches

Basting straight lines fasten the parts of the product together by applying one part to another and further basting. They baste the side gasket on the shelf, pockets, etc. The lines are performed without landing and with landing.

Copy stitch

Rice. Straight Stitch Copy Stitch

Copy stitches are used to transfer contours and markings on paired parts. The parts are superimposed on each other, aligned along the cuts, copy stitches 0.5-1.5 cm long (depending on the type of fabric) are laid along the markup, loops 1-1.5 cm high are pulled out. Then the parts are carefully moved apart and cut in the center stitches.

Rice. Assembly line

For the formation of assemblies, a straight stitch is used. Two lines are laid at a distance of 0.2-0.4 cm from each other with a stitch length of 0.5-0.7 cm. The threads are pulled to the desired length with the formation of folds.

Bias stitches

Skew stitches are also used for temporary and permanent fastening of parts, but skew stitches, unlike straight stitches, create stronger and more elastic connections. Oblique stitches for temporary purposes are used for basting and basting stitches, for permanent purposes - overcasting, as well as quilting, hemming and stitching (used for inconspicuous connection of parts).

Rice. Bias stitches

The following types of stitches are sewn with oblique stitches.

Basting stitch

Rice. Basting stitch with bias stitches

The basting stitch of bias stitches is used in cases where it is required to obtain a stable, strong connection of several layers of fabric. This line eliminates the displacement of parts in the process of further processing. Baste the details of pockets, collars, selection on the shelves, etc. Stitch length 0.5-2 cm.

Rice. Shirt pockets with tucked in allowances

Basting stitch

Rice. Basting stitch with bias stitches

The basting stitch with bias stitches is used to finish the edges of stitched parts. To begin with, the parts are machine-stitched, the allowances are trimmed, the parts are folded to the front side, the seams are straightened and sewn with oblique stitches on the front side. Allowances remain inside.

Rice. Pocket flap basting

Overlock stitch

Rice. Overcasting with bias stitches

Overcasting stitches with oblique stitches are performed when overcasting sections of parts, in order to protect them from shedding. This line is also performed on products with a lining. The overcasting line, made with thin silk threads, is practically invisible when sewing products from thin fabrics and does not create an excessive thickness of the seam allowance, which is important for the appearance of the product. As a rule, 3-4 stitches are performed for every 10 mm of a length of 0.5-0.7 cm.

Quilting stitch

Rice. Quilting stitches

Quilting stitches are used to connect multiple layers of pieces - usually base and lining fabrics - to give a piece that holds its shape well and to give it a certain curve for a flattering fit. The lining fabric is stitched through, the main fabric by half the thickness. On the front side, the quilting line should not be visible.

Rice. Quilting stitches for jackets

Shelves of men's suits and coats, selection, collars are quilted. In this case, oblique stitches are performed over the entire surface of the part. Depending on the fabric, the length and distance between stitches may vary: stitch length 0.5-1.5 cm, width 0.5-0.7 cm, distance between lines 0.5-0.7 cm.

Hem stitch

Hem stitching with oblique stitches is used when securing allowances and folded parts with open cuts and is performed similarly to overcasting (Fig. Overcasting stitch with oblique stitches). This line is used to process allowances and hem of the bottom of the sleeves in a jacket with lining on loose fabrics, etc. Perform 3-4 stitches for every 10 mm, stitch length 0.4-0.5 cm.

Stitch stitch

Rice. Stitch stitch

The stitch stitch is mainly used for repairing clothes. With its help, dense, non-shrinking tissues are sewn together in places of rupture or cut. 6-7 stitches are made for every 10 mm, 0.2-0.3 cm long.

Cross stitches

Cross stitches are used for hemming the bottom of products. A feature of manual hemming is the absence of a seam on the front side of the product. It is standard to sew 2-3 stitches for every 10 mm of length for easily fraying fabrics and 1 stitch for every 5 mm for normal fabrics. Stitch width 0.3-0.5 cm depending on the type of fabric. The hem can be made open along the edge or hidden - inside the hem allowance. Cross stitches are also used for finishing stitches in the manufacture of women's and children's clothing.

Cross Stitch

Rice. Cross Stitch

Cross stitches are divided into hemming and finishing stitches. Hem stitches are very flexible, due to the interweaving of stitches cross-over and are used to fix the hem of the product and sleeves. Also, cross stitches are used for finishing women's and children's clothing.

Rice. Hem cross stitch

Loop stitches

Loop stitches are used for the most durable and elastic stitches. Using loop stitches, permanent stitches can be sewn for a strong blind fastening of parts. With the help of loop stitches, sewing, hemming, fluffy, marking lines are performed. The very name "loop-shaped" indicates that the stitches are made in the form of a loop.

Stitch stitch

Rice. Stitched hand stitch

The stitch line resembles a machine seam and is performed in those places where it is not possible or difficult to perform a machine line. Its peculiarity is that there are no gaps between the stitches, and the needle enters into the exit of the previous stitch.

Fluff Stitch

Rice. Fluff Stitch

The fluffy finishing stitch is used to finish the edges of cuffs, sleeves, lapels of jackets and coats, sides, etc. The distance between the stitches, as well as the length of the stitches, is determined by the designer.

Rice. Fluffy hand seam

Another such manual seam is called "back needle". The top layer of fabric is pierced through, the bottom half. Fluff stitching can also be used to fix internal allowances in order to secure them in the product (turning, picking, etc.).

Marking stitch

Marking stitches are performed similarly to fluff stitches and are used mainly for flexible permanent fastening of two or more layers of fabric in places where it is necessary (for example, they fix allowances on the lining of sleeves, selection, sew shoulder pads, etc.) Stitch length - 1.5- 2 cm

Copy stitch

Rice. Copy Stitch Loop Stitch

The loop stitch copy stitch is used to transfer outline markings to paired parts. After each stitch, the thread is pulled out by 1-1.5 cm. The length of the stitches is 0.5-0.7 cm, 1-2 stitches for every 10 mm of stitching. After the stitches are laid, the parts are moved apart and the threads are cut in the center.

Hem stitch

Rice. Hem buttonhole stitch

The hem stitch is used to permanently secure the hems of the bottom of the product and sleeves, lining, pockets. The allowance is pre-overcast with an overlay seam. The product is folded down from the allowance and a loop-shaped hem stitch is performed. The peculiarity of this line is that the stitches are not visible either from the front or from the wrong side of the product, but are completely hidden inside the hem. Perform 3-4 stitches for every 10 mm stitch length of 0.3 - 0.4 cm.

To secure stitches

Buttonhole stitches are used to secure the ends of stitches after doing manual work such as sewing on buttons, hooks, buttons. And also for bartacking the ends of buttonholes, pockets, etc. Stitch length 0.3 - 0.4 cm.

Buttonhole stitches

Buttonhole stitches are used for overcasting hand loops - straight, curly with an eye.

Rice. Buttonhole stitches

Buttonhole stitch

The buttonhole stitch is used for overcasting buttonholes, and it is also performed as a finishing stitch for processing the edges of napkins, bedspreads, and clothes.

Rice. Buttonhole stitch

The frequency and length of stitches are determined by the tasks of the designer. For making buttonholes, the frequency of stitches is 6-10 for every 10 mm, the width is 0.2-0.3 cm.

Rice. Hand buttonholes made with buttonhole stitches

Special stitches

Bartacks are made with special stitches and accessories are sewn to the product: buttons, hooks, loops, buttons, etc. . Direct bartacks are performed on pockets (for fixing corners), the ends of the loops. Curly bartacks are used to secure the ends of folds and reliefs. With the help of stitches, air thread loops (a kind of straight bartacks) can be made.

Rice. Hand bartack on skirt lining

Buttons with two holes are sewn with 4 - 5 stitches, with four - 3 - 4 stitches in each pair of holes, a match is placed under the button to form a "leg" 0.1 - 0.2 cm high, depending on the thickness of the fabric. The leg is wrapped around with 2 - 3 turns of threads, the end of the thread is fixed and cut off.

Now you know more about hand stitches and stitches and can use them to create your own unique garments. Subscribe to the free news of the Anastasia Korfiati Sewing School and sew stylish models with us!

Surgical sutures are used to connect the edges of wounds using absorbable (catgut) or non-absorbable (silk, nylon, nylon, and other synthetic threads). Distinguish (see), imposed immediately after surgery or injury, and secondary suture (see), applied to the granulating wound. Surgical sutures placed on the wound, but not tightened, are called provisional. They are tied on the 3-4th day after application in the absence of an inflammatory process in the wound. A delayed primary suture is applied 2-4 days after the primary surgical treatment. Removable sutures are applied to the skin, which are removed after the wound has healed. Surgical sutures made of non-absorbable material applied to deep tissues are usually left permanently in the tissues.

Rice. 1. Types of surgical sutures: 1 - nodal;
2 - continuous; 3 - purse-string; 4 - Z-shaped; 5 - straight knot; 6 - double knot.

Rice. 2. Threading the needle.

In appearance, surgical sutures can be nodal (Fig. 1.1), continuous (Fig. 1.2), purse-string (Fig. 1.3), Z-shaped (Fig. 1.4) and twisted. After suturing, they are pulled together so that the edges of the wound are in contact, and tied with a non-dissolving straight (marine) knot (Fig. 1.5). Some suture materials (kapron, nylon) are tied with a double (Fig. 1.6) or triple knot due to the fact that otherwise they are easily untied.

For suturing, needle holders and curved or straight needles of various curvature and section are used. The thread is threaded into the eye of the needle from above (Fig. 2). More and more widespread use is received by a mechanical seam with the help (see), and metal brackets (mainly tantalum) serve as a suture material.

Fig 3 Suture removal.

Stitches for accidental incised, non-contaminated wounds of the skin, face, lips, fingers can be independently working paramedic. Suturing, accompanied by surgical treatment of the wound, is performed only by a doctor. The removal of sutures is often entrusted to a paramedic or dressing room. It is performed on the 7-10th day after application (at an earlier date - on the face, neck, in the absence of tissue tension and good wound healing, later - in elderly and senile patients). After lubricating the suture line with an alcoholic solution of iodine, one of the ends of the suture is taken with anatomical tweezers and pulled so that a part of the thread that is not stained with iodine tincture appears below the knot (Fig. 3). It is crossed with scissors and the entire seam is removed by sipping. After secondary lubrication of the suture line with an alcoholic solution of iodine, a glue bandage is applied. Preparation of material for seams - see.

On some tissues and organs, special types of surgical sutures are used - intestinal suture (see), nerve suture (see), (see), (see). Surgical sutures connecting the bones - see Osteosynthesis.

Surgical sutures - bloody and bloodless ways to connect the edges of accidental and surgical wounds. Bloody surgical sutures are applied by passing the suture material through the tissue. If the suture material is removed after wound healing, then such surgical sutures are called removable, if it remains, submersible. Usually, removable surgical sutures are applied to the integument, and submersible to the internal organs and tissues.

Surgical sutures, which must hold the tissues together only during any one stage of the operation, are called temporary or retainer sutures. According to the timing of the imposition of surgical sutures on wounds, there are primary surgical sutures on a fresh wound, primary delayed, early and late secondary sutures. A delayed primary is a suture that is applied to the wound not at the conclusion of its surgical treatment, but during the first 5-7 days (before the appearance of granulations). A variation of the delayed surgical suture is provisional, in which the threads are passed through the edges of the wound at the end of the operation, but are not tightened until it turns out that there is no infection. A secondary suture is a surgical suture applied to a granulating wound without excision of the granulations (early secondary suture) or after excision of the granulating defect and its surrounding scars (late secondary suture).

Depending on the methods of application and the materials used, the following surgical sutures are distinguished: non-bloody, metal lamellar skin (according to Lister), metal wire bone, soft ligature threads (the most common), mechanical metal staples.

Non-bloody surgical sutures - tightening the edges of the wound with an adhesive plaster or passing threads through matter (flannel) pasted along the edges of the wound are recommended mainly to accelerate the healing of granulating wounds (Fig. 1). For wounds of the chest and abdomen, it is recommended to apply plastic “bridges” across the surgical incisions, which should contribute to faster healing. The possibility of using methods for joining the edges of wounds of soft tissues and bones using synthetic cyanoacrylate glue (Eastman-910, USA; Tsiacrin, USSR; Aron-Alpha, Japan) is being studied.

Rice. 1. Adhesive bandage with drawstring tie-down seams.
Rice. 2. Wire plate seams.
Rice. 3. Interrupted skin sutures on the rollers.
Rice. 4, a and b. Wire bone sutures: a - two staples and wire fastening; b - tightening the wire seam.

Metal wire Surgical sutures were already used in the first half of the 19th century (N. I. Pirogov's lead-silk surgical sutures; Neiderfer's aluminum sutures). Wire plate surgical sutures make it possible to bring the edges closer together even with relatively large tissue defects, and therefore are indicated for high tension on the wound edges (Fig. 2). To reduce tension and avoid eruption of skin sutures, you can make them nodal using soft ligature threads that are not connected in knots, but tied on each side on rollers (Fig. 3).

Metal wire bone surgical sutures are carried out through holes made with a drill in bone fragments (Fig. 4, a), or the bone is pulled together with wire, or through grooved notches (Fig. 4, 6). The ends of the wire are twisted.

Rice. 5. The position of the hand when using the needle holder: a - the hand is in the pronation position (in); b - hand in the position of supination (vykol); c - atraumatic needle.

Rice. 6. Types of ligature knots: a - double surgical; b - oblique; in - sea, or direct.

For surgical sutures, soft ligature threads, as well as flexible metal wire, are used with surgical straight or curved needles; the latter are manipulated with a needle holder. The most simple and convenient needle holder of the Hegar type with a rack. The needle is inserted into the needle holder so that it is clamped at the border of the middle and posterior thirds (Fig. 5).

The needle is injected into the tissue perpendicular to the surface to be stitched and advanced following its curvature.

For denser fabrics (skin) it is necessary to use a trihedral (cutting) curved needle, for less dense ones (guts) - a round (stabbing) curved or straight one, which is sewn without a needle holder. Conventional surgical needles with open ears injure tissues, as the threads folded in half are pulled through the suture channel. In this regard, in vascular, ophthalmic, cosmetic surgery, and urology, atraumatic needles are used, which differ in that the tip of the thread is pressed into the lumen of the rear end of the needle (Fig. 5). In order to eliminate unwanted rotation in the needle holders of round curved needles, the inner surfaces of the working sponges of the needle holders began to be coated with diamond grit (diamond needle holders). At the suggestion of E. N. Taube, the part of the needle that is pinched with a needle holder should be made not round, but oval.

Surgical sutures are applied sequentially from left to right or towards oneself, but not away from oneself. The simplest type of surgical suture with a soft thread is a nodal (the old term is “knotty”) surgical suture, in which each stitch is applied with a separate thread and tied with a double surgical (Fig. 6, a) or marine (Fig. 6, c), but not oblique ( "Woman", Fig. 6, b) knot. Various techniques are used to tie a knot (Fig. 7, a-e). For long or complex wounds of the skin and subcutaneous tissue, guide (situational) sutures are first applied: one suture in the middle of the wound, then one or two more in the places of greatest divergence of the edges and tied with a double surgical knot. Usually, skin sutures are applied at intervals of 1-2 cm and removed after an average of 7 days. Lifting the knot with tweezers, pull the thread out of the channel a little so that when removing the thread, do not drag through it that part of it that was outside the channel, then cut the thread below the knot (Fig. 8) and remove it.

Rice. 7. Techniques for tying knots:
a and b - tying the first loop of the double surgical knot; the thread is held with the little finger of the right, hands from left to right;
c - the first loop of the double knot is tied;
g - tying the second loop of the sea knot; the thread is held III and IV with the fingers of the left hand from right to left;
e and f - Frost's technique: the loop at the end of the thread is thrown onto the tip of the pricked needle and is automatically tightened when the latter is removed.

Rice. 8. Reception of removing the skin interrupted suture.

Aponeurotic and pleuromuscular sutures should be applied frequently - at a distance of 0.5-1 cm from each other. The ends of the silk thread are cut off, leaving the antennae no more than 2 mm from the knot. The ends of the catgut thread are usually cut off at a distance of at least 1 cm from the knot, taking into account the possibility of the thread slipping and the knot blooming (even triple!). When suturing muscles crossed transversely to the axis of their bundles, mattress, interrupted or U-shaped sutures are used to avoid eruption (Fig. 9). Z-shaped interrupted sutures (Fig. 10) according to Zultan or purse-string sutures (Fig. 11) can be made as hemostatic or chipping ones.

Rice. 9. U-shaped seam on the muscle, dissected across the course of the bundles.
Rice. 10. Z-shaped interrupted suture on the intestine according to Zultan.
Rice. 11. Purse-string suture for immersion of the appendix stump.

Rice. 12. VNIIKHAI instruments and a needle (1) for purse-string sutures: a - on the duodenum; b - on the small intestine; c - on the caecum; d - diagram of the straight needle (1).

Rice. 13. Michel's staples for skin sutures (a) and tweezers (b) for staples.

The advantage of nodal skin sutures (Fig. 14, a) is that, by removing one suture, it is possible to give an outlet to the wound discharge.

A continuous suture is applied faster than a nodal suture, but if the thread breaks in one place or it is necessary to partially open the wound, it diverges along the entire length. Continuous surgical sutures are of different types: simple (Fig. 14, b), wrapping according to P. Ya. Multanovsky (Fig. 14, c), mattress (Fig. 14, d), furrier according to Schmiden (Fig. 14, e) , intradermal cosmetic according to Halsted (Fig. 14, f). If it is difficult to bring the edges of the wound together (for example, ribs), they are pulled together with a block pulley suture (Fig. 15, a). To strengthen the fascial-aponeurotic layer, it is doubled (Fig. 15, b) or the so-called overcoat fold is made (Fig. 15, c). To strengthen the anterior abdominal wall, it is preferable to make two or even three floors of sutures, not counting the suture placed on the parietal peritoneum, instead of the more complex Moser suture (Fig. 16). In order to close the line of sutures placed on the wall of the hollow organ with a serous membrane (peritoneum, pleura), a second one is placed over this first row of sutures - a serous serous suture, called invaginating, or immersing (distinguish from submersible, see above).

Rice. 14. Various types of soft ligature sutures: a - a line of correctly applied interrupted skin sutures; b - a simple continuous seam and a method for tying it; c - continuous continuous seam according to Multanovsky; g - mattress continuous seam; d - furrier seam according to Schmiden; e - intradermal cosmetic suture according to Halsted.

Rice. 15. Seams to strengthen the fascial-aponeurotic layers: a - block pulley; b - doubled; in - a seam in the form of an "overcoat fold".

Rice. 16. Seam to strengthen the anterior abdominal wall according to Moser: upper seam - on the skin, subcutaneous fat and muscles; lower - on the peritoneum.

Thus, a two-story seam is obtained. In some cases, a three-story seam may be needed.

Mechanical submerged sutures are applied with metal brackets, which have become widespread worldwide after the introduction of staplers developed at VNIIKHAI into practice. Michel (P. Michel) suggested brackets for removable skin sutures (Fig. 13).

For the formation of anastomoses of hollow organs (intestines, blood vessels), in addition to manual and mechanical sutures, various devices are used to facilitate the operation technique, ensure greater strength of the sutures and asepsis. For operations on the intestines, a pulp and a needle of I. G. Skvortsov were proposed; for operations on blood vessels - tools of G. M. Shpug and N.K. Talankina, V.I. Bulynina, V.I. Pronin and N.V. Dobrova, rings of D.A. Donetsk.

See also Intestinal suture, Nerve suture, Osteosynthesis, Vascular suture, Tendon suture, Surgical instruments, Suture material.

With X-shaped preparation, welding is carried out from two sides. The edge is not removed for the entire thickness of the sheet, but a blunt edge 1-3 mm wide is left. The edges of both sheets are located with a gap of 1-2.5 mm so that the top of the seam is well welded. If you do not leave a gap, then the arc may deviate to the side and then the melting of the sheet will begin not from the edge, but higher, as a result of which lack of penetration may result.

If you give edges without blunting and fold them before welding with a gap, then the sharp edges will immediately melt and a wide, difficult-to-weld gap is formed.

Butt welding with X preparation is performed in the same way as welding with V preparation. The seam filling technique is as follows: first, a seam is applied on one side according to the rules for welding seams with a V-shaped groove, then the welded sheets are turned over, the root of the seam is hemmed and a control seam is welded. In multilayer welding, the layers are deposited alternately on both sides, or, if it is impossible to rotate the product, welding is carried out in a vertical position, simultaneously on both sides.

The disadvantage of the X-shaped seam is the possibility of lack of penetration in the center of its section.

There are transitional shapes between the V-stitch with back-weld and the symmetrical X-stitch. They are used in cases where, in order to reduce the amount of metal deposited in an uncomfortable position, a smaller bevel angle is made to the side where welding is more difficult.

For welding critical products with a wall thickness of more than 20-30 mm, for example, for high-pressure steam boilers, a one-sided or two-sided V- or X-shaped curved bevel is used. The welded edges in this case are not limited by planes, but by specially selected curved surfaces.

Such preparation provides reliable penetration, uniform shrinkage and a small amount of deposited metal. Welding the root of the seam with such preparation and one-sided cutting is required.

To obtain V- and X-shaped seams along the entire length of the same width, it is necessary that the penultimate layers have a flat surface and are 1-2 mm below the upper edges of the product to be welded. When applying the penultimate layer, it is necessary that the upper boundaries of the edges are not melted by the arc, since these edges should be used as guides when welding the last layer, limiting the limits of the transverse oscillations of the electrode.

The end of the electrode during transverse oscillatory movements should only reach the specified boundaries and not go beyond them. With this technique of applying the penultimate layer, the last layers along the entire length will have the same width, which usually does not exceed 2-3 mm of the width of the groove.

Various types of sutures are used to connect the edges of a skin wound. According to the overlay technique, they are classified as simple nodal, continuous (twisting, submersible, mattress, cosmetic), U-shaped and Z-shaped. In relation to the surface of the skin, the seams are divided into vertical and horizontal. Depending on the relationship to the wound, there are supra-wound sutures (the wound cavity remains under the suture) and sub-wound sutures (the thread is held under the bottom of the wound). An extrafocal connection of the edges of the wound is also used. According to the function performed, adaptive, suggestive and hemostatic sutures can be distinguished. Differences in the method of application divide the seams into manual and mechanical. There are also non-invasive methods for closing wounds - closing the edges with adhesive tape, tightening plaster-zipper, adhesive bandage on hooks.

All seams, regardless of their purpose, are subject to the same requirements. Seams should:

1) accurately adapt the edges of the wound (precision);

2) eliminate cavities and pockets;

3) minimally injure the stitched tissues;

4) avoid skin tension;

5) achieve a hemostatic effect;

6) achieve a cosmetic effect;

7) be able to be completely removed or biodegraded;

8) quickly apply and remove;

9) not interfere with the natural drainage of the wound;

10) be applied with a minimum amount of suture material in the wound cavity.

A seam that simultaneously meets all these requirements at once does not exist, since some of these requirements contradict each other. Therefore, the choice of one or another seam should be individual and depend on the specific situation. When suturing wounds on open parts of the body, the focus is on the cosmetic result. In case of impaired microcirculation in the sutured tissues, preference should be given to sutures that minimally injure the skin flaps. When suturing infiltrated tissues, as well as deep wounds with a large diastasis of the edges, sutures are used that deeply capture the underlying tissues and exclude skin eruption. Increased bleeding of stitched tissues requires the use of a hemostatic suture, and in the case when there is a high risk of infection of the wound, a suture located outside the wound cavity should be preferred.

Types of hand seam

(Fig. 1) - a kind of vertical seam. It is widely used in surgical practice due to its ease of application, hemostatic effect, and the possibility of good adaptation of the wound edges. Injections and punctures are located at the same distance from the edge of the wound, strictly perpendicular to the skin surface. The knot should be located at the injection or injection site. The optimal distance between the sutures is 1-2 cm. More often, sutures lead to impaired microcirculation at the edges of the wound and skin necrosis in the stitch area, and also impede the outflow of wound contents. Infrequently applied sutures may not provide the necessary adaptation of the skin margins.

Rice. 2. Compression-decompression seam on D.L. Pikovsky

(Fig. 2) consists of simple interrupted sutures, differing from each other in the depth of tissue capture. Sutures that deeply capture the underlying tissues alternate with sutures that capture only the skin. At the same time, the former eliminate the residual cavity and provide a hemostatic effect, while the latter adapt the skin well. Deep stitches are removed on the 2-3rd day after the operation, and the rest - on the 6-7th day. This staged removal of sutures improves wound healing and leads to the formation of a more durable scar.

(Fig. 3) is a type of simple interrupted suture and can be used to adapt infiltrated tissues or to partially approximate wound edges.

Rice. 4. Seam Donatti

(Fig. 4) - nodal vertical suture with a massive capture of the underlying tissues and good adaptation of the wound edges. Effectively used for suturing deep wounds with large diastasis edges. It is applied with a large cutting needle. They make a deep injection on one side of the wound so that the first stitch, if possible, grabs the bottom, and the injection is on the other side, symmetrically to the injection, then again, on the same side, only close to the edge, and the injection on the opposite side, also near the edge of the wound . The injection and injection points are located symmetrically, the outer ones are 1.5-2 cm, and the inner ones are 0.4-0.5 cm from the edges of the wound, while the first stitch provides a massive capture of the underlying tissues, eliminating the residual cavity, and the second, carried out superficially, adapts the edges of the wound. The disadvantages of the Donatti suture include an unsatisfactory cosmetic result due to the formation of coarse transverse stripes, which is why it is used to a limited extent on open parts of the body.

Good adaptation of the wound walls can be ensured by Allgover suture(Fig. 5), although with loose subcutaneous fat, thread eruption is not excluded.

In order to suture deep wounds with a deficiency in the length of the suture needle, seams of Spasokukotsky(Fig. 6), M.B. Zamoshchina(Fig. 7), as well as multi-stitch knotted seam(Fig. 8).

Knotless adaptive cosmetic skin suture(Fig. 9), proposed by O.S. Kochnev and S.G. Izmailov (1988), allows you to eliminate the residual cavity and adapt the tissues with a subsequent good cosmetic effect. The injection is made at a distance of 2 cm from the edge of the wound, the ligature is carried out under the bottom of the wound, the injection is carried out under a layer of skin. Then an injection is made under the skin of the opposite edge with the needle passing under the bottom of the wound and puncturing opposite, symmetrically to the injection. The edges are matched by pulling the threads to the sides with their subsequent fixation in the slot of the rubber tube. The disadvantage of the method is the time consuming and skin contact with the fixing tubes.

Rice. 10. Seam V.F. Babko

Double-row knotted removable seam(Fig. 10) proposed by V.F. Babko (1986) for suturing deep wounds. First, the first row of sutures is applied to close the residual cavity, knots are tied on the surface of the skin 2-3 cm from the edges of the wound. Then a second row of simple superficial interrupted sutures is applied. The method allows a good adaptation of the wound edges, leaving no cavity under the suture line. Removal of the first row of (deep) sutures after wound healing excludes the appearance of ligature fistulas in the future. The suture was not widely used due to the complexity of the application and the unsatisfactory cosmetic result.

(Fig. 12) among all interrupted sutures provides the best cosmetic effect and adaptation of the wound edges. The injection of the needle is carried out into the side wall of the wound, the injection - into the thickness of the skin on the same side, then - the injection into the skin of the opposite side and the injection opposite, symmetrically to the injection. Tied knots are located in the subcutaneous tissue. Such seams are superimposed at a distance of 0.7-0.9 cm from each other. The disadvantage is the possible leaving of a cavity under the seams. The method requires the use of absorbable suture material of small diameter.

Rice. 13. U-shaped seam

(Fig. 13) refers to horizontal. Injection and excision are performed symmetrically, at the same distance from the edge of the wound and from each other. This distance can be different (from 1 to 3 cm or more) and depends on the condition of the skin. With an increase in the distance between the seams, the adaptation of the edges worsens, but microcirculation suffers less. U-shaped sutures create a good hemostatic effect, can be successfully used in case of large diastasis of the wound edges and the presence of inflammatory infiltration. To avoid eruption of the skin, sutures can be tied on gauze balls, drainage tubes, or plastic plates of various shapes. The disadvantages of the U-shaped seam include a greater violation of the blood supply to the edges of the wound and an unsatisfactory cosmetic result.

The horizontal also includes Z-stitch. It is rarely used because it does not allow proper adaptation of the wound edges. It can be applied with a hemostatic purpose in conditions of severe inflammatory tissue infiltration for a period of 2-3 days.

(Fig. 15) is a kind of continuous. When applying it, the thread must be lashed after each stitch. This technique prevents the seam from unraveling when untying the thread. The disadvantages of a tailor's seam are the same as those of a continuous one.

Continuous Tailor Stitch Schmieden(Fig. 17), proposed for suturing the walls of the stomach, was used in the 19th century to close wounds in the perianal region. It was believed that the inward turning of the skin edges created by this suture reduces the risk of infection of the wound with intestinal contents. Poor adaptation of the skin edges leads to delayed epithelialization, which prompted surgeons to abandon its use on the skin in the future.

Rice. 18. Continuous intradermal suture

(Fig. 18) is performed using a long thread in a horizontal plane with the capture of the surface layers of the skin. The ends of the thread are tied without tension to each other or fixed to the corners of the wound. The imposition of such a suture provides excellent adaptation of the wound edges and cosmetic effect, but it requires careful hemostasis, preliminary elimination of the residual cavity and the absence of skin tension. In the case of a long wound (over 8 cm), it may be difficult to remove a long thread, therefore, when applying such a suture, it is recommended to puncture the skin surface every 8 cm in order to be able to remove the thread in parts.

Rice. 19. Continuous multi-story removable seam

(Fig. 19) is used for suturing deep wounds in order to eliminate the residual cavity and better adapt the wound edges. At the beginning, an internal continuous horizontal suture is applied to the subcutaneous tissue with the thread brought to the surface of the skin and fixed with a vinyl chloride tube or gauze ball. Then a continuous intradermal suture is applied. There is a rapid healing of the wound with an excellent cosmetic result. The inner suture is removed on the 4th day, the outer one - on the 6-7th day after the wound is sutured. If the length of the wound is 8 cm or more, the removal of sutures is performed with some effort.

Rice. 20. Shov E.L. Sokova

(Fig. 20) is superimposed outside the wound cavity parallel to its edges with 2 ligatures that are held under the skin, tied together along the edges and fixed to a bent-tense bracket (Kirchner wire). The bracket, unbending, stretches the ligatures and brings the edges of the wound closer together. As a result, conditions are created for perfect adaptation of the edges, a good cosmetic effect and full microcirculation in the edges of the skin. The absence of ligatures in the wound cavity reduces the risk of infection. The presence of excessive skin tension can impair the adaptation of its edges.

Mechanical seams

(Fig. 21) are small nickel plates 2.5 mm wide and 1 cm long, tucked at the ends and having a sharp spike. The imposition and removal of brackets is carried out with special tweezers. The advantage of the method is the absence of suture material in the wound, which reduces the risk of infection, and the speed of wound closure, due to which it has been widely used in the past decades. Currently rarely used.

"Autogriff" Lenormand- a metal bracket, larger in size than the Michel bracket. No special tools are needed for its application, it is applied manually by bending in the middle. May cause inconvenience when applying a bandage and with active movements of the patient.

Seam with surfers. Surfins are small wire staples that allow the edges of the wound to be brought together due to their springy properties resulting from the twisting of the wire. Pressing the surf with your fingers causes the gripping hooks to move apart. After applying to the wound, the serfin is released, its ends are brought together, while ensuring the adaptation of the edges of the skin. An example would be Herff brackets(Fig. 22).

Rice. 22. Herff brackets

To perform a hardware staple seam, SB-2, SKT-2, etc. devices are used, which look like tweezers with needles at the end. The needles are the matrix for the 0-fold brace. When suturing, the edges of the skin are pierced with the needles of the apparatus, the branches are brought together and brackets are applied. The device STIM-27 with a single flashing allows you to apply 8 brackets, which significantly reduces the time for suturing the wound. Staples are removed with ordinary tweezers.

With extrafocal connection of the edges of the wound spoke adaptive-reposition apparatus according to S.G. Izmailov(Fig. 23) after manual injection of the guide pins (4-5 cm apart), the edges of the wound are smoothly brought together by a rack and pinion drive, which looks like a retractor. The method can be successfully used for suturing granulating wounds with a large diastasis of the edges, as well as the primary suture of infected wounds, if necessary, their subsequent revisions and planned sanitation. The possibility of preventing implantation infection is another important positive factor of this type of wound connection. In this regard, there is an interesting parallel with Thiersch method(Fig. 24), involving the use of metal wire, which does not absorb the infected wound discharge and has high mechanical strength. The wire is twisted with a special tool, after which it is bitten.

Non-invasive wound closure methods

The reduction of the edges of the wound can be achieved with adhesive tape or other adhesive-coated material. The edges of the wound are first brought together by hands and adapted with strips of adhesive plaster 1-2 cm wide, applied across the wound. The method is applicable for the treatment of superficial wounds.

Adhesive bandage on hooks(Fig. 25) is applied as follows. On both sides, parallel to the wound, wide strips of adhesive plaster or fabric with hooks pre-sewn to them are glued. The edges of the wound are brought together with a long elastic cord, hooked on hooks like shoe lacing. The method allows for the revision and sanitation of the wound.

Rice. 26. Atrazip

In recent years, to reduce the edges of the wound, atrazip is used - an atraumatic wound tightening plaster-lightning (Fig. 26). It consists of 2 strips of hypoallergenic self-adhesive fabric, which are connected to each other with a zipper. These strips are glued to the wound after preliminary reduction of its edges by hand. The fastening creates a good adaptation of the skin edges, which has a beneficial effect on the cosmetic result, and the finely porous surface of the atrazip provides good natural ventilation and drainage of the wound.

Thus, the surgeon has a wide variety of sutures in his arsenal. The rational choice of one or another of their types is a necessary component of successful wound treatment.

Algorithm for imposing an interrupted suture Imposing an interrupted suture is performed by suturing the skin and subcutaneous tissue, aponeuroses of the broad muscles. 1. The first needle in the stake is made from the surface side of the fabric, after which it is punctured 2. The second one is in the stake from the inside of the second stitched edge. (The distance of the first stake and the second stake from the edge of the stitched fabrics should be equal) , tie the thread with one of the knots. When applying a nodal suture, a possible mistake is the mismatch of the sewn edges of the fabrics and their tucking. This happens due to the unequal distance between the stake of the needle and the puncture from the stitched edges and the creeping of the tissues over each other due to this when the knot is tightened.

A vertical circular suture consists in running a thread perpendicular to the length of the wound along a circle of different radii, depending on the thickness and properties of the tissues being joined. Advantages of a vertical circular interrupted suture Relative technical simplicity of execution.

Disadvantages of a vertical circular interrupted suture 1. Significant tissue compression inside the circular thread with a tendency to subsequent eruption, ischemia or necrosis; 2. the possibility of deformation of the edges of the wound due to the deviation of the plane of the seam from the normal to the debtor of the wound. The plane of the interrupted circular seam must be strictly perpendicular to the lines of force of the wound; 3. the possibility of developing a postoperative scar in the form of a "railroad track" due to a mismatch between the stable rigid construction of the circular suture and the volumetric dynamic properties of the wound edges; 4. with a significant swelling of the wound edges after the suture of a fixed ring-shaped structure, the thread may cut through the tissues, and with a rapid subsidence of the edema, the wound edges may diverge and heal by secondary intention due to the impossibility of changing the parameters of the circular suture. These shortcomings limit the use of a circular suture on edematous loosened edges of wounds and can be corrected by using the so-called plate suture.

Algorithm for applying a U-shaped horizontal suture 1. Insert a needle from the surface of one edge of the wound 0.7 cm into the stake 2. We pass along the bottom of the wound and puncture symmetrically on the opposite side (0.7 cm from the edge, as if we made a nodal suture) 3. The second injection is carried out parallel to the first needle injection, stepping back 0.4-0.5 cm. The injection is made into the dermis without affecting the subcutaneous fatty tissue, we exit into the wound space and again stick into the dermis of the opposite side at a symmetrical distance from the edge. 4. We form a node. When tying the ends of the thread, the seam has a U-shape.

Horizontal U-shaped suture Advantages of the horizontal U-shaped interrupted suture 1. Improved quality of connection of the middle part of a deep wound; 2. small labor intensity. Disadvantages of the horizontal U-shaped interrupted suture 1. Possibility of divergence of the skin edges with wound healing by secondary intention; 2. Insufficient hemostatic properties; 3. The danger of the formation of a closed cavity with the possibility of suppuration between the suture line and the bottom of the wound.

If it is difficult to match the edges of the skin wound, a horizontal U-shaped suture can be used. 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. Horizontal U-stitch

Vertical U-shaped or MacMillan Donatti's Suture 1. The first in a stake is made at a distance of 0.7-1 cm or more from the edge of the wound, the needle is inserted as deep as possible to capture the bottom of the wound. 2. The puncture on the opposite side of the wound is done at the same distance. When holding the needle in the opposite direction into the stake and the puncture is made at a distance of 0.3 cm from the edges of the wound. 3. To tie the threads when suturing a deep wound should be after all the sutures are 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.

Algorithm for applying a continuous twisting suture The imposition of a continuous twisting suture is performed when suturing the fascia, aponeuroses, serous membranes (peritoneum, pleura) 1. Place an interrupted suture at the edge of the wound so that one end of the thread is much longer than the other. 2. Then, with a needle threaded with the long end of the thread, continuously sew the fabric stitch to stitch throughout (the distance between the stitches should be 0.5-0.7 cm.) 3. At the last stitching, the thread is not completely removed, but is used for tying the last knot with the working end of the ligature.

The imposition of a continuous screwing suture of Schmiden The imposition of a continuous screwing suture is used as one of the stages of imposing an inter-intestinal anastomosis. The Schmiden suture technique is similar to the continuous twist suture technique. The difference lies in the fact that in the stake the needles are produced in all cases from the inner surface of the edges to be sewn.

Technique of a continuous skin suture Pros: Quick application Continuous suture: the first stitch of a continuous suture is superimposed in the same way as with a separate nodal suture (points in the stake and needle puncture opposite each other) The peculiarity of tying the knot of the last stitch of a continuous suture is that in one hand there will be a double thread, and in the other single

Continuous twisting seam Multanovsky The first stitch and all subsequent stitches of the seam are superimposed in the same way as with a separate nodal seam (points in the stake and needle puncture are opposite each other). The thread at the place in the stake is placed in the form of a loop so that the needle is inside it when it is punctured. The knot of the last stitch is tied in the same way as with a simple continuous seam. The continuous twisting seam of Multanovsky is less prone to unraveling.

The technique of "cosmetic" (adaptive) skin suture. Halstead-Zoltan suture. 1. Prick the needle into the skin by 1 cm, stepping back from one of the corners of the wound (it should be punctured through the dermis to the corner of the wound. 2. Fix the free end of the thread to the gauze ball with a knot. 3. Apply further stitches in stakes and passing the needle only through the skin then one, then the other edge of the wound (the place in the stake of the needle on one edge of the wound should correspond to the place of the puncture on the other.) 4. After applying each stitch, bring the edges of the wound together by pulling the thread. 1 cm away from it 6. Tie the thread on a gauze ball