Various Incision and Suture

Suture :-

             Surgical suture is a medical used to hold body tissue together after an injury or surgery.Generally involves using a needle with an attached length of suture.

Types of suture  :-

                   Suture has two types

•   Absorbable 
•      Non Absorbable

 Absorbable :-

               Absorbable suture do not require your doctor to remove them. This is because enzyme found in the tissue  of your body naturally digest them.

Non absorbable :-

                 Non absorbable suture material will need to be removed by your doctor at a later day or in some cases left in permanently.

Types of absorbable suture :-

Gut :-

      This natural monofilament suture is used for repairing internal  soft tissue is used for repairing internal soft tissue wounds.Gut should not be used for cardiovascular or neurology procedure.

Polyglactin ( vicryl ) :-

                         This synthetic braided suture is good for repairing hand or facial lauratious. It should not be used for cardiovascular or neurological procedures.

Poliglecaprone ( Monocryl) :-

                           This is  synthetic monofilament suture is used for general use in soft tissue repair.  this  suture is most commonly used to close skin in an invisible manner . It should not be used for cardiovascular and neurological procedure

Polidioxanone ( PDS ):-

                       This suture synthetic monofilament suture can be used for many types of soft tissue wound repair ( such as abdominal ) as well as for paediatric cardiac procedure.

Non absorbable suture :-

                        Some example of non absorbable suture can be found below. These types of suture can  be used generally for soft tissue repair including for both cardivascular and neurological procedures.

Nylon :-

        A natural monofilaments suture.

Polypropylene ( Prolene ) :-

                           A synthetic  monofilament suture.

Silk :-

       A braided natural suture.

Polyester ( Ethibond ) :-

                        A braided synthetic suture.

                 

                   Incision 

Incision :-

          In surgery, a surgical incision is a cut made through the skin and soft tissue to facilitate an operation or procedure. Often, multiple incisions are possible for on operation. In general, a surgical incision is made as small and unobtrusive as possible to facilitate safe and timely operating condition.

1. A cut of wound of body tissue made especially in surgery.

2. An act of incision something the surgeon’s incision of the tissue.

  Head And Neck :-

• Wilde's incision – This post-aural incision is used for a variant mastoiditis drainage .

Chest :-

• Medin  Sternotomy – This is the primary incision used for cardiac procedures. It extends from the sternal notch to the xiphoid process. 

Thoractomy  – A division of the ribs from the side of the chest.

Abdomen and  Pelvic  :-

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 Various Incision diagram 

• Midline incision or midline laparotomy  – The most common incision for laparotomy is the midline incision, a vertical incision which follows the linia Alba . Midline incisions are particularly favoured in diagnostic laparotomy, as they allow wide access to most of the abdominal cavity.
  • The upper midline incision usually extends from the xiphoid  process to the umblicus.
  • A typical lower midline incision is limited by the umbilicus superiorly and by the pubic symphysis inferiorly.
  • Sometimes a single incision extending from xiphoid process to pubic symphysis is employed, especially in trauma  surgery . Typically, a smooth curve is made around the umbilicus.
• Pffannenstial incision  , Kerr incision, or Pfannenstiel-Kerr incision is the lower transverse incision made in the lower segment of uterus below the umbilicus and just above the pubic symphysis. It is commonly used in Caesarian Section  and for abdominal hysterectomy  for benign disease. In the classic Pfannenstiel incision, the skin and subcutaneous tissue are incised transversally, but the linea alba  is opened vertically.
• Chevron incision – This incision is a cut made on the abdomen below the rib cage. The cut starts under the mid-axillary line below the ribs on the right side of the abdomen and continues all the way across the abdomen to the opposite mid-axillary line thereby the whole width of the abdomen is cut to provide access to the liver. The average length of the incision is approximately 24 to 30 inches.
• Cherney  incison  – Cherney described a transverse incision that allows excellent surgical exposure to the space of Retzius and the pelvic sidewall. The curvilinear skin and rectus fascial incision is made 2 finger breadths above the symphysis pubis and carried in Langer's lines from 2 fingerbreadths medial to one anterior superior iliac spine to the corresponding position medial to the opposite anterior superior iliac spine. The anterior rectus fascia is mobilized distally off the underlying rectus muscle bodies. The pyramidalis muscles are dissected free and sharply excised to expose the underlying rectus tendons. With an index finger, a plane is developed between the fibrous tendons of the rectus muscle and the underlying transversalis fascia. Using a sharp no.10 scalpel blade, the rectus tendons are transected transversely 1–2 cm distal to the superior edge of the pubic bone. Rectus muscle should never be cut. The rectus muscles are retracted and the peritoneum opened. The inferior epigastric vessels may need division. Closure is accomplished with 5 to 6 horizontal mattress sutures of permanent braided suture approximating the anterior rectus tendons to the intact distal anterior rectus fascia. Continuous monofilament suture closure of lateral edges of the rectus muscle to the anterior rectus fascia prevents hernia. Patients should wear a binder for at least 2 weeks. No incision provides wider pelvic exposure, and is relatively painless compared to midline incisions. Result is the most pleasing cosmetic result of any abdominal incision.
• Kocher's incision  – An oblique incision made in the right upper quadrant of the abdomen, classically used for open cholestectomy . Named after Emil Theoder Kocher. It is appropriate for certain operations on the liver gallbladder . This shares a name with the Kocher incision used for thyroid surgery: a transverse, slightly curved incision about 2 cm above the sternoclavicular joints;
• Kustner’s incision  – A transverse incision is made 5 cm above the symphysis pubis but below the anterior iliac spine. The subcutaneous tissue is then separated in the midline and the linea alba is exposed. A vertical midline incision is made through the linea alba. Care is taken to control and ligate any branches of the superficial epigastric vessels. This step of the incision is usually time consuming and is one of the limitations associated. This type of incision offers little extensibility and less exposure than a Pfannestiel incision.
• Lanz incision – A variation of the traditional Mc Burney's incision, which was made at McBurney's point  on the abdomen: The Lanz incision is made at the same point along the transverse plane and deemed cosmetically better. It is typically used to perform an open appendectomy. Variations exist on the method used to locate the incision. Some surgeons advocate that the incision is made approximately 2 cm below the umbilicus centered on mid-clavicular-midinguinal line. Others imply use of McBurney's point to center the incision (1/3rd of the distance from the anterior superior iliac spine to the umbilicus).
• .McBurney incision / gridiron incision  – Described in 1894 by McBurney, used for appendectomy. An oblique incision made in the right lower quadrant of the abdomen, classically used for appendectomy. Incision is placed perpendicular to the spinoumblical line at McBurney's point, i.e. at the junction of lateral one-third and medial two-thirds of spino-umblical line. This is the incision used for open appendectomy, it begins 2 to 5 centimeters above the anterior superior iliac spine and continues to a point one-third of the way to the umbilicus (McBurney's point). Thus, the incision is parallel to the external oblique muscle of the abdomen which allows the muscle to be split in the direction of its fibers, decreasing healing times and scar tissue formation. This incision heals rapidly and generally has good cosmetic results, especially if a subcuticular suture is used to close the skin.
• McEvedy's incision – McEvedy's original incision was a lateral paramedian incision which used to incise the rectus sheath along its lateral margin and gain access by pulling the rectus medially. This incision became obsolete because of very high incisional hernia rate. A modification was introduced by Nyhus which used a transverse (oblique) skin incision 3 cm above the inguinal ligament and a transverse incision (oblique) to divide the anterior rectus sheath. The rectus muscle was then pulled medially. This modification prevented the high incisional hernia rate.
• Turner-Warwick's incision – This type of incision is placed 2 cm above the symphysis pubis and within the lateral borders of the rectus muscles. The sheath overlying the rectus muscles at the symphysis pubis is released, 4 cm transversely, and the incision angled up to the lateral borders of the rectus muscles. The lateral edges of the incisions remain medial to the internal oblique muscles. The sheath may be released off the aponeurosis with the help of traction applied using Kocker clamps. The pyramidalis muscles are typically left attached to the aponeurosis. The rectus muscles are separated and the incision is made in the midline. This type of incision is good for exposure of the retropubic space but offers limited access to the upper pelvis and abdomen.