๐ ็ธฝ็ฎ้ ๏ฝ ๐ ่ฑๆๅๆ๏ผๆฌ็ฏ๏ผ ๏ฝ ๐ ๅฎๆด็ฟป่ญฏ ๏ฝ โญ ็ฒพ่ฏ็ญ่จ
Purse-string Suture Step-by-Step
Purse-string Suture Step-by-Step
a. The wound edges are broadly undermined. b. With the tail of the suture material resting between the surgeon and the far end of
the wound, the needle is inserted through the epidermis on the far edge of the wound with a trajectory running parallel to the incision. The entry point in the epidermis should be approximately 3 to 6 mm set-back from the epidermal edge, depending on the thickness of the dermis and the anticipated degree of tension across the closure. The needle, and therefore the suture, should pass through the deep dermis into the undermined space at a uniform depth. c. The needle is then grasped with the surgical pickups and simultaneously released
by the hand holding the needle driver. As the needle is freed from the tissue with the pickups, the needle is grasped again by the needle driver in an appropriate position to repeat the above step to the left of the previously placed suture. d. A small amount of suture material is pulled through and the needle is inserted into
the dermis to the left of the previously placed suture, and the same movement is repeated. e. The same technique is repeated moving stepwise around the entire wound until the
needle exits close to the original entry point at the far end of the wound. Once the point closest to the surgeon is reached, it may be more comfortable to shift to a backhand technique. f. Once the desired number of throws has been placed, the suture material is then
pulled taught, leading to complete or partial closure of the wound, and tied utilizing an instrument tie. Alternatively, a hand tie may be used if desired.
For a detailed discussion of the advantaged and applications of this technique, see the section above on the buried purse-string technique. A monofilament suture is generally used to permit easy pull-through as well as straightforward suture removal.
The purse-string technique may also be used to affect hemostasis in the case of an oozing wound. For wounds in highly vascular areas, such as the scalp, a purse-string suture may be performed distant from the wound edge; small vessels will be captured within the ring of the purse-string suture and compressed when the suture material is tightened, leading to improved hemostasis. A double ring of purse-string sutures may be used as well to take even better advantage of this hemostatic effect.