Tutorials in Suturing Techniques for Orthopedics [1st ed. 2021] 9813363290, 9789813363298

Table of contents :
Preface I
Preface II
Introduction
Contents
Contributors
Editors
Deputy Editor
1: The History of Knots and Surgical Suturing
1.1 The History of Ropes
1.1.1 Overview
1.1.2 Materials of Early Ropes
1.1.3 Rope Making Methods
1.1.3.1 Basic Structure of Ropes
1.1.3.2 General Classification
1.1.3.3 How Ropes Were Made
1.2 The History of Knotting
1.2.1 Overview
1.2.2 Development of Knotting
1.3 A Brief History of Surgical Suture
References
2: Basis for Soft Tissue Repair and Healing
2.1 Soft Tissue Repair Pathology
2.1.1 Basis for Wound Repair–Regeneration
2.1.1.1 Concept and Classification of Regeneration
2.1.1.2 Regeneration Ability of Histocytes
2.1.2 Formation of Granulation Tissue and Its Significance
2.1.2.1 Formation and Structure of Granulation Tissue
2.1.2.2 Significance of Granulation Tissue
2.1.3 Basic Pathophysiological Process of Wound Healing
2.2 Types of Skin Healing and Healing Disorders
2.2.1 Types of Skin Repair and Healing
2.2.2 Skin Healing Disorders
2.2.2.1 Factors That Cause Wound Healing Disorders
Systemic Factors
Local Factors
2.2.2.2 Types of Skin Wound Healing Disorders
References
3: Measures for Prevention and Control of Surgical Site Infection
3.1 Diagnosis of Surgical Site Infection and Incision Classification
3.1.1 Definition and Diagnostic Criteria of Surgical Site Infection
3.1.2 Classification of Surgical Incisions
3.2 Measures for Prevention and Control of Orthopedic Surgical Site Infection
3.2.1 Evaluation of Risk Factors for Orthopedic Surgical Incision Complications
3.2.2 Incision Suture Techniques in Orthopedic Surgeries
3.2.2.1 Selection of Suture Methods
3.2.2.2 Selection of Suture Materials
3.2.2.3 Suture of Incisions of Special Types
3.2.2.4 New Incision Suture Method
3.2.3 Common Incision Complications as Well as Prevention and Treatment in Orthopedic Surgery
3.2.3.1 Incision Exudate
3.2.3.2 Incision Bleeding
3.2.3.3 Swelling Around Incision
3.2.3.4 Blister Around Incision
3.2.3.5 Ecchymosis Around Incision
3.2.3.6 Incision Infection in orthopedic Surgery (Superficial and Deep)
3.2.3.7 Poor Healing of Incision
3.2.3.8 Incision Scar
References
4: Design and Selection of Surgical Suturing Materials
4.1 Surgical Suture Needle
4.1.1 Key Points of Ideal Suture Needle
4.1.1.1 Materials of Surgical Suture Needle
4.1.1.2 Key Points of Suture Needle Design
4.1.1.3 Selection Principles of Surgical Suture Needle
4.1.2 Structure and Type of Suture Needle
4.1.2.1 Basic Components of Suture Needle
4.1.2.2 Measurement of Suture Needle
4.1.2.3 Suture Attachment End of Suture Needle
Advantages of Swaged Needle
4.1.2.4 Needle Body
Straight Needle
Half Curved Needle or “Ski” Needle
Curved Needle
Compound Curved Needle
4.1.2.5 Needle Point
4.1.2.6 Needle Tail
4.1.2.7 Material Science of Suture Needle
Stainless Steel Alloy
Coating
4.1.2.8 Types of Needle
Cutting Needle
MICROPOINT Suture Needle
Other Cutting Needles
Taper Cutting Needle
Stab-Prevention Blunt Needle
4.1.3 Needle Holder: Important Assistant in Suturing
4.1.3.1 Selection of Needle Holder
4.1.3.2 Precautions When the Instrument Nurses Use Needle Holder
4.1.3.3 Precautions When Surgeons Use Needle Holder
4.1.4 Correct Tissue Suturing Technique
4.1.5 Using Suture Needle Safely
4.2 Surgical Suture
4.2.1 Suturing Materials
4.2.1.1 Ideal Suturing Materials Should Meet the Following Standards
4.2.1.2 Size and Tensile Strength of Suture
4.2.1.3 Monofilament and Multifilament Sutures
4.2.1.4 Absorbable and Non-absorbable Sutures
4.2.2 Introduction to Common Suturing Materials
4.2.2.1 Natural Absorbable Sutures
4.2.2.2 Synthetic Absorbable Sutures
4.2.2.3 Non-absorbable Sutures
4.2.2.4 Surgical Silk
4.2.2.5 Alloy Sutures
4.2.2.6 Synthetic Non-absorbable Sutures
References
5: Basic Training of Orthopedic Suture Techniques
5.1 Skin Suturing Training
5.1.1 Training Purpose
5.1.2 Preparation of Articles
5.1.3 Training Process
5.1.4 Skin and Subcutaneous Suturing Steps and Common Suturing Methods
5.2 Tendon Suture Training
5.2.1 Training Purpose
5.2.2 Preparation of Articles
5.2.3 Training Process
5.2.4 Tendon Suturing Steps and Common Suturing Methods
5.3 Nerve Suture Training
5.3.1 Training Purpose
5.3.2 Preparation of Articles
5.3.3 Training Process
5.3.4 Key Points of Epineurial ing Technology
5.3.5 Key Points of Perineurial Suturing Technology
5.4 Blood Vessel Suture Training
5.4.1 Training Purpose
5.4.2 Preparation of Articles
5.4.3 Training Process
5.4.4 Two Fixed-Point End-To-End Interrupted Vascular Anastomosis Technique
5.4.5 Vascular End-to-Side Anastomosis Technique
5.5 Muscle and Fascia Suturing Training
5.5.1 Training Purpose
5.5.2 Preparation of Articles
5.5.3 Training Process
5.5.4 Common Suturing Methods and Steps of Muscles
5.5.5 Common Suturing Methods and Steps of Fascia (Fig. 5.28)
5.5.6 Basic Principles of Muscle Fascia Suturing
References
6: Orthopedic Operating Room Settings and Aseptic Techniques
6.1 Orthopedic Operating Room Settings
6.1.1 Location of Operating Room
6.1.2 Layout of Operating Room
6.1.3 Basic Facilities of Operating Room
6.2 Aseptic Techniques [2, 3]
6.2.1 Surgical Items
6.2.2 Surgical Personnel
6.2.3 Surgical Patients
References
7: Hand Surgery Tendon Suture Techniques
7.1 Historical Review of Tendon Repair
7.2 Biological Process of Hand Tendon Healing
7.2.1 Hand Flexor and Extensor Tendon Division
7.2.2 Tendon Nutrition
7.2.3 Biological Process of Tendon Healing
7.3 Two Major Issues of Tendon Repair
7.3.1 Tendon Adhesion
7.3.2 Tendon Rupture
7.4 Principles of Tendon Repair
7.4.1 Bunnell Proposed the Principle of Tendon Suture in 1918 [14]
7.4.2 Tang Jinbo also Proposed the Principle of Tendon End-to-End Suturing in 2002 [15, 16]
7.5 Methods of Tendon Repair
7.6 Basic Tendon Suture Techniques for Hand Surgery
7.6.1 Bunnell Stitching
7.6.2 Modified Kessler Stitching
7.6.3 Tsuge Loop Stitching
7.6.4 Figure-of-8 Stitching and Double Cross Stitching
7.6.5 Extensor Tendon Repair Technique
7.6.6 Fish Mouth Stitching
7.6.7 Weaving Stitching (Fig. 7.36)
7.7 Common Repair Techniques for Tendon Rupture
7.7.1 Repair of Extensor Tendon Insertion Rupture (Fig. 7.37)
7.7.2 Repair of Middle Phalanx Level Extensor Tendon Rupture (Fig. 7.38)
7.7.3 Repair of Proximal Interphalangeal Joint Level Extensor Tendon Rupture (Fig. 7.39)
7.7.4 Repair of Metacarpophalangeal Level Extensor Tendon Rupture (Fig. 7.40)
7.7.5 Repair of Flexor Tendon Insertion (Zone I Dp1) Rupture (Fig. 7.41)
7.7.6 Repair of Middle Phalanx Level Flexor Tendon Insertion (Zone II Dp2) Rupture (Fig. 7.42)
7.7.7 Repair of Proximal Phalanx Level Flexor Tendon Insertion (Zone II Dp2) Rupture (Fig. 7.43)
7.7.8 Repair of Palm Level Flexor Tendon Insertion (Zone III Dp3) Rupture (Fig. 7.44)
7.7.9 Repair of Wrist Level Flexor Tendon Insertion (Zone IV Dp4) Rupture (Fig. 7.45)
7.8 Early Rehabilitation after Tendon Repair
7.9 Summary of Hand Surgery Tendon Repair
References
8: Achilles Tendon Rupture Suture Techniques
8.1 Overview
8.2 Anatomy of Achilles Tendon Injury
8.3 Classification of Achilles Tendon Injury
8.4 Evaluation of Achilles Tendon Injury
8.4.1 Clinical Evaluation
8.4.2 Imaging Evaluation
8.5 Treatment of Achilles Tendon Injury
8.5.1 Treatment Principles
8.5.2 Krackow Lockstitch Suture for Open Repair of Acute Achilles Tendon Rupture
8.5.3 Percutaneous Minimally Invasive Suture and Repair of Acute Achilles Tendon Rupture
8.5.4 Repair of Subacute Achilles Tendon Rupture with Abraham V-Y Plasty
8.5.5 Lindholm Technique to Repair Old Achilles Tendon Rupture
8.6 Complications and Prognosis of Achilles Tendon Injury
8.6.1 Misdiagnosis or Missed Diagnosis of Achilles Tendon Rupture
8.6.2 Incision Issues
8.6.3 Postoperative Adhesion
8.7 Rehabilitation of Achilles Tendon Injury
8.8 Author’s Comments
References
9: Suturing Techniques in the Repair and Reconstruction of Peri-Articular Injuries of Upper Limbs
9.1 Clinical Anatomy of Shoulder Joint and Principles for Repair of Injuries
9.1.1 Clinical Anatomy of Shoulder Joint
9.1.2 Clinical Structure of Shoulder Joint and Principles for Repair of Injuries
9.2 Learn to Use Anatomical Landmarks in Reduction and Repair
9.2.1 Anatomical Landmarks of the Shoulder Joint
9.2.2 Surgical Approaches for Shoulder Joint
9.3 Suture-Assisted Technique for Plate Nails and Intramedullary Nails in Internal Fixation of Proximal Humeral Fractures
9.3.1 Suture-Assisted Repair of Proximal Humeral Fractures with Steel Plates
9.4 Shoulder Prosthesis and Suturing Techniques
9.4.1 Overview
9.4.2 Surgical Methods
9.4.2.1 Position and Approach
9.4.2.2 Installation of Glenoid Prosthesis
9.4.2.3 Installation of the Humeral End Prosthesis
9.4.2.4 Tubercular Reconstruction During the Operation
9.4.2.5 Postoperative Management and Rehabilitation
9.4.3 Efficacy of Reverse Shoulder Joint Replacement with Prosthesis and Prevention of Complications
9.5 Suturing Technique for Repair and Reconstruction of Peripheral Injury of the Shoulder Joint
9.5.1 Repair of Rotator Cuff Injury
9.5.1.1 Causes of Rotator Cuff Injury
9.5.1.2 Pathology and Classification
9.5.1.3 Clinical Manifestation and Diagnosis
9.5.1.4 Repair of Rotator Cuff Injury
9.5.2 Repair and Reconstruction of Shoulder Joint Capsule Injury
9.5.2.1 Capsular Ligament Avulsion on the Attachment Surface of Humeral Head (HAGHL)
9.5.2.2 Capsular Ligament Laxity of the Shoulder Joint
9.5.2.3 Absence of Capsular Ligament
9.5.2.4 About Superior Capsular Reconstruction (SCR) Technique
9.5.3 Repair of Acromioclavicular Joint Injury
9.5.3.1 Anatomical Structure of the Acromioclavicular Joint
9.5.3.2 Mechanism of Joint Injury
9.5.3.3 Assessment of Acromioclavicular Joint Injury
9.5.3.4 Therapeutic Regimens
9.5.4 Repair and Reconstruction of Coracoclavicular Ligament Injury
9.5.4.1 Reconstruction Technique of Ligament Between Coracoid Process and Clavicle
9.5.4.2 Non-Anatomical Reconstruction of Coracoclavicular Ligament
9.5.4.3 Anatomical Reconstruction of Coracoclavicular Ligament
9.5.5 Reconstruction of Rotator Cuff Functions in Artificial Shoulder Arthroplasty
9.5.5.1 Role of Rotator Cuff in Shoulder Joint Movement
9.5.5.2 Reduction of the Greater and Lesser Tubercles of the Humerus and Rotator Cuff Functions
9.5.5.3 Free Soft Tissue Protection as well as Prosthesis Position and Rotator Cuff Functions
9.5.5.4 Reverse Shoulder Arthroplasty and Functional Substitution of Rotator Cuff
9.5.5.5 Recovery of Rotator Cuff Functions After Artificial Shoulder Arthroplasty
9.6 Suture Techniques for Repair and Reconstruction of Injuries Around the Elbow Joint
9.6.1 Repair and Reconstruction of Ulnar Collateral Ligament Injuries of the Elbow Joint
9.6.1.1 Direct Repair of Ulnar Collateral Ligament Ruptures of the Elbow Joint
9.6.1.2 Reconstruction of Ulnar Collateral Ligament Old Injuries of the Elbow Joint
9.6.2 Repair and Reconstruction of Lateral Collateral Ligament Complex Injuries of the Elbow Joint
9.6.2.1 Diagnosis of Lateral Collateral Ligament Injuries of the Elbow Joint
9.6.2.2 Surgical Technique
9.6.2.3 Postoperative Management
9.6.2.4 Complications
9.6.3 Repair and Reconstruction of the Triceps Brachii Tendon Insertion Rupture
9.6.3.1 Direct Repair of Triceps Tendon Injuries
9.6.3.2 Repair Techniques for Chronic Injuries with Partial Loss and Retraction of the Tendon
9.6.3.3 Repair Technique of Old Triceps Brachii Rupture
9.6.3.4 Postoperative Rehabilitation and Prognosis
9.6.3.5 Complications and Key Points
9.6.4 Repair and Reconstruction of Distal Rupture of the Biceps Tendon
9.6.4.1 Direct Repair Method of Distal Biceps Tendon Rupture
9.6.4.2 Delayed Reconstruction
9.6.4.3 Postoperative Management
9.6.5 Suture Techniques for Repair of Articular Cartilage Fractures Around the Elbow Joint
9.6.5.1 Overview
9.6.5.2 Suture Techniques for Various Cartilage Fractures Around the Elbow Joint
References
10: Incision Suture Technique After Total Hip and Knee Arthroplasty
10.1 Hip and Knee Joint Replacement Surgical Approach
10.1.1 Hip Joint Replacement Surgical Approach
10.1.1.1 Posterolateral Approach
10.1.1.2 Direct Lateral Approach (Modified Hardinge Approach)
10.1.1.3 Direct Anterior Approach
10.1.2 Knee Joint Replacement Surgical Approach
10.1.2.1 Medial Parapatellar Approach
10.1.2.2 Auxiliary Exposure Technique
10.2 Incision Suturing Technique for Joint Replacement Surgeries
10.2.1 Incision Suturing of Hip Joint Replacement
10.2.1.1 Posterolateral Approach
10.2.1.2 Direct Lateral Approach
10.2.1.3 Direct Anterior Approach
10.2.2 Incision Suturing of Knee Joint Replacement
10.3 Prevention and Treatment of Incision Complications
References
11: Cosmetic Skin Suture and Irregular Skin Wound Suture
11.1 Skin Structure
11.1.1 Skin Anatomy
11.1.2 Relaxed Skin Tension Line
11.2 Skin Cosmetic Suture Methods and Techniques
11.2.1 The Principle of Cosmetic Skin Suture
11.2.2 Standard Suture Technique
11.2.3 Suture Techniques for Irregular Wounds
11.2.4 Special Suture Technique
11.2.4.1 Continuous Intradermal Suturing
11.2.4.2 Vertical Mattress Suture (Donati Suture)
11.2.4.3 Interrupted “Heart-Shaped” Subcutaneous Suturing
11.2.4.4 Zhang’s Super Relaxation Suture
11.3 Selection of Instruments and Sutures
11.3.1 Device Selection
11.3.2 Suture Selection
11.3.2.1 Incision with Less Tension (Subcutaneous Suturing + Skin Suturing)
11.3.2.2 Incision with Greater Tension
11.3.2.3 Needle Selection
11.4 Wound Healing and New Wound Closure Products
11.4.1 Wound Healing
11.4.2 New Wound Closure Products
References
12: Microsurgical Reconstruction Suture Techniques
12.1 Training Requirements for Microsurgery Repair Techniques
12.2 Suture of Blood Vessels
12.2.1 Vascular Repair
12.2.2 Angiorrhaphy
12.2.2.1 End-to-End Anastomosis
12.2.2.2 End-to-Side Anastomosis
12.2.2.3 Disc-to-Side Anastomosis
12.2.2.4 Disc-to-End Anastomosis
12.2.2.5 Mosaic Anastomosis
12.3 Nerve Reconstruction Suture Techniques
12.3.1 Basic Principles to be Emphasized Before Nerve Suture
12.3.2 Nerve Suture Methods [3]
12.3.2.1 Epineurial Suture
12.3.2.2 Perineurial Suture
12.3.2.3 Combined Epiperineurial Suture Method
12.3.2.4 End-to-Side Neurorrhaphy
12.3.2.5 “Fish-Mouth Like” Suture
12.3.3 Comparison of Epineurial Suture and Perineurial Suture
References
13: Suture Techniques for Spinal Soft Tissue Reconstruction
13.1 Suture Techniques for Posterior Spinal (Cervical, Thoracic, and Lumbar) Surgery
13.1.1 Anatomical Features of Spinal Soft Tissue
13.1.2 Characteristics of Dorsal Spinal Soft Tissue and Suture Requirements
13.1.3 Suture Techniques of Cervical Posterior Soft Tissues Reconstruction
13.1.4 Incision Closure Technique for Thoracolumbar Posterior Median Approach
13.2 Incision Closure Technique for Anterior Cervical Spine Surgery
13.2.1 Incision Selection
13.2.2 Incision Closure
13.2.3 Cerebrospinal Fluid Leakage
13.2.4 Esophagus Fistula
13.3 Incision Closure Technique for Scoliosis Orthopedics
13.3.1 Anatomy by Posterior Approach
13.3.2 Exposure by Posterior Approach
13.3.3 Closure Method of Posterior Incision
13.3.4 Risk Factors and Prevention of Incision-Related Complications
13.4 Repair and Suturing of Spinal Dura Mater and the Prevention and Treatment of Postoperative Cerebrospinal Fluid Leakage
13.4.1 Understand Dural Suturing Repair and Postoperative Cerebrospinal Fluid Leakage
13.4.2 Dural Repair by Suturing and Treatment of Postoperative Cerebrospinal Fluid Leakage in Anterior Cervical Surgery
13.4.3 Dural Repair and Treatment of Postoperative Cerebrospinal Fluid Leakage in Posterior Thoracic Surgery
13.4.4 Dural Repair and Treatment of Postoperative Cerebrospinal Fluid Leakage of Posterior Lumbar Surgery
13.5 Prevention of Spinal SSI and Treatment of Infected Incisions
13.5.1 Background
13.5.1.1 Early Superficial Infection
13.5.1.2 Early Deep Infection
13.5.1.3 Delayed Deep Infection
13.5.2 Spinal Surgery Infection Prevention and Infected Wound Suturing Technique
References
14: Orthopedic Knotting Techniques
14.1 Surgical Instruments Concerning Suture Technology
14.1.1 Surgical suture
14.1.2 Surgical Suture Needle
14.1.3 Needle Holder
14.1.4 Selection of Surgical Gloves
14.2 Common Orthopedic Suture Knots
14.2.1 Structure of a Suture Knot
14.2.2 Types of Suture Knot
14.3 Application of Suture Technique in Fracture Reduction and Fixation
14.3.1 Proximal Humeral Fracture
14.3.2 Avulsion Fracture of ACL (Anterior Cruciate Ligament)
14.3.3 Treatment of Butterfly Fragments
14.3.4 Olecranon Fracture
14.3.5 Calcaneus Fracture
References
15: Orthopedic Drainage
15.1 Overview
15.1.1 Historical Review
15.1.2 Purpose of Drainage
15.1.3 Classification of Drainage
15.1.4 Common Drainage Materials and Time Limit for Application
15.1.5 Indications and Common Methods of Orthopedic Drainage
15.1.6 Precautions for Orthopedic Drainage
15.1.7 Time for Removal of Various Drainage Methods
15.2 Vacuum Sealing Drainage Technology
15.2.1 Vacuum Sealing Drainage
15.2.1.1 Technical Principle of VSD
15.2.1.2 Application of VSD Technology
15.2.1.3 Advantages of VSD Technology
15.2.2 Closure of Drainage Port
15.2.3 Precautions for Orthopedic Drainage
15.2.4 Time for Removal of Various Drainage Methods
References
16: Debridement and Closure of Soft Tissue Injuries
16.1 Soft Tissue Injury Classification and Injury Mechanism
16.1.1 Classification
16.1.1.1 Closed Trauma
16.1.1.2 Open Trauma
16.1.2 Morel-Lavallée Injury
16.1.2.1 Injury Mechanism and Pathological Process
16.1.2.2 Clinical Symptoms
16.1.2.3 Imaging Examination
16.1.2.4 Treatment Methods
16.2 Treatment of Open Fracture with Soft Tissue Injury
16.2.1 General Treatment of Traumatic Patients
16.2.2 Debridement and Routine Treatments in Trauma Rooms
16.2.3 Bacterial Culture, Anti-Infection, and Tetanus
16.2.4 Wound Dressing
16.3 Principles of Debridement of Soft Tissue Injury
16.3.1 Debridement and Suturing
16.3.2 Debridement Procedures
16.3.2.1 Washing
16.3.2.2 Cleaning
16.3.2.3 Repairing
16.4 Wound Closure
16.4.1 Wound Treatment Concept
16.4.2 Patient Assessment and Wound Assessment
16.4.3 Preoperative Plan and Selection of Operation Timing
16.4.3.1 Preoperative Plan
16.4.3.2 Selection of Operation Timing
16.4.4 Primary and Secondary Closure of Wounds
16.4.4.1 Primary Wound Closure
16.4.4.2 Secondary Wound Closure
16.4.5 The Method for Closure of Some Special Wounds
16.5 Wound Coverage
16.5.1 Wound Assessment
16.5.2 Skin Grafting and Skin Substitutes
16.5.2.1 Skin Grafting
16.5.2.2 Skin Substitutes
16.5.2.3 Skin Flap Grafting
16.5.2.4 Decision on Wound Coverage
References