Tendon Suture

Tendon ruptures and defects are common diseases, mostly caused by injuries or lesions. In order to restore the function of the limbs, fingers and toes, the broken or defective tendons must be repaired in time. However, almost all repaired tendons form different degrees of adhesion and joint activity disorder with surrounding tissues, which is closely related to local pathological conditions, surgical technique, suture material, and correct postoperative treatment, and must be taken seriously. Indication 1. Acute or old tendon injury and fracture or defect. 2. Open injury tendon rupture, within 8 to 12 hours after injury, the pollution is not heavy, debridement thoroughly, with complete healthy skin coverage, suture the tendon in one stage. Otherwise, it should be postponed or the wound should be repaired after the wound is completely healed. 3. Tendons that need to be cut or partially removed due to tumors or other lesions should be repaired in one stage. Contraindications 1. The muscle tendon is brittle and the wound is seriously polluted; 2. Tendon rupture, and there are obvious soft tissue blood circulation disorders; 3. In some industries, such as meat processing, fur processing, sewage operations and other work injuries, although the wound is clean, but postoperative infection, and finally left in the second or late treatment. Preoperative preparation 1. Edema and inflammation of the limbs and wards, even if mild, should be actively treated, so that it completely disappears after 2 to 3 months of surgery. 2. Local large and hard scars should be removed first and the flaps should be repaired to ensure a good blood supply and a soft loose tissue bed around the tendons. 3. Before the tendon is sutured, the joint stiffness of the dominant tendon should be treated first, and the physical therapy and active and passive exercise should be given to restore the greater activity, so that the effect of the tendon suture can be operated and received. 4. The suture material should be selected from the varieties with small reaction, large pulling force and smooth surface. Generally, soft stainless steel wire with a diameter of 0.25 to 0.30 mm is preferred, and is mostly used for drawing steel wire stitching. Tendons with small or small diameters can be sutured with Nilon monofilament. The filament suture has a certain degree of tissue reaction, and is mostly used for bunnell burying and suturing, but the silk thread must be able to withstand a pulling force of 1 to 1.5 kg. 5. Prepare a slender straight round needle for suturing the tendon. Surgical procedure a) Bunnell buried suture method ( suture) Applicable to the diameter of the two ends of the tendon. 1. Position, incision: According to the location of the suture tendon, the limbs are required to be stable and suitable for surgery. The incision should be slightly longer. 2. Tension of the tendon near the end of the tendon: first use the hemostat to clamp the tendon of the tendon and tighten. Take a 30cm long silk thread and wear a slender straight needle at both ends. The needle is traversed through the tendon at a distance of 1.5 cm from the broken end, and the two sides are drawn to be equal in length, and then the needle is inserted next to the needle point, and the oblique end is crossed and symmetrically passed through the tendon, so that the needle is crossed 2 to 3 times. Finally, pierced 3mm proximal to the hemostat. Followed by the sharp knife along the proximal side of the hemostat to cut the tendon, flip the hemostatic forceps to reveal the section, the same as the upper needle, the symmetry of the two sides of the sacral section, remove the tendon stump, tighten the suture. 3. Tendon long-end suture: Same as the above method, first use the hemostat to clamp the broken end, cut the tendon along the inner part of the forceps, turn the hemostatic forceps, expose the section, adjust the axis of the tendon and the near end, and select and close in the far section. The corresponding position of the section suture point is obliquely crossed and inserted into the needle-distance section 3mm, and the oblique cross-symmetry is also sewed 2 to 3 times. One needle is traversed to the other side of the needle, and the stern end is cut. 4. Tighten the suture, and press the suture: first pull a suture, hold the distal end of the tendon with the other hand, and straighten the suture to eliminate the slack in the suture. Pulling another suture is also tightened, so that the tendon sections are closely connected. 5. Ligation of the suture: The two wires that are adjacent to each other are ligated to cause the knot to sink into the sacral surface. The knot is the weakness of the stitching and should be trapped in the jaw and subject to the lowest tension. 6. Suture the skin and skin. (2) Bunnell steel wire extraction and suturing method Mainly used for suturing of tendon rupture with greater tension. 3. Position, incision: the same as the bunnell buried suture method. 2. Tendon near the end of the tendon: with the Bunnell buried suture method. Only through a 15cm long wire at the corner of the first needle crossing the line, twist the number of turns and turn it through the triangle needle, and take it out from the nearby skin. After the tendon is healed, the wire for suturing the tendon is taken out. 3. The tendon is cut at the distal end of the tendon: the steel wire drawn from the proximal section of the tendon is passed through the corresponding point of the distal section and paralleled along the axis of the iliac crest for 2 cm, and then passed through the shallow sides of the iliac crest. 4. Button fixing: the needle thread of the sewed tendon is taken out from the skin of the distal end in the direction of the suture, passes through the smear of the multi-layer gauze pad and the button, and the wire is tightened to move the proximal end At the distal end, the sections are closely aligned, and then the buttons are pressed in the opposite direction, and the wires are tightened. The needles of the aponeurosis were sutured with a thin thread. 5. Stitching: suture the skin and skin by layer. (three) double cross stitching method This method is simple to operate, saves time, and is often used for limb amputation, broken hand replantation, or when the condition needs to end the operation as soon as possible. 1. Position, incision: with Bunnell buried suture. 2. Suture tendon: the silk thread is firstly sutured from the shallow surface perpendicularly at a distance of about 0.5 to 1 cm on the proximal tendon, and the line is crossed over the section, and the lateral transverse position at the equivalent distance of the distal tendon is sutured; The side of the scorpion is sewed through the suture, and then the vertical sew is sutured in the deep side of the distal iliac crest, which is drawn from the shallow side, and the 2 lines are crossed in the iliac crest. 3. Tightening and merging: Gradually tighten the thread so that the section is closely aligned, ligature the thread, and the knot is caught in the raft. 4. Stitching: stitching by layer (4) Fish mouth suture method This method is applicable to the difference in the diameter of the broken ends on both sides of the tendon. 1. Position, incision: the same as the bunnell buried suture method. 2. Sew a pull line at the end of the fine cut. 3. Through the tendon: first use the sharp-edged knife tip to pierce the center of the bottom of the rough v-port from the back side of the crotch, clamp the tip with a mosquito-claw, and take out the v-port as the blade exits, and expand to form a tunnel. It can hold a fine raft, and then pull the tunnel out of the fine traction line. At the distance of 0.5cm from the tunnel entrance, another tunnel is traversed and rough, and the fine raft is pulled again. 4. Stitching and fixing: After tightening the fine sputum to the tension, the two shackles are sutured in the middle of the two tunnels to fix the two scorpions, and the exposed fine scorpion stump is cut outside the rough sputum, stuffed into the rough sputum, and the aponeurosis is sutured. One stitch to keep the surface smooth. Finally, the upper and lower pieces of the fish mouth are sewn on the fine raft. 5. Stitching: suture the subcutaneous tissue and skin by layer. complication joint pain.